[Insert name of Aspirant Foundation Trust]

3. Board insight and foresight
3.1 Board Performance Reporting

Section RAG rating:

Green

Evidence of compliance with good practice (Please reference any supporting documentation below and attach with your submission)	Action Plans to achieve good practice (Please reference Actions Plans below and attach with your submission)	Explanation if not complying with good practice
Q1. The Board has debated and agreed a set of quality and financial metrics outside the national and regionally agreed metrics that are relevant to the Board given the context within which it is operating and what it is trying to achieve. A1 Board have agreed quality metrics at the Quality Committee and financial metrics at F&I Evidence: Committee minutes, Board IPR Q2. The Board receives a performance report which includes: 1. A fully integrated performance dashboard which enables the Board to consider the performance of the Trust against a range of metrics including quality, performance, activity and finance and enables links to be made (e.g. financial variances are linked to activity); 2. Variances from plan are clearly highlighted and explained; 3. Key trends and findings are outlined and commented on; 4. Future performance is projected with associated risks and mitigations provided where appropriate (e.g. forecast outturn); 5. Key quality information is triangulated (e.g. complaints, claims, incidents, Rule 43 issues, key HR metrics, and audit findings) so that Board members can accurately describe where problematic service lines are; 6. Benchmarking of performance to comparable organisations is included where possible; 7. Supporting performance detail is broken down by Service Line so members can understand which services are high and low performing from a financial and quality perspective. A2. Board has an Integrated Performance Report and Committees review CSU balanced scorecards. Evidence: Committee and board papers Q3. The Board receives a brief verbal update on key issues arising from each Committee meeting from the relevant Chair. This is supported by a written summary of key items discussed by the Committee and decisions made. A3 The Board receives verbal updates and written summary reports from the Chair and minutes discussed at each Board meeting Evidence: Board agendas and minutes Q4. The Board regularly discusses the key risks facing the AFT and plans to manage or mitigate them. A4 The Board discusses risks associated with the FT application. Evidence: Level 1 Risk Register included in monthly Integrated Performance Report and BAF considered quarterly, Regular reports on specific FT items and updates included in CEO reports Q5. An action log is taken at Board meetings. Accountable individuals and challenging / demanding timelines are assigned. Progress against actions is actively monitored. Slips in timelines are clearly identifiable through the action log and individuals are held to account. A5 Action log is completed and reviewed at every Board meeting. This details accountability and timeframes. Evidence: Board agendas, papers and minutes	Q2. Triangulation of information required in Integrated Performance Report. Q4Risk and Downside to be presented with the IBP and LTFM in July 12 to the Board
Red Flags	Action plans to remove the Red Flag(s) or mitigate the risk presented by the Red Flag(s)	Notes/ comments
Q1. Significant unplanned variances in performance have occurred A1 There were no significant unplanned variances in performance Evidence: IPR and minutes of meetings Q2. Performance failures were brought to the Board’s attention by an external party and/or not in a timely manner. A3 There were CQC and MHA visits that raised concerns about patient experience, patient safety and clinical environments. All reports lead to action plans returned within agreed timescales and monitored locally. There is also in place a system of quality governance that monitors successful delivery and improvements. CQC presented to the Board in May 2012 (Board Development Session) Evidence: Action plans. Q3. Finance and Quality reports are considered in isolation from one another. A3 Finance and Quality reports are considered together e.g. CIPs and integrated performance report. The Medical Director attends the Audit committee and clinical audit programme is examined by Audit committee. Evidence: Board CIP papers, TMT and committee minutes (e.g. May 2012 Risk Impact Assessment B block). Q4. The Board does not receive 12 month rolling cash flow forecast information. A4 The Board receives 12 month rolling cash flow forecast information. Evidence: Finance & Investment Committee papers and Finance reports Q5. The Board only receives minutes of Committee meetings and does not tend to discuss them. A5: The Board discusses chair reports and minutes, as well as annual reports from committees. Evidence: Minutes, HDD observations. Q6. The Board does not have an action log. A6 The Board and all committees have action logs which are reviewed at every meeting. Evidence: Board agendas and papers. Q7. Key risks are not reported / escalated up to the Trust Board. A7 Key risks are reported via the BAF and level 1 risks are reported in the IPR monthly. BAF also considered quarterly by Board and Audit committee. Chair’s reports from Committees also include any variance/issue Evidence: Monthly IPR report to the Board and quarterly BAF report.

