Agenda item 5 THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST COUNCIL OF GOVERNORS EXECUTIVE REPORT CURRENT ISSUES 1. Executive Team Insatiable demands necessitate striking a balance between (a) the day to day operational interface, ensuring service delivery and outcomes match expectations within given resource constraints, targets and the financial plan and (b) addressing a plethora of strategic issues and challenges arising out of national policy, reorganisation upheaval and uncertainty, then to ensure the organisation is in robust enough shape to not only remain a going concern in the short to medium term but be well placed to secure appropriate breadth of service base and scope (tertiary, secondary, community and primary) to match public expectations in terms of quality and cost. Particular attention is drawn to: (i) (ii) (iii) (iv) (v) (vi) (vii) Safe and Sustainable Children s Heart Surgery - Agenda item 2(ii) Transforming Community Services - Agenda item 4(iv) Month 10 Financial Position - Agenda item 6(ii) Readmissions and tariffs 2011/12 Agenda item 6(iii) Healthcare Associated Infection Agenda item 8(ii) Month 10 Quality Account - Agenda item 8(iii) Monitor Q3 2010/11 Executive Summary Results - Agenda item 11(i). 2. Key Impact Documents from Government/Regulators/Others (i) A route map for sustainable health (Department of Health 1 st February 2011) The NHS Sustainable Development Unit has published guidance which aligns the QIPP agenda with sustainability. It describes how NHS organisations can help the NHS become sustainable by taking not only financial but also social and environmental criteria into account when making a decision. (ii) Equitable Access Programme Primary Medical Care Services (Department of Health 3 rd February 2011) The proposed future responsibility for the contracts that PCTs have entered into for GP health centres is set out. Also explained are the arrangements for 2011/12 1
allocations for PCTs which commissioned new GP practices under the programme, including the requirement to provide quarterly updates via SHA primary care leads. Implications for Freeman Clinics Ltd are being addressed. (iii) Response to the House of Commons Health Select Committee: Commissioning Published on 18 th January 2011, this Command Paper sets out the Government s response. In essence the failure of commissioning is acknowledged and how Liberating the NHS; Legislative Framework and Next Steps vis à vis the now published Health and Social Care Bill shall bring about the solution that has proved to be so elusive since commissioning per se was introduced some two decades ago. The Command Paper Cm 8009 shall be tabled at the meeting for ease of future reference. (iv) Managing Sickness Absence in the NHS (Audit Commission 10 th February 2011) According to the latest Audit Commission health briefing, levels of staff sickness in the NHS vary dramatically across the country, with the North of England showing the highest levels. The briefing highlights a significant variation in rates between grades of staff; types of Trusts; and between different departments within Trusts. It also finds that more NHS staff take sick leave in areas of high deprivation. However it is cited that these factors cannot explain all the variation, which it is felt must be due in part to differences in the way NHS organisations manage, motivate and support their staff. By understanding and tackling these factors it is postulated the NHS could increase staff productivity, improve morale and save 290 million. To achieve such savings it is recommended that managers: review their organisation s sickness absence rates and benchmark against others identify specific staff groups with a particularly high sickness absence rate calculate the cost of sickness absence to their organisation consider whether their organisation could reduce its sickness absence and what savings could be made. The Audit Commission advise of tools that can also help NHS organisations improve efficiency and manage sickness absence. The Board of Directors has addressed initiatives already underway. (v) Care and Compassion? (Parliamentary and Health Service Ombudsman 15 th February 2011) The report is based on the findings of ten independent investigations into complaints about NHS care for people over the age of 65 across England. 2
The Ombudsman states that the findings serve to illuminate the gulf between the principles and values of the NHS Constitution and the felt reality of being an older person in the care of the NHS in England. The Ombudsman s findings show how ten older patients suffered unnecessary pain, indignity and distress while in the care of the NHS. Her investigations highlight common failures in pain control, discharge arrangements, communication with patients and their relatives and ensuring adequate nutrition. The Ombudsman explains: The findings of my investigations reveal an attitude both personal and institutional which fails to recognise the humanity and individuality of the people concerned and to respond to them with sensitivity, compassion and professionalism. The reasonable expectation that an older person or their family may have of dignified, pain free, end of life care, in clean surroundings in hospital is not being fulfilled. Instead, these accounts present a picture of NHS provision that is failing to meet even the most basic standards of care. It is to be noted that the ten investigations covered in the report are not isolated cases. Of the nearly 9,000 properly made complaints to the Ombudsman about the NHS last year, 18 per cent were about the care of older people. The Ombudsman accepted twice as many cases for investigation about older people as for all other age groups put together. The Ombudsman concludes: These often harrowing accounts should cause every member of NHS staff who reads this report to pause and ask themselves if any of their patients could suffer in the same way. I know from my caseload that in many cases, the answer must be yes. The NHS must close the gap between the promise of care and compassion outlined in its Constitution and the injustice that many older people experience. Every member of staff, no matter what their job, has a role to play in making the commitments of the Constitution a felt reality for patients. The Clinical Governance & Quality Committee is to give consideration to these findings and report back to the April meeting of the Board of Directors. (vi) The Procurement of Consumables by NHS Acute and Foundation Trusts (National Audit Office 2 nd February 2011) The NAO explain that hospital Trusts in England have complete freedom to decide what consumables they buy and how they go about doing so. Trusts can make use of a network of regional collaborative procurement hubs, and a national supplies and distribution organisation, NHS Supply Chain, but there is no requirement for them to do so, and they are free also to buy directly from suppliers. Most Trusts use a combination of all three arrangements. The local control of procurement decisions and budgets in the NHS contrasts with the direction that is being taken for central government procurement. As part of the Efficiency and Reform Group work being carried out by the Cabinet Office at the time of writing, plans to centralise commodity procurement across central departments are being developed that are expected to deliver annual savings and cost reductions of 500 million. In October 2010 Sir Philip Green s efficiency review of central government departments spending found large inefficiencies in 3
