SUPPORTING PAPER (FOR INFORMATION) BOARD OF DIRECTORS’ MEETING
Date of meeting: Thursday, 27 November 2014
Title of paper: Chief Executive’s Report
Presented by: Chief Executive
Executive Summary: This paper provides an overview of recent developments affecting the Trust.
Recommendations: The Board is asked to note the content of the report.
CQC Essential Standards of Involvement and Information Quality & Safety: Personalised care, treatment and support Safeguarding and safety Suitability of staffing Quality and management Suitability of management
Legal Issues: Changes in legislation and regulation.
Author: S McAskell – Monitoring and Compliance Officer
Date: 21 November 2014
Board of Directors’ Meeting – November 2014 Chief Executive’s Report
1. CQC Fundamental Standards Regulations Published
Following the consultation the CQC launched on its proposed “guidance for (all) providers on meeting the fundamental standards and on CQC’s enforcement powers”, the government have now published the fundamental standards regulations, and confirmed that the fit and proper person requirements for directors for NHS foundation trusts will take effect on Thursday 27th November. The remaining fundamental standards will come into force from April 2015.
The duty of candour and the fit and proper requirement regulations will help to ensure that providers have robust systems in place to be open and honest when things go wrong and to hold directors to account when care fails people.
In collaboration with NHS Employers and engagement with a selection of chairs and chief executives, the FTN has developed two documents to assist boards with assuring themselves of compliance with the regulations for new and existing executive appointments, which will be launched in late November. These will be living documents that will be updated progressively from trust feedback and as new information about implementation is available, and will be approved by the regulators.
2. Health Workers Plan Joint Strike on Wages
Members of 11 unions, including nurses, midwives, domestic staff and radiographers, will walk out for four hours in England on 24th November in protest at the government’s decision not to accept a recommended 1% pay rise for all NHS staff. The strike follows a series of stoppages by different groups in recent months. Unions said the stoppage would be “stronger than ever” and warned that the commitment of health workers was now at “breaking point”. A Department of Health spokesman said: “We are disappointed by this decision – NHS staff are our greatest asset and we want to make the current pay system fairer, which is why we have put forward proposals that would ensure all staff would get at least a 1% pay rise this year and next but these have been rejected by the unions.”
3. CQC Identifies Variation in Care Quality
CQC’s annual State of Care report, noted many examples of excellent NHS care despite financial constraint and called for more consistent, decisive action to help struggling providers. In 2013/14 CQC began to introduce a new, tougher approach to inspecting care services. It’s more rigorous, expert-led inspections are starting to provide a deeper understanding of the quality of health and social care than ever before.
It has found many examples of good and outstanding care, but also found a wide variation in quality. There are big differences in the quality of care that people experience from one trust to another, from hospital to hospital within trusts, between different services within hospitals and sometimes at different times of the day or days of the week. This widespread variation in the quality of care is unacceptable.
Across health and social care, CQC has found that staff provide compassionate care, but there are two aspects of quality that stand out: basic safety and leadership. Variation in basic safety is a serious problem, particularly a lack of effective safety processes and the lack of a culture that truly learns from mistakes and near misses. Strong, effective leadership with an open and supportive, values-driven culture and stable management at all levels is vital to drive up quality and safety overall.
CQC, in its report is challenging every health and care provider in England, and every commissioner and oversight body, to deliver the high standards of care that each person has a right to expect. It is also issuing an invitation to the public: to become empowered consumers, to use CQC's inspection reports and ratings to make decisions about their own care and the care of those close.
4. Responses to the Five Year Forward View
The FTN welcomed the Five Year Forward View (5YFV) as a "statement of great confidence in the NHS". Chief executive Chris Hopson said "it both recognises the strengths and unique place of the NHS in our nation to improve its peoples' health and changes it will need to make to achieve them". The FTN is encouraged that the 5YFV has been developed in partnership with other NHS regulators and national bodies, and Simon Stevens' talk of both patients and citizens is a "meaningful affirmation that healthcare is not simple and only about treatment and transactions, but about lifestyle, social cohesion and community collaboration". He adds that with the general election looming, the 5YFV presents a "perfect opportunity for political unity on the way forward" and calls for the political parties to commit to its vision.
However, health ministers from the three main parties refused to commit to an extra £8bn funding sought by NHS England chief executive Simon Stevens. They backed the principles of The NHS Five Year Forward View, which looked at the looming cost pressures facing the NHS, claiming it endorsed their current political positions, but shied away from an extra commitment to extra money above inflation. Liberal Democrat health minister Norman Lamb said there needs to be a “fundamental review” of funding in the NHS. Shadow health secretary Andy Burnham said he could not commit to £8bn at this stage but said Labour’s £2.5bn Time to Care fund, paid for by the mansion tax and a levy on tobacco plans, allied to his plans to integrate health and social care, would get the party on the way to the £8bn.
