NHS Tayside Transformation Support Team: second progress report

AAG Recommendation 6 – Effective Delegation

"Further and appropriate delegation of decision-making to managers and staff at operational level is required in order to ensure that executive director level capacity is released for strategic development and transformation of services."

NHS Tayside's Assessment

"A new structure has been agreed and is being implemented in the Operational Division by the Chief Operating Officer and transition will be completed by March 2018. A short life working group, including staff side, was established to review the Senior Leadership Team [ SLT] and agreement reached that there was a role for the continuation of the Senior Leadership Team. The purpose of the SLT is to provide a forum for networking and information sharing, with a test of change planned from January to March 2018 which will allow updated Terms of Reference to be produced. This was agreed at the SLT meeting in November 2017.

The format of the NHS Tayside Board agenda was changed to ensure time for discussion on strategic and high risk issues. NHS Tayside Board approved updates to its Standing Committees in December and the implementation of the resulting changes to the Code of Corporate Governance and Scheme of Delegation will be progressed during January 2018 to March 2018.

The establishment of the Executive Review Team (Directors and Staff Side Leads) in July 2017 has provided a forum for accelerated and enhanced decision making in partnership.

Enhancement to financial reporting (August 2017) and improved workforce reporting (the use of TEAPA from October 2017) has ensured the disaggregation of key cost and workforce information to individual managers and clinicians.

The Audit Committee on 14 December 2017 agreed principles to underpin a governance framework between NHS Tayside and the three Integration Joint Boards ( IJBS). The resulting work to update NHS Tayside's governance framework will be completed in January-March 2018.

NHS Tayside's Board agenda has been changed to separate business into two elements: Part A includes items for discussion and Part B includes items for approval or noting, where discussion is not required. This is to allow more time for discussion regarding key strategic issues. In addition, from April 2017 the NHS Tayside Board now considers at each meeting those strategic risks which exceed the Board Risk Appetite at each meeting.

Next Steps

Between January 2018 and March 2018, Directors' portfolios will be reviewed and updated, including the requirement for Planning and Performance activity. The SLT short life working group will implement the test of change and this will be adapted and modified for full adoption for 2018-19.

The new Tayside NHS Board / IJB governance framework will be developed and agreed for adoption for the new financial year in 2018-19 this will also allow the Scheme of Delegation to be appropriately updated."

TST comment

The actions described above in NHS Tayside's assessment should help to address both elements of this recommendation; to facilitate and support increased delegation of operational decision-making and for Executive Directors to be able to take a more strategic focus.

In a dynamic and challenged system such as within NHS Tayside, Executive Directors must give appropriate priority to setting the strategic direction and managing the overall change process for their services and for the organisation as a whole. This requires an ability to balance both the overall responsibility for the day to day delivery of their own area of business with active consideration of a wider picture and a further time horizon. This in turn requires a robust operational structure capable of providing assurance that both front line and supporting service performance is well managed.

NHS Tayside has taken a number of practical and sensible steps that support Executive Directors to do this. In particular, the Executive Review Team's daily huddle provides a forum for informal information sharing, fast problem-solving and collective decision-making about cross-cutting issues – and has proved its worth over the last few months since its introduction.

The on-going restructuring of the Operational Division is also intended to bolster the resources available to take on a more active role in robust operational management, freeing up time for Directors to do other things. Combined with the improvements in the reporting processes which are also described above, this should be sufficient to provide the assurance required to sustain appropriate delegation.

However, at this stage of implementation, it is not yet possible to see whether this potential will be realised and whether it will deliver the required results. While work has continued over the last three months to progress the necessary changes to structures and processes, these in themselves will not be sufficient to deliver the desired outcomes unless individual and group behaviours also change. While there are some encouraging indications of a willingness to make this happen, the impact is unlikely to be clearly seen until well into the next financial year.

TST rating in September 2017 = Amber
TST rating in January 2018 = Amber