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{"sheet":"FTs 3 months - OLD","index":0,"n_rows":69,"n_cols":16,"rows_kept":69,"cut":false,"hidden":true,"merged":[[18,4,18,8],[8,4,8,8],[10,4,10,8],[12,4,12,8],[14,4,14,8],[16,4,16,8],[36,4,36,8],[19,4,19,8],[20,4,20,8],[22,4,22,8],[24,4,24,8],[26,4,26,8],[27,4,27,8],[28,4,28,8],[30,4,30,8],[32,4,32,8],[33,4,33,8],[34,4,34,8],[53,4,53,8],[38,4,38,8],[52,4,52,8],[68,3,68,12],[54,4,54,8],[57,4,57,8],[59,4,59,8],[61,4,61,10],[63,4,63,10],[65,4,65,10]]}
[]
[null,null,null,"Worksheet \"Corporate Governance Statement\""]
[null,null,null,"Click to go to index"]
[null,null,null,"Corporate Governance Statement from the Board of [Foundation Trust]"]
[]
[]
[null,null,null,null,"The board are required to respond \"Confirmed\" or \"Not confirmed\" to the following statements, setting out any risks and mitigating actions planned for each (see notes below)"]
[null,null,null,null,"For quality, that:",null,null,null,null,"Response","Risks and mitigating actions","Historical or prospective","Timing of declaration"]
["CERT","CERT20",null,1,"The board is satisfied that, to the best of its knowledge and using its own processes and having assessed against Monitor’s Quality Governance Framework (supported by Care Quality Commission information, its own information on serious incidents, patterns of complaints, and including any further metrics it chooses to adopt), its NHS foundation trust has, and will keep in place, effective arrangements for the purpose of monitoring and continually improving the quality of healthcare provided to its patients.",null,null,null,null,null,null,"Prospective (applies as at date of certification and the current/[upcoming] financial year)","Three months from FT's year end (30 June deadline)",null,null,"Confirmed"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Not confirmed"]
["CERT","CERT21",null,2,"The board is satisfied that plans in place are sufficient to ensure ongoing compliance with the Care Quality Commission’s registration requirements."]
[]
["CERT","CERT22",null,3,"The board is satisfied that processes and procedures are in place to ensure all medical practitioners providing care on behalf of the trust have met the relevant registration and revalidation requirements."]
[null,null,null,null,"For finance, that:"]
["CERT","CERT23",null,4,"The board anticipates that the trust will continue to maintain a financial risk rating of at least 3, as defined in Monitor's Compliance Framework, over the next 12 months"]
[]
["CERT","CERT24",null,5,"The board is satisfied that the trust shall at all times remain a going concern, as defined by relevant accounting standards in force from time to time."]
[null,null,null,null,"For governance, that:"]
["CERT","CERT25",null,6,"The board will ensure that the trust remains at all times compliant with its licence and has regard to the NHS Constitution"]
[]
["CERT","CERT26",null,7,"All current key risks to compliance with the trust’s licence have been identified (raised either internally or by external audit and assessment bodies) and addressed – or there are appropriate action plans in place to address the issues – in a timely manner"]
[]
["CERT","CERT27",null,8,"The board has considered all likely future risks to compliance with its licence and has reviewed appropriate evidence regarding the level of severity, likelihood of a breach occurring and the plans for mitigation of these risks to ensure continued compliance."]
[]
["CERT","CERT28",null,9,"The necessary planning, performance management and corporate and clinical risk management processes and mitigation plans are in place to deliver the annual plan, including that all audit committee recommendations accepted by the board are implemented satisfactorily."]
[]
["CERT","CERT29",null,10,"An Annual Governance Statement is in place pursuant to the requirements of the NHS Foundation Trust Annual Reporting Manual, and the trust is compliant with the risk management and assurance framework requirements that support the Statement pursuant to the most up to date guidance from HM Treasury (www.hm-treasury.gov.uk)."]
[]
["CERT","CERT30",null,11," The board is satisfied that plans in place are sufficient to ensure: ongoing compliance with all existing targets (after the application of thresholds) as set out in Appendix B; and a commitment to comply with all known targets going forwards."]
[]
["CERT","CERT31",null,12,"The board is satisfied that its NHS foundation trust can operate in an economic, efficient and effective manner."]
[]
["CERT","CERT32",null,13,"The board will ensure that the trust will at all times operate effectively within its constitution. This includes: maintaining its register of interests, ensuring that there are no material conflicts of interest in the board of directors; that all board positions are filled, or plans are in place to fill any vacancies; and that all elections to the board of governors are held in accordance with the election rules."]
