Urgent and Emergency Care Project Governance Introduction
Improving Urgent and Emergency Care for people in Northern Devon is a key priority for both Commissioner and Provider. The slide inserted below sets out which aspects of those changes is the prime responsibility of Northern Devon NHS Trust and which are delivered in partnership or are a commissioner responsibility
This paper sets out the roles and responsibilities of the Emergency Hub Project Board that has been established by the Trust Board to deliver the planned capital development and associated changes to operational policies and workforce. A high level draft project plan is attached; this will be refined by the Emergency Hub Project Board over the coming months. In particular, the initial feasibility stage of the capital development project will enable affordability parameters and project timescales to be confirmed. The Trust Board has made provision for capital funding for this project in its Business Plan and the revenue consequences of the development will need to be accommodated within expected income. It is therefore essential that the planned changes enable increasing demand to be accommodated whilst reducing unit costs.
The Emergency Hub Project Board
The illustration overleaf sets out how the Emergency Hub Project Board will work. There are four separate but inter-dependant functional areas each of which will require a separate sub-committee to undertake the more detailed work:
• Ambulatory Care including assessment
• ‘Front Door’ – A and E Minors and Primary Care Treatment Centre • A and E Majors and Resuscitation
• Medical Short stay beds
The Project Board will be supported by a Capital Project Team who together with the Project manager will ensure that associated enabling functions (eg IT or support services) are involved in a timely and appropriate manner.
Two cross cutting issues have been identified; the management of frail elderly patients and the workforce changes associated with scheme delivery. The
Emergency Hub Project Board will establish task and finish groups for each of these issues. There is also a requirement to agree with the Urgent Care Forum whether work to address known interface issues eg relating to mental health services will be managed by it or devolved to the Emergency Hub Project Board
Terms of Reference and membership:
The terms of reference of the Emergency Hub Project Board are set out below: • Decision making on behalf of or advice to Executive Team and Board on
all policy and investment matters for the Trust relating to the Hub • Ensuring capital scheme is delivered on time and within budget • Scrutinises operational policies and procedures to ensure that will be
achievable within available workforce and revenue
• Plans and implements transition from existing to new operational model and facilities (including decant) ensuring achievement of targets • Establishes and manages supporting work-streams and ensures timely
input from relevant SMEs (subject matter experts) •
The proposed core membership of the Project Board is as follows: • Director of Operations (Chair)
• Medical Director • Director of Facilities
• Clinical/task leads including Chair from each sub-committee/task and finish group (proposed membership, Liam Kevern, Jackie Munns, Jo Hope, Alaistair Watt, Andrew Davies, John Taylor, Darren Alcorn, Kerri Storey, Tim Chesworth, Ryan Hewitt)
• DGM Emergency Services (Chair of Capital Scheme Project Team) • DGM Clinical Support Services
• Co-opt advice and input from Subject Matter experts including appointed Architect/QS etc. as appropriate to stage of project
The Project Board will be accountable to the Trust Board through the Executive Team and its minutes will be reported to CCSEC for information. The governance structure and composition of the project team will vary in detail from project to project depending on the nature of the work to be carried out and type of service involved and may need to be amended within the life of the project. It is however it is essential to confirm and clarify the roles and responsibilities of the Project Board, associated sub-committees and each of the team members. The individual roles and responsibilities defined are in line with best practice set out by the NHS Purchasing and Supplies Agency and the Prince 2 Project Management philosophy. Confirmation of roles and responsibilities should be established as soon as possible so that the Project Board is clear as to who is doing what and within what timeframe. However, building on the work already completed the proposed roles and responsibilities for this project are as follows.
1. Executive Director
Director of Operations will act as the Executive Director for the project and will report to Trust Board. The Executive is ultimately accountable for the project supported by the senior user and the senior supplier. The Executive has to ensure the project gives value for money and a business case focused approach to the project, balancing the demands of business user and supplier.
2. The Senior Users or Customers
This role represents the interest of all those who will use the final products of the project. The senior user role is responsible for ensuring that the product produces products and outcomes that meet the user requirements, ensuring that the product and outcomes provide the expected user benefits. Within the current project the key senior users have been identified as:
Medical Director
Clinical Leads (named project board members to be finalised (see above))
3. The Senior Supplier
Director of Facilities will act as the senior supplier. The senior supplier is accountable for the quality of all products delivered by the suppliers. Part of this role is to ensure that any technical proposals or designs are realistic and practical. This means that we are likely to achieve the results required by the user within the cost and time perimeters for which the Executive is accountable. The role represents the interests of the designing, developing facility, procuring, implementing and supply of products. The senior supplier will ensure that control is maintained under Trust’s SFI’s and SO’s, and that procurement regulations are maintained.
4. The Project Manager
The Trust has commissioned Pam Smith to be the Project Manager. As the project manager is not an employee of the Trust the DGM Operations will retain oversight of her work on behalf of the Executive Director. The Project Manager is given the authority to run the project on a day to day basis on behalf of the Project Board, within the constraints laid down by that Board. The Project Manager’s prime responsibility is to ensure the project produces the required products, to the required standards of quality and within the specified constraints of time and cost. The Project Manager is responsible for the project producing the result that is capable of achieving the benefits defined in the project brief.
