REPORT TO THE TRUST BOARD November Paper Ref: 8.1 TB (13) 74 Paper Title: Sponsoring Director: Author: Purpose: The purpose of bringing the report to the board Action required by the board: What is required of the board e.g. to note, to approve? Document previously considered by: Name of the committee which has previously considered this paper / proposals Foundation Trust Application Process: Update Director of Corporate Affairs Suzanne Marsello Foundation Trust Programme Director The report provides the with an update of progress against the FT programme timescales, and details the final documentation that the Trust Board is asked to approve for submission to the NHS Trust Development Agency (NTDA)on 18 th. The Board is asked to note the progress update, and approve the documents detailed for submission to the NTDA, with any revisions required. N/A Executive summary Key points in the report and recommendation to the board Key messages The Trust is on track to make the final FT submissions to the NHS Trust Development Agency (NTDA) on the 18 th. These will be used by the NTDA to inform the Board to Board meeting with the Trust in March/April 2014, and enable the NTDA Board to make a final decision as to whether to refer the Trust to Monitor for assessment. The FT Programme Director has worked closely with the NTDA to ensure that the submissions will meet their requirements. Foundation Trust Trajectory The revised Trust FT trajectory is still under discussion with the NTDA. The Trust will make the final submission of required documentation to the NTDA on 18 th. The final Board to Board meeting and approval of submission of the Trust s application to Monitor by the NTDA Board are expected to be in March/April 2014, with referral to Monitor the beginning of the following month. Trust Submissions to the NTDA Appendix 1 contains an overview of the documentation that the Trust is required to submit to the NTDA by the 2 nd January 2014 (but the Trust will make the submissions on the18 th ). A number of documents have already been approved by the FT Programme Board/ Trust Board and submitted to the NTDA, as shown. The NTDA team will use the documentation to prepare a briefing pack for the NTDA Board ahead of the Board to Board meeting with the Trust. Submissions To The NTDA: Approval The Board is asked to review and approve the following documentation for submission to the NTDA, subject to any required revisions: Integrated business plan
Long-term financial model(ltfm), including: 8.1 TB (13) 74 o Base case, downside and mitigated downside case o Implied efficiency model base case and mitigated downside o Detail of CIP schemes on a rolling 24 month basis o Workforce analysis to reconcile CIP reductions to the LTFM o Detail of mitigations to support the mitigated downside LTFM Board Governance Assurance Framework: reassessment by Trust Board governance self-certification: Monitor Board statements and supporting evidence Chairman s statement that directors meet the fit and proper test CEO statement that the Trust has a capable workforce, fit for purpose CEO letter of declaration A brief overview of each submission and key points for the to note is provided below. Integrated Business Plan (IBP): TB(13)74 Appendix 1 The IBP has now been in development for 18 months. The document has been updated and refined over that period, responding to issues raised by NHS London, the NTDA and Deloitte. An iteration of the IBP was shared with the NTDA in October, and the feedback was that the document was developing well and that it was clear where the Trust had updated the content to reflect both their comments and the evolving position on, for example, service developments. The IBP has been circulated in full to members of the FT Programme Board on four occasions since September 2012, and to all members of the twice for review, comment and input. The IBP has also been shared with the members of the FT Stakeholder Steering Group, and commissioner support for the Trust s FT application, and its IBP and LTFM, has been consistent. Following these external and internal reviews and input, the Trust is confident that the IBP meets the mandated requirements of both the NTDA and Monitor. The Board is asked to approve in principle the submission of the IBP, as circulated, to the NTDA. Any final updates will be approved in line with the agreed process, at the FT Programme Board LTFM: Base Case, Downside and Mitigated Downside: Base Case The base case continues to be developed in line with the Trust s evolving financial plans including the Cost Improvement Plans (CIPs) and Capital Programme. Updated versions of each of