Efficient
In this section:
- Corporate Governance and Accountability
- Audit Committee
- Remuneration Committee
- Financial Targets
- Revenue Resources
- Capital Resources
- Collaborative Working
- Sustainable Economic Growth
- Efficiency and Productivity
- Fraud
- Annual Review
- Mental Welfare Commission (MWC) Annual Meeting
Corporate Governance and Accountability
The State Hospitals Board for Scotland is accountable to Scottish Ministers, through the Scottish Government, for the quality of care and the efficient use of resources. The Board consists of a Chair, four Non-Executive Directors, Executive Directors and a number of other individuals who regularly attend Board meetings.
The role of the Board is to provide strategic leadership, direction, support and guidance to the Hospital and promote commitment to its core values, policies and objectives. The Chair has a particular duty to ensure that Board members are provided with timely, accurate and clear information in order to fulfil their duties, as well as facilitating effective contributions from Non-Executive Directors.
The main functions of the Board are to establish strategic direction, aims and values, ensure accountability to the public and assure that the Hospital is managed with integrity. The Board allocates resources, delegates operational matters to management, monitors organisational and executive performance, and oversees senior management arrangements and appointments.
Corporate governance arrangements are set out in Standing Orders, Standing Financial Instructions and the Scheme of Delegation.
The Board is supported by a Board Secretary and a number of Committees to advise and help carry out its duties. Clinical governance, staff governance and corporate governance is overseen by the Clinical Governance Committee, Audit Committee, Staff Governance Committee and the Remuneration Committee. Risk management and performance management bring all the elements together.
The Board met six times during the year to progress strategy and review performance. Board meetings were all held in public. Public notices advertising Board Meetings are placed on The State Hospital’s website alongside Board agendas, papers and minutes.
The Audit Committee oversees arrangements for internal and external audit of the Board’s financial and management systems and considers the Board’s overall systems of internal control.
The Internal Audit Plan from RSM for 2018/19 was approved in June 2018. The plan was kept under review for the remainder of the year. The plan was designed to target priority issues and structures to allow the Chief Internal Auditor to provide an opinion on the adequacy and effectiveness of internal controls to the Committee, the Chief Executive (as Accountable Officer) and the External Auditors.
During financial year 2018/19, the Committee met on five occasions. Details of activity can be found in the Annual Report of the Audit Committee 2018/19.
The Remuneration Committee seeks to support the Board’s aim to be an exemplar employer with systems of corporate accountability for the fair and effective management of all staff. The Committee met on three occasions during the year.
The Remuneration Committee Annual Report 2018/19 outlines the key achievements and key developments overseen by the Committee. The stock-take also includes the Committee’s Terms of Reference, reporting structures and work programme which is largely determined by the requirement to implement Executive and Senior Managers’ pay with reference to relevant Scottish Government instruction and performance appraisal. In addition, oversight of the application and award of discretionary points is a routine consideration of the Committee as is consideration of ad-hoc issues relating to remuneration.
The Board is required to operate within three budget limits:
- A revenue resource limit - a resource budget for ongoing operations.
- A capital resource limit - a resource budget for capital investment.
- A Cash requirement – a financing requirement to fund the cash consequences of the ongoing operations and the net capital investment.
During the financial year ended 31 March 2019, the Board was within all three of its statutory financial targets and reported a carry-forward of £12k on its revenue resource limit.
The table below illustrates the Board’s performance against agreed financial targets. The limit is set by the Scottish Government Health & Social Care Directorates.
The Statement of Comprehensive Net Expenditure provides analysis in the annual accounts between clinical, administration and non-clinical activities. Excluding the effect of annually managed expenditure, net expenditure in 2018/19 increased by £916k from the previous year.
The Board’s Capital Programme for 2018/19 focused on improving Hospital security, maintenance of the estate and improvements to eHealth systems.
Special / National Health Boards were tasked by the Scottish Government Health and Social Care Directorate (SGHSCD) to work together to identify ways to collectively standardise and share services with a target to reduce the operating costs of Special Boards by £15m in 2018/19 so that this could be reinvested in frontline NHSScotland priorities.
The work in delivering the target has focused on four key workstreams:
- Transformation to deliver quality improvements and efficiencies across NHSScotland to support the Health and Social Care Delivery Plan.
- Delivery of reduced operating costs through a critical review of support services to deliver sustainable savings.
- Delivery of cash releasing efficiency savings for territorial Boards.
- Management of non-recurring spend and collaborative initiatives to deliver the target for 2018/19 whilst the work plans in the first two bullets deliver more sustainable quality improvements and reduced costs.
The National Boards’ commitment to reduce costs by £15m annually is now a recurring target for 2019/20 and beyond.
The Board is committed to the continuous delivery of a high quality professional service based on the principles of sustainable development and their relevance to State Hospital activity. As in previous years, an equitable balance continued to be sought between meeting the needs of patients, staff and the community; delivering value for money; and minimising environmental impacts and ensuring protection of environmental resources within the Hospital’s sphere of control.
Climate Change Report (November 2016)
Property and Asset Management Strategy 2015/20
Sustainability Development Action Plan (Report to the Board August 2014)
Wind Turbine - Report to the Board (June 2013)
Modernisation
- Contract - Skanska (2008)
- Full Business Case for the Re-development of the Hospital (September 2007)
- Outline Business Case (May 2006)
- Initial Agreement (May 2003)
The Hospital is committed to supporting the drive for efficiency and productivity. Savings targets have been met in each of the recent years.
In future years, it is very likely that the Hospital will have increasing difficulty generating the same level of cash releasing savings. In order to ensure that service delivery can continue to improve and develop, the focus will need to move to improvements in operational productivity. This will require new approaches to driving and monitoring efficiency and productivity.
The Hospital’s vision is to incorporate the essential elements of the Sustainability & Value Programme, 2020 Vision, and the Health and Social Care Delivery Plan. Current challenges include:
- Physical health inequality of our patients.
- Redeployment of resources to meet the needs of patients and drive out inefficiencies.
- Requirements for recurring savings.
- Excessively high levels of staff sickness.
- High proportion of staff reaching retirement age.
- Proactively support the National Strategy in relation to Special Boards through collaborative working.
The State Hospital continues to take a zero-tolerance approach to fraud. In 2018/19, the Hospital reviewed its top ten fraud risks, completed a Counter Fraud Assessment Tool, and saw the e-learning fraud module being completed by 178 staff.
The State Hospitals Board for Scotland is the governing body of the Hospital. It is accountable to Scottish Ministers, through the Scottish Government, for the quality of care and the efficient use of resources.
Every year an annual review of performance is undertaken by the Scottish Government. The Board completes and submits a composite assessment report to the Scottish Government. A review meeting between the Board and the Scottish Government then takes place. Members of the general public can attend if they so wish.
The State Hospital’s Annual Review for 2017/18 took place on 14 January 2019. This was a ministerial review. The date of the 2018/19 Annual Review has not yet been advised.
Annual Review self-assessments and feedback letters are placed on the Board’s website.
Annual Review Feedback Letters are placed on the Board’s website.
Mental Welfare Commission (MWC) Annual Meeting
The annual meeting with the Mental Welfare Commission for Scotland was held on 14 December 2018 providing an opportunity to share information on key issues for the MWC both locally and nationally.