1. CHIEF EXECUTIVE’S BRIEFING Tom Taylor Chief Executive 1 st August 2006

2. PATIENT FOCUS Consultation document on public involvement. “Obligation” on PCTs to respond to community views. How do we get patient issues and clinical achievements more prominent? First County-wide volunteers forum.

3. APPOINTMENTS David Nicholson – CEO NHS Andrew Cash – Director of Provider Development Cynthia Bower - NHS West Midlands CEO (Acting) Peter Spilsbury – Director of Strategy Jo Lenaghan – Director of Communications Various – PCT Chairs / CEOs

4. PERFORMANCE & FINANCE Performance ahead of contract. Performance ahead of 2005/06 target achievement. Costs are reducing month on month. Need to plan now for Practice Based Commissioning and Our Health, Our Care, Our Say.

5. TURNAROUND SaTH public consultation commences 4 th September (officially!!). Increased clinical engagement. Delivery teams in place. Clinical structure progressing. Turnaround is the day job not just finance!

6. NEW RISK ASSESSMENT AND MONITORING FRAMEWORK Principles – Board accountability – Making action proportionate – Transparency – Rules basis to assessment – Preparation for external regulatory regime – Helps SHA to focus our resource Rating formally revised monthly and formally notified to organisations Need to learn from experience in operating this system

7. OUTLINE OF RISK ASSESSMENT SYSTEM Risk AreaElementsDescription FinancialDemand ManagementQuantified assessment of demand management risk based on LDP Plans and updated by monthly performance data LegacyCurrent National Turnaround status, receipt of NHS Bank Loans Cost Improvement ProgrammesQuantified risk scoring of CIP plans, updated by performance WorkforceScale and quality of workforce plans updated by performance PCT Fitness for Purpose and FT Diagnostic Reviews Significant issues will shift rating GovernanceStatement of RequirementsBoard self-certifying compliance with requirements Performance on key targetsMonthly monitoring to assess compliance Exceptional reportseg. Reports of Healthcare Commission or other third-party reports PCT and Trust Board reportsQuality and content of board reports PCT Fitness for Purpose and FT Diagnostic Reviews Significant issues arising will shift rating Risk Score 1 - 4 Updated Monthly Risk Score 1 -4 Updated Monthly

8. CONSEQUENCES OF RISK RATING RatingSummaryFinancialGovernance 4LowLight-touchRoutine returns 3ModeratePerformance Management Challenge Above plus - issue based exception reporting where needed Above plus - issue-based exception reporting where needed 2HighBoard-level Challenge and intensive monitoring Above plus - quarterly joint reporting - monthly review with health economy/ individual organisations - 3rd part review - access to peer review and support Above plus -Significant degree of investigation and intervention. - Requirement for rectification plans signed off by Board. - Regular monitoring reports on issues of concern 1Very HighTurnaround- style monitoring and intervention As above plus -"Local turnaround regime" for those not in national turnaround, including - Fortnightly reporting - SHA turnaround team - External support mandatory Above plus - high-degree of SHA and 3rd-party intervention as organisation appears to be failing on fundamental aspects of Statement of Requirements

9. NEXT STEPS Issue Statement of Requirements and Risk Assessment and Monitoring Framework next week Issue Performance to Date comparative data next week Review with every health economy in August – low-risk: confirmation/assurance and scope for surpluses – high-risk: placing discussions which are now taking place with many on a formal footing