Enclosure 23 - Audit Committee Minutes

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Enclosure 23 SUNDERLAND TEACHING PRIMARY CARE TRUST Audit Committee thNotes of the meeting held on Friday 12 March 2004 at 9.30 am in the Board Room, Armstrong House, Washington Present: - Mr P Watson, Non-Executive Member, STPCT (Chair) Mr M Greenfield, Non-Executive Member, STPCT GK Lloyd-Williams, Non-Executive Member, STPCT In attendance: Mrs K Straughair, Chief Executive, STPCT Mr C Macklin, Director of Finance, STPCT Mrs N Harris, Head of Corporate Affairs, STPCT Mr J Connolly, Audit Manager, Audit Commission Mrs A Oswald, Internal Auditor, CHS Mrs V Peacock, Internal Auditor, CHS Mrs J Anthony, Corporate Affairs Administrator Mr Glen Gregory, Audit Commission 1. Apologies: Mrs Sheila Rooney, Non-Executive Member, STPCT Welcome The Chair welcomed everyone to the Audit Committee. 2. Minutes of Previous Meeting (Enclosure 1) Page 7 - Progress Report on Tactical Audit Plan (Enclosure 7) The Chair pointed out that in paragraph 4 “Newcastle PCT” should read as “new Acute Trust”. Subject to this amendment the minutes were received as a true and accurate record. 1 Sunderland TPCT Audit Committee th12 March 2004 3. Matters Arising Page 3 - Annual Audit Letter (Enclosure 2) - Mr Macklin stated that the Main stAccounting System went live on 1 January 2004 and that the team was still undergoing a transitional period. Page 5 – Financial Aspects of Corporate Governance (Enclosure 4) – ...

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• Publié par: Awlau
• Nombre de lectures: 37
• Langue: English

Extrait

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Sunderland TPCT

Audit Committee

12

th

March 2004

Enclosure 23

SUNDERLAND TEACHING PRIMARY CARE TRUST

Audit Committee

Notes of the meeting held on Friday 12

th

March 2004 at 9.30 am in the Board

Room, Armstrong House, Washington

Present: -

Mr P Watson, Non-Executive Member, STPCT (Chair)

Mr M Greenfield, Non-Executive Member, STPCT

Mr GK Lloyd-Williams, Non-Executive Member, STPCT

In attendance:

Mrs K Straughair, Chief Executive, STPCT

Mr C Macklin, Director of Finance, STPCT

Mrs N Harris, Head of Corporate Affairs, STPCT

Mr J Connolly, Audit Manager, Audit Commission

Mrs A Oswald, Internal Auditor, CHS

Mrs V Peacock, Internal Auditor, CHS

Mrs J Anthony, Corporate Affairs Administrator

Mr Glen Gregory, Audit Commission

1.

Apologies:

Mrs Sheila Rooney, Non-Executive Member, STPCT

Welcome

The Chair welcomed everyone to the Audit Committee.

2.

Minutes of Previous Meeting (Enclosure 1)

Page 7 - Progress Report on Tactical Audit Plan (Enclosure 7)

The Chair pointed out that in paragraph 4 “Newcastle PCT” should read as “new

Acute Trust”.

Subject to this amendment the minutes were received as a true and accurate

record.

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3.

Matters Arising

Page 3 - Annual Audit Letter (Enclosure 2) -

Mr Macklin stated that the Main

Accounting System went live on 1

st

January 2004 and that the team was still

undergoing a transitional period.

Page 5 – Financial Aspects of Corporate Governance (Enclosure 4)

– Mrs

Harris explained that the Board considered the paper in January 2004 and would

outline further details in agenda item 6.1. Mrs Harris explained that she was still

trying to find details regarding an “legality protocol”. Mr Connelly agreed to provide

Mrs Harris with some helpful suggestions.

Mr Macklin stated that the TPCT was in partnership with CHS in developing the

NHS Foundation model which is based on a non-NHS contract. He mentioned that

he, Mrs Straughair and Mr Bremner, (CHS), had met to discuss the document

further. He explained that it was a very detailed and complex contract. The TPCT

has entered into a risk sharing agreement with STW, CHS and SS.