[]
["CERT","CERT33",null,14,"The board is satisfied that all executive and non-executive directors have the appropriate qualifications, experience, skills and training to discharge their functions effectively, including setting strategy, monitoring and managing performance and risks, and ensuring management capacity and capability."]
[]
["CERT","CERT 34",null,15,"The board is satisfied that: the management team has the capacity, capability, training and experience necessary to deliver the annual plan; and the management structure in place is adequate to deliver the annual plan."]
[]
["CERT","CERT36",null,17,"The board is satisfied that plans are in place to ensure that the trust will at all times comply with all applicable legal requirements"]
[]
[]
[null,null,null,null,"Signed on behalf of the board of directors, and having regard to the views of the governors"]
[]
[null,null,null,null,"Signature",null,null,"Signature"]
[]
["CERT","CERTSIG",null,null,"Name",null,null,"Name"]
[]
["CERT","CERTJOB",null,null,"Capacity","[job title here]",null,"Capacity","[job title here]"]
[]
["CERT","CERTDATE",null,null,"Date",null,null,"Date"]
[]
[]
[null,null,null,"Notes:","The contents of this statement are specified in Monitor's Compliance Framework for  2013/14",null,null,null,null,null,{"$f":"16-COUNTA(K9:K38)","v":16}]
[null,null,null,null,"Monitor will accept either 1) electronic signatures pasted into this worksheet or 2) hand written signatures on a paper printout of this declaration posted to Monitor to arrive by the submission deadline."]
[null,null,null,null,"In the event than an NHS foundation trust is unable to fully self certify, it should NOT select 'Confirmed’ in the relevant box. It must provide commentary (using the section provided at the end of this declaration) explaining the reasons for the absence of a full self certification and the action it proposes to take to address it. Monitor may adjust the relevant risk rating if there are significant issues arising and this may increase the frequency and intensity of monitoring for the NHS foundation trust."]
[]
[]
[null,null,null,null,"Where boards are unable to self-certify, they should make an alternative declaration by amending the self-certification as necessary, and including any significant prospective risks and concerns the foundation trust has in respect of delivering quality services and effective quality governance"]
[]
[null,null,null,null,"The board are unable make one of more of the confirmations on the preceding page and accordingly declare:"]
[]
["CERT","ALT1",null,"A"]
[]
["CERT","ALT2",null,"B"]
[]
["CERT","ALT3",null,"C"]
[]
[]
[null,null,null,"Note: Monitor will accept either 1) electronic signatures pasted into worksheet or 2) hand written signatures on a paper printout of this declaration posted to Monitor to arrive by the submission deadline."]

{"sheet":"Cover Sheet","index":1,"n_rows":22,"n_cols":10,"rows_kept":22,"cut":false,"hidden":false,"merged":[[1,1,1,13],[18,1,18,9],[15,1,15,9],[8,1,8,9],[11,2,11,9],[12,2,12,9],[13,2,13,9],[2,1,2,13]]}
[]
[null,"This template may be used by Foundation trusts and NHS trusts to record the self-certifications that must be made under their NHS Provider Licence.  "]
[null,"You do not need to return your completed template to NHS Improvement unless it is requested for audit purposes."]
[]
[null,null,"Self-Certification Template - Condition FT4"]
[null,null,null,null,null,null,null,null,"Gloucestershire Hospitals NHS Foundation Trust","Insert name of organisation"]
[]
[]
[]
[]
[null,"Foundation Trusts and NHS trusts are required to make the following self-certifications to NHS Improvement:"]
[]
[null,null,"Corporate Governance Statement - in accordance with Foundation Trust condition 4 (Foundations Trusts and NHS trusts)"]
[null,null,"Certification on training of Governors - in accordance with s151(5) of the Health and Social Care Act (Foundation Trusts only)"]
[]
[null,"These self-certifications are set out in this template.  "]
[]
[]
[null,"How to use this template"]
[null,"1) Save this file to your Local Network or Computer."]
[null,"2) Enter responses and information into the yellow data-entry cells as appropriate."]
[null,"3) Once the data has been entered, add signatures to the document."]