these are being submitted to this months Finance, Performance and Investment Committee for review, and will subsequently be incorporated into the Long- Term Financial Model (LTFM) prior to submission to the NTDA. Financial Downside and Mitigations The major financial risks to the Trust were developed in conjunction with the LTFM, and their rationale and value has been reviewed throughout the process of IBP / LTFM development. The risks are grouped into three broad categories: activity related, tariff related and cost related risks. The two biggest risks in the downside scenario, which account for 50% of the risks, are the increased efficiency requirement specified by Monitor and the risk of CIP slippage. The current working model has a cumulative total financial risk over the five year forecast period of 134M, with mitigations of 128M. The Trust is currently working with the NTDA to determine how the impact of the Integrated
Transformation Fund should be shown in the final submission. 8.1 TB (13) 74 For each of the specific risks the Trust is continuing to develop a summary mitigation plan, which will be set out as an appendix to the IBP as part of the submission to the NTDA. The plan details the actions the Trust would take should each specific risk materialise. The focus of recent work has been the development of a range of central mitigations, in liaison with the clinical divisions, which escalate according to the level of financial exposure, and contain increasingly challenging options such as reducing workforce remuneration or total staff numbers, or withdrawal from loss making services. This suite of plans should provide Monitor with the assurance that the Trust has a range of options to address any reasonable potential downside to the Trust s financial plans over the course of the next five years. Implied Efficiency Model The implied efficiency model demonstrates how the Trust s assumptions on inflation and national cost pressures compare with those set out in Monitor s guidance on their assessment of the impact on the implied level of efficiency required of Trusts over the next five years. The Trust continues to work with the NTDA to ensure that these are set out in the Trust s LTFM in accordance with Monitor s expectations and have accordingly been updated to reflect Monitor s latest advice on tariffs. The Trust has also been working with the NTDA to ensure that the planned level of efficiency savings (i.e. expenditure savings) over the next five years is within expected limits of what trusts can reasonably deliver (i.e. less than 5.4% per annum). CIP Schemes The proposed CIP programme for submission to the NTDA will be reviewed at the Finance, Performance and Investment Committee in November, prior to the Board meeting on 28 th November. Progress will be reported to the Board accordingly. Workforce Analysis to Reconcile CIP Reductions to the LTFM The Trust has undertaken a detailed exercise related to workforce reductions and CIP plans to be included in the LTFM. This exercise has been conducted in a bottom-up approach from work undertaken by the Clinical/Corporate Divisions and their HR managers. The reconciliation is a submission specifically required by the NTDA as part of the final Trust documentation ahead of the Board to Board meeting with the NTDA. Workforce planning is the subject of the Board development session in. Board Governance Assurance Framework (BGAF): Reassessment: TB(13)74 Appendix 2 The Trust is required to reassess itself against the original BGAF assessment completed by Deloitte in 2012, and assign a current RAG rating to each domain. This item was reviewed by the in the meeting on 25 th July, and has been updated in line with comments made by the Board. The completed reassessment is enclosed with the papers for the to review and approve for submission to the NTDA. Board Governance Self-Certification: Monitor Board Statements:TB(13)74 Appendix 3 There are 14 Board governance statements that the Trust is required to self-certify against. The Trust is considered to be compliant with 13 of the statements, and has identified a risk in relation to Statement 7 which is related to ongoing compliance with all existing targets. The Board is asked to consider the evidence/assurance provided in relation to each Board statement, and confirm that all necessary evidence has been provided to enable the Board to selfcertify against each statement. The will be expected to self-certify against the Board statements on a regular basis. Monthly reporting to the NTDA is required as part of the oversight process, and Monitor will require
