Performance issues in the area of finance
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Finance: The Management of investment decisions relating to the Broadmoor Hospital redevelopment programme
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Brief description of issue
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Over recent years the Trust has experienced delays with the approval of the OBC for Broadmoor Hospital but needed to maintain momentum to ensure delays to the completion date were minimised and as much preparation work as possible could be undertaken to shortened the time period between OBC and FBC approvals
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Outline Board’s understanding of the issue and how it arrived at this
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The Board acknowledged that PDC funding from DH was staged in phases and there were potential risks in terms of capital expenditure, local authority planning approvals, land sales timings. The Board recognised that increased time delays may necessitate a decision to stop the scheme at short notice. The time delays with the approval for the OBC could also result in further delay as environmental studies could expire. The position was further complicated by a series of enabling projects which also required completion prior to the main redevelopment scheme.
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Outline the challenge / scrutiny process involved
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The Board requested that detailed monthly updates on the progress of this scheme. The Board reviewed the expenditure and funding arrangements on a monthly basis and approved expenditure to specific limits and timetables. The Board discussed stakeholder management issues particularly with the DH and local Authority and challenged the programme team on key milestone objectives.
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Outline how the issue was resolved
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The Board reports changed to provide a monthly report on planning, timetables and financial expenditure. The Board allocated time within the Board meetings and forward plan to enable substantial discussion on this programme. Additional reports requiring approval for enabling projects were presented separately to the Board. The Programme Director, Director of Capital, Estates and Facilities regularly attend Board meetings to present their reports.
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Summarise the key learning points
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Improved reporting arrangements in place. Reports include a summary of key events, Capital budget and expenditure, required mitigations and a summary of timeline of key milestones
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Summarise the key improvements made to the Trust’s governance arrangements directly as a result of the above
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The Board have a clear understanding of the issues relating to the Trust’s largest Capital programme. The Board receives up to-date information on issues and risks associated with this scheme. The Board is able to make informed and timely decisions on the overall programme of work.
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5. Board impact case studies
Organisational culture change
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Culture change: The QUASIC Programme
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Brief description of area of focus
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In 2011 the Trust had identified the need to provide management development training for ward and middle managers in the organisation as part of the action plan for the staff survey and the recommendations arising from SUI reports.
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Outline reasons / rationale for why the Board wanted to focus on this area
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The Director of High Secure Services and the Director of Organisation Development and Workforce identified a senior leadership and learning course that had been successfully implemented in other NHS organisations. The QUASIC programme would assist clinical managers in identifying and benchmarking the standards expected and linked performance to the Trust’s values. The scheme became part of the action plan for the Trust to support clinical and middle management staff within the organisation.
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Outline how the Board was assured that the plan/(s) in place were robust and realistic
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The Board approved the commencement of a pilot project at Broadmoor Hospital and received a presentation on the outcome of the pilot from three ward mangers who had completed the programme. The Board agreed to extend the programme to other Directorates and increase the range of the individuals involved.
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Outline the assurances received by the Board that the plan/(s) were implemented and delivered the desired changes in culture
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The Board received updates on the progress of the programme on a regular basis and were able to gain assurance from the presentation to the Board and through Board member visits to individual wards and clinical teams.
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Organisational strategy
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Vision and strategy shaping
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Brief description of area of focus
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In 2012 the Trust considered the future vision for the organisation and recently spent time considering how the future vision will influence the future strategic direction of the organisation.
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Outline reasons / rationale for why the Board wanted to focus on this area
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As part of discussions on the Trust’s business plan 2012/13 the Non Executive Directors requested further discussion on the strategic direction of the Trust and clarity on the Trust’s future direction.
The Board allocated two development sessions to discuss the future strategic direction of the organisation which concluded that the Trust would focus exclusively on the core expertise of providing integrated Mental Health services. This has resulted in an adjustment to the Trust’s vision statement which will now be subject to wide consultation with staff, service users and carers and other stakeholders.
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Outline how the Board was assured that the plan/(s) in place were robust and realistic
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The Medical Director and other Executive Directors considered the outputs from the discussion at a Board Development event and the Medical Director wrote a detailed summary of the future direction of the organisation. This prompted further discussion amongst the EDs on the strategic advantage and focus on recovery which was identified as a key driver for many of the Trust’s services. The changes to the vision were represented to a Board Development session and will be subject to a full consultation.
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Outline the assurances received by the Board that the plan/(s) were implemented and delivered the desired changes in culture
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The document on the response to the vision produced by the Medical Director was fully reviewed at a Board Development session and the outcome of the consultation process will be presented to the Board in September 2012.
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Specifically explain how the NEDs were involved
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This case study was commenced following a series of questions raised by Non Executive Directors at a Board meeting. This identified that the Board needed to undertake further work to clarify the vision and the implications that the vision has for the future strategic direction of the organisation.
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