{"sheet":"FT4 declaration","index":2,"n_rows":33,"n_cols":12,"rows_kept":33,"cut":false,"hidden":false,"merged":[[32,4,32,10],[30,4,30,9],[21,4,21,8],[11,4,11,8],[13,4,13,8],[15,4,15,8],[17,4,17,8],[19,4,19,8]]}
[]
[null,null,null,"Worksheet \"FT4 declaration\"",null,null,null,null,"Financial Year to which self-certification relates",null,"2021-22","Please Respond"]
[]
[null,null,null,"Corporate Governance Statement (FTs and NHS trusts)"]
[]
[]
[null,null,null,null,"The Board are required to respond \"Confirmed\" or \"Not confirmed\" to the following statements, setting out any risks and mitigating actions planned for each one"]
[]
[]
[null,null,null,null,"Corporate Governance Statement",null,null,null,null,"Response","Risks and Mitigating actions"]
[]
["CERT","CERT20",null,1,"The Board is satisfied that the Licensee applies those principles, systems and standards of good corporate governance which reasonably would be regarded as appropriate for a supplier of health care services to the NHS.",null,null,null,null,"Confirmed","A full corporate governance review, including reporting mechanisms and meeting structures, was started in February 2022 to ensure effective and efficient systems and processes in relation to information flow and risk management. Detail is provided in the Annual Governance Statement. ",{"$f":"IF(J12=\"\",\"Please Respond\",IF(J12=\"Not Confirmed\",#REF!,IF(J12=\"Confirmed\",#REF!)))","v":{"$error":"#REF!"}}]
[]
["CERT","CERT21",null,2,"The Board has regard to such guidance on good corporate governance as may be issued by NHS Improvement from time to time",null,null,null,null,"Confirmed","The Board responds to new guidance in a timely manner through its business cycle and work of the Audit and Assurance Committee. Corporate governance practices will continue to be refined upon the release of the new Code of Governance.",{"$f":"IF(J14=\"\",\"Please Respond\",IF(J14=\"Not Confirmed\",#REF!,IF(J14=\"Confirmed\",#REF!)))","v":{"$error":"#REF!"}}]
[]
["CERT","CERT22",null,3,"The Board is satisfied that the Licensee has established and implements: \n(a) Effective board and committee structures;\n(b) Clear responsibilities for its Board, for committees reporting to the Board and for staff reporting to the Board and those committees; and\n(c) Clear reporting lines and accountabilities throughout its organisation.\n",null,null,null,null,"Confirmed","A full corporate governance review, including reporting mechanisms and meeting structures, was started in February 2022 to ensure effective and efficient systems and processes in relation to information flow and risk management. Clear effectiveness reviews and Terms of Reference reviews take place to ensure effective operation and will be used to inform any future changes. New processes in place include Key Issues and Assurance Reports to provide clear lines of reporting from Committees to Board, and a revised Board Assurance Framework which is discussed and reviewed on a monthly basis and is used a key assurance document for the organisation. Key Issues and Assurance Reports will be implemented throughout the governance structure to improve assurance and management of risk from the frontline to the Board.",{"$f":"IF(J16=\"\",\"Please Respond\",IF(J16=\"Not Confirmed\",#REF!,IF(J16=\"Confirmed\",#REF!)))","v":{"$error":"#REF!"}}]
[]
["CERT","CERT23",null,4,"The Board is satisfied that the Licensee has established and effectively implements systems and/or processes:\n\n(a) To ensure compliance with the Licensee’s duty to operate efficiently, economically and effectively;\n(b) For timely and effective scrutiny and oversight by the Board of the Licensee’s operations; \n(c) To ensure compliance with health care standards binding on the Licensee including but not restricted to standards specified by the Secretary of State, the Care Quality Commission, the NHS Commissioning Board and statutory regulators of health care professions;\n(d) For effective financial decision-making, management and control (including but not restricted to appropriate systems and/or processes to ensure the Licensee’s ability to continue as a going concern); \n(e) To obtain and disseminate accurate, comprehensive, timely and up to date information for Board and Committee decision-making;\n(f) To identify and manage (including but not restricted to manage through forward plans) material risks to compliance with the Conditions of its Licence;\n(g) To generate and monitor delivery of business plans (including any changes to such plans) and to receive internal and where appropriate external assurance on such plans and their delivery; and\n(h) To ensure compliance with all applicable legal requirements.\n",null,null,null,null,"Confirmed","The Annual Governance Statement and Annual Report document compliance with regulatory requirements. ",{"$f":"IF(J18=\"\",\"Please Respond\",IF(J18=\"Not Confirmed\",#REF!,IF(J18=\"Confirmed\",#REF!)))","v":{"$error":"#REF!"}}]
