THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST EXECUTIVE REPORT - CURRENT ISSUES Agenda item A4(i) 1. Executive Team Particular attention is drawn to: i) Executive arrangements during the period of Sir Leonard s extended leave.. ii) Involvement with Northumberland Tyne & Wear (including North Durham) Strategic Transformation Plan (STP). iii) iv) Addressing Winter Pressures and subsequent implications for waiting times and patient flow. Prioritising continuing attention to quality and patient safety matters in order to maintain and enhance the CQC outstanding status of the Trust. v) Commissioning bedside white boards throughout the Trust as part of enhanced patient monitoring and National Early Warning Score (NEWS) assessments. vi) vii) Engagement with neighbouring Trusts to facilitate improvement and rationalisation of appropriate patient pathways. Control Total update and implications thereof. viii) Operational planning 2017/8 and 2018/9 ix) Progress in contract negotiations 2017/18 and 2018/19 (local and national). x) The NHS New Care Models Programme and potential opportunities and challenges for this organisation. xi) Further realignment of the Capital Investment Programme 2017/18. 2. Key Impact Documents/Statements from Government/Regulators/Advisory Bodies/ Others (i) NHS New Models of Care (NMCs) This programme is a nationally endorsed set of approaches that aim to deliver better care to patients by varying the means by which care has been traditionally provided in the UK which include making changes that cross organisational and professional boundaries. The New Care Models (NCMs) have been developed by 50 Vanguards. Five different NCMs have been identified: Enhanced health in Care Homes EHCH (eg Gateshead). 1
Integrated Primary and Acute Care Systems (PACS) (eg Northumberland). Multispeciality Community Providers (MCP) (eg Sunderland). Urgency and Emergency Care (eg NE Urgent care Network). Acute Care Collaboration (eg Northumbria Group). The PACS and MCP NCMs are population-based models, attracting most attention both nationally and locally. It is acknowledged that it will take several years between conception and maturity of these models. A draft MCP contract (set out in 14 documents) was published in December 2016; this covers how MCP models will be funded, whole population budget approaches, incentive schemes and risk/gain share agreements across the economy: Implementing MCP Models can transition to PACS over time. (ii) NHS Identity Briefing Pack To achieve the national standard and consistency that our patients expect from the NHS published by NHS Improvement This relates to NHS logo consistency and will be rolled out gradually. It appears that there will be cost implications as yet not fully identified. (iii) 4.29m funding for Northumberland as county leads the way for future NHS Northumberland Gazette The funding is part of the Vanguard Programme to integrate health and social care services across the county. The Vanguard Programme works to deliver an integrated primary and acute care system. The Northumberland Accountable Care Organisation (ACO) is the first of its kind in the UK and is a partnership between providers and commissioners of local NHS services (iv) Recovering the Cost of NHS Treatment of Overseas Patients The National Audit Office has found that the Department of Health and the NHS, working with other parts of Government, have made progress to recover most of the cost of treating overseas visitors who are not entitled to free hospital treatment. However, hospital Trusts remain some way from complying in full with the requirement to charge and recover the cost of treating overseas visitors. In the past two years, the amounts charged and amounts actually recovered have increased. Much of this increase is the result of changes to the charging rules. If current trends continue and the charging rules remain the same, the Department will not achieve its ambition of recovering up to 500 million of overseas visitor income a year by 2017-18 and faces a potential shortfall in the region of 150 million. The Department s management of the cost recovery programme demonstrates many elements of good practice, and it has taken action to help Trusts identify chargeable patients more easily and to secure the engagement of NHS staff. The 2
charging regulations are complex, however, and Trust staff may have to rely on judgement in determining whether a patient is chargeable, sometimes with limited information. Whilst being notable for good practice, the Trust is working with the national Cost Recovery Support Team (CRST) to see if there are any further opportunities to support us in refining our policies and guidance. Consideration of participating in a pilot of new processes in a distinct area of service is underway. (v) Planning Process 2017/28 and 2018/19 Following submission of Operational Plans by providers and commissioners and ongoing contractual negotiations, NHS Improvement and NHS England are in the process of jointly reviewing plans. A key area of testing for all organisations and systems is the robustness, credibility and transformation of savings plans to achieve control totals. Progress towards the transformation being described in Sustainability Transformation Plan submissions is to be set out in a quarter by quarter plan. This will be tested for each system in joint meetings with providers and commissioners over coming weeks. (vi) Provider Bulletins Share your views on use of resources and