Methodology and Assessment
The TST has undertaken its assessment on the basis of:
(a) the evidence submitted by NHS Tayside concerning new arrangements, processes and structures put in place, set alongside our own observations and discussions with NHS Tayside staff;
(b) where possible evidence of demonstrable results and impact delivered;
(c) our own observations of relationships, behaviours and partnership working set alongside those from members of the AAG who attended a series of meetings in the period April – June, and revisited the same meetings in November- December 2017.
Information from each of these sources, including consideration of the strength of the evidence base provided to support NHS Tayside's self-assessment, has been triangulated to produce our overall assessment. It is worth noting that NHS Tayside's assessment, which we reproduce in this report, was based on the situation at 31 December 2017. There is activity that they refer to in their 'next steps' sections that is due to be completed in January 2018, but which is out-with the scope of our assessment and also coincides with writing this report.
As in September 2017, we have assigned a Black, Red, Amber or Green ( BRAG) rating to each recommendation, based on the definitions below:
- Black – there is no confidence that plans will deliver the anticipated outcomes, or there is a complete lack of a plan for a recommendation.
- Red – significant activity is still required to develop realistic plans that will give confidence that the outcomes will be realised timeously, or substantial activity may have already begun but there is a high level of risk that anticipated results will not be realised.
- Amber – realistic and credible plans are in place to deliver the outcomes but they have not yet been implemented, or have been partially implemented, and results are still to be seen.
- Green – plans are robust with activity already leading to results in line with the anticipated outcomes.
In our September report we identified that the recommendations of the AAG were designed to deliver an immediate improvement in the in-year financial position ( recommendation 1) and also to address issues of longer term sustainability through significant transformational service change ( recommendation 3).
Delivery of recommendations 2, 4 and 5 were recognised as being fundamental to being able to model and have in place processes that would deliver that transformational change and ensure sustainable quality services.
The remaining recommendations, 6 to 10, are important enablers of the work that will be needed in the Board to deliver short and longer term changes. Full implementation of this group of recommendations will create the conditions in relation to delegation, engagement, ways of working, effective skill mix, scrutiny and leadership that are required to transform and to continue to evolve services to meet changing demands.
The following table summarises the BRAG ratings we assigned to each recommendation as at the end of September, and then again at the end of December.
|Recommendation||BRAG rating as at end-September||BRAG rating as at end-December (this report)|
The table above notes an improvement in the BRAG rating across recommendations 1 to 5. These are the areas where it has been possible for us to assess not only the systems and processes that NHS Tayside has put in place since July 2017 but also to identify that these processes are starting to achieve the results that the recommendations were designed to achieve. As noted above, recommendations 6 to 10 will create the conditions that enable the Board to implement transformational change. It is the nature of this sort of improvement work that it will take longer for results to be clearly evidenced. The ratings against these recommendations therefore reflect the fact that, whilst work has been done to put in place revised systems and processes, it will take longer for the results of this work to be evident. It will be important for the Board to continue to assess whether the measures they have put in place are achieving the desired impact.
NHS Tayside has worked hard to implement the recommendations of the AAG report. There is still significant work to be done, particularly to further develop, approve and implement the Integrated Clinical Strategy in partnership with the Integrated Joint Boards and Local Authorities. This is fundamental to providing the authorising environment within which the transformational change that is required to provide sustainable high quality and safe services can take place. As the Integrated Clinical Strategy is developed the Board will need to continue to focus on the requirement to deliver significant in-year savings.
We note the progress made using data, identifying areas where NHS Tayside is at variance from benchmarks and top quartile performance in NHS Scotland, being used as part of the new Business Planning Process and the Board will need to ensure that improvements and efficiencies result. At the same time the Board must continue to work on the improvements to delegation, engagement, ways of working, effective skill mix, scrutiny and leadership that will support change and continual evolution of services.
The Board has taken important steps to improve their capacity and capability in key areas, particularly through embedding the role of Alan Gray as Regional Finance Lead (North of Scotland) and through the more recent appointment of interim support in the area of strategic planning and performance. The Board should take advantage of the opportunities for further collaboration with colleagues across the North region to draw on additional capability and insight and also to share areas of best practice. These measures, together with the support provided in areas such as team development and public engagement should help NHS Tayside to continue to make progress towards sustainable high quality services.
We recognise that NHS Tayside has been subject to considerable scrutiny over the last year, and we appreciate the additional burden that this can place on staff. We therefore consider that the Board needs to be allowed some time to demonstrate that work that they have delivered so far, and the learning that they have taken from this process can deliver tangible results.