Agenda and supporting papers - Plymouth Hospitals NHS Trust

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Item 18, Annex 1 Five of the seven Non-Executive Directors present had been appointed since the close of the previous financial year and in seeking to develop a more informed understanding of the respective roles of internal and external audit, including the processes and evidence used by both audit functions to determine their respective end of year opinions, a broad discussion developed. Non-Executive Directors used this as an opportunity to triangulate their own knowledge and observations of the Trust’s performance with the arguments presented to them by internal and D external audit and to share their perspective, as Board Directors with corporate responsibility, of audit’s findings. In general terms the discussion covered: • Understanding the roles of internal and external audit and their respective focus on process/controls and on outcomes. R • The requirement of the Trust Board, via the Audit Committee, to have earlier visibility of the inconsistent application of controls when this could lead to serious risks, for example controls around discretionary pay. Professor Lewis sought clarification on the costs included within discretionary pay. Mr Teape stated A that service lines had been asked to prepare workforce plans which included substantive and discretionary pay for the full year. Temporary and agency staff, overtime and waiting list initiative payments all contributed to discretionary pay costs. Professor Lewis highlighted the importance of ensuring that workforce and activity were aligned. F • The longer term intention to devolve autonomy to service lines within the current imperative to apply strict financial controls to ensure that the Trust’s overall financial position did not deteriorate further. After the last Audit Committee meeting Non-Executive Directors had received copies of the Trust- T commissioned PWC report on financial controls. Mr Teape placed PWC’s work into context for the Committee. Their recommendations had been incorporated into an action plan, the implementation of which would be overseen by FPIC. • Understanding why the known problems of bed capacity had not emerged as part of internal and external audits’ focus. Mr Barber stated that this was covered in the review of resources and his firm had commented on this. For the last three years the focus of his firm’s Value for Money (VFM) conclusion had shifted from generic to financial resilience. In 2010/11 his firm qualified its conclusion. An improvement was noted in 2011/12 and the Trust delivered in a challenging environment and therefore their opinion had not been qualified in 2011/12. The position had deteriorated in 2012/13 in the area of financial resilience and the evidence for this was set out in his firm’s report. 7
Item 18, Annex 1 The Committee noted Internal Audit’s Annual Report and the HOIAO. 47/13 Audit Committee Annual Report 2012/13 The Committee reviewed and approved this Annual Report. 48/13 External Audit: Financial Resilience Report (draft) D Mr Barber presented this report which summarised the financial resilience element of his firm’s VFM conclusion on their audit work for 2012/13. The report RAG-rated the Trust’s arrangements on: • Key indicators of financial performance. • Strategic financial planning. • Financial governance. • Financial controls. R Mr Barber drew the Committee’s attention to the Executive Summary and to high level risk assessments of red for key indicators of financial performance and strategic financial planning and to amber for financial governance A and financial control. These ratings contributed to a qualified VFM conclusion. Mr Douglas drew Mr Barber’s attention to page 7 of the report and stated that there was, in fact, clinical representation on all the Board’s Committees. F Dr Williams suggested that the Trust’s financial challenges resulted from whole system problems. Did Mr Barber’s firm audit other health organisations, thereby facilitating an holistic view? Mr Barber stated that his firm audited other NHS organisations and would submit to the Department of Health on overall performance report, although within this individual organisations Twould not be named. In this context his firm played a role in taking forward topical debates nationally. Professor Lewis queried whether Mr Barber’s firm had a conflict of interest. Mr Barber stated that there was not because his firm audited individual organisations and was not involved in contract negotiations. Mr Warren sought to clarify a definition of ‘Value for Money’. Mr Bray explained that the Audit Commission, in their Code of Audit Practice, set out the relevant criteria. This Code, followed by all auditors for consistency, was approved by Parliament every five years. The Committee noted the draft report. 49/13 External Audit: Audit Findings Report (draft) Mr Barber stated that this report had been issued on 29 May and his firm’s deadline to comment on the financial statements fell on 10 8
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Trust Board Friday 5 July 2013, 9.0
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Members of Plymouth Hospitals NHS T
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Item 3 observer. The Chairman requi
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Item 3 Board oversight of contribut
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Item 3 the Board next month. • Th
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Item 3 been involved and there was
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Item 3 continuing to build. Mr Babe
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Item 3 to Norovirus, Professor Lewi
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Item 3 • Careful communication of
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Item 3 • Approved the writing off
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Updated: prior to July Board Item 4
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Updated: prior to July Board Item 4
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Item 8 Quality Impact Assessment Pa
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Item 8 3.2 Quarterly Summary Hospit
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Item 8 4.4 Monthly Proportion of Pa
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Item 8 Inpatient falls are currentl
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Item 8 REI signage PALS were contac
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Item 8 Complaints received listed b
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Item 8 The graphs below illustrate
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Item 8 5.5 Friends and Family Test
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Item 8 1. Pressure Ulcers (EoC) 2.
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Item 8 Observations The essence of
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Item 8a SUMMARY REPORT Trust Board
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Annex 2 Item 8a Summary of Serious
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Item 9 Key Recommendations The Trus
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Item 9 Effective Care (Section B2 o
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Item 9 Description 31 days from 'de
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Item 9 4.6 Non Elective Activity is
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Item 9 Summary of performance excep
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Item 9 Ensure that all patients adm
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Item 9 Forecast Significant progres
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Item 9 Update on previous actions C
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Contents EXECUTIVE SUMMARY D FINANC
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B1 Safe care Description Hospital S
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Response Rate Recommender Score B3
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B5 Other safety & quality metrics D
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C2 Non-Elective Activity Descriptio
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C4 Referral To Treatment (RTT) Desc
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C6 Other access & activity metrics
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D2 Cost improvement programme (CIP)
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D4 Cash Management Description Revi
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E1 Staffing numbers Description Est
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E3 Sickness absence PERFORMANCE IND
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Risk Rating F2 Monitor's Financial
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Item 10 DETAILED REPORT Trust Board
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Item 10 4. Key Issues for the Board
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Item 11 SUMMARY REPORT Trust Board
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Item 11 DETAILED REPORT Trust Board
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Item 11 • Challenge in respect of
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Item 11 Over the past two years, me
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Item 11 Getting it Right Charter An
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Item 11 Outcome of review with exte
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Page 109 and 110: Item 12 Next Steps 1. Conversation
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Page 131 and 132: Item 15, Annex 1 • Top three issu
Page 133 and 134: Item 15, Annex 1 The Chair asked SS
Page 135 and 136: Item 16 COMMITTEE MINUTES Finance,
Page 137 and 138: Item 16 pay and staffing, highlight
Page 139 and 140: Item 16 • PACS contract - likely
Page 141 and 142: Item 17 Terms and Conditions of Emp
Page 143 and 144: Item 17, Annex 1 29/2013 Minutes an
Page 145 and 146: Item 17, Annex 1 31/2013 Francis Re
Page 147 and 148: Item 18 SUMMARY REPORT Trust Board
Page 149 and 150: Item 18 Next Steps The Audit Commit
Page 151 and 152: Item 18, Annex 1 Matters arising 4/
Page 153 and 154: Item 18, Annex 1 time to embed and
Page 155: Item 18, Annex 1 Payroll & Expenses
Page 159 and 160: Item 18, Annex 1 Going Concern Revi
Page 161: Item 18, Annex 1 if Internal Audit
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Agenda and supporting papers - Plymouth Hospitals NHS Trust

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