Governance

The Inquiry recommends a programme of work by the Trust to:
• Consolidate governance improvements into a clear, prioritised programme overseen by the Board. This will ensure that the large number of improvement plans do not become overwhelming or get lost due to time pressure.
• Develop a comprehensive data and information strategy to support assurance, learning and decision-making.
• Streamline its governance forums to ensure that information presented leads to action and improvement.
A revised programme of work led by the Board and SMT at the Trust should include:
• Agreement regarding an ongoing way of assessing governance effectiveness.
• Identification of any current gaps in assurance.
• An agreed approach to developing a high-quality data and information function to use relevant and timely data to help manage and assure standards of care and drive decision making. This would not only shine a light on areas that need improvement but also on those areas where there is good assurance and standards are high.
• The Inquiry recommends the development of a data and information strategy with clear aims and ambitions to cover the provision of assurance and learning to improve. Such a strategy requires broad input and expertise. It could usefully encompass a specific focus on developing agreed patient safety and quality standards.
• There is a need to re-evaluate the weekly SMT governance meeting and consider how it could be streamlined. This meeting was set up to increase the oversight of key quality and safety issues and to share learning across directorates. The breadth and depth of information shared is significant, but the Inquiry considers that there could be clearer links between the audits, investigations shared at this meeting and agreed improvement initiatives. The idea of a need for a transformation manager came out of Trust learning from the Inquiry and the post was supported by the Board. As this role is advanced it could usefully help to bring initiatives together.
The opportunity presented by the relatively manageable region of Northern Ireland and the recently introduced patient record management system, 'encompass', provides a significant opportunity to develop a regional approach in this area. The Inquiry considers that:
• The Department should take the opportunity to develop a regional information strategy. In the meantime, Trusts should be supported to incrementally improve their information systems in a way that sustains governance and decision making generally across the system.
• The Department should consider how safety issues that cross organisational divides could be overseen in the future. For example, in the prescription of drugs.
• The Department and Trusts should agree where decisions can be made regarding the kind of data required to provide assurance or signal problems. This would allow appropriate safeguards to be put in place.