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Section RAG rating:

Amber /Green

. Board insight and foresight
3.2 Efficiency and Productivity

Evidence of compliance with good practice (Please reference any supporting documentation below and attach with your submission)	Action Plans to achieve good practice (Please reference Actions Plans below and attach with your submission)	Explanation if not complying with good practice
Q1. The Board is assured that there is a robust process for prospectively assessing the risk(s) to care quality and the potential knock-on impact on the wider health and social care community of implementing CIPs. This process requires the Medical, Nursing and Operations Directors to all sign-off each major CIP to ensure that patient safety is not compromised. A1 Board is assured that there is a robust process in place assessing the risk to quality of care of CIPs and their knock on effect for the health & social care community Evidence: Board papers Feb and March 2011 & 2012 Q2. The Board can provide examples of CIPs that have been rejected or significantly modified due to their potential impact on patient safety. A2 The Board can provide examples of rejected CIPs/modifications due to impact on quality/patient safety. Evidence: TMT debate on block B – March 2012 Q3. The Board receives information on all major CIPs/ QIPP plans on a regular basis, including how other organisations in the local health economy are performing against QIPP. Schemes are allocated to lead Directors and are RAG rated to highlight where performance is not in line with plan. The risk(s) to non-achievement of each major CIP is clearly stated and contingency measures are articulated. A3 All major CIP/QIPP plans are reported routinely at Committee meetings The risk of achievement is coded (traffic lighted) and the risk of not achieving is known. The trust benchmarks performance e.g. Audit commission Benchmarking and High Secure Services. Evidence: Audit Commission Report on MH Benchmarking – Quality Committee Q4. There is a process in place to monitor the ongoing risks to care quality for each scheme once a scheme has been implemented, including a programme of formal post implementation reviews. Change(s) to working practice(s) due to major CIPs are supported by a programme of organisation development. A4 Medical Director and Director of Nursing and Patient Experience are developing a system of monitoring risks post CIP/QIPP implentation. A QIA has been endorsed by TMT. Prior to sign off of annual budgets, CIPs were subject to a QIA. The Director of Nursing attended CSU Senior Management Team meetings and independently challenged decision making and rationale behind QIA rating. In addition, major capital schemes affecting patient care have been subject to QIA and were presented to TMT and the Board. Evidence: Minutes of SMT, TMT and Board meetings.	Q3 Need to consider expanding reporting at Board level on other organisations’ performance Q4 Medical Director and Director of Nursing and Patient Experience are developing a system of monitoring risks post CIP/QIPP implementation.
Red Flags	Action plans to remove the Red Flag(s) or mitigate the risk presented by the Red Flag(s)	Notes/ comments
Q1. The Board does not receive performance information relating to progress against CIPs and QIPP targets and plans. A1 The Board receives performance information on progress against CIPs and QIPP targets via committees Evidence: Finance & Investment Committee receive an update from each CSU on CIPs – e.g. May 2012 Q2. There is no process currently in place to prospectively assess the risk(s) to care quality presented by CIPs. A2 There is a process in place to prospectively assess the risk(s) to care quality presented in CIPs Evidence: See above

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Section RAG rating:

Amber /Green

. Board insight and foresight
3.3 Environmental and strategic focus

Evidence of compliance with good practice (Please reference any supporting documentation below and attach with your submission)	Action Plans to achieve good practice (Please reference Actions Plans below and attach with your submission)	Explanation if not complying with good practice
Q1. The CEO presents a report to every Board detailing important changes or issues in the external environment (e.g. policy changes, quality and financial risks in the health economy, PBR new tariffs etc.). The impact on strategic direction is debated and, where relevant, updates are made to the Trust’s risk registers and BAF. A1 CEO report highlights key changes and issues in the external environment. Evidence: CEO reports part 1 & 2 Q2. The Board has reviewed lessons learned from Inquires and has considered the impact upon themselves. Actions arising from this exercise are captured and progress is followed up. A2 The Board has learnt lessons from PB/RL and elsewhere or inquiries and considered the impact e.g. Mid Staffs, and more recently the risk of increased suicide during time of complex change Evidence: Quality Committee and Board Minutes. Reports on action plan from Director of High Secure Services. The Medical Director recommended risk to be added to Level 1 risk register on care provision during service reconfiguration as suggested by an Inquiry. Recommendation – No Q3. The Board has conducted or updated an external stakeholder mapping exercise, market analysis and/or PESTLE analysis within the last year to inform the development of the IBP. A3 The Board has completed a review of external stakeholders and FT development session to inform the PESTLE and SWOT. Evidence: CELF and IBP Q4. In developing the IBP, the Board as a whole has explored market opportunities and threats in relation to the services it provides, discussed its appetite for risk and has considered various alternative futures (e.g. scenario planning). A4 During IBP development the Board has explored market possibilities and threats. Evidence: Board Development session on opportunities in November 2011 Q5. The Board has agreed a set of corporate objectives and associated KPIs/ milestones that enable the Board to monitor progress against implementing its vision and strategy for the Trust. Performance against these corporate objectives and KPIs/ milestones are reported to the Board on a quarterly basis. A5 Board agreed detail behind the vision and corporate objectives and priorities are included in the Business plans (Trust and CSU) Evidence: Vision and objective discussion. Business plans 2012 Q6. The Board’s annual programme of work sets aside time for the Board to consider environmental and strategic risks to the Trust and downside scenario planning (e.g. the risks presented by PBR, commissioning intentions and efficiency requirements). Specifically, the Board can demonstrate that it has sufficiently discussed the downside scenarios that underpin the LTFM, including key mitigation plans and trigger points for deploying these plans. A6 Performance against objectives is reported quarterly to the Board. Evidence: IBP discussion at Trust board, Notes from Board sub group sessions Q7. Strategic risks to the Trust are actively monitored through the Board Assurance Framework (BAF). A7 Strategic risks are monitored through the BAF. Evidence: BAF Recommend – Yes	Q4 Board needs to finalise discussion on appetite for risk and complete scenario planning link to work on the vision. Q6 Annual work plan needs to include time to discuss strategy and risks Q7 Need to ensure all strategic risks are considered and included in BAF as appropriate
Red Flags	Action plans to remove the Red Flag(s) or mitigate the risk presented by the Red Flag(s)	Notes/ comments
Q1. The Board does not receive an update on developments within the external environment at each Board meeting. A2 The Board receives reports from the CEO at every meeting. Evidence: CEO reports since early 2012 Q2. The Board’s annual programme of work does not set aside time for the Board to consider environmental and strategic risks to the Trust and downside scenario planning. A2 The Board has time protected to undertake this work. Annual work plan needs to include time to discuss downside options and risks to plans Evidence: Q3. The Board does not formally review progress towards delivering its strategy. A2 Evidence: Business plans, R&D review. Business cases reviewed

