SUMMARY REPORT Meeting Date: 31 May 2018 Agenda Item: 7 Enclosure Number: 4 Meeting: Title: Author: Accountable Director: Other meetings presented to or previously agreed at: Formal Trust Board Chief Executive s Report Jan Ditheridge N/A Committee Date Reviewed N/A Key Points/Recommendation from that Committee Purpose of the report To update the Board on key policies, issues and events and to stimulate debate regarding potential impact on strategy and levels of assurance. Strategic goals this report relates to: To deliver high quality care To support people to live independently at home To deliver integrated care Consider for Action Approval Assurance Information To develop sustainable community services Summary of key points in report See main report. Key Recommendations The Board are asked to consider the implications, opportunities or risks because of the proposed changes regarding NHS Improvement / NHS England s strategic decision to work together more closely. The Board are asked to note the proposals and consider any implications, risks or opportunities for our organisation and the delivery in relation to the Agenda for Change proposed pay award The Board are asked to consider what they wish to be included in our response in relation to Consultation on proposed standards for new nursing Associate role given this is an area of workforce we are starting to develop. The Board are asked for initial thoughts on our ability to meet the expectations set out in the Freedom to Speak Up (FSTU): Guidance for NHS Boards. 1 Accountable Director: Jan Ditheridge Board Meeting: 31 May 2018
Is this report relevant to compliance with any key standards? YES OR NO CQC Yes CQC committed to align their procedures and focus to support the strategic decision of NHSI and NHSE to work together. IG Governance Toolkit No Board Assurance Framework Impacts and Implications? Patient safety & experience Financial (revenue & capital) OD/Workforce Legal To be considered by the Board YES or NO No Yes Yes No State specific standard or BAF risk Well Led If yes, what impact or implication Potential pay uplift and impact of Workforce Strategy Consultation document Potential gaps in our workforce capacity / capability and an opportunity to address these gaps. 2 Accountable Director: Jan Ditheridge Board Meeting: 31 May 2018
CHIEF EXECUTIVE S REPORT 31 May 2018 1. National Issues This section highlights new national policy, reports and consultations that are likely to have an impact on our strategic goals to: Deliver high quality care Deliver integrated care Support people to live independently at home Deliver sustainable community services and our strategic priorities: Care Quality Commission (CQC) Good and Beyond Our 5 Year Plan Implementing Electronic Patient Record (EPR) This report should also be considered for impact on our Board Assurance Framework (BAF). 1.1 NHS Improvement (NHSI) / NHS England (NHSE) NHSI and NHSE have made the strategic decision to work together to: Integrate and align national programmes and activities Integrate NHSE and NHSI regional teams, to be led by one Regional Director, spanning both organisations and accountabilities. Operate through single teams where appropriate Move to seven regional teams / geographies. This move is to support the policy drivers to develop new collaborative relationships and integrate care at local level, to reduce variation and duplication. Chief Executives have been asked for their views on the proposed make-up of their own region. It is proposed that Shropshire, Telford & Wrekin will be part of the Midlands region, along with Staffordshire, Derbyshire, Lincolnshire, Nottinghamshire, Leicester, Leicestershire & Rutland, Black Country & West Birmingham, Birmingham & Solihull, Coventry & Warwickshire and Herefordshire & Worcestershire. This proposed region was based on factors such as local relationships and politics, existing patient flows, the spread of challenged systems (geographically and financially) population and organisation size. The changes are expected to be realised in Autumn 2018. The Care Quality Commission (CQC) have committed to align their procedures and focus to support these changes. This includes CQC inspections of whole systems, for example. The Board are asked to consider implications, opportunities or risks because of these proposed changes. Accountable Director: Jan Ditheridge, Chief Executive 1
2.0 Care Quality Commission (CQC) The CQC Board have appointed a new Chief Executive, Ian Trenholm; presently the Chief Executive of NHS Blood and Transplant. Ian replaces David Behan when he leaves in July. The CQC Chair, Peter Wyman, commented that Ian s track record of delivering technological innovation at scale will support the CQC s strategic focus on delivering an intelligence driven approach to regulation. 3.0 Workforce 3.1 Agenda for Change Proposed Pay Award Since our last meeting the NHS Staff Council has formally signed off a framework agreement for the reform of the NHS pay structure for all Agenda for Change staff. The NHS Trade Unions are presently consulting members; which includes balloting. If approved, the framework will be implemented in July 2018, backdated to April 2018. The key proposals are: A three year deal up to 2021, subject to Trade Union consultation and government clearance. This is fully funded, reforming pay structures, faster progression through increments and higher starting salaries. A minimum rate of pay in the NHS to be set at 17,460 from April 2018. Top of pay bands will be increased by 6.5% over 3 years (apart from 8d & 9 which will be capped at the 8c increase). Other proposed changes include: Enhanced shared parental leave Child bereavement leave Framework to buy and sell leave Unsocial hours while off sick to be paid only to earners less than 18,160. Our staff side team are working in partnership with our union representatives to support the consultation. Corporate colleagues are working through financial, personnel and resource impacts. The Board are asked to note the proposals and consider any implications, risks or opportunities for our organisation and the delivery of our priorities. More detail can be found: http://www.nhsemployers.org/your-workforce/2018-contract-refresh/keypoints-at-a-glance 3.2 CQC Response to the Consultation Document Workforce Strategy - Health Education England. The Board have had the opportunity to comment on this strategy and may find CQC s response helpful. CQC response highlights: Early system reviews have found that capacity and capability of the system workforce are a significant challenge, especially in the delivery of integrated, joined up care for older people The need to identify models of care for the future, then who is required to staff these models. System-wide workforce planning should be considered. Flexible working across health and social care should be supported, allowing staff to move easily between the two. Move to the Health and Social Care System (not just the NHS) being the employer of choice. All of these responses support our organisation strategic focus on partnership working and the developing system workforce strategy, which I am the Chief Executive sponsor for. We will consider all of the responses in the context of our own strategies. Accountable Director: Jan Ditheridge, Chief Executive 2
