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
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, six Non-Executive Directors, and four Executive Directors.
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 are overseen by the Clinical Governance Committee, Audit Committee, Staff Governance Committee and the Remuneration Committee.
The Board met publically six times during the year and each governance committee met four times.
In 2019/20, following a self-assessment, an improvement plan to support key corporate governance priorities was developed as part of the Blueprint for Good Governance. This focused on setting the direction, holding to account, assessing risk, engaging stakeholders, and influencing culture. The improvement plan was reviewed by the Board during each of its meetings during 2019/20. Of particular note, the Board focussed on assurance of information including performance metrics as well as engagement of stakeholders and the wider public.
See Appendix 1 for Board Members’ and Senior Managers’ Interests 2019/20, Appendix 2 for Board Governance Committees 2019/20, and Appendix 3 for ‘At A Glance’ Key Performance Indicators 2019/20.
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 2019/20 was approved in June 2019. The plan, which was kept under constant review, 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.
Details of activity can be found in the Annual Report of the Audit Committee 2019/20.
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 Remuneration Committee Annual Report 2019/20 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 operates 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 2020, the Board was within all three of its statutory financial targets and reported a carry-forward of £21k 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 2019/20 increased by £1,971k from the previous year.
The Board’s Capital Programme for 2019/20 focused on improving Hospital security, maintenance of the estate and improvements to eHealth systems.
NHS Scotland national Boards are required to work together to identify ways to collectively standardise and share services to reduce operating costs by £15m (a recurring target from 2018/19) so this can be reinvested in frontline NHS Scotland priorities.
The work in delivering the target has focused on four key work-streams:
- Transformation to deliver quality improvements and efficiencies across NHS Scotland 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 2019/20 whilst the work plans in the first two bullets deliver more sustainable quality improvements and reduced costs.
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 in 2019/20 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 national Boards through collaborative working.
The State Hospital continues to take a zero-tolerance approach to fraud. In 2019/20 the Hospital reviewed its top ten fraud risks, completed a Counter Fraud Assessment Tool, and saw the e-learning fraud module being completed by staff.
The Scottish Government monitors the Board’s performance (in relation to the quality of care and the efficient use of clinical, financial and people resources) through a process known as the Annual Review.
Staff and members of the general public can attend as observers, and ask questions of Scottish Government officials and the Board Chair.
The 2019/20 Annual Review is arranged for 10 November 2020.
Annual Review meetings have been very positive and productive, with only a number of actions to follow up each year.
Annual Review Feedback Letters are placed on the Board’s website.