the Trust to provide a corporate governance statement annually as part of the Forward Plan (previously annual plan) that all FTs are required to submit. In addition Monitor requires the Board to self-certify against the corporate governance statement on a quarterly basis as part of the Monitor Risk assessment, with additional in-year assurance on an exception basis. Monitor will expect to see evidence of the Board having reviewed and discussed the corporate governance statement and supporting evidence on a regular basis. It is proposed that this will be included in the Risk and Compliance Report to each Board meeting. Letters of Declaration The three letters of declaration required to be submitted to the NTDA were reviewed by the Trust Board on 25 th July, and have been revised in line with comments made by the Board. Chairman s Statement that Directors Meet the Fit and Proper Test: TB(13) 74 Appendix 4 This submission is a new requirement from the NTDA. The Chairman s statement has been reviewed by the NTDA, who have confirmed that this meets their requirements. The Board is asked to approve this statement for submission to the NTDA. CEO Statement that the Trust has a Capable Workforce Which isfit for Purpose: TB(13)74 Appendix 5 This submission is a new requirement from the NTDA. The CEO s statement has been reviewed by the NTDA, who have confirmed that this meets their requirements. The Board is asked to approve the statement for submission to the NTDA. CEO Letter of Declaration: TB(13) 74 Appendix 6 The letter is a standard template from the Monitor guidance Applying for NHS FT Status Guide for Applicants October. The Board is asked to approve the letter of declaration for submission to the NTDA. Items For Board Information: Letters of Support The Trust is required to submit a number of letters of support from external stakeholders, including a commissioner convergence letter on behalf of key commissioners. The full list of letters of support received and previously submitted to the NTDA in July can be found in Appendix 1, item 28. Since July, the NTDA has required additional letters of support from the NHSLA and the Local Supervisory Midwifery Officer. These have both been received. The NTDA has also asked for the letters of support from the Trust s key commissioners (Wandsworth CCG, Merton CCG and NHS England Specialised Commissioning) to be updated. This is being led by Trudi Kemp. Recommendation The Board is asked to note the progress update provided with the FT process, and approve the documents for submission to the NTDA. Key risks identified: Are there any risks identified in the paper (impact on achieving corporate objectives) e.g. quality, financial performance, compliance with legislation or regulatory requirements? Key Programme Risks The key programme risks to the revised FT trajectory at this stage are: The Trust receiving an acceptable CQC Chief Inspector of Hospitals review before the Board to Board meeting in March Delivery of the detailed CIP plans required Maintaining operational/quality and financial performance at an acceptable level Related Corporate Objective: Reference to corporate objective that this paper refers to. Strategic Aim 5: Deliver robust operational and financial performance
Related CQC Standard: Reference to CQC standard that this paper refers to. 8.1 TB (13) 74 Objective 14; To take necessary steps to position the organisation for FT status by Winter 2012 Not applicable. Equality Impact Assessment (EIA): Has an EIA been carried out? NO If yes, please provide a summary of the key findings If no, please explain you reasons for not undertaking and EIA. There is no direct impact on patients or the public and therefore an EIA has not been completed.
Appendix 1: FOUNDATION TRUST: DOCUMENT SUBMISSION REQUIRED BY THE NTDA The NTDA has produced a list of all documentation that the Trust is required to submit as part of its FT application. The NTDA uses the documentation to produce a briefing pack ahead of the Board to Board meeting between the Trust and NTDA. Documents Already Approved Lead Director Trust Approval Process Submis sion to NTDA Comments 1 Enabling strategies: Clinical, Quality, Estates, Workforce & OD, IT Trudi Kemp Already approved by Submitted 4 th April with version 2 of the IBP 2 All other strategies Trudi Kemp Already approved by / EMT 3 Membership strategy Already approved by FT Programme Board 4 Consultation document Already approved by 5 Working Capital Review assurance Steve Bolam Approved by March 6 CIP strategy / governance process Steve Bolam Already approved by 7 Consultation Response Approved by May FT Programme Board Documents For Approval by the FT Programme