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.