procurement. However, this approach does not apply to the NHS which operates as a discrete sector, increasingly driven by a regulated market approach, in which the government does not control providers such as hospital Trusts. Central government, by contrast, operates as a single body of departments where consistent and collaborative procurement arrangements can be pursued. The Supplies and Services Procurement Committee is set to address the key findings and recommendations, reflecting upon our current position and to advise the Board of Directors as to further opportunities for improvement. (vii) Framework for Health Services Resilience Publicly Available Specification (2 nd February 2011) Healthcare Resilience is defined as the ability of an organisation to adapt and respond to disruptions, whether internal or external, to deliver organisationally agreed critical activities. This builds on the definition of resilience in BS 25999. In essence Healthcare Resilience is created by having robust day-to-day operations that can detect, prevent, and if necessary, withstand disruption, supported by effective crisis response and recovery processes. This extended definition is intended to reflect the complexity, size and scale of healthcare services by all providers of NHS-funded healthcare. The Publicly Available Specifications promotes the use of integrated emergency management (IEM) as a framework for resilience. All NHS funded organisations are required to plan and implement emergency plans, including business continuity plans, as though they were Category 1 or 2 responders under the Civil Contingencies Act 2004 (CCA 2004). While the responsibility for detailed planning is likely to be delegated to a suitably qualified officer(s), ultimate responsibility for this clearly lies with the Chief Executive and Board of Directors. This includes ensuring that arrangements are made within the boundaries of NHS-funded organisations and with partners are adequate, appropriate to local circumstances, and built on the principles of risk assessment, co-operation with partners, emergency planning, communication with public and sharing information. This document brings together the different strands of resilience planning within the NHS to create a framework that supports organisations efforts to become more resilient. It does this through: helping to drive compliance with the relevant legislation, particularly the Civil Contingencies Act 2004 (CCA 2004); adopting a unified and cohesive approach to resilience and business continuity which build on BS 25999, the British Standard for business continuity; developing resilient relationships with commissioners and providers in the health service, which can be benchmarked against other similar sized organisations; outlining the criticality of patient pathways and critical interdependencies by providing robust health services in all circumstances; developing a sound understanding of partnership working within the resilience agenda; and 4
helping to protect the reputation of the NHS and related services, and to maintain public confidence. Action is being taken to assess our standing. (viii) Health Visitor Implementation Plan 2011-15 (Department of Health 4 th February 2011) Serves to confirm the Government s intention to recruit an extra 4,200 health visitors by 2015 a 42% increase on current numbers. The Plan sets out its vision to re-energise the profession, defines what success looks like including the enhanced offer to families that the increased workforce will bring and provides high level plans for delivery. The Plan is supported by a letter which sets out trajectories for training and posts growth necessary to secure the extra health visitors and reassures commissioners that increased funding is reflected in NHS budget allocations. (ix) Eliminating mixed sex accommodation (Department of Health 4 th February 2011) The 2011/12 NHS Operating Framework requires all providers of NHS-funded care to publish a declaration on or by 1 st April 2011 that they are compliant with the national definition to eliminate mixed sex accommodation except where it is in the overall best interests of patients or reflects their patient choice. All providers should have plans in place to deliver this commitment. Such a declaration should be accompanied by a commitment to audit data quality and publish the results. The Nursing & Patient Services Director shall give assurances in this regard. (x) Self care education programmes a tool for commissioners (Department of Health 10 th February 2011) Working with the Expert Patient Programme Community Interest Company, the Department of Health has developed a tool that provides locally-tailored, evidencebased business cases for self care education programmes. The tool stimulates demand for both generic and disease-specific self care education courses and suggests the most cost-effective way of providing self care education, based on local population characteristics and budget available. Information sheets on supporting long-term conditions, including how to assess need and manage risk have been published. (xi) NHS Standard Contract for acute hospital services 2011/12 (Department of Health 24 th February 2011) To be used by PCTs when commissioning NHS funded services. 5
(xii) The never events list 2011/12 The Government has extended the list of serious patient safety incidents which should never occur and therefore are considered to be never events. The expectation is that the full list of never events should be used when agreeing contracts for 2011/12. The Medical Director will comment further at the meeting. (xiii) Payment by Results: confirmation of arrangements for 2011/2012 (Department of Health 24 th February 2011) The final version of the Payment by Results arrangements has been published. The Government has also published guidance setting out how the tariff should be implemented, together with details of a number of changes made to prices and exclusions lists since the tariffs and associated guidance was tested in January 2011. The Finance Director and also the Chief Operating Officer shall advise of the anticipated impact. Agenda item 6(iii) refers. (xiv) NHS Litigation Authority Clinical Negligence Scheme for Trusts (CNST) Assessment Governors will be aware of the significance the Assessment Ratings attract in respect of annual premiums as well as esteem for the organisation. There are two service elements i.e. General Acute Services Maternity Services Arising out of a two day intensive on-site scrutiny by two assessors on 28 th February and 1 st March 2011, the General Acute Services rating has been revised from Level 2 to Level 3 i.e. the best possible rating and which incurs a 30% discount in premiums paid. It is to be noted that Maternity Services (currently Level 3) will be the subject of an assessment in September 2011. These ratings serve to inform the service delivery dimension of risk and quality across a range of organisational domains. Sir Leonard Fenwick Chief Executive 9 th March 2011 6