Board 8 HDD2 report& action plans and evidence of delivery against action plan 9 BGAF report& action plans and evidence of delivery against action plan BGAF repeat self-assessment Steve Bolam/ FT Programme Board FT Programme Board 10 QGF report& action plans FT Programme Board Communications, Marketing, Commercial strategies/plans submitted 28 th June R&D, Education and Training submitted 23 rd July Submitted 31 st May Submitted 31 st May Submitted 31 st May Submitted to NTDA with the final CIP plans on 8 th July Submitted 31 st May HDD2 report submitted to NTDA on 9 th July Progress with action plan for September submitted on 15 th October BGAF report submitted to NTDA on 9 th July Progress with action plan for September submitted on 15 th October QGF report submitted to NTDA on 9 th July
11 FT Programme Risk Register FT Programme Board Documents For Approval by the : May 12 Constitution Approved by May 13 Governance Rationale Approved by May 14 Solicitor s letter to support constitution May Documents For Approval by the : June 15 Copy of Trust quality account, auditors opinions and progress with Francis action plan Documents For Approval by the : July Register of Director s Interests B1 Third Party Inspection reports B1 Schedule of Services: o Mandatory Health Services B6a o Mandatory Health Services: Commissioner Support B6b Relevant assets B7 Board Job Descriptions B16 Section 75 and Other Forms of Agreement B18: EOC and Moorfield s / Alison Robertson PJ PJ TK/SB ND PJ TK 6 th June Progress with action plan for September submitted on 15 th October Submitted 4 th July Submitted 4 th July Submitted 4 th July Monitor Guide Appendix B8 Submitted 28 th June IBP/LTFM: 16 IBP and appendices: Trudi Kemp November 17 LTFM (1. base case, 2.downside and 3. mitigated downside) Steve Bolam November 5 th August 22 nd July Submitted on 5 th August Submitted July need updating from July 18 Implied Efficiency model base case and mitigated downside case Steve Bolam November 19 Workforce analysis to reconcile CIP reductions to LTFM by PID. Wendy Brewer/Steve Bolam November
20 Detail of CIP schemes on rolling 24 month basis Steve Bolam Finance and Performance Committee November Submitted to NTDA on 8 th July CIP Book 21 Detail of mitigations to support mitigated downside LTFM Steve Bolam November GOVERNANCE: 22 BAF November 23 Performance update Steve Bolam Performance report from meeting November Submitted 24 th July 24 CEO letter of declaration that with regard to their duty of good faith they have disclosed all relevant information 25 Chair to confirm process and basis by which he has confirmed all Directors meet fit and proper test 26 Assurance that the Trust has a workforce fit for purpose i.e. capable of providing high quality / safe care 27 Board Governance Self-Certifications: Corporate Governance Statement Wendy Brewer November November November November Letter reviewed and approved in July Board meeting Monitor Guide Appendix 21 Letter reviewed and approved in July Board meeting Kate Southwell has confirmed that the content of the letter is what the NTDA requires Letter reviewed and approved in July Board meeting. Kate Southwell has confirmed the content of the letter is what the NTDA requires Compliance Framework Board statements submitted 2 nd August Documents to be Submitted: for To Note 28 Letters of Support as set out in the NTDA Accountability Framework / Trudi Kemp FT Programme Board NEEDS UPDATING The NTDA has confirmed the additional letters of support they require: an update of the letters of support from commissioners: Wandsworth CCG and NHSE Specialised Commissioning. Submitted to NTDA: SGUL King s Health Partners
29 Board Development carried out for previous 12 months Director of Corporate Affairs 30 Board Development Plans for next 12 months Director of Corporate Affairs 31 Latest membership report Director of Corporate Affairs 32 Media analysis identifying issues and action plans FT Programme Board 33 Progress on obtaining Working Capital Facility (WCF) Steve Bolam Director of Finance, Performance and Informatics 34 Council of Governors: Confirmation of elected and stakeholder governors and brief rationale Croydon Healthcare NHS Trust Specialised Commissioning Surrey Downs CCG SWL CCGs Commissioner Convergence letter Epsom and St. Helier University Hospitals NHS Trust HealthwatchWandsworth Health Education South London Richmond Council Kingston Hospital FT AHSN Merton Council Wandsworth HOSC Local Supervisory Authority Midwifery Officer NHSLA Submitted 25 th July Submitted 25 th July To be signed off by 7 Submitted 29 th July Submitted 31 st May Suzanne Marsello 20 th November