[]
["CERT","CERT24",null,5,"The Board is satisfied that the systems and/or processes referred to in paragraph 4 (above) should include but not be restricted to systems and/or processes to ensure:\n\n(a) That there is sufficient capability at Board level to provide effective organisational leadership on the quality of care provided;   \n(b) That the Board’s planning and decision-making processes take timely and appropriate account of quality of care considerations;\n(c) The collection of accurate, comprehensive, timely and up to date information on quality of care;\n(d) That the Board receives and takes into account accurate, comprehensive, timely and up to date information on quality of care;\n(e) That the Licensee, including its Board, actively engages on quality of care with patients, staff and other relevant stakeholders and takes into account as appropriate views and information from these sources; and\n(f) That there is clear accountability for quality of care throughout the Licensee including but not restricted to systems and/or processes for escalating and resolving quality issues including escalating them to the Board where appropriate.\n",null,null,null,null,"Confirmed","The Trust Remuneration Committee and Governors' Governance and Nominations Committee meet regularly to review skill mix and succession planning. Quality and Performance is a key item on all Board agendas, with the Quality and Performance Committee maintaining oversight of quality issues and reporting key issues and assurance through to Board. Quality reporting is in development to streamline information to make it more succinct and efficient.",{"$f":"IF(J20=\"\",\"Please Respond\",IF(J20=\"Not Confirmed\",#REF!,IF(J20=\"Confirmed\",#REF!)))","v":{"$error":"#REF!"}}]
[]
["CERT","CERT25",null,6,"The Board is satisfied that there are systems to ensure that the Licensee has in place personnel on the Board, reporting to the Board and within the rest of the organisation who are sufficient in number and appropriately qualified to ensure compliance with the conditions of its NHS provider licence.",null,null,null,null,"Confirmed","The fit and proper persons requirements are undertaken on appointment of Board members, and annually to ensure ongoing appropriateness of the Board. Regular Board and Committee reporting on staffing, recruitment, retention, staff engagement, talent and leadership developmnet is in place, with a new culture and organisational development framework in development. The Trust Remuneration Committee and Governors' Governance and Nominations Committee meet regularly to review skill mix and succession planning. ",{"$f":"IF(J22=\"\",\"Please Respond\",IF(J22=\"Not Confirmed\",#REF!,IF(J22=\"Confirmed\",#REF!)))","v":{"$error":"#REF!"}}]
[]
[null,null,null,null,"Signed on behalf of the Board of directors, and, in the case of Foundation Trusts, having regard to the views of the governors"]
[]
[null,null,null,null,"Signature",null,null,"Signature"]
[]
["CERT","CERTSIG",null,null,"Name","Robert Graves",null,"Name","Mark Pietroni"]
[]
[]
[null,null,null,null,"Further explanatory information should be provided below where the Board has been unable to confirm declarations under FT4."]
[]
["CERT","ALT1",null,"A",null,null,null,null,null,null,null,{"$f":"IF(LEN(E33)=0,\"Please Respond\",\"OK\")","v":"Please Respond"}]

{"sheet":"Training of governors","index":3,"n_rows":28,"n_cols":11,"rows_kept":28,"cut":false,"hidden":false,"merged":[[10,4,10,8],[6,4,6,9],[27,4,27,9]]}
[]
[null,null,null,"Worksheet \"Training of governors\"",null,null,null,"Financial Year to which self-certification relates",null,"2021-22","Please Respond"]
[]
[null,null,null,"Certification on training of governors (FTs only)"]
[]
[]
[null,null,null,null,"The Board are required to respond \"Confirmed\" or \"Not confirmed\" to the following statements.  Explanatory information should be provided where required."]