3.3 Nursing and Midwifery Council (NMC) Consultation on Proposed Standards for New Nursing Associate Role. Consultation on the Regulation of a New Profession The NMC launched the consultation on the regulation of a new profession at the beginning of April, to run until July 2018. Nursing Associate roles were introduced in October 2015 to bridge the identified skills gap between the role of health care assistants and registered nurses, and help meet the changing health and care needs of patients and the public. The first Nursing Associates Education Programmes started in January 2017, and the first Nursing Associates are expected to qualify in early 2019. The Government has determined that statutory regulation of the Nursing Associate profession is required to protect the public. The NMC agreed to regulate Nursing Associates in England. It is proposed that Nursing Associates will broadly be regulated in the same way as nurses and midwives, following the same four key functions: Fitness to Practise Registration Education Code and Standards The consultation will focus on the standards and processes required to regulate nursing associates. Our Director of Nursing will lead a response on our behalf. The Board are asked to consider what they wish to be included in our response given this is an area of workforce we are starting to develop. 3.4 Effective Workforce Planning NHSI have developed an operational workforce planning tool to support Boards and their teams to carry out an organisational workforce planning diagnostic against a key set of indicators; leadership, technology, information, method and governance and policies and resources. Our Human Resources (HR) Team will lead on this diagnostic assessment, engaging and involving the Board and teams as appropriate. https://improvement.nhs.uk/resources/operational- The workforce planning tool can be found: workforce-planning-self-assessment-tool/ More details and the consultation document can be found: https://www.nmc.org.uk/globalassets/sitedocuments/na-consultation/nursing-associates-consultationon-the-regulation-of-a-new-profession.pdf Accountable Director: Jan Ditheridge, Chief Executive 3
4.0 Freedom to Speak Up (FTSU): Guidance for NHS Boards This guidance sets out expectation of Boards and board members in relation to Freedom to Speak Up and includes a self-review tool. This guide aligns to the Well-Led framework. The expectations set out in the guidance are that leaders: Are knowledgeable about FTSU Have a structured approach to FTSU Actively shape the speak up culture Are clear about their role and responsibilities Are confident that wider concerns are identified and managed. Receive assurance in a variety of forms Engage with all relevant stakeholders Are focussed on learning and continual improvement The FTSU guardian, Alison Trumper, will support Julie Thornby, Director Lead FTSU and Rolf Levesley, Non-Executive FTSU lead, to take the Board and teams through the self- assessment, identify gaps and actions. The Board are asked for initial thoughts on our ability to meet the expectations set out in the guidance. The guidance document can be found at: https://improvement.nhs.uk/documents/2468/freedom_to_speak_up_guidance_may2018.pdf 5. Local Issues The issues considered are relevant to both our strategic priorities and / or the day to day delivery of our services. 5.1 Operational Plan 2018/19 Submission Our refreshed 2 year Operational Plan was submitted on the required deadline of April 30 th 2018. This followed further consideration of feedback from NHS Improvement, after the first draft submission. This feedback mainly related to more detail about our cost improvement plans and the processes we have in place to quality impact any plans. We expected and responded to this feedback in the final submission, the headline content having been reviewed at our April Board meeting. We expect to get further feedback from NHSI in due course which will be shared and discussed with the Board. 5.2 Integrated Urgent Care GP-Led Out of Hours The Board have agreed to enter into a partnership with the Shropshire Doctors Co-operative (Shropdoc) to deliver high quality G.P. led out-of-hours services. We are presently in a competitive process to tender for the new Integrated Urgent Care Service (IUCS) commissioned by Shropshire, Telford and Wrekin Clinical Commissioning Groups (CCGs). We are expecting a decision in June. The new service will start on October 1 st 2018. Our respective teams have worked closely on this exciting project and report positively about the level of engagement and partnership working to create a new model for out-of-hours services. Board members, particularly Non-Executive Directors, had the opportunity to meet with Shropdoc Board members last month before entering into this partnership arrangement. Accountable Director: Jan Ditheridge, Chief Executive 4
5.3 Round Table with Rt Hon Jeremy Hunt MP, Secretary of State for Health and Social Care All Chief Executives were invited to a listening event with the Secretary of State for Health and Social Care. I attended one of these sessions. He took the opportunity to brief us on priority areas in the Department of Health, but the majority of the meeting was an opportunity for Chief Executives to share their views, challenges and ideas for the future. The Key areas of focus were: Integration how health and social care work together for patients in the future Workforce Financial Planning Information Technology Innovation creating environments for it to flourish Patient Safety next steps It was a valuable experience, not only to get the opportunity to discuss community issues with the Secretary of State, but also hear from other Chief Executives around the country to hear their challenges and thoughts. I used my opportunity to highlight health and care issues and challenges in rural communities, asked for support from the centre to be clear on what they mean by integration and to continue to share the many positive aspects of working for and in the NHS. Jan Ditheridge Chief Executive Accountable Director: Jan Ditheridge, Chief Executive 5