Effective

Efficient

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Corporate Governance and Accountability

The State Hospitals Board for Scotland (the Board) is the governing body of the Hospital and is accountable to Scottish Ministers through the Scottish Government for the quality of care and the efficient use of resources.

Non-Executive and Executive Directors make up the Board and Board members share collective responsibility for the Board’s decisions and performance.

The Board allocates resources and monitors organisational and executive performance, delegates operational matters to management and oversees senior management arrangements and appointments.

The Board has a statutory responsibility to embrace the three strands of statutory governance:

Clinical governance ensures continuous improvement in the quality of services, safeguarding high standards of care and creating an environment in which excellence in clinical care can flourish.
Staff Governance focuses on how staff are managed, and feel they are managed.
Corporate Governance is the system by which organisations are directed and controlled. The focus is on structures and processes for decision making and accountability, controls, and behaviours at the top of organisations. Corporate governance arrangements are set out in Standing Orders, Standing Financial Instructions and the Scheme of Delegation.

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 Clinical Governance Committee, Audit Committee, Staff Governance Committee and the Remuneration Committee support the Board in its work. A range of supporting frameworks, strategies and action plans are in place to ensure delivery of high standards of governance.

During 2020/21 the Board met seven times; all meetings were held virtually with agendas, papers and minutes being easily accessible via The State Hospital’s website. The Audit Committee met five times, both the Clinical Governance Committee and Staff Governance Committee met four times, and the Remuneration Committee met three times.

During 2020/21, due to the circumstances of the Covid-19 crisis, the structure of management meetings to support key corporate governance policies was reviewed and updated. A new interim structure of Corporate Management Team, Organisational Management Team and Hospital Management Team was piloted.

A Board Seminar on the development of the Blueprint for Good Governance for The State Hospital took place in November 2020. This supported linkage to the ‘Once for Scotland’ approach nationally and the key aspects of the refreshed approach through ‘Active Governance’.

Audit Committee

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 (internal auditors) for 2020/21 was kept under constant review during the year. The plan targets priority issues and structures to allow the Chief Internal Auditor to provide an opinion on the adequacy and effectiveness of internal controls to the Audit Committee, the Chief Executive (as Accountable Officer) and the External Auditors. RSM completed a review and assessment of the quality of The State Hospital Board Pack for management. The assessment highlighted many areas of good practice in reporting to the Board, as well as a range of low priority actions to further enhance the operation of current governance practice.

Overall, the internal audit opinion was that the Board can take reassurance that the controls upon which the organisation relies upon in each area are suitably designed, consistently applied and operating effectively.

Details of activity can be found in the Audit Committee Annual Report 2020/21.

Remuneration Committee

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 2020/21 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.

Financial Targets

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 2021, the Board was within all three of its statutory financial targets and reported a carry-forward of £232k on its revenue resource limit which is set by the Scottish Government Health & Social Care Directorates.

Revenue Resources

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 2020/21 increased by £1,252k from the previous year.

Capital Resources

The Board’s Capital Programme for 2020/21 focused on improving Hospital security, maintenance of the estate and improvements to eHealth systems.

Collaborative Working

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 workstreams:

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 ongoing target whilst the work plans in the first two bullets deliver more sustainable quality improvements and reduced costs.

Sustainble Economic Growth

The State Hospital remains committed to cutting carbon emissions as part of the fight against climate change. A Sustainability Action Plan and a Carbon Management Programme have been developed to ensure sustainability becomes embedded in ways of working and decision making. The operation of a biomass boiler has the potential for significant savings in both CO2 emissions and energy consumption. Additionally, the Hospital continues to investigate the viability of renewable energy options which have the potential to make a strong contribution towards increasing energy efficiency.

Modernisation

Efficiency and Productivity

The Board’s 2020/21 Remobilisation Plan replaced the 2020/21 provisionally agreed Annual Operating Plan (AOP) as a result of the ongoing Covid-19 pandemic.

The plan described the Hospital’s approach to remobilisation for the period August 2020 to March 2021. All aspects of the Board’s remobilisation were aligned and reflective of the key principles outlined in the ‘Re-mobilise, Recover, Redesign’ framework for NHS Scotland.

The Interim Clinical & Support Services Operational Policy, which supports and enables the delivery of an enhanced model of care delivery and wider support in the context of Covid-19 restrictions, was updated continually throughout 2020/21.

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 patients.
Redeployment of resources to meet the needs of patients and drive out inefficiencies.
Requirements for recurring savings.
Increasing levels of staff sickness.

Fraud

The State Hospital continues to work in partnership with Counter Fraud Services and NHS Scotland to help reduce the risk of fraud and corruption.

In 2020/21:

The Hospital reduced its top ten fraud risks to two.
The mandatory Fraud e-learning module was completed by 304 staff.
Fraud alerts were shared regularly via the staff bulletin and remained readily available via the Hospital’s Intranet.
Work commenced to complete the Counter Fraud Services matching exercise which is undertaken every two years by all Boards.

In June 2021, The State Hospital participated in the annual Counter Fraud Services customer engagement ‘virtual visit’.

Annual Review

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. The core purpose of the Annual Review will continue to be for NHS Boards to be held to account for their performance.

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 took place on 10 November 2020. The 2020/21 Annual Review is expected to take place early in 2022. Annual Review meetings have been very positive with only a few actions to follow up each year.

Annual Review Feedback Letters are placed on the Board’s website.