Key indicators:
FIGURE 4
- Almost nine in ten respondents agreed or strongly agreed with every statement, apart from 'Committee agendas are manageable and relevant'. Just over three quarters (76%) of respondents agreed with this, and there was a higher proportion of neither agree nor disagree (12%), disagree
(11%), and 1% strongly disagreed. - Compared to last year, all applicable statements showed equal or slightly higher levels of agreement.
- The statement 'Overall, I am content that the reporting and assurance arrangements enable the board to have sufficient oversight of the organisation' was a new statement this year. This will be monitored in the future: 10% of respondents were unable to agree with this statement.
- There was slight change to the statement 'The way the committees report to the board provides it with assurance' from 'The way the committees report to the board can provide it with assurance' last year. This year's statement on committee reporting providing assurance had 89% agreement from respondents, compared to 99% with last year's statement. Although we cannot attribute all the change in agreement to a change in wording, it is interesting to note that this year's more direct
wording received less agreement.
Committee agendas are manageable and relevant
- For this statement, there was a higher proportion of disagreement for both chairs (13%) and governance leads (11%) compared to other statements.
- Nearly a quarter (24%) of acute trusts disagreed with this statement, higher than all other trust
types and the survey average (12%).
The board can dedicate adequate time to receiving assurance and/or escalations from committees of the board
- Chairs were less likely to agree than governance leads (chairs: 82%, governance leads: 92%). A higher proportion of chairs also selected neither agree nor disagree, or disagreed.
- There was variation in responses by trust type: only 64% of mental health/learning disability trusts agreed or strongly agreed, compared to over 89% for the survey overall. Over a quarter (27%) of mental health/learning disability trusts neither agreed nor disagreed, compared to 8% as the survey average.
FIGURE 5
If you have disagreed with any of the statements please tell us more, or feel free to explain any of your answers:
- The overall sense in the comments was that agendas are too lengthy, and the information included is sometimes duplicated or irrelevant. Respondents said there was often more reassurance than assurance provided, and more time was needed to focus on strategy and risks. Many members highlighted their ongoing efforts to improve assurance processes.
“For me the length of the quality and safety agendas are far too long and full of external requirements. Each new scandal creates a new set of reporting requirements... Nothing ever
drops off the other end. Obscures what we as an individual trust need to concentrate on.”
Chair, Acute Trust
"Board and committee agendas often trying to fit too much in, with papers that are overly long. Papers need to be more targeted to the audience, with presenters briefed to provide the
key points in two to three minutes then allowing time for discussion.”
Company Secretary, Combined Acute and Community Trust
“Whilst I have not disagreed with any of the statements, I have cautiously responded regarding the board having time to focus on key risks and issues, as there have been increasing demands
on its time to consider the financial challenges within the ICS, which have a direct impact on the trust's own ability to operate efficiently.”
Company Secretary, Mental Health/Learning Disability Trust
Triangulation
Please tell us how your board members triangulate what they hear about patient safety:
- Most respondents mentioned ward, department or site visits in their responses through planned and unplanned board walkabouts and service visits, either by executives, NEDs, or other senior leaders.
- Other ways that board members triangulate what they hear at the board about patient safety include engaging with patients and staff, for example through patient and staff stories presented at boards, reviewing complaints, and staff or patient survey results.
- Alongside the use of externally sourced data, such as CQC inspection findings, several respondents mentioned the role of NEDs, specifically regarding meetings with patients and staff, and participating in audits and visits.
- Other approaches included the use of freedom to speak up (FTSU) intelligence.
"All members undertake a walkabout to different areas of the trust. There's also a partnership of executive and NED which is on a rota. There is a space on the board agenda to feedback on walkabouts.”
Company Secretary, Combined Acute and Community Trust
“They consider a range of information relating to services including safety incidents, demand on services, staffing levels and staff satisfaction. They visit services and also hear from patients and families using services.”
Company Secretary, Combined Mental Health/ Learning Disability Community Trust
Changes made to committees
If, in the past 12 months, you have significantly changed your committee structure or the remit of your committees to provide assurance to the board around system-working, partnerships and/or collaborations please tell us about the changes you have made and why you have made them:
- Respondents described a variety of approaches to adapting their committee structures and practices. These included including shifting discussions about system working from committees to the full board to enhance transparency and ensure these topics receive strategic attention while others have integrated system working into all committee agendas and board discussions without altering the committee structure.
- Several respondents highlighted specific structural changes, such as reducing the number of committees and sub-committees, introducing new committees and restructuring governance mechanisms to align with integrated care systems (ICSs) frameworks. Trusts are also enhancing reporting processes to reflect activities within provider collaboratives and ICSs.
“Our strategic transformation committee has opened its membership to include our system partners for this reason. We need their involvement much earlier than traditionally and this is a good way to ensure they are involved form the word go.”
Chair, Acute Trust
“The trust is currently undergoing an organisational and governance restructuring which is aimed to incorporate the integrated working system and more effective systems working framework.”
Company Secretary, Acute Trust
“We have continued to develop our partnership reporting to reflect activities in the provider collaborative and integrated care system.”
Company Secretary, Combined Mental Health/Learning Disability and Community Trust