well-led The following is an extract on this consultation: NHS Improvement and the Care Quality Commission (CQC) continue to align our approaches to overseeing providers and understanding where support is needed. To help with this, we are consulting on a new use of resources assessment and a new well-led framework (https://improvement.nhs.uk/resources/consultation-useresources-and-well-led-assessments/). The NHS continues to deliver many high quality services in spite of increasing pressure from slowing growth in the NHS budget and from the increasing complexity associated with the demographics of an ageing population, increasing levels of co-morbidity, higher patient expectations. They also require the national oversight and regulatory bodies to play their part by reducing burdens on providers and behaving more consistently. Strong and effective leadership and governance is a key component in addressing the challenges facing the sector. Both the Care Quality Commission (CQC) and NHS Improvement have seen what a difference a positive culture, open and transparent leadership, and good governance and processes to oversee care quality, finances and operational performance can make. We have built on the aligned well-led framework developed by CQC and Monitor and the NHS Trust Development Authority (the latter two organisations now operating as NHS Improvement) following the Francis Inquiry, to set out a single vision of what good leadership looks like. 3
This document seeks views on the new well-led framework, building on the strengths of the previous version, and how this will be used for CQC s assessment of well-led, within NHS Improvement s Single Oversight Framework, and by Trusts themselves for development purposes. How effectively a provider uses its resources is one of the factors that determines the quality and responsiveness of its care. As one Trust Chief Executive has said Quality without efficiency is unsustainable, efficiency without quality is unthinkable. The Health and Social Care Act 2008 already recognises the relationship between quality of care and the efficient and effective use of resources, and requires CQC to have regard to the latter within its overall purpose as a quality regulator. CQC and NHS Improvement are committed to working together to recognise the fact that effective use of resources is fundamental to enable health and care providers to deliver and sustain high quality, including safe, services for patients. This joint consultation sets out our plans to do so, including introducing an assessment of Trusts use of resources as part of CQC ratings, starting with acute Trusts, in line with the Secretary of State for Health s request in June 2015. CQC and NHS Improvement are independent organisations with distinct legal duties. In particular, CQC carries the power to provide ratings of Trusts and all final judgements about ratings of well-led and use of resources remain with CQC. NHS Improvement oversees Trusts, forming views of their support needs in areas including quality, operational performance, finance and use of resources, leadership and improvement capability, and strategic change. We are committed to reducing duplication between our organisations and minimising the requirements we place on Trusts: Working together in the effective discharge of our respective functions, while recognising that each organisation is legally and operationally independent. Greater alignment between our organisations so that our definitions, measurement and operations are based on a single shared view of quality. Working to remove duplication between our organisations. Focusing on quality, and demonstrating that it should and can be maintained and improved alongside financial sustainability. This consultation seeks views on: The new Use of Resources assessment: - The proposed approach to carrying out Use of Resources assessments, initially for acute Trusts only, including how we will assess Trust performance and reach a rating (sections 3.1 and 3.2). - How NHS Improvement s Single Oversight Framework will reflect use of resources in its finance and use of resources theme (section 3.3). 4
The new well-led framework: - The joint structure of the well-led framework for acute, mental health, community and ambulance Trusts (section 4.2). - The proposed changes to the content, which includes more detail on themes such as compassionate, inclusive leadership, system leadership, and financial and resource governance (section 4.3). - How CQC and NHS Improvement will make use of the well-led framework in our regulatory and oversight activities (sections 4.4 and 4.5). - The relationship between the CQC well-led assessment and rating and the Single Oversight Framework (section 4.6). Responses to this consultation, engagement events and iterative testing in early 2017 will shape our final approach and how it is implemented. Thirteen specific questions on our proposed approach appear throughout this consultation document. Responding to the consultation We look forward to receiving the views of providers and other stakeholders on our proposals. We ask all interested parties to respond to the consultation by 5pm on 14 February 2017 via our survey: https://www.surveymonkey.co.uk/r/cqcnhsiconsultation. Please email NHSICQC.Consultation@nhs.net. NHS efficiency map updated Working with the Healthcare Financial Management Association (HFMA) and the Provider Cost Improvement Group, we have revised and updated the NHS efficiency map