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Assurance


Board assurance

During planning, mobilisation and early transition, boards and commissioners will want to know that all is going to plan. Once the service is established it needs to be measured against the agreed baselines to provide assurance that the partnership agreement has been delivered.

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Both partners need to be clear about what the host trust expects to be the agreed benefits coming from the new services and how these will be delivered by the specialist provider.

During mobilisation and early transition an agreed monitoring mechanism will be required to provide this assurance in addition to routine performance reporting. Depending on the form of partnership, once the service starts, this should become less of an issue for stakeholders.

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Board assurance for the new networked service should sit alongside business as usual and within the governance of the partnership agreement so that it is managed appropriately; in the SLA if the service transfers entirely; or in a subcontract if the host trust retains activity ownership. For the specialty provider this should be part of the business case detail.

We have considered board concerns and what sort of defined, measurable metrics might demonstrate both improvement to existing provision and value added by the specialty provider. These are geared towards justifying the move to a new provider rather than monitoring future operational performance. Such assurance could involve measuring the following before and after the change:

  • patient complaints.
  • Friends and Family Test results.
  • staff absence.
  • current treatments provided.
  • number of patients referred to a tertiary provider.

Other benefits can be evidenced from:

  • staff training and development.
  • new extended skills roles.
  • more tertiary care locally.
  • increased staff education.
  • patient participation in service development.
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Expectations around financial benefits to the host trust must be managed carefully. Although costs associated with providing the service and staff costs will be reduced, and there will be new income from renting the space to the specialty provider, this must be balanced against the loss of income. There are also the hidden costs of a failing service: actual and potential litigation, cost of poor or untimely diagnosis and cost of investigating serious incidents.

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In this section we looked at whether a balanced scorecard has a role to play in the new model assurance. We concluded that it is an organisational tool to monitor and flag up performance issues to the trust and its commissioners and not the comparative tool needed during early transition.

Board members were, however, concerned about future performance so we have included some performance metrics in our resources section. These are aligned to the CQC domains and a ‘dashboard’ which individual services can use with their information analysts to measure their own service productivity.

Board executives told us:

  • a networked model must support the organisation’s strategy.
  • patients must get the right experience and care.
  • the new service should improve organisational resilience. This could be by helping overheads and the bottom line; increasing the skill base, catchment and/or market; and/or improving the organisation’s influence and/or reputation.
  • they would want to be clear on who is responsible for what – who would the regulator hold to account for performance issues?
  • that whether there were joint or separate boards, all expressed the need for transparency in reporting and assurances and about delivery on the business case.
  • there would need to be a sufficient flow of information from any individual site to the centre (specialty provider) and the right amount of information to the boards (both partners) – not too much or little.
  • there would need to be assurance on the estate and infrastructure supporting services on all sites including but not limited to compliance with fire safety, water quality (Legionnaire’s).
  • the board might need extra support to understand the model and its implications.
  • there would need to be an understanding of the contractual relationship and its liabilities and implications for staff.
  • they would want a clear sense of the network objectives and whether they were being realised.
  • they would need a clear understanding of the money flow and risks of a network.
  • there would need to be clarity about what happened if either host or specialty provider had a crisis – would they consider the needs of the other organisation?

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The SLA or other form of contract document is where most of these questions should be settled. We have established that it is critical to a successful partnership to agree and sign up to one before mobilising any new networked service.

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“We want to be a world leader in delivering specialist care and research – does networked care enhance that?”
“A key improvement should be a reduction in unwarranted variation in clinical care, quality and the model. Networks can provide a framework that describes what good looks like – not sticking rigidly to organisational viewpoints but what is best. “
“We have a board that sits between the two partners – a steering board – which signs things off and they are then approved by our board. A joint memorandum of understanding binds us together as partners.”
“You need an effective way of dealing with someone who doesn’t deliver to a good standard.”
“We’d want transparency around performance with numbers of cancellations, complaints and so on.”