The Project Manager is responsible for issuing work packages and reporting progress to the Board, together with having responsibility for ensuring that risks are identified, recorded and regularly reviewed via a risk log.
5. Sub Committee and Task-group Management
The Project Manager will identify a number of ‘work packages’ to be undertaken. For each work package a written brief will be prepared, normally in conjunction with the potential ‘Task Lead’ and this will be agreed by the Executive Director or where appropriate the Project Board.
The Task Lead will then undertake these specific “work packages” as requested. Within each “work package” there will be a description, details of communication links, quality checks, programme information and signing off regime. Each “work package” will be agreed with potential Task Lead, and it will be the responsibility of the Task Lead to issue further work to members of their team and to report back as required to the Project Manager on progress. Numerous staff within the Trust may be identified from time to time to undertake “work packages” and this may include the Executive Director, Senior Supplier, Finance or Senior Users. Indeed, the Project Manager will very often undertake “work package” in the role of Task Lead. The key aim of this approach is to break down the project into manageable chunks whist enabling the Project Board to maintain overall control.
6. Project Assurance
There are a number of associated tasks within the quality and risk management agenda that will need to be formally monitored. Clearly, the senior user, senior supplier and the Executive Director have responsibilities for managing the quality and risk issues but there have also been a number of other key areas where individual professional control needs to be added. These key areas are Finance, Procurement, Infection Control, HR and Trust Board representation.
These roles are identified as part of the formal project roles, and it is the Project Manager’s responsibility to ensure that these professional advisers
6.1 Finance Manager
Ensuring that the project contains financial viability is key. The Finance Project Manager will sit on the Project Board and offer independent financial project assurance throughout the life of the project. Key financial evaluation of tenders will need to be undertaken as well as whole life cycle costing. The project must remain within the financial envelope of the current budget allocations. The Finance Project Manager may also be asked to act as Task Lead or as a member of a team to undertake specific work packages as required.
6.2 Procurement
Ensuring that the project complies with all appropriate Procurement regulations and best practice. The Procurement Manager should ensure that appropriate planning is built into the programme and that adequate and competent resource is identified to undertake key tasks.
6.3 Infection Control
As per Health Building Note 00-09 “The Infection Prevention and Control Team should be consulted throughout every stage of a capital project and their views taken into account”. Their role is to ensure that the project provides and maintains a clean and appropriate environment that facilitates the prevention of control of infection.
6.4 Workforce
The likely requirement for significant workforce changes to deliver an affordable solution for this project has been identified as a key risk. The Project Board will establish a task and finish group to agree how this issue is best addressed.
The requirement to maintain Trauma Unit status and achieve appropriate 24 hour/7 day emergency medical cover whilst not compromising elective activity presents a significant challenge for a small District General Hospital. The Medical Director will have the lead responsibility for this work.
The Director of Human Resources will identify a named the HR lead to support this project and lead the cross-cutting work. It will be important to maximise the flexibilities offered by improved physical accommodation and co-location to enable more patients to be treated within the available workforce. There are close links with EPR implementation and opportunities to improve information flows with consequent benefits to staffing requirements.
6.5 Trust Board, Non-Executive
**************** is the nominated Non-Executive member of the Trust Board who will act as the Trust Board representative of the project. The role of the Non-Executive is to ensure that the project progresses with the appropriate Board approval and that the needs of the Trust within the financial and risk framework are met.
7. Internal Auditors
It would be helpful for the Trust’s Internal Auditors to be involved in the project as ultimately they will be responsible for confirming to the Trust Board that the Project Board has delivered the agreed terms of reference.
8. External Consultants
The external consultants will be appointed by the Senior Supplier to offer technical advice to the Executive Director, Senior Supplier and the Project Manager. They will also be required to undertake certain work packages and maybe asked to act as Task Lead where appropriate. All variations and contract control will go via Senior Supplier.
9. Capital Project Team
As this will be a large and complex project a Capital Project Team, Chaired by the DGM Operations will be developed to assist the Project Manager in giving an overall assurance to the Project Board.
The Capital Project Team will comprise a series of individuals whose work is co-ordinated or managed by the Project Manager, to ensure that key work packages deliver against their plan, their outputs and that the risk log is maintained. Key functions of this team will include the development of service packages, estates related work packages, procurement work packages and staff change work packages. Core members of the Capital Projects Team are set out below:
• Sharon Hinsley, DGM Operations (Chair) • Chris Cruise, ADGM Operations
• Lisa Edmondson, Capital Projects Manager • Glenda Forrester, Finance Project Manager • Pam Smith, Project Manager
In addition the Chair and Project Manager will ensure that the Team receives: • Regular reports detailing the planned project timetable and
inter-dependencies (Gaant Chart) so that the Project Board can be alerted to any potential variances and ensure corrective action is taken
• Advice and input from appointed professional experts e.g. Architect/QS etc. as appropriate to stage of project
• Advice from (or co-opt other membership as required) on a task and finish basis through the life of the project e.g. control of infection, IT,
• Assurance that the cross-cutting and interface issues are being
addressed and that out-puts are being reflected in the work of individual sub-committees
Pam Smith 14 October 2013
