Barking, Havering and Redbridge University Hospitals NHS Trust Independent review of Board governance

NHSI and the Board should give due consideration to the appointment of a new CEO who has the appropriate level of expertise and ambition to successfully tackle the financial challenges currently being faced by the Trust.

The Trust should embark on a comprehensive executive team development programme as a priority, with a view to promoting cross-disciplinary working where all EDs assume joint corporate responsibility for delivery of the full Trust agenda, but specifically the financial agenda.

The Board should commission a detailed review of the medical leadership and cultural issues underpinning current tensions amongst the consultant body at the Trust.

NHSI and the Chair should give due consideration to refreshing the NED cohort with circa two new appointments, to include a new Chair of FIC with commercial finance experience (see A.2.3). There should also be a development programme for existing NEDs.

The Chair should take active steps to build opportunities into its Board development programme to promote more informal interactions between Board members and to generally support team building across Board members.

The Trust should make provision for a range of activities outside of the Board room which will allow NEDs to build greater levels of ‘soft intelligence’ regarding key challenges being faced at the operational level of the organisation.

The Trust should conduct a comprehensive review of the relationship between OMG and TEC to include clarity over objectives, membership, escalation policy and respective responsibilities for overseeing the finance agenda.

The Chair should consider the need for revising the timing of Board meetings to reduce the five week period between financial month end and the Board meeting. This should also consider the need to have monthly Board meetings.

The Trust should review its risk management arrangements to ensure the systematic reporting of key corporate and operational risks to the Board and its key committees.

The Trust should introduce a structured leadership development programme for the divisional leadership teams to develop competencies but also to build clarity over expectations in relation to assumed accountability and ownership for delivery of the finance agenda.

NHSI should consider the effectiveness of its current approach to monthly submissions and oversight meeting in the context of gaining greater assurance over the underlying trading position and forward cash profile for trusts. In particular, NHSI should consider:
- The design of submission returns, in order to ensure that key performance concerns are highlighted;
- The accompanying narrative reports and the need for more-detailed narrative to provide further performance context;
- The need for greater triangulation of reporting and soft intelligence through the over-sight meetings; and
- The robustness of follow-up arrangements in light of the emerging messages flagged by the Trust during August 2017.

NHSI should consider conducting risk assessments of the potential impact from recruiting key staff from other NHS organisations, particularly where Executive teams are not at full strength due to sickness absence or substantive vacancies.