https://improvement.nhs.uk/news-alerts/working-hfma-share-bestpractice-cost-improvement-programmes/). The map brings together efficiency guidance, tools and examples to help provider finance teams produce cost improvement plans. The HFMA and NHS Improvement have worked in partnership to update and revise the NHS efficiency map. The map is a tool that promotes best practice in identifying, delivering and monitoring cost improvement programmes (CIPs) in the NHS. NHS organisations continue to work hard delivering savings through improving efficiency and reducing waste. NHS England s Five-year forward view makes clear the scale of gap between current spending and resources, setting out how NHS organisations will be expected to close the gap by 2021. Alongside this, Lord Carter s productivity review found savings could be made through addressing unwarranted variation in the cost of providing clinical and back-office services, through improved staff engagement, better management of services and performance data and using digital technology more often. Implementing Carter s recommendations is a priority that NHS England and NHS 5
Improvement set out in their July 2016 paper Strengthening financial performance and accountability in 2016/17. The national focus on improving efficiency and productivity will mean taking local action to deliver savings remains a priority for all NHS organisations. Aimed at NHS Finance Directors and their teams and other NHS staff with an interest in the delivery of CIPs, the purpose of the NHS efficiency map is to highlight existing resources on eliminating waste, increasing efficiency and at the same time improving quality and safety. The map is split into three sections: enablers for efficiency, provider efficiency and system efficiency. The map highlights the successes some NHS providers have had in delivering specific efficiency schemes and provides sign-posts to existing tools and reference materials. It also includes updated definitions for different types of efficiency. This map will be updated as new tools and case studies are produced. Recent A&E workshop and next steps Following Jim Mackey s letter of 19 th December Broadening our oversight of A&E, over 50 representatives from the sector attended a workshop on 12 th January focusing on the practical next steps to help relieve pressure on systems and support performance improvement. Areas covered included taking a more standardised approach to the streaming of patients when they arrive at emergency departments, how support is prioritised for our sickest patients and ensuring there is a consistent and holistic view of providers performance on emergency care. Over the coming weeks we will work with clinical and sector leads to develop products and support offers for the system, followed by piloting and testing. (vii) Transformation Fund Call to Bid To support the implementation of the Five Year Forward View vision of better health, better patient care and improved NHS efficiency, NHSE has created a Transformation Fund. This is specifically to enable local areas to deliver on key ambitions identified by the independent cancer and mental health taskforces. Additionally, this will continue to build on the Transferring Care priority for those with learning disabilities and kick start, at scale, revolutions for diabetes treatment and prevention. The Planning Guidance for 2017-19 set out that NHS England would: Use the Best Possible Value framework approach to assess all transformation investment decisions. Run a single co-ordinated application process to minimise the administrative burden on local areas who would be applying for funding. 6
On 12 th December 2016, the Transformation Fund Call to Bid process was launched and documents published. An addendum to the guidance reiterated that all potential beneficiaries of the transformation funding should have agreed plans in place around control totals. They encouraged all Alliances/Vanguard sites to submit a bid with the expectation that an agreement will be reached on the management of control totals by year-end. The interventions for which transformation funding is available are: Mental Health Improving access to psychological therapies (Integrated IAPT). Urgent & Emergency Mental Health Liaison Services for Adults and Older Adults. Cancer Early diagnosis for people with cancer. Cancer recovery package. Cancer stratified follow up pathways. Diabetes Improving uptake of structured education for people with diabetes. Improving the achievement of the NICE recommended treatment targets. New or expanded multi-disciplinary foot care teams (MDFTs). New or expanded diabetes inpatient specialist nursing services (DISNs). Learning Disabilities Reducing reliance on specialist inpatient care for people with learning disabilities. Reduction in children with learning disabilities placed away from their home and local community. The timetable for submission is shown below: Date Action December 2016 Support provided to bidders through Webinar sessions for each programme / intervention 18 th January 2017 Submissions deadline for bidders February 2017 Investment Decision taken by NHS England Investment Committee March 2017 Notification of investment decisions 7
The Trust is either leading or actively participating in all of the bids identified for approval by the Northumberland, Tyne and Wear and North Durham STP. Mr Andrew Welch Medical Director Louise Robson Executive Director of Business and Development 23 rd January 2017 8