The Independent says the plan, Five Year Forward View ‘throws down the gauntlet’ to the next Government on the long-term future and funding of the NHS. Focusing on prevention by cutting rates of drinking, smoking and obesity and looking after patients with long-term conditions outside of hospital is expected to save the NHS money. David Bennett, chief executive of Monitor, said if spending on the NHS was not increased it would need to find other ways to survive. He did not rule out charging for hospital stays or GP appointments. Health secretary Jeremy Hunt welcomed the report, saying the NHS could only continue to improve with important reforms, but shadow health secretary Andy Burnham said the report ‘laid bare the inadequacy’ of the Tories’ NHS spending plan.
5. Nearly All Better Care Fund Plans Approved
Ninety-seven per cent of the 151 Better Care Fund (BCF) plans have now been approved, health secretary Jeremy Hunt said at the National Children and Adults Services’ conference, where he provided a progress report on the government initiative.
The Secretary of State’s announcement highlights the Government’s commitment to driving more integrated models of care and recognises the hard work put in by all those involved in developing and agreeing Better Care Fund plans locally. In many areas that the Better Care Fund has acted as an important catalyst, leading to difficult conversations about pooling resources and working collaboratively to transform health and care services for their communities, but it still holds risks for members and the wider health and care system such as the ability of some local areas to achieve the reductions in levels of emergency activity and financial savings that the Better Care Fund requires.
Dr Amanda Doyle, co-chair of NHS Clinical Commissioners, the membership organisation of clinical commissioning groups (CCGs), said “we welcome Jeremy Hunt’s announcement that 146 BCF plans have been approved. It shows that CCGs are working well and in partnership within their local areas. These areas, and the CCGs within them, now need to be given the freedom and space to get on and deliver for their patients and local populations. For the areas that require support or where a plan was not approved, practical support needs to happen quickly to resolve any concerns or local difficulties. “In all of this though, we must remember that a plan is just a plan! Getting approval is just the beginning of the journey. What really matters is that local areas make integration a reality and deliver for their populations.”
6. National Audit Office (NAO) Say Better Care Fund Plans are Overoptimistic
A report from the National Audit Office (NAO) has found that plans to save £1bn for the NHS by reducing unnecessary hospital visits by elderly people are overoptimistic, writes the Guardian. The NAO says that setting up the Better Care Fund will achieve at best a third of that saving. The shortfall is due to overambitious targets and plans to save money from emergency services which will not be realised, it says. The report concludes that one of the programme’s aims – to reduce emergency admissions by at least 3.5% - will be a struggle when such admissions have risen 47% over the past 15 years. The auditors raised concerns that the time available for local bodies to make the necessary preparations for the April 2015 start has been more than halved from 11 months to five after a pause to expand the scope of the fund following initial plans being submitted in April.
7. NHS England Takes Big Steps Towards Patient Safety
NHS England is funding a new national programme to improve the safety of patients and ensure learning sits at the heart of healthcare. The programme will see Patient Safety Collaboratives established which will empower patients, carers and staff to highlight, challenge and implement local improvements in patient care.
8. EU-USA Trade Agreement TTIP Backlash: NHS Needs Protecting From US Trade Deal, Says Labour
Speculation has been rife recently about the possible impact on healthcare and a range of other public policy areas of the Transatlantic Trade and Investment Partnership (TTIP) agreement currently being negotiated between the EU and the USA. Concern about the NHS has focused on the fear that such an agreement could open the NHS ‘market’ to American companies, leading to widespread privatisation of services and possibly damaging consequences for patient care. Private firms could take over the health service under TTIP, claim critics.
Supporters of the proposed agreement focus on the benefits to UK citizens and businesses of removing unnecessary trading barriers so that the UK can more easily export our products and expertise (such as in pharmaceuticals, innovative treatments and devices) to the USA, and in return be able to access the best they have to offer. A more integrated transatlantic marketplace could foster economic growth, create jobs and stimulate fruitful collaboration in leading-edge technologies, to the benefit of patients.
As David Cameron and European leaders face a growing backlash against the plans, Labour will demand at the Commons debate on 21st November that the NHS must be explicitly excluded from the controversial trade deal being struck between the EU and the United States.
The Prime Minister argues that the Transatlantic Trade and Investment Partnership (TTIP) could provide a £10bn boost for Britain and has promised to put “rocket boosters” behind efforts to clinch the deal. He has praised the planned agreement as “good for Britain, good for jobs, good for growth and good for the British economy”.
More than 920,000 Europeans have signed a continent-wide petition against TTIP on the grounds it would cost large numbers of jobs, undermine consumer rights and environmental protection, as well as transferring power from elected governments to unelected international business corporations. Similar objections are also being raised against a parallel agreement between the EU and Canada, which is nearing completion.
