>> This follows on from the tradition I think we started at the very first Board meeting,
when we were the Commissioning Board Authority in those days, and we published a risk register.
I think that was something that was quite unusual, I think, and unique perhaps in public
service at the centre.
We think through the process of transition it served us really well; we were very honest
about the challenges we faced, we were very open about them, and that enabled us seriously
to deal with them and tackle them.
We thought it was very important to carry on in that vein as we have taken on all of
our responsibilities, and that is what this Board Assurance Framework is about.
I am very grateful to Ed and the Audit Committee for the work they have done to help us develop
the methodology, and perhaps if I can just speak very briefly about that methodology
first.
What you have in front of you are 25 strategic risks.
They are, in the judgement of the Executive Team, the most significant strategic risks
we are facing to the delivery of all our objectives, what we want to achieve for patients and the
public.
They come from two directions.
The first is just looking at the difficulty of the task and the objectives we are facing,
and being honest about the obstacles in the way; then importantly, saying, 'What is it
we are doing about it, to mitigate those risks?'
However, there are also some risks, this second source, which are external -- for example,
the financial environment that we are operating in -- that we need to take account of, because
that really does impact on our ability, the likelihood of us delivering everything we
want to deliver.
That is how these have come together.
We are setting up a process to ensure that this is not 25 set-in-stone, or else it can
become just an end in itself.
Throughout our organisation, we are developing an approach to understanding objectives and
the risks that are attendant upon them, whether that is in an area team in Cornwall or whether
it is part of the Support Centre in Leeds.
There is the ability then for those risks -- where they change or where something new
and impactful comes along -- to be escalated first of all to directorate level, but then
to the Executive Risk Committee.
That is an important role that we collectively play in filtering some of those and understanding
them: 'Yes, they are noteworthy, but we think you should be able to manage that perfectly
well.'
Where we think there is something more significant for us as an Executive Team, to really get
a grip on it, to give it the right senior oversight; and where there is something we
believe is strategic, to bring it through this process, to the attention of the Board.
Therefore, these 25 will not stay still forever.
Some, management can leave; some will be brought to your attention as the escalation process
works.
The majority of the 25 are outward-facing, as you will see.
They are about our confidence in delivering the sort of quality, improvement and outcomes
we want for patients and the public, and relating those to some of the actions we are taking.
Then there are seven at the end that are about our organisation still in transition: the
set of challenges that we still have to work through to make sure that we are an excellent
organisation and therefore best fit to serve patients and the public.
I am very happy to take any comments from colleagues, but also, Ed might want to give
his perspective from the Audit Committee on the overall process.
>> Thank you.
If I may call on Ed first?
>> I am happy to do so.
Firstly, we should recognise that the NAO, in their report on the transition, remarked
on the way in which we did this through the transition and were positive in that approach.
Therefore, I think adopting this in operations is absolutely the right thing to do.
It is a best practice.
The transparency, though, which we reported through these meetings, is also a best practice.
You were right, and I will reinforce this: it is only as good as the dynamic nature by
which it is used by the whole of the organisation and, in particular, by the Board in monitoring
the way in which items move through this list, either add to it or subtract from it, and
the actions that we are taking to mitigate both the likelihood and the impact of the
risks.
I am therefore hugely supportive of it.
It has to be underpinned by a bubbling-up of risks from across the organisation, and
it then forms a vital piece of the way in which the internal audit function operates,
the quality and clinical risk committee operates, and the Board operates.
I certainly commend it to this Board, Malcolm, and I hope it becomes an essential Board and
leadership tool in the months and years ahead.
>> Again, it is really good to see, in a terrifying way.
It is good to see the one on procurement there; I think just from observing from my day job,
I have seen people who want to improve services being stymied by what I would regard as maybe
overcomplicated procurement rules (not imposed by anybody in this room).
I am also wondering if there is another risk, which is maybe still a transition risk, around
the relationship of the system with itself.
I do not have a view as to whether Bournemouth and Poole merging as a Foundation Trust is
or is not a good idea, but I do have a view that if it is the right thing for outcomes,
another body saying, 'No, you cannot do that,' for whatever duty that they have, is not the
right way to do it.
I am wondering if there is another risk, which is all the different components in the system
rubbing up against each other.
We have not really worked out how to interact with competition, with Monitor, with the EQC,
and so on.
These are just thoughts really, rather than comments, maybe.
>> I think that is a very good point.
Much of what we do will depend upon the quality of our relationships with partner organisations,
and aligning our effort.
It is certainly something to take back to the Executive Committee.
>> It may not just be relationships; it may be that people are doing what they have been
told to do in the new system, and that may be directly contradictory to what we think
we have been told to do and how we are going to work through that.
>> Absolutely.
It is the alignment of effort, yes.
>> I was just going to say, I think there are some aspects of that in some of them.
In 1 and 5, it is referred to, Ciarán, but I do not know if you are looking for something
more specific.
>> I had a meeting about two months ago with the Chief Executive of the acute hospitals
in the southwest of England, which seems to be a place where this is a particular issue.
There were some extraordinary stories coming out of that.
Whether they were real or not, I am not absolutely sure, particularly about the interplay between
Monitor and the OFT, and their focus on the implications for competition as opposed to
the implications for clinical standards, quality or whatever.
I think what we do not have here yet is quite a mechanism to get that to bubble up through
our system to enable it to happen, and I just think that operational issue is something
we need to reflect on and think about how we do it.
I think it is a good point.
>> Okay, thank you.
Are we happy to approve the Board Assurance Framework?
Thank you.
>> I have nothing really much to say; it is more of a record that they are now on the
website, they have been laid before Parliament, they were laid in time, to schedule and with
full accounting honours, as it were.
I do not think the Board needs to know anything more about them, unless there are any questions.
>> On the basis that the Board does not need to know anything more about them, we shall
move on, but thank you for getting them delivered and laid before Parliament on time.
That is an important formal step.