Governance, management and sustainability

There is an inclusive and positive culture of continuous learning and improvement. This is based on meeting the needs of people who use services and wider communities, and all leaders and staff share this. Leaders proactively support staff and collaborate with partners to deliver care that is safe, integrated, person-centred and sustainable, and to reduce inequalities.

There are effective governance and management systems. Information about risks, performance and outcomes is used effectively to improve care.

Governance, management and sustainability

• We can evidence how our governance and management enables us to consistency deliver high standards of care.
• We can evidence how our governance and management enables us to maintain safe and consistent levels of care and treatment across the service.
• We continually review performance at a senior level and act promptly to respond to emerging issues.
• We ensure that our service is effectively insured and protected from associated risks.
• We continually invest in the management, workforce and digital systems needed to maintain the financial sustainability of our service.
• Our leaders and managers have effective oversight of information used to monitor and improve the quality of care in line with quality frameworks and recognised standards.
• We ensure everyone at our service understand their role, responsibility, and associated accountability.
• We ensure our managers and staff team are effectively trained to use the systems and processes necessary to govern and manage our service. These systems are robust enough to maintain high standards but flexible enough to enable us to develop further.
• We ensure there’s a clear, documented management structure at all levels.
• We can evidence that we have a senior manager who is responsible for protecting the confidentiality of people’s health and care information and making sure it is used properly.
• We are committed to ensuring our business continuity and contingency planning mitigates against short and longer-term issues that could impact our ability to deliver safe care.
• We ensure that there is a clear, documented plan and structure for all digital systems and a robust contingency plan in place if digital systems go down/fail.
• We ensure that our managers and leaders clearly understand CQC regulations and associated legal requirements and implications. Data and other notifications are submitted as required.
• We ensure our governance and management arrangements enable us to routinely submit and track notifications to CQC and other bodies.
• We ensure our managers and leaders are resourced and supported by the owners of the service to deliver good care and avoid falling below CQC standards.
• We deliver timely and effective communications and feedback across the organisation.
• Where a board and/or directors exist, we ensure they’re effective in their role and proactively engage and support us to deliver high standards of care.
• We regularly review performance and manage people effectively to maintain the highest standards of care.
• Where required, we’re unafraid to performance manage our managers and leaders if they’re not able to meet the high standards of care expected.
• We clearly document all decisions related to actions, behaviours, and performance.
• We have robust policy and procedures to ensure effective record management, including the secure retention of documentation where required.
• We maintain all records in strict compliance with the UK General Data Protection Regulations (UK GDPR).
• We annually complete the Data Security Protection toolkit to keep people’s information safe and protect the risk of a data breach or cyber-attack (covering both paper and digital record).
• We ensure managers and leaders empower others through effective delegation and opportunities to develop skills and expertise across the staff team.

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We organise our corporate meeting schedule as follows, with structured agenda's:

April - Annual General Meeting

1. WELCOME (15min)
   1.1 Chair’s Introduction and Apologies
2. MINUTES OF LAST MEETING AND ACTION LOG (15min)
   2.1 Approve minutes of previous meeting
   2.2 Action Log
3. YEARLY PERFORMANCE STATISTICS (1hr)
   3.1 Performance
   3.2 Areas of Improvement
   3.3 Actions
4. YEARLY FINANCE STATISTICS (1hr)
   4.1 Performance
   4.2 Areas of Improvement
   4.3 Actions
5. SAFE (1hr)
   5.1 Performance
   5.2 Areas of Improvement
   5.3 Actions
6. EFFECTIVE (1hr)
   6.1 Performance
   6.2 Areas of Improvement
   6.3 Actions
7. RESPONSIVE (1hr)
   7.1 Performance
   7.2 Areas of Improvement
   7.3 Actions
8. WELL-LED(1hr)
   8.1 Performance
   8.2 Areas of Improvement
   8.3 Actions
9. CARING (1hr)
   9.1 Performance
   9.2 Areas of Improvement
   9.3 Actions
10. STRATEGY (1hr)
    10.1 Vision
    10.2 Aims
    10.3 Goals

Quarterly - Medical Advisory Committee
The Vesey has a Medical Advisory Committee (MAC) to ensure we achieve and maintain medical excellence across all our services.

Medical Practitioners at The Vesey are appointed to the MAC, which offers guidance and advice on all areas of clinical practice and meets at regular quarterly intervals through the course of the year. The MAC has a robust clinical governance strategy with appointed leads for clinical governance and clinical audit. This ensures robust controls are always in place for the quality and effectiveness of care we deliver.

Our Medical director and our head of governance and audit is Mr Gunaratnam Shyamalan

We believe this closely joined governance and reporting structure ensures clinical safety is maintained across all our services.

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Monthly 28th - Staff Meeting

1. WELCOME (5min)
   1.1 Chair’s Introduction and Apologies
2. MINUTES OF LAST MEETING AND ACTION LOG (5min)
   2.1 Approve minutes of previous meeting
   2.2 Action Log
3. MONTHLY PERFORMANCE STATISTICS (10min)
4. STAFF FORUM (20min)
   4.1 Issues
   4.2 Discussion
   4.3 Action
5. PATIENTS (20min)
   5.1 Complaints
   5.2 Feedback
   5.3 Incidents
6. PEOPLE (5min)
   6.1 New starters
   6.2 Leavers
   6.3 Soft intelligence
7. SERVICES (20min)
   7.1 Service Review
   7.2 Equipment review
   7.3 New equipment requests - Capital
8. CLOSING MATTERS (5min)
   8.1 Items to escalate to directors.
   8.2 Any Other Business
   8.3 Date and time of next meeting:

Weekly - Senior Management Meeting [Directors only]
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1. WELCOME (5min)
2. MINUTES OF LAST MEETING AND ACTION LOG (5min)
   2.1 Approve minutes of previous meeting
   2.2 Action Log
3. PERFORMANCE STATISTICS (10min)
   3.1 Approve minutes of previous meeting
4. WORKFORCE (10min)
   4.1 Issues
   4.2 Discussion
   4.3 Action
5. PATIENTS (10min)
   5.1 Complaints
   5.2 Feedback
   5.3 Incidents
6. PEOPLE (10min)
   6.1 New starters
   6.2 Leavers
   6.3 Soft intelligence
7. SERVICES (10min)
   7.1 Service Review
   7.2 Equipment review
   7.3 New equipment requests - Capital
8. PRIVATE SESSION (60min)
   8.1 Discussion of Confidential Business matters.
9. CLOSING MATTERS (5min)
   9.1 Items to escalate to directors.
   9.2 Any Other Business
   9.3 Date and time of next meeting:

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