1. Assurance Frameworks: How do you know what you need to know?

2. (c) copyright - GSTT NHS Foundation2 Guy’s and St Thomas’ (GSTT) Foundation Trust – 2004 900 year history Three hospitals on 2 separate sites ~750,000 patient contacts per year Annual Budget £700m ~9,000 staff

3. (c) copyright - GSTT NHS Foundation3 The N.E.D.s’ dilemma Changing accountability/roles for NEDs CEO turnover Increased regulatory framework

4. (c) copyright - GSTT NHS Foundation4 The Regulatory Framework Healthcare Commission Monitor or SHA Primary Care Special Authorities Local Authorities Patients and Public

5. (c) copyright - GSTT NHS Foundation5 So in the past, how did we know what we needed to know?

6. (c) copyright - GSTT NHS Foundation6 Different strokes for different folks Using King’s Fund support mechanisms Direct liaison with frontline staff ‘NED only’ meetings within the trust Close working with executive directors

7. (c) copyright - GSTT NHS Foundation7 Do these strategies still work in the new world?

8. (c) copyright - GSTT NHS Foundation8 What is the New World? New processes/behaviour to support new form of regulation Changing emphasis for committees ‘Comply or Explain’ Media scrutiny

9. (c) copyright - GSTT NHS Foundation9 So…..what do you know now?

10. (c) copyright - GSTT NHS Foundation10 What we found……… Data vs. Information Process vs. Outcome Management vs. Assurance

11. (c) copyright - GSTT NHS Foundation11 What we found…(contd.) Measuring what matters Imbalance of proactive vs. reactive Dilution factors

12. (c) copyright - GSTT NHS Foundation12 Process vs. Outcome

13. (c) copyright - GSTT NHS Foundation13 This means……. understanding the difference between: Policy Practice Performance

14. (c) copyright - GSTT NHS Foundation14 So where did we go next…..?

15. (c) copyright - GSTT NHS Foundation15 Start of a long journey….. Review of risk policy, practice & performance Assurance directory, map and training Strengthen BAF Review of committee structures Map of organisational policies

16. (c) copyright - GSTT NHS Foundation16 Assurance Framework Purpose of framework Perception of its functionality Process of population

17. (c) copyright - GSTT NHS Foundation17 Using the BAF Accountability Differentiating controls & assurances Value of assurances

18. (c) copyright - GSTT NHS Foundation18 Committee Structures Does one size fit all? Breadth & depth of assurance agenda Meaningful involvement

19. (c) copyright - GSTT NHS Foundation19 So what else?

20. (c) copyright - GSTT NHS Foundation20 Challenges Faced Tensions created Critique is not criticism – Executive sensitivities Information overload Creating effective filters Establishing intelligent information

21. (c) copyright - GSTT NHS Foundation21 What now? Shifting the balance to assurance Understanding new risks Developing knowledge and skills Maintaining the horizon scanning Comparing ourselves internationally

22. Assurance Frameworks: Anna Tapsell, Non-Executive Director Eileen Walsh, Director of Assurance