[]
[null,null,null,null,"Training of Governors"]
[]
["CERT","CERT37",null,1,"The Board is satisfied that during the financial year most recently ended the Licensee has provided the necessary training to its Governors, as required in s151(5) of the Health and Social Care Act, to ensure they are equipped with the skills and knowledge they need to undertake their role.",null,null,null,null,"Confirmed",{"$f":"IF(J11=\"\",\"Please Respond\",IF(J11=\"Not confirmed\",IF( LEN(E28)=0,\"Please complete the explanatory information\",\"OK\"),\"OK\"))","v":"OK"}]
[]
[]
[null,null,null,null,"Signed on behalf of the Board of directors, and, in the case of Foundation Trusts, having regard to the views of the governors"]
[]
[null,null,null,null,"Signature",null,null,"Signature"]
[]
["CERT","CERTSIG",null,null,"Name","Robert Graves",null,"Name","Mark Pietroni"]
[]
["CERT","CERTJOB",null,null,"Capacity","Vice-Chair",null,"Capacity","Interim Chief Executive Officer"]
[]
["CERT","CERTDATE",null,null,"Date","2022-07-14",null,"Date","2022-07-14"]
[]
[]
[]
[null,null,null,null,"Further explanatory information should be provided below where the Board has been unable to confirm declarations under s151(5) of the Health and Social Care Act"]
[]
["CERT","ALT1",null,"A","The pandemic had limited the amount of training and development sessions that the Trust was able to provide, however virtual quality and strategy sessions continued for governors, along with NHS Providers events. The Trust is currently refreshing its approach to Council of Governors training and development, walkabouts, member sessions etc. to ensure improved involvement and engagement. "]

{"sheet":"Finance Risk Indicators","index":4,"n_rows":26,"n_cols":10,"rows_kept":26,"cut":false,"hidden":true,"merged":[[21,4,21,7],[7,4,7,7],[8,4,8,7],[9,4,9,7],[16,4,16,9],[19,4,19,7],[20,4,20,7]]}
["[Needed??]"]
[null,null,null,{"$f":"\"Worksheet \"\"\"&MID(CELL(\"filename\",D2),FIND(\"]\",CELL(\"filename\",D2))+1,99)&\"\"\"\"","v":"Worksheet \"Finance Risk Indicators\""}]
[null,null,null,"Click to go to index"]
[null,null,null,"Finance Risk Indicators for Happy Hospitals"]
[]
[null,null,null,null,"Please respond \"True\" or \"False\" to the following statements"]
[null,null,null,null,"Finance Risk Indicators",null,null,null,null,"Response"]
["CERT","FRI02",null,1,"Finance Declaration 2 signed (Trust unable to certify that Board anticipates that the Quarterly FRR will be at least 3 over the next 12 months)"]
["CERT","FRI03",null,2,"Planned FRR 2 (or less) for any one quarter in 13/14"]
["CERT","FRI04",null,3,"Working capital facility (WCF) was used at any point in 13/14 financial year"]
["CERT","FRI07",null,4,"Two or more changes in Finance Director in a twelve month period"]
["CERT","FRI08",null,5,"Interim Finance Director in place over more than one quarter end"]
["CERT","FRI09",null,6,"Quarter end cash balance <10 days of (annualised) operating expenses"]
[null,null,null,null,null,null,null,null,{"$f":"IF(J14>0,\"Indicators with no response :\",\"\")","v":"Indicators with no response :"},{"$f":"6-COUNTA(J8:J10,J11:J13)","v":6}]
[]
[]
[null,null,null,"Notes:","As set out in Monitor's Compliance Framework 2012-13, Monitor will separately consider this limited set of indicators to highlight the potential for any future material financial risk. Where Monitor believes that one or more of these indicators are present at an NHS foundation trust, Monitor will consider whether an earlier meeting with the trust to discuss them is appropriate. Following this meeting, Monitor may request the preparation of plans, or the provision of other assurances as to an NHS foundation trust’s capacity to mitigate any potential risk. The use of these indicators will not form part of the formal regulatory framework or Monitor’s approach to the potential use of its statutory powers of intervention.\n               \n"]
[]
[null,null,null,null,"Other indicators for Risk",null,null,null,null,"Response"]
["CERT","FRI11",null,1,"How many interim (voting) Directors are there on your Board at 31 May 2013"]
["CERT","FRI12",null,2,"How many acting (voting) Directors are there on your Board at 31 May 2013"]
["CERT","FRI13",null,3,"How many of the following posts are interim or acting or both ( Chair, CEO, Finance Dir, Medical Dir) at 31 May  2013"]
["CERT","FRI14",null,4,"How many changes in Finance Director have you had in the twelve month period to 31 May 2013"]
["CERT","FRI15",null,5,"How many governors posts (filled and unfilled) does your FT have (i.e in constitution)"]
["CERT","FRI16",null,6,"How many governors posts are vacant (unfilled) at 31 May 2013"]
[null,null,null,null,null,null,null,null,{"$f":"IF(J26>0,\"Indicators with no response :\",\"\")","v":"Indicators with no response :"},{"$f":"6-COUNT(J20:J25)","v":6}]

{"sheet":"Lookups","index":5,"n_rows":3,"n_cols":1,"rows_kept":3,"cut":false,"hidden":true,"merged":[]}
["Confirmed"]
["Not confirmed"]
["N/A"]