The NHS Board’s strategic direction and aims are set out in a range of Strategy documents, providing the direction and aims for the organisation as a whole, and for individual services. These strategic documents are accessible on the NHS Lanarkshire Public Website.
Performance reports against the Local Delivery Plan, in key areas such as:
- Waiting Times,
- Primary Care Out-of-Hours Services,
- Healthcare Associated Infection,
- Clinical Governance
- and Quality
is reported monthly to the NHS Board. Meetings of the NHS Board are held in public and the performance reports are accessible on the NHS Lanarkshire Website prior to Board Meetings being held.
Ministerial Annual Review of Performance
Each year, the Board’s overall performance against the Local Delivery Plan is rigorously scrutinised by the Cabinet Secretary for Health and Wellbeing and her Ministerial officials during the Annual Review process, which is held locally and is open to members of the public.
The outcome of the Annual Review is confirmed in a detailed letter from the Cabinet Secretary, which is reported to the Board along with progress reports on the delivery of agreed actions, and is replicated, in full, within the NHS Board’s Annual Report published in December.
Code of Conduct for Board Members
In order to ensure that the organisation is governed and managed with probity and integrity, there is in place a Code of Conduct for Board Members. All Board Members are required, each year, to complete a Declaration of Interests in accordance with the Code of Conduct. A report on members’ Declarations of Interests is considered annually by the NHS Board, typically, in May, and the Declarations are posted on the NHS Lanarkshire Public Website. The Declarations are also included in the NHS Board’s published Annual Accounts.
Allocation of Resources
The allocation of resources is overseen by the NHS Board through the consideration in March each year of the rolling five year Financial Plan and an accompanying five year Capital Investment Plan. Performance against the five year Financial Plan and the five year Capital Investment Plan is routinely reported to the NHS Board.
Review of Executive Performance
Executive performance is overseen by the Remuneration Committee against Executive Directors’ personal objectives which are linked directly to the organisation’s corporate objectives. The Chief Executive’s performance is reviewed by the NHS Board Chair, and the performance of all of the other Executive Directors is reviewed by the Chief Executive. At the conclusion to the performance year, Executive Directors are subject to rigorous Performance Appraisal, and the outcome, in support of annual salary awards, is reported to the Remuneration Committee.
The appointment and contractual arrangements for Executive Directors are overseen by the Remuneration Committee, the members of which are Non Executive Directors.
The NHS Board’s responsibility for understanding and managing risk is articulated in a Risk Management Strategy, the implementation of which is through Strategic and Operational Risk Registers, with oversight of progress through the Executive level Risk Management Steering Group, divisional and locality risk management arrangements in the Acute Division and in the North and South Lanarkshire Community Health Partnerships, and through reporting to relevant board committees, including the Clinical Governance Committee and the Audit Committee.
Scheme of Delegation and Schedule of Decisions Reserved for the NHS Board
Delegation to management is documented in a Scheme of Delegation and a Schedule of Decisions Reserved for the NHS Board, both of which were approved by the Audit Committee and by the NHS Board, and are available on the NHS Lanarkshire Public Website.
Mechanisms for the Discharge of Governance
The functions of Governance are discharged through the NHS Board, and its principal governance and other committees, namely:
- Audit Committee
- Clinical Governance Committee
- Staff Governance Committee
- Remuneration Sub Committee
- Property Sub Committee
- Equality, Diversity and Spirituality Committee
- Acute Division Operating Management Committee
- North Lanarkshire Community Health Partnership Operating Management Committee
- South Lanarkshire Community Health Partnership Operating Management Committee
Membership of the Governance Committees is drawn from Non Executive Directors of the NHS Board, with officer support drawn from relevant Executive Directors, e.g. the Director of Finance provides Executive support to the Audit Committee.
There are agreed Terms of Reference for each of the Governance Committees. Governance Committees meet regularly, and the minutes of meetings are routinely considered by the NHS Board each month. They are, thereby, available with published Board Papers on the NHS Lanarkshire Website.
In May each year, the NHS Board considers a report on governance. This summarises the principal activities of the governance committees, set against their Terms of Reference, in order that the Board might take an overall view on the discharge of its overarching governance responsibilities. The discharge of the governance responsibilities through individual Governance Committees is also the subject of discussion between the NHS Board Chair and Non Executive Director Chairs of relevant committees at the annual one-to-one appraisal interviews which the Chair has with Non Executive Directors.
Patient Focus Public Involvement
The NHS Board is clear about its relationship with and responsibility to the public, around driving Health Improvement and reducing health inequalities, and providing ease of access to increasingly responsive services.
The NHS Board has a published Patient Focus Public Involvement Strategy, for which the lead Executive Director is the Director for Strategic Implementation, Planning and Performance. This articulates the Board’s commitment to Public Involvement and sets out the way in which genuine involvement and engagement will be taken forward as part of strategy development and Service Design and Redesign.
The Board produces quarterly progress reports on Patient Focus Public Involvement for the Scottish Health Council. Prior to submission to the Scottish Health Council, the quarterly progress reports are considered by the Board’s Clinical Governance Committee.
Board Member Contribution to Strategy Development
NHS Board Members, Executive and Non Executive, are actively involved in strategy formulation from the earliest stages, including through opportunities to participate in particular pieces of development work; consideration of emerging strategy issues in Board Seminars, and ultimately through the formal consideration of strategies submitted for approval. There are, therefore, a number of opportunities for Non Executive Board Members to scrutinise and challenge proposals developed by the Executive.
The NHS Board’s strategic aspirations require to be matched with available Capital and Revenue resource, and any strategy submitted to the Board includes a prioritised Action Plan and a financial framework, such that the Board can consider the affordability of strategy implementation.
Appointment and Remuneration of the ‘Top Team’
The appointment and remuneration arrangements for the top team, namely: Executive Directors, is overseen by the Remuneration Committee, Membership of the Remuneration Committee is, exclusively, Non Executive Directors, namely the:
- Board Chair,
- Chair of the Acute Division Operating Management Committee,
- Chair of the North Lanarkshire Community Health Partnership Operating Management Committee
- and the Chair of the South Lanarkshire Community Health Partnership Operating Management Committee.
Thereby, Executive Directors are excluded from decisions about their remuneration. The Remuneration Committee is free to make recommendations to the NHS Board. Levels of remuneration for Executive Directors are under Direction from the Scottish Government.
Delineation of Roles: Chair and Chief Executive
There is clarity between the respective roles of the NHS Board Chair and the Chief Executive. Although they share in the leadership role for the organisation, the Chair’s role is to lead the NHS Board, as the governing body, ensuring it makes an effective contribution to the governance of the organisation; whereas the Chief Executive’s role is to lead the organisation in implementing strategy and managing the delivery of services.
The Chair’s responsibilities are described in the letter of appointment from the Cabinet Secretary for Health and Wellbeing. The Chief Executive’s overall responsibilities are described in his Job Description. The specific responsibilities of the Chief Executive as ‘Accountable Officer’ for the stewardship of the Board’s Finances, are described in a formal letter from the Scottish Government Health Department.