Page 8 – Losses and Compensations Register (02/03)

– Mr Macklin explained

that the piece of work looking at trends had not been completed as yet, but would

concentrate on the number of claims made against lease cars. He stated that a

note on safe parking had been issued to all users. Mrs Peacock mentioned that

STW had raised the same issues of safe parking etc.

Mrs Harris mentioned

problems occurred not only due to drivers but also due to the physical parking

facilities around Health Centres and other sites.

Page 8 – Controls Assurance Statement (03/04)

– Mrs Harris stated that the

TPCT was on target to deliver this document. She stated that the SHA had not

mentioned a prescribed format and therefore our information was presented to the

SHA in the wrong format. This has now been corrected and will be presented to

the Board in March.

4

Audit Commission Issues / Reports

4.1

Annual Audit Letter (Enclosure 2)

Mr Connolly gave the background to this paper and stated that work was

progressing in line with the planned timetable and highlighted that the risk

assessment was an ongoing process and changes to the Plan may be necessary if

significant risk emerged. Mr Connolly stated that the audit would be completed

earlier than usual this year to fall in line with the TPCT’s financial year.

Mr

Connelly stated that he was anxious to start the survey for the IM&T arrangements

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part 2. Mr Macklin suggested that he view the CHI questionnaires to see what

information can be gained from this existing source.

4.2

Reference Costs / H.R.G.S. (Enclosure 3)

Mr Gregory presented this paper and highlighted that the NHS Plan have signalled

investment of significant extra resources in the NHS to deliver improved patient

care. In October 2002, the DOH have issued “Reforming NHS Financial Flows:

Introducing Payments by Results which sets out the changes to the way funds are

flowed through the NHS. Mr Gregory stated that the new funding arrangements

would be phased in over the next five years with a national tariff for each HRG.

He went onto explain that due the TPCT being a new PCT it was the first time it

had made a reference costs submission and highlighted that many positive aspects

were found. Mr Gregory pointed out that due to the incorrectly excluded costs and

unsupported activity data, there was a risk that the Trust’s reference costs may be

materially inaccurate and stated that the TPCT needed to address any weakness

identified. Mr Gregory explained the main findings and highlighted the key areas

for action.

Mr Macklin explained that reference costs submission guidelines were followed but

unfortunately there were incorrect guidelines.

He highlighted that this was a

learning curve for the TPCT and for 03/04 these would be presented correctly.

The Chair acknowledged Mr Macklin’s comments. Mr Greenfield asked what type

of evidence the TPCT wasn’t collecting.

In reply, Mr Macklin explained that

national returns should have been used instead of the local nursing information.

Mr Connelly pointed out that lessons had been learnt. Mr Macklin explained that

the DOH had laid on training sessions which the TPCT had attended.

4.3

NHS Plan Implementation Review (Enclosure 4)

Mr Connolly presented the background to this paper and highlighted that this was a

national piece of work and that this was the final year that this work would be

carried out. He explained that a review was undertaken during November and

December 2003 and covered key themes; LDP process, PPF targets, patient

experience and perspective, working in partnership and sustainability.

Mrs Straughair stated that nationally this was not a popular review but at least the

findings locally were consistent with PCT views and it is good to receive this

feedback.

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LDP Process

Mr Connolly explained that an assessment had been taken of how well the new

planning processes were implemented for the LDP and how robustness of the

resulting plans. He went onto state that the assessment was based on a rating

scale.

PPF Targets

Mr Connolly explained that the PPF targets were assessed on whether or not the

PCT was likely to achieve key targets and whether current performance was

sustainable and likely to improve.

Mr Connolly explained the way in which

assessments were rated.

Mr Connolly highlighted the main findings and explained that the PCT continues to

make solid progress towards the NHS Plan implementation. He explained that the

LDP process was relatively robust and that delivery against PPF targets was

generally sound. He explained that the indications were that the PCT was able to

sustain and improve on performance.

Mr Connolly pointed out a number of areas where progress needed to be made to

meet targets and highlighted that the TPCT had recognised these and actions had

been taken to address them. One of these areas was in Workforce Planning where

relationships have now been established with the Workforce Development

Confederation and a Workforce MARG established. The PCT needs to build on

this start and develop a medium to long-term Workforce Plan.

Mr Connolly

explained that this was an important process for the TPCT in terms of its

performance. Mr Connolly also mentioned some areas where PPF targets could

be improved.

Patient Experience and Perspective

Mr Connolly explained that they would wait until the CHI review results were in

place.

