Outcomes of the Trust Board evaluation 2013/14
Produced by:
Ian Tombleson, Director of Corporate Governance
Trust Board
26 June 2014
Outcomes of the Trust Board evaluation 2013/14
June 2014 Trust Board
Background
Following responses from Board Directors under each heading, this report summarises the outcomes of the Trust Board self-evaluation for 2013/14.A good contribution has been received with a total of fifteen out of a possible seventeen responses.Responses consisted of completed evaluation forms and as part of the methodology, some engagement from Directors with the Director of Corporate Governance about the responses they had provided.
1. Role of the Board
1.1 Leading the organisation
Although Moorfields has an agreed vision and values, which were developed when the Trust’s strategy was launched in 2010, Directors believe that more can be done to reinforce the knowledge and understanding of the Trust’s values and standards across the organisation. The values are not as clearly understood as they should be; howeverwork led by the Executive team has commenced through a staff engagement strategy called ‘the Moorfields Way’which will help refresh and reinforce ownership of the Trust’s vision and will refresh the Trust’s values. Measures will be put in place tounderstand whether staff are adhering to them.
There was recognition by most Directors that as result of the consistent growth in the size and complexity of the organisation, further thought is required about how to provide the appropriate structures and the right people to manage delivery within the organisation, and that work has commenced, led by the CEO and Executive team.
Many Directors said that good progress had been made in achieving a good balance between looking forwards and looking backwards, however many also said that more time should be spent on strategy. This has already been remedied to some extent by the introduction of two Board strategy sessions in 2014/15, but further reflection may be helpful about whether two or three sessions are required and how those sessions are structured.
1.2Monitoring the performance of management
A fundamental requirement of the Board is to monitor operational, financialand quality performance and most Directors believe that there is sufficient monitoring across the broad range of requirements that the Trust Board needs to consider. However some views were expressed that there should be more focus on risk, information technology, communication, education and research. One view put forward was that there should be greater accountability by Executive Directors when objectives or timescales are missed. It was recognised that there must be no complacency in the area of performance management and the organisation should be continuously working to develop better systems and analytical capability to improve the efficiency by which monitoring takes place.
The main focus of the Board is on NHS activities and there was a consensus that the Board strikes the correct balance between its consideration of NHS and commercial matters, which is reflected in the Trust Board agendas. Further consideration is needed about how the commercial content should be presented.
2.Structure and membership
The large majority of Directors believe that the Board is of the right size and that the Associate Directors bring added skills and value to supplement those of Board members. However going forward there is scope to review the Board size, composition and skills. One view expressed was that in time the Board might become smaller and in doing so become more efficient at discharging its responsibilities. Suggestions were made about the need for clinical expertise among the NEDs as well as experience and expertise in major construction project management and possibly marketing or someone with a hospital management background. Consistent views were expressed that there needs to be succession planning for Executive and Non-Executive Directors and currently this was not evident.
The structure, membership, functioning and discharge of the duties by Board committees were on the whole believed to be good. However a view was expressed that the Q&S committee had further work to do to provide the Board with the assurance it needs in the area of clinical quality and patient safety whilst noting this work is underway. Work is required by all Board committees to continually monitor whether they are discharging their duties sufficiently and specific initiatives are underway. Also further work is required to consider how Board committeescan reduce the burden of material and consideration of detail undertaken by the Trust Board.
3.Meetings and materials
A number of Directors expressed the view that Board agendas and the quantity of material coming to the Board should be reduced. However it was recognised that dedicated time is required to understand exactly how this streamlining can be achieved and still obtain the right balance between satisfying the needs for the Board to monitor and assure itself and the regulatory requirements, against the desire to reduce the burden of paperwork.
Several Directors (including the Chief Executive) suggested that it would be helpful for the NEDs and the Chief Executive to spend more time together and that regular meetings between the CEO and NEDs should be re-established in due course. Some views were expressed that it would be helpful to reflect further on the differing contributions of Board members and their impact on the Board. One view was expressed that there might be more meetings between the NEDs and the Chairman.
4.Connecting and influencing
In relation to the question about NEDs having sufficient understanding of the hospital, most NEDs said they would welcome more briefing about the hospital, particularly insight into the relationships between the hospital and Institute of Ophthalmology. No specific additional training needs were identified by the NEDs. A view expressed was that NEDs might be able to provide a more formal role in mentoring Executive colleagues in areas where they have specific expertise.
Generally it was felt that the organisation has the right balance and range of partnerships with other organisations. Work is needed to maintain and build relationships with those partners and this is underway in several areas, for example more formal relationship meetings with the RNIB.
Some specific areas were identified where more influence is required in the short to medium term. Firstly in relation to the broad range of influencing needed for the new hospital build (Project Oriel) which Rob Elek and Tim Fry are leading. Secondly in relation to fund-raising through Rob Aldous and his team and the support required from the Board to achieve this. Other areas where engagement is required is with NHS England about specialised commissioning, NICE in relation to cataract thresholds and Monitor in relation to tariff setting. The work that Kate Jeffreys is leading and which will shortly be completed will help progress this.
Some views were expressed about the need for Board members to be more visible to staff within the organisation; although recognising this has a different meaning for Executive and Non-Executives. A similar point was made about potentially making staff more aware of what the Board and the Board committees do.
5.Working together
Apart from the two examples already set out in the text above (about more strategy meetings and a meeting between the NEDs and the John Pelly), Directors believe that there is sufficient quality time spent between Board members, both formally and informally. The Board working environment is seen as constructive and conducive to effective working and NED challenge is on the whole seen to work well. There is an overall acceptance that the governance systems for the Trust are applied well in the context of the Board and the Membership Council and the organisation is constructive in making some of the less well defined and unclear parts of the Foundation Trust governance model work.
A range of considered responses were made by Directors in relation to whether the Board has a culture of self-promotion (as was found as part of the negative culture present at Mid Staffordshire). Views were expressed that it is natural that to some degree Boards will have a tendency to promote themselves, however within that the real test is how open and honest the Board is and its desire to promote honesty and transparency. There was a solid consensus from Directors that the Board works hard to be very transparent and open particularly when adverse situations are brought to the Board’s attention. Indeed views were expressed that in some circumstance perhaps this is done too much and the Board can be too self-critical, but it is difficult to be negative about this sort of behaviour.
6.Governance review
This was seen in some ways as an unnecessary question because of the new requirement from Monitor to have three yearly formal governance reviews. A number of positive views were expressed that a review could support some of the governance challenges that the Board faces, some of which are reflected in this evaluation.
7. Conclusions
I have summarised the views and some outcomes in each section of this report and have tried to reflect a balanced view of the comments that I have received. This evaluation has received good input from Board Directors and a range of comments have been provided. I have not attempted to capture every view, but have reflected the key points. The next step will be to act upon the significant points from this paper and those that arise in discussions.
I would welcome further views from the Board about this evaluation.
Ian Tombleson
Director of Corporate Governance
19 June 2014
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