Embedding the golden threads that lead to quality care every time…… Putting governance at the heart of Powys Teaching Health Board: Governance Improvement Programme Progress Update Embedding the golden threads that lead to quality care every time…… Audit and Assurance Committee: 12 July 2016

What we are trying to achieve: Good governance Engaging and Listening Empowering and Facilitating Supporting and Safeguarding Ensuring quality care and treatment every time Putting people and quality at the heart of decision making Audit and Assurance Committee: 12 July 2016

The ten key themes of governance we are aiming to address Clarity of purpose, roles and responsibility Standards of behaviour Leadership and strategic direction Effective external relationships – patients stakeholder, communities Effective internal relationships Transparency and public reporting Systems and structures: quality and safety, boundary issues Challenge on delivery of agreed outcomes Risk and compliance Organisational effectiveness: adding value Audit and Assurance Committee: 12 July 2016

Governance is multifaceted and must operate at many levels. Governance needs to be based on the concept of subsidiarity, which means that control and responsibility should be pushed down as near to the coalface of delivery as possible. Controls, assurance mechanisms and governance arrangements need to be embedded at the delivery end not just at Board level. Responsibility for the first line of controls and assurance rests with those who are at the operational level delivering and commissioning the services Audit and Assurance Committee: 12 July 2016

What steps have we taken over the last 6 months? Audit and Assurance Committee: 12 July 2016

Audit and Assurance Committee: 12 July 2016 Taken steps to increase the effectiveness of the Board and its committees Audit and Assurance Committee: 12 July 2016

Audit and Assurance Committee: 12 July 2016 Ensure that the Board and its Committees have sufficient coverage and that there are no gaps in terms of assurance What we have achieved: Next Steps: Reviewed the effectiveness of the Committees established by the Board: Developed and facilitated a process of self-assessment for each of the Committees Reviewed the Terms of Reference of each Committee Developed a Board Work Programme for 2016-17: aligned to the health board's strategic objectives Developed 2016-17 Work Programmes for each of the Committees Strengthened the format of Chairs reports Review the information needs of the Board and Its Committees Establish a Stakeholder Reference Group Establish a Health Professionals Group Appoint an Independent Member (Trade Union} Introduce a programme of bi-annual service reviews that will look at the performance of provided and commissioned services. Develop and engagement map Develop an engagement plan. Audit and Assurance Committee: 12 July 2016

Audit and Assurance Committee: 12 July 2016 Ensure Board and Board Committee meetings are timely, efficient and effective What we have achieved: Next Steps: Reviewed the timing of Board and Board Committee meetings, ensuring alignment with the availability of information Developed guidance on the production of Board and committee papers. Developed a revised Board and Board Committee paper template Implemented a lead Executive Director report Introduces Chairs briefing packs for each Board/Committee meeting Develop a Board and Board Committee Handbook Reduce the length of meeting agenda’s and meetings: introduce meeting agenda protocol. Review Executive Team arrangements and increase the frequency of formal meetings Further strengthen the Committee Chair Board Report Roll out a programme of training in the production of Board and committee papers. Develop governance packs for each of the Board committees. Introduce paperless meetings Audit and Assurance Committee: 12 July 2016

Support Board Members to fulfil their roles What we have achieved: Next Steps: Independent Members issued with identification badges so that they can take part in assurance visits and engagement events. Independent Members have had a DBS check so that they can take part in assurance visits and engagement events. Independent Members have access to health board information technology and systems so that they can receive information safely and securely and have easy access to mandatory training. Annual appraisals for Independent Members completed Appointments renewed/extended Develop a succession plan for Independent Members Develop and implement a Board development programme as well as individual development programmes for Independent Members Establish an Independent Member’s information section on the Intranet. Implement monthly ‘Corporate Matters’ newsletters that will provide all Board members with updates on key corporate issues, such as Welsh Health Circulars, freedom of information requests and AM and ministerial letters. Audit and Assurance Committee: 12 July 2016

Audit and Assurance Committee: 12 July 2016 Taken steps to further improve governance structures, processes, procedures, policies and documentation, improve understanding of governance and strengthen the health board’s internal and external audit arrangements. Audit and Assurance Committee: 12 July 2016