Supporters of the Europe-wide petition, which has been championed by trade unions and environmental groups, had believed it would automatically trigger a detailed response from the European Commission once it reached the one million mark. However, the Commission has announced it will not take the petition into account in negotiations with the US. Signatories are now threatening to take the Commission to the European Court of Justice over the issue.
9. Implementing the EU Public Procurement Directive in the UK
The NHS European Office will respond to the Cabinet Office consultation on the draft Public Contracts Regulations 2015, which will implement domestically the new EU Public Procurement Directive. The Regulations are of great importance to all NHS organisations and in particular to commissioners, as they will introduce a new ‘light touch’ regime for the procurement of clinical services, which will sit alongside the NHS Procurement, Patient Choice and Competition Regulations (s75 regulations).
The NHS European Office has produced a briefing on the new Directive on procurement and its implications for NHS commissioners and providers.
Key provisions in the new Directive include: New regime for health service contracts Derogation from the rules for forms of cooperation between public bodies Preventing conflicts of interest Market consultation and more access to negotiation Procurement of innovation Strategic use of public procurement
10. NHS England Publishes Never Events Policy Framework Review Consultation
NHS England published the Never Events Policy Framework Review consultation, which closed on 31st October 2014. The purpose of the consultation is make it is clearer as to what needs to be done, and by whom, to prevent never events. Part of the review will also consider financial penalties for never events, and how this might be included in the NHS Standard Contract for 2015/16.
The review is focusing on five key issues: the purpose, definition, list of, management, and application of learning from never events. The overall aim of the review is to keep patient safety as a focus for action, and to foster a culture which aims to share learning and improve, rather than to blame and penalise.
11. CQC Regulatory Fees Consultation
The CQC is consulting on the fee level, which is increasing in general by 9%, for providers in 2015/16. The consultation also describes its initial plans regarding the fees consultation next year. The CQC expect to publish their response and final fees scheme in March 2015, for implementation on 1st April 2015. If you would like to contribute to the response please provide comments to S. McAskell by 20th December.
12. NHS Pension Scheme Draft Regulations 2015
The Department of Health has published a consultation on the instrument that will provide the legal basis for the 2015 pension scheme. Transitional measures for members of previous schemes will be published for consultation in early November. If you would like to respond please contact the Department of Health directly by 5 December.
13. FTN to Become NHS Providers
The FTN is changing its name to NHS Providers, with the strapline of the association of foundation trusts and trusts. Nick Samuels, director of communications, said: “We decided to make this change, following extensive consultation with FTN members, staff and stakeholders”. He added: “Our research clearly demonstrated the need and desire for a new name and branding which would both encompass our important heritage and more accurately reflect what the FTN and its members do today. NHS Providers was the selected candidate from a wide-ranging naming exercise and expresses in a simple, direct way the focus of the association”.
14. Troubled CCGs Could Face ‘Special Measures’ Regime
A "special measures" regime could be introduced for clinical commissioning groups with severe problems under plans being considered by NHS England. The adoption of the term is under consideration as part of an overhaul of the CCG assurance regime, with its use being seen as a way to acknowledge that some CCGs also have major performance, finance or quality problems, and to create greater impetus for them to improve. Commissioning sources estimate there are between 10 and 12 groups that could face “special measures” if the plan is adopted. Under the current assurance framework, CCGs are rated as “assured”, “assured with support” or “not assured”. The ratings do not identify which CCGs have serious problems. An NHS England document said using the term “special measures” would be “consistent with the rest of the NHS” and "gives a way of identifying those CCGs who want or need additional support”. Senior sources said plans remained under discussion and no final decisions had been made.
15. Spending on Private Ambulances Soars
Freedom of Information requests have disclosed that spending on private ambulances by the NHS has almost doubled in just two years, as the overall budget for private ambulances in England leapt from £37 million in 2011/2012 to £67.5 million last year. The most dramatic increase was in London, where spending was up by 1,000 per cent from £796,000 to more than £38.8 million. The figures also revealed that spending quadrupled in Yorkshire and the North East, reaching £3.6 million and £2.9 million respectively, while it rose by 143 per cent on the South East Coast to reach £13.7 million. NHS England is currently conducting a review of emergency services, including “new models of care for ambulance services.” A Department of Health spokesman said: “Use of the private sector in the NHS represents only six per cent of the total NHS budget, an increase of just one per cent since May 2010”.
16. Data Quality Standards to be Published by October 2015
NHS England’s information director has acknowledged trusts will need “incentives” as well as “consequences” to encourage them to hit new national standards for information technology. Tim Kelsey spoke to HSJ as the pan-NHS National Information Board set out plans to give regulators a role in taking action against trusts that were missing the proposed targets. The board’s strategy document revealed the new data quality standards would be published next October, and trusts would be regulated against them from April 2016. However, Mr Kelsey said details of what sort of regulatory action might be taken still needed to be worked out. The strategy also reveals that Health Education England will outline a new informatics training programme by April 2016.