Board paper cover sheet - NHS Ayrshire and Arran.

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NHS Board Meeting23 June 2010 Paper 5STATEMENT ON INTERNAL CONTROLScope of ResponsibilityAs Accountable Officer, I have responsibility for maintaining a sound system ofinternal control that supports the achievement of the organisation’s policies, aims andobjectives, set by Scottish Ministers, whilst safeguarding the public funds and assetsfor which I am personally responsible, in accordance with the responsibilitiesassigned to me.Each of the Board’s four governance committees own corporate risks relevant to theirremit and receive biannual reports on these. Eight risks were scored as high risk onthe Corporate Risk Register at March 2010, however following review by theDirectors’ Team, the following four are most significant:-• Failure to implement NHS QIS clinical governance and risk managementstandards• Not achieving current waiting times guarantees within orthopaedics• Unsafe staffing levels in accident & emergency departments• Achieving the HEAT sickness absence target of 4%In autumn 2009 NHS Ayrshire and Arran submitted written evidence to NHS QISagainst their clinical governance and risk management standards. This was followedin January 2010 by a two day visit by the inspection team. The outcome is that NHSAyrshire and Arran has moved from an assessment of 6 to an improved level of 8.Section 3 of the Operating and Financial Review shows the performance against keynon-financial targets. HEAT target A10a shows “red” because at 31 March 2010,NHS Ayrshire and Arran had 20 orthopaedic patients waiting over 12 weeks forinpatient/day case treatment. In 2009/10 over £2.5 million was spent on the privatesector to treat orthopaedic patients as well as £581,000 on internal waiting listinitiatives. A Lean review of orthopaedic processes has identified significantproductivity improvement opportunities and it is proposed to increase internalcapacity in 2010/11. An option appraisal will also be completed since both electiveand emergency orthopaedics are currently provided on both Ayr and Crosshousesites.When the SNP government came into office in May 2007, they reversed the approvalof the previous administration to move from two to one full accident & emergency sitefor Ayrshire and Arran. As a result over £500,000 has been invested in additionalmedical staffing, however levels of consultant staffing in the accident & emergencydepartments has been a problem despite considerable expenditure on medicallocums each year.Monitoring of sickness absence is done by senior management on a monthly basisand many staff have attended “Promoting Attendance” training. Significantimprovement in sickness absence rates were seen during 2009/10 with the ratereducing from 5.47% in 2008/09 to 4.93% in 2009/10. This still is above the standardaimed for of 4%.Page 34 of 136
NHS Board Meeting23 June 2010 Paper 5The Scottish Public Finance Manual (SPFM) is issued by the Scottish Ministers toprovide guidance to the Scottish Government and other relevant bodies on theproper handling and reporting of public funds. It sets out the relevant statutory,parliamentary and administrative requirements, emphasises the need for economy,efficiency and effectiveness, and promotes good practice and high standards orpropriety.Purpose of the System of Internal ControlThe system of internal control is designed to manage rather than eliminate the risk offailure to achieve the organisation’s aims and objectives; it can therefore only providereasonable and not absolute assurance of effectiveness.The system of internal control is based on an ongoing process designed to identifyand prioritise the principal risks to the achievement of the organisation’s aims andobjectives, to evaluate the nature and extent of those risks and to manage themefficiently, effectively and economically.The process within the organisation accords with guidance from the ScottishMinisters in the SPFM and supplementary NHS guidance and has been in place forthe year up to the date of approval of the annual report and accounts.Risk and Control FrameworkAll NHS Scotland bodies are subject to the requirements of the Scottish PublicFinance Manual (SPFM) and must operate a risk management strategy inaccordance with relevant guidance issued by Scottish Ministers. The generalprinciples for a successful risk management strategy are set out in the SPFM.An updated risk management strategy was approved at the October 2009 Boardmeeting. During the year a new risk register information system, (Datix) wasimplemented and supported by training for staff and the risk management annualreport for 2009/10 was considered by Board members at their meeting on 9 June2010.More generally, the organisation is committed to a process of continuousdevelopment and improvement: developing systems in response to any relevantreviews and developments in best practice in this area. In particular, in the periodcovering the year to 31 March 2010 and up to the signing of the accounts theorganisation has:• led a financial services Consortium and host six other Boards (which requireda SAS 70 report to be produced)• completed our review of primary care services• continued implementation of our mental health strategyReview of EffectivenessAs Accountable Officer, I also have responsibility for reviewing the effectiveness ofthe system of internal control.Page 35 of 136
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Board paper cover sheet - NHS Ayrshire and Arran.

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