Audit and Assurance Committee: 12 July 2016 Review and strengthening of standing orders, standing financial instructions, scheme of delegation and Board Assurance Framework. What we have achieved: Next Steps: Developed guidance and principles for a Board Assurance Framework Undertook an audit against Standing Orders identifying areas of non-compliance Implement and embed a Board Assurance Framework Review and strengthen Standing Orders Review Standing Financial Instructions Review and ensure a robust Scheme of Delegation Develop programme of assurance work to ensure on-going compliance with Standing Financial Instructions Audit and Assurance Committee: 12 July 2016

Audit and Assurance Committee: 12 July 2016 Develop and implement governance procedures, policies and documentation What we have achieved: Next Steps Legal Advice: Developed and consulted on strengthened procedures for the proper management and control of requests for legal advice Welsh Health Circulars and important documents: Developed and consulted on procedures for their proper management and control Common Seal: Developed and implemented procedures to ensure the control and proper use of the Common Seal Declarations of Interest: Developed strengthened procedures for the declaration of interest - to include arrangements related to meetings, procurement, recruitment Sought declarations of interest from high risk areas of organisation Policies: Benchmark PTHB policies to ensure that all required policies are in place AM and ministerial Correspondence: strengthen arrangements. Consultations: Develop and implement strengthened procedures for the management of the health board's responses to consultations Policies: Strengthen procedures for the development and approval of policies FoI: Strengthen procedures to ensure compliant with the Act Implement the strengthened procedures developed to date Develop programme of work to ensure on-going compliance with policies Audit and Assurance Committee: 12 July 2016

Improve understanding of governance across the organisation What we have achieved: Next Steps: Embed governance session into induction programmes Develop and roll-out a programme of governance training Develop a Corporate Governance Guidance Section for the Internet and Intranet Audit and Assurance Committee: 12 July 2016

Strengthen the health board's internal and external audit arrangements What we have achieved: Next Steps: Worked with Internal Audit to ensure an holistic annual audit programme fro 2016/17 [linked to Assurance Framework] Improved liaison with External Auditors Audit Recommendations: Strengthen arrangements for the implementation and monitoring of audit recommendations Audit and Assurance Committee: 12 July 2016

Audit and Assurance Committee: 12 July 2016 Embedding sound risk management and assurance arrangements through developing a risk appetite statement, risk strategy and policy. Audit and Assurance Committee: 12 July 2016

Strengthen the health board’s risk management arrangements What we have achieved: Next Steps: Developed a Risk Appetite Statement Develop and implement a strengthened Risk Strategy and Related Policy Develop a strengthened corporate/Board risk register Clarify the role of the Board Committees in relation to the ‘assurance framework’ and risk management. Put in place a mechanisms to identify and regularly review the strategic risks linked to our strategic objectives and priorities. Embed sound risk management and assurance arrangements: develop a training programme and on-going review process Review the risk management and assurance arrangements operating across the health board to test their adequacy. [align to work on the Assurance Framework] Audit and Assurance Committee: 12 July 2016

Audit and Assurance Committee: 12 July 2016 Ensuring governance arrangements take account of all statutory and legislative requirements Audit and Assurance Committee: 12 July 2016

Audit and Assurance Committee: 12 July 2016 Ensure arrangements are in place to meet Welsh Government and legislative requirements What we have achieved: Next Steps: Publish an Annual Governance Statement in line with WG guidance Publish an Accountability Report Undertake a review of the legislative requirements placed on PTHB and establish its level of compliance Develop a legislative compliance programme: purpose to address any identified gaps Develop an equality and human rights action plan Develop a programme of equality and human rights training Develop and implement an integrated equality and legislative impact assessment Map statutory and legislative requirements to each Committee of the Board Develop a Legislation Section for the Internet and Intranet Develop a programme of Welsh language, equality and human rights assurance checks Audit and Assurance Committee: 12 July 2016

Audit and Assurance Committee: 12 July 2016 Ensuring effective management and participation in change programmes and partnership and collaborative working arrangements. Audit and Assurance Committee: 12 July 2016

Audit and Assurance Committee: 12 July 2016 Develop, agree and implement a programme of governance development work to cover the PSB, part 9 Regional Partnership Board, JPB, JMT What we have achieved: Next Steps: Established a Joint Partnership Board Revised the terms of reference of the Joint Management Board Developed and agreed a collaborative agreement with PCC Developed draft joint scrutiny arrangements Develop a programme of governance Audit and Assurance Committee: 12 July 2016