OMG!
Office of Modern Governance
Tavistock and Portman NHS Foundation Trust Well Led Review
Final Draft Report
3 December 2021
Extracts highlighted by Hannah Barnes:
page 74 of 181
Gender identity services
1.15 The Gender Identity Service (GIDS) is commissioned by NHS England. The service is commissioned to provide assessments of young people, refer young people for medical treatment when appropriate and provide some continuing support when this is required. It is a national specialist service and is the only service available in England for children and young people with gender dysphoria. The service also treats children and young people from Wales.
1.16 The CQC undertook a focused inspection of the service in October 2020 and the report, published in January 2021, rated the service “inadequate”, driven by “inadequate” ratings for the ‘responsive’ and ‘well led’ CQC domains.
1.17 The GIDS Judicial Review around capacity and consent of children receiving hormone intervention for gender dysphoria has furthermore been a significant focus for the Trust and has resulted in significant media scrutiny on the Trust. The Trust successfully appealed a High Court ruling at the Court of Appeal in September 2021.
1.18 The Trust is also working closely with the NHS England commissioned Independent Review being led by Dr Hilary Cass, former President of the Royal College of Paediatrics and Child Health which is looking at the wider care pathway for young people with issues about gender identity.
page 80
We observed a lack of challenge and effective scrutiny of the executives by NEDs, and not enough evidence of holding to account. NEDs are skilful and knowledgeable about the Trust but often very ready to accept positive assurances without always fully testing and probing. This point was made to us on a number of occasions and we were able to directly observe that ourselves in meetings
page 81
Concerns that the recent safeguarding Employment Tribunal has impacted the ability of staff to be able speak up if they have concerns
▪ Review the Freedom to Speak Up (FTSU): Raising Concerns and Whistleblowing Procedure in the light of the recent Employment Tribunal and use this as an opportunity to ensure the new process is communicated to staff across the Trust
▪ A considerable amount of the SR is about addressing deep seated cultural issues and given its scale and ambition in this regard, this will need significant investment in capacity and capability, particularly in relation to Human Resources (HR) and Organisational Development (OD)
▪ Board oversight processes and mechanisms for providing insight and assurance on people and culture could be strengthened
▪ The external review of race equality has yielded an outpouring of emotion that suggests many BAME staff do not feel consistently supported, respected or valued. There is now a key question about how the Board responds with pace to the deliverability of that change
▪ A number of Board Committees have a number of features that are not consistent with governance good practice, particularly in relation to the role of NEDs. and the rigour with which these Committees conduct their business. As configured they are not providing a robust assurance route to the Board
▪ While recognising some current gaps in resources supporting these Committees several aspects of the way the current Committees operate - limited papers at several of the Committee meetings we observed, a heavy reliance on verbal assurance, lack of oversight and scrutiny, lack of focus on risk, limited evidence of linkage between Committees, poor reporting to the Board, is not consistent with governance good practice or what we have observed elsewhere in the NHS
▪ Committee reporting to the Board is in our view weak as currently established and fails to provide the level of assurance they should
▪ Consideration should be given to the sequence of Committee and Board meetings to promote more timely reporting and upwards assurance to the Board
▪ Our review of the current terms of reference of all Board Committees suggests that they need further review and enhancement
▪ The Committee structure in our view needs to be reconfigured so that it can better provide effective oversight of the key themes emerging from the SR
page 82
The scale of the corporate governance issues we have identified across the Trust are multiple and suggest that the Trust needs to strengthen the corporate governance function and that this cannot await conclusion of the SR
▪ Furthermore, governance support and advice to the Board and its Committees needs to be delivered to a consistent high set of standards by a single central well-resourced corporate governance function
▪ Some NEDs are currently involved in activity that supports the work of the Committees but is far more operational than we would have expected to see
▪ EMT meetings to ensure all key programmes of work are effectively managed in a structured way take place for less time at the Trust than we have observed elsewhere in the NHS
▪ Meetings to hold divisional leadership to account for delivery across all key work streams need to be strengthened
page 85
4. Concluding Remarks and Recommendations Concluding remarks
4.1 The boards of all NHS providers have a substantial and challenging agenda to address over the next few years.
4.2 Alongside a range of Trust specific issues, there are external challenges around addressing the regulatory landscape, operating in a post pandemic world, and operating within the ICS.
4.3 For the Trust Board to successfully address this agenda will require effective and sustained Board leadership, using the recommendations we have made as the primary focus for that.
4.4 Whilst our review has identified a number of development areas, we also observed and heard many positive examples to demonstrate that there is a very exciting agenda available to the Trust Board if they focus on the right things.
4.5 We also strongly believe that the Trust Board has all the constituent elements to be effective and is serious about board leadership, board processes and effective governance.
4.6 In that sense, this review presents a unique opportunity to further renew and reinvigorate the governance arrangements within the Trust and our recommendations in this concluding section of this report seek to do that.
4.7 Addressing the areas for development that we have identified as part of this review in a systematic manner, building on progress to date and drawing on learning from other sectors will, we have no doubt, noticeably accelerate Board leadership and governance arrangements at the Trust.
Recommendations
4.8 In taking the issues we have identified in our report forward, the Trust the Board should take the following recommendations we have set out below forward.
4.9 We suggest that the Chairman and Chief Executive, consider the findings outlined within this report and support the Governance Team to develop an implementation plan to take our recommendations forward for final approval by the Board.
4.10 This should also set out how the Audit Committee will on behalf of the Board monitor on- going progress and embeddedness.
4.11 We have given each recommendation a priority and a suggested timescale for implementation, but recognise that the Board will wish to review these carefully to ensure that the subsequent implementation plan is owned and deliverable.
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page 12
As Directors will be aware the Trust Chair, Paul Burstow, has announced his intention to step down from the end of April 2022. With the support of the ICS, we are proceeding to appoint a new Chair. We are also taking the opportunity to appoint to two NED vacancies which will occur by the end of the year.