3. Board insight and foresight
3.4 Quality of Boards papers and timeliness of information

Section RAG rating:

Green

Evidence of compliance with good practice (Please reference any supporting documentation below and attach with your submission)	Action Plans to achieve good practice (Please reference Actions Plans below and attach with your submission)	Explanation if not complying with good practice
Q1. The Board can demonstrate that it has actively considered the timing of Board and committee meetings and the presentation of Board and committee papers in relation to month and year end procedures and key dates (e.g. submissions to CQC) to ensure that information presented is as up-to-date as possible and that the Board is reviewing information and making decisions at the right time. A1 The Board can demonstrate active consideration of timings to ensure key deadlines for returns are made and there is time to review the information e.g. accounts / CQC. Evidence: Despatch times Q2. A timetable for sending out papers to members is in place and adhered to. A2 Timetable for sending papers is available and adhered to Evidence: SO state 3 days. Papers are despatched up to 4 working days in advance of meeting. Measures have been put in place to allow papers to be received by members 7 calendar days/ 5 working days in advance. Q3. Each paper clearly states what the Board is being asked to do (e.g. noting, approving, decision, discussion). A3 All papers to the Board have a cover report and utilise the Trust report template and outline reason and decision/action required Evidence: Board agendas and papers Q4. Board members have access to in-month flash reports to demonstrate performance against key metrics and there is a defined procedure for bringing significant issues to the Board’s attention outside of formal monthly meetings. A4 IPR has flash report format to demonstrate performance against key indicators. The Finance & Investment Committee receives monthly finance report (via email in between meetings) Evidence: Reports Q5. Board papers outline the decisions or proposals that Executive Directors have made or propose. This is supported, where appropriate, by: an appraisal of the relevant alternative options; the rationale for choosing the preferred option; and a clear outline of the process undertaken to arrive at the preferred option, including the degree of scrutiny that the paper has already been through. A5 Board papers adhere to the Trust format and construct a clear argument. This position has improved during 2011/12. Evidence: Board papers Q6. The Board is routinely provided with data quality updates (e.g. Information Governance Toolkit scores). These updates include external assurance reports that data quality is being upheld in practice and are underpinned by a programme of clinical and/or internal audit to test the controls that are in place. A6 The board is regularly provided with quality updates as part of IPR (includes IG scores) Quality reports need to be backed by a programme of clinical audit to test controls. Evidence: We have an independent review by KPMG of Quality Governance arrangements. F&I also examine on a routine basis Q7. The Board can provide examples of where it has explored the underlying data quality of performance metrics that have been RAG rated green. A7 The Board can provide examples where it has explored underlying quality performance metrics rated green. Evidence: IPR examples. F&I report/presentation in May 2012.	Q2 Further work on timescales is required to achieve a constant 7 day target performance
Red Flags	Action plans to remove the Red Flag(s) or mitigate the risk presented by the Red Flag(s)	Notes/ comments
Q1. Reports are regularly tabled on the day of the Board meeting and members do not have the opportunity to review or read prior to the meeting. A1 The Board agreed in March 2012 not to accept late or tabled papers. Evidence: Minutes and Etiquette Q2. Board discussions are focused on understanding the Board papers as opposed to making decisions. A2 Board debate is focused on decisions as the quality of papers has improved during 2011/12. Evidence: Board Papers and RSM Tenon Board Observation report Q3. The Board does not routinely receive assurances in relation to Data Quality or where reports are received, they have highlighted material concerns in the quality of data reporting. A3 Presentations to committees on data quality and action plans e.g. F&I May. IPR identifies and data concerns/corrections Evidence: IPR, F&I minutes