Working in Partnership

Mr Connolly went onto highlight that working partnership with Social Services was

a very positive sign and that there was a strong public sector community

developing. He explained that the PCT benefited from a stable top management

team which had contributed to the rating of “fairly strong” in terms of management

capacity with only one or two gaps in the structure. He highlighted that the TPCT

needed to draw up robust plans to develop, recruit and sustain the skilled

workforce it needed to meet the challenges of modernisation.

Mrs Straughair explained that this had not been a popular review. It had been a

difficult start but that Mr Connolly and his team had highlighted areas that other

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organisation had already highlighted so at least it was good that feedback was

being received albeit weaknesses or strengths.

Mr Greenfield thanked Mrs Straughair for her reflection and asked when the

vacancies within the structure would be filled as Primary Care, Partnerships and

Commissioning was a huge directorate with major areas of work. In reply, Mrs

Straughair stated that the breadth of the directorate was indeed massive and

highlighted that work was being undertaken to try to take some work out of the

directorate. The TPCT does recognise this issue and changes will be seen within

the structure.

5.

Internal Audit Issues

5.1

Progress Report (Enclosure 5)

Mrs Oswald gave the background to this paper which detailed the findings arising

since that last Audit Committee Meeting relating to STPCT and the CSA and asked

the Audit Committee to receive the progress report.

Mrs Oswald went onto

highlight one high priority issue and a few medium concerns.

Sunderland Teaching Primary Care Trust

Nurse Bank Staff

Mrs Oswald highlighted that there were five medium priority issues in relation to

appropriate authorisation before staff are requested to work. Actions have been

agreed with management and have now been implemented.

Procurement – Proactive Fraud Review

Mrs Oswald explained that a review was carried out in accordance with the

proactive fraud plan to detect possible fraudulent activity in respect of procurement

arrangements. No evidence of fraud was found, however, one high priority issue

was identified in relation to the failure to advertise tenders in accordance with

European Union regulations. All action was agreed with management and now

been implemented.

Mr Macklin explained that the high priority at CSA could easily have occurred at

STPCT and therefore a decision was made to move supplies from 3N’s to CHS

supplies. The TPCT would be able to take advantage of CHS’s experience and

knowledge in doing so.

St Benedict’s Hospice

Mrs Oswald explained that the purpose of this audit was to review aspects of

internal control arrangements.

She highlighted that four medium priority issues

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relating to; recording and charging for training provided to third parties;

establishment of formal SLAs with other PCTs; the necessity for a robust

mechanism to ensure that all costs are recovered for out of area patients; and

improvement required in the production and monitoring of performance data.

Actions have been agreed with management and recommendations will be

reviewed within agreed timescales.

Service Maintenance Contracts

Mrs Oswald explained that the purpose of the audit was to review the control

arrangements in place for service maintenance contracts.

There were three

medium priorities identified relating to the responsibility for contract monitoring not

being clearly assigned and the rollover of contracts without formal contract

monitoring or review. This could be improved to ensure that value for money is

being attained.

Mr Macklin stated that an advert for the Head of Estates post had been placed and

the candidate would assist in maintaining the TPCT’s SLAs.

Tyne and Wear Contractor Services Agency

IM&T Organisation, Management and Development

Mrs Oswald highlighted that 2 medium priority issues relating to; workload of the

department and an insufficient staff complement; and the lack of target dates and

performance indicators in the department’s business plan. Mrs Oswald highlighted

that the outcome of the review was a significant improvement on the previous

review. All action was agreed with management and been implemented.

Spectacle Vouchers

Mrs Oswald explained that no evidence of fraud was found although the review

identified that a third of the claims submitted were incorrectly completed which

could result in inaccurate payments. All actions were agreed by management and

implemented.

5.2

Follow up of Internal Audit Recommendations (Enclosure 6)

Mrs Peacock presented this paper and explained the purpose of the report. She

explained that all recommendations had been actioned except for Financial

Control. The outstanding recommendation was considered as a medium risk.

Mrs Harris stated that a paper had been developed describing what a risk register

was and what tools would be used to access risk. She went onto report that a draft

copy had gone to the Board and that the risk register would be presented to the

Board in March.

