Annual Report and Accounts 2012/13 - Royal Devon & Exeter Hospital

4. Our Governance
Royal Devon and Exeter NHS Foundation Trust
Annual Report and Accounts 2012/13
81
of its transformation programme.
The Senior Management Review has
focused on assessing whether the
senior management structure was:
1) enabling as efficient delivery as
possible of current patient services
2) capable of delivering the future
strategy. The scope of the review
included some Band 7 roles up to,
and including, the Executive Team.
The EDRC welcomed the SMR because
the Committee was keen to ensure
that the senior leadership team had
the right capacity and capability
to maintain its 'business as usual'
performance but also transform
the way the organisation meets its
objectives, so that it is able to deliver
good quality services that meet the
needs of patients in a financially
sustainable way. The EDRC have been
clear that achieving these goals during
a time of austerity was mission-critical
but, given the volume and complexity
of the work underway, represented
perhaps the biggest challenge that
had faced the Trust in a generation. The
Committee engaged in developing the
senior management review in relation to:
• Ensuring that the revised portfolios
of the Executive Director team was
appropriate and fit for purpose
• Ensuring that, in the design of the
SMR, there was sufficient capacity
and capability in the rung below
the Executive Directors
• To either make any changes to the
structure cost-neutral or to reduce
expenditure.
The Committee agreed the reshaped
portfolios of the Executive team during
the year. The main changes were:
• The reduction in the number of
Executive Directors from five to
four posts
• The establishment of a
new Executive Director of
Transformation and Organisational
Development to drive the new
ways of working both within the
Trust and beyond its four walls, to
ensure that the services offered
by the Trust are delivered to a
good quality, meet the needs of
patients and are undertaken in a
financially sustainable way. This
new role includes some functional
areas linked to the transformation
agenda such as Organisational
Development, Human Resources
and Communications and
Engagement. This post was
advertised during the year and the
post will be taken up during April
2013
• Bringing together a new
role encompassing nursing,
performance and operations,
patient safety, quality and
engagement, and governance in
a Chief Nurse/Executive Director
of Service Delivery. This role was
taken up by Em Wilkinson-Brice
from the 1st December 2012.
The Committee considered the
appropriate remuneration for this
new role based on relativities with
other ED portfolios. On the basis
of this comparison, the Committee
took a view about the appropriate
level of compensation and this is
reflected in the accounts.
• The establishment of a single,
full-time Medical Director is a
move away from the existing
arrangements, in which the Trust
has a single post filled through
a job share. This was felt by the
Committee to be an important
change in ensuring that greater
capacity could be applied to the
leadership necessary for the clinical
staff in the Trust. This post was
advertised and recruited during the
year and the new post-holder will
take up the position in the next
financial year.
In addition to the changes made at
the Executive Director level, the
Committee also helped develop
proposals for the tier below Executive
Directors. To support the new Chief
Nurse/Executive Director of Service
Delivery the supporting sub-structure
has been re-organised and an
Operations Director role has been
established. Mr Peter Adey took up this
role in March 2013.
The clinical and operational structure
within the Trust has also been reviewed
and proposals are currently subject
to staff consultation. Within the
proposal structure the focus has been
on streamlining lines of reporting
and enhancing engagement in the
leadership of the Trust. The structure
will establish three new clinical
divisions, replacing the current five,
each headed by a Divisional Director.
The remuneration for the new
Divisional Director roles will be set
by the EDRC. The establishment of a
re-organised supporting management
tier was to extend the number of
posts that fall within the remit of the
Committee.