8 March 2016 CORPORATE GOVERNANCE IN THE HEALTH SECTOR In association with

IPA Governance Forum/CIPFA 8 March, 2016 Corporate Governance in the Health Sector IPA Governance Forum/CIPFA 8 March, 2016 Jim Breslin Secretary General Department of Health

Figuring out good governance Good governance is about delivering priorities, achieving objectives, behaving with integrity and acting in the public interest. A strong governance framework provides clarity in relation to authority and responsibility, supports effective decision making and identifies the assurance and accountability arrangements that are in place. “The simplest thing cannot be made clear to the most intelligent man if he is firmly persuaded that he knows already, without a shadow of doubt, what is laid before him “ Tolstoy Reasonably simple, eh?

Governance Requirements

Simple or up there with 3 dimensional chess?

and with High Stakes… Portlaoise (HIQA Investigation, 2015) “Our findings point to failures, over a number of years by the HSE at a national, regional and local level to decisively address numerous clinical governance and management issues.” Tallaght (HIQA Investigation, 2012) “The findings of this investigation reflect a history of longstanding challenges in leadership, governance, performance and management at Board and Executive level of the Hospital, and a failure of the State to hold the Hospital, which was in receipt of significant amounts of State funds, effectively to account for the quality and safety of services it provided.”

Making the governance load manageable means each of us carrying our share.

Central Government’s own Governance Responsibilities

Department of Health – Governance Challenges

Public Value What is our vision for our organisation’s contribution to population health? Good governance is about… behaving with integrity and acting in the public interest What are our values?

Public Value - Department’s Role Leadership and policy direction for the health sector to improve health outcomes Governance and performance oversight to ensure accountable and high quality services Collaboration to achieve health priorities and contribute to wider social and economic goals An organisational environment where, on an ongoing basis, high performance is achieved and the knowledge and skills of staff are developed

Legitimacy & Support How do we ensure through our priorities that we generate legitimacy and support? Good governance is about delivering priorities, achieving objectives…

Strategy Statement,

Year 1 Achieved includes: Public Health legislation Healthy Ireland National Healthcare Quality Reporting National Clinical Effectiveness Guidelines Hepatitis C Treatment Plan Maternity Care Strategy National Framework for Suicide Prevention GP services without fees for under 6s & over 70s VHI authorisation & stabilisation of private insurance market Improve HSE income collection arrangements Increase investment in ICT & establish ‘eHealth Ireland’ Significant Delivery Challenges include: Targets for reduction in patients waiting for admission on trolleys achieved and sustained Targets for reduction in patients on hospital waiting lists achieved and sustained 2015 and subsequent HSE National Service Plans delivered within budget

Operational Capacity & Capability How do we develop our organisation? A governance framework that gives clarity in relation to authority and responsibility, supports effective decision making and identifies the assurance and accountability arrangements that are in place.

Improving Capacity & Capability Working Better Together organisational change programme established in 2015 New organisational design implemented Q Projects Group established involving ⅓ of Department’s staff Groups align with Civil Service Renewal objectives and the components of the Corporate Governance Standard for the Civil Service. Project Groups assessing how we adapt our work to meet the needs of a modern, open and value-driven health service. Engaging with a broad range of stakeholders: for example, health professional regulators, the HSE, other government departments and NGOs to assess whether we can work better together. The output of the project groups (end April) will feed into one overall implementation plan with timelines 17

Working Better Together Improvement Projects 1.Integrated, unified approach to business planning and risk management, in the context of the common corporate governance standard 2.High performance work environment through learning and development and people management 3.Corporate support services including knowledge management 4.Performance dialogue with the HSE and other health agencies 5.Organisational arrangements in respect of professional regulation 6.Policy development 7.Strengthen internal communications 8.Collaboration and strategic network-building within the health sector and cross-sectorally 9.Parliamentary work

Department of Health Governance Framework  We will shortly finalise the Department’s Corporate Governance Framework  It will meet the requirements of the Corporate Governance Standard for the Civil Services  More fundamentally, drawing on the work of the Working Better Together programme, it will codify the strengthened organisational capacity and capability we require to meet our leadership responsibilities in the public interest 19

Building Stronger Corporate Governance

From Corporate Governance to Health System Governance WHO/Euro Observatory Health System Framework Transparency – Public Reporting, FoI, Information for Oireachtas Accountability – Contracts, Standards, Organisational Separation, Regulation, Choice Participation – Stakeholder forums, Consultations, Representation, Surveys Integrity – Merit-based career pathways, audit, budget, procedures, professional codes Policy Capacity – Performance intelligence, research/analytical capacity, policy skills development, recruitment, networks

Thank you!