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5.3

Local Counter Fraud Specialist Update (Enclosure 7)

Mrs Peacock stated that there were no ongoing investigations of suspected cases

of fraud and that the TPCT had no fraudulent activity has been detected.

Mrs Peacock highlighted the National Fraud Initiative Data Matching Exercise

which had involved matching data on the TPCT’s payroll system to data held by

other public sector bodies on payroll, national insurance and benefits systems.

She went onto highlight that nothing untoward had been identified. She explained

that this year’s report will be concentrating on registration of patients with GPs and

this would be reported back to the Audit Committee at a later date.

5.4

Appraising Internal Audit / Working with Internal Audit (Enclosures 8

and 9)

These briefing papers were presented for information only.

6.

Controls Assurance / Risk Management

6.1

TPCT Update (Enclosure 9)

Mrs Harris formally apologised for tabling this report and went onto give the

background to the document explaining that the document was being presented to

the Audit Committee on behalf of the Risk Management Committee (RMC).

Mrs Harris explained that the TPCT had failed by 75% in all areas of its CNST

assessment and was currently developing an action plan which would be monitored

by the RMC. Mrs Harris has asked that the reassessment take place no earlier

than September 04.

The Health and Safety group was now established and an Infection Control

committee had also been established with an Infection Control Nurse now in post.

DEEL was now an established group with monthly meetings taking place. The

group was still developing ways of working but will be a focus for the organisation’s

learning from incidents, complaints, Health & Safety etc. The Clinical Governance

Action Committee had now re-established with a full team of 15-20 members in

place. Mrs Harle was the Non Executive Director Lead. Information Governance

had now been established bringing together key components of information. FHS

process is a complex piece of work and should be presented to the next RMC

meeting.

Mrs Harris reported that the Controls Assurance Report would be submitted on

May 15

th

and asked the Audit Committee whether the scores needed to be

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presented to the Board or just the Audit Committee which would give more

breathing space.

The Chair stated that under the Terms of Reference Controls Assurance falls under

the Audit Committee branch and therefore it was a sensible approach to just be

presented at the Audit Committee.

Mr Macklin highlighted that some progress has been made under Standard 19,

Security Management. A lone worker policy was to be presented to the Board for

approval in March and that a satellite tracking system was in place for those

personnel working in risk situations. He also stated that on signing the lease for

the new Headquarters, 24 hour security was in place along with surveillance

videos.

7.

Performance Indicators (Enclosure 10)

Mr Macklin gave the background to this report highlighting that the new indicators

were issued in December 03. He explained that the new indicators were still a set

of 9 “Key Indicators” plus the remainder of the indicators forming a “balanced

scorecard”. Mr Macklin stated that this would be presented to the Board in March

to note the performance of Sunderland as a “health economy” against the various

performance measures.

Mr Lloyd-Williams stated how well the TPCT had performed with regards to GP

Appraisal having an 80% compliance rate. This is a positive step forward which will

not be far off the deadline. Mrs Straughair stated that GP Appraisal had gone

exceeding well in Sunderland and was very much down to the hard work

undertaken by Dr Stephenson, Mrs Forster and Mrs Taylor who have managed to

involve as many assessors as possible to be trained.

Mr Lloyd-Williams asked what would be the impact if members of the public who

are not currently registered with a dentist wished to be registered. In reply, Mr

Macklin stated that there was availability in the area and the TPCT was

encouraging people to access dentistry.

He explained that an Oral Health

Awareness session had been launched.

Mrs Straughair explained that it was a good point and that it did form part of the

Oral Health Strategy which had been developed and approved by the Board and

that the TPCT would need to monitor access to services.

Mrs Straughair

highlighted that there was a very active Oral Health Group in place which reports to

the PEC.

She also explained that the number of private dentists had been

extended to provide services to NHS patients.

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9

Any Other Business

The Chair read out a letter from Mrs Rooney with regards to the Research and

Audit Committee (RAC) which asked the Audit Committee to consider three points

of linking the Audit Committee to the RAC. After discussions it was decided that as

Mrs Rooney was a member of both Committee then in the first instance she would

be the link and would bring any relevant information to the Audit Committee under

AOB.

8

Date and Time of Next Meeting

The date and time of the next meeting will be held on Wednesday, 12

th

May 2004,

1.30pm in the Board Room at Armstrong House, Washington.

On a final note the Chair thanked everyone for attending and closed the meeting.