Northumberland, Tyne and Wear NHS Foundation Trust. Council of Governors Meeting. Paper for Debate, Decision or Information: For information

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1 Agenda item 7) Northumberland, Tyne and Wear NHS Foundation Trust Council of Governors Meeting Meeting Date: Thursday 12 November 2015 Title and Author of Paper: Chief Executive s Report John Lawlor, Chief Executive Paper for Debate, Decision or Information: For information Why is this paper coming to the Council of Governors? To make the Council of Governors aware of any national, regional, local and Trust issues. What will happen as a result of the Council of Governors contribution? Any contributions by the Council of Governors will be considered at today s meeting. 1

2 Chief Executive s Report November 2015 National issues 1. Monitor Quarterly Report The Quarterly Report by Monitor on the performance of the Foundation Trust sector showed that the 151 licensed NHS Foundation Trusts recorded a net deficit of 445m for the three months to the end of June NHS Foundation Trusts generated a deficit of 445m, offset by a gross surplus of 40m at 33 Trusts. This shows a sector in significant financial distress, and while measures such as stretch targets for individual organisations and the introductions of caps of agency costs will have some impact, this is unlikely to be to a significant degree in 2015/16. In terms of operational performance, the sector struggled in meeting a range of indicators. In the mental health sector 25 of the 43 NHS Foundation Trusts were in deficit, with the sector generating a net surplus of only 7m. However, mental health continues to perform relatively strongly with an aggregate EBITDA of 4.6%, and being the only sector to deliver a net surplus. Four Mental Health Foundation Trusts have a red rating for governance. Overall the sector performed better in terms of delivery against the four standards by which they are measured under Monitor s current code. At the end of quarter 1 nine mental health Foundation Trusts reported breaches against at least one of the standards. 37 Foundation Trusts were subject to regulatory action as at the end of September, and nine new investigations were launched in the quarter. Two day visits were made to 47 Foundation Trusts in response to annual plans. Non-Foundation Trusts reported a deficit of 485m in the quarter. With Clinical Commissioning Groups now forecasting a surplus for the year of 358m this looks like a very challenging year from a financial perspective. 2

3 2. Agency Nurse Cap The cost of temporary staffing, particularly for nurses and doctors, presents a challenge for most Trusts. Fundamentally, this is because there is a supply gap across many professional groups in the system. The supply gap can be attributed to a number of issues including workforce planning, attrition rates in training and a post-francis rise in required nursing numbers. In some regions of the country shortages of supply are even more pronounced. Monitor have highlighted that Trust spending on agencies has increased to the extent that it is one of the most significant causes of deteriorating Trust finances and evidence suggests it can be linked to quality concerns. Monitor has introduced an annual ceiling for total nursing agency spending for each Trust, and mandatory use of approved frameworks for procuring agency staff. Following the guidance issued by Monitor in August 2015, NTW have reviewed the levels of nursing agency spend and are within the 3% threshold, however overall agency spend across all groups of staff is 3.6%. The price cap rules apply to nursing agency spend only, with rules on spending on other agency staff to follow shortly. The annual ceilings are for nursing agency spend as a percentage of total nursing staff spend. The ceilings set depend on Trusts 2014/15 nursing agency spend percentage of their total nursing staff spend. Trusts are expected to provide a monthly profile of the planned nursing agency spend that enables it to achieve its ceiling for October 2015 to March Trusts will be held to account on a quarterly basis for meeting their ceiling in that year. In assessing value for money, Monitor is likely to look at the extent to which Trusts have followed good practice. In addition from 19 October 2015, Trusts subject to this agency spending rule will have to secure nursing agency staff via framework agreements. This rule is designed to bring: Greater transparency on nursing agency spend. Greater assurance on quality of nursing agency supply. Control on cost of nursing agency spends. 3

4 NTW is actively recruiting to the Trust; it is currently compliant with the cap and framework arrangements. We will continue to measure performance against this target at Clinical Care Group level and via the Trust-wide Bank and Agency Review Group, Chaired by the Executive Director of Nursing and Operations. 3. Junior Doctors Contract Negotiations Since 2013 NHS Employers has been negotiating a new contract for junior doctors in training with the British Medical Association (BMA). Concerns had been raised that the 13 year old contract was no longer working as well as it could for NHS Employers, doctors and dentists in training and patients. Heads of Terms were developed in October 2014 but the BMA walked away from negotiations due to concerns about the proposed new contract. The BMA subsequently released its ten reasons why they could not agree to the new contract. In September 2015, NHS Employers proceeded to set up meetings directly with junior doctors to seek their views on the proposals but these meetings were postponed due to the new Chair of the BMA Junior Doctors Committee accepting an invitation to meet personally with Jeremy Hunt. Following this meeting a number of concessions and reassurances have been offered in an attempt to restart negotiations. The BMA responded on 12 October 2015 setting out the terms on which they would re-enter negotiations, predominantly about the need for a safe contract and now await a response. On 4 November 2015, a new offer was made to the juniors and Trusts have been asked to engage with their junior doctors ensuring that the offer is understood and a range of materials have been made available via NHS Employers to support local discussions. Plans are underway to do this with a task and finish group established to oversee and manage the impact of any industrial action. The BMA will be holding a ballot for industrial action with the junior doctors and the results of this will likely be known towards the end of November. Our Executive Medical Director and Director of Medical Education have met once with some of our 126 junior doctor workforce and it is likely further meetings will be needed. The Corporate Decisions Team have considered a detailed paper on the whole position and short, medium and long term risks. Operational 4

5 services are considering possible impact on service delivery and out of hours on call issues, should any industrial action be instigated. A helpful NHS Employers fact sheet is available via and%20reward/junior-doctors-contract-factsheet.pdf and a number of questions and answers are set out on their web site Regional issues 4. Update on Vanguards The Five Year Forward View for the NHS introduced the concept of developing a number of new models of care and testing them across the country. The test sites were to be called vanguards, essentially with the purpose of setting up and working with these new models to enable lessons to be learned for other areas of the country to subsequently develop their own models. The models to be tested were: Multi-specialty Community Providers - essentially bringing together provision of care in the community, built around and supporting primary care services. Primary and Acute Care Systems - directly integrating the provision of hospital, community and primary care. Solutions for smaller hospitals - looking at ways in which smaller hospitals could work together to ensure they were sustainable for the future. Integrating care around care homes - looking at developing better integrated care for the elderly and frail. Since the initial publication a further vanguard model looking at urgent and emergency care systems on a regional scale has also been announced. A number of vanguard sites have been supported across the country and NTW are involved in four in Sunderland, Gateshead, Northumberland and an urgent and emergency care vanguard across the North East. This puts us in a good position to influence the local and national agenda, but also brings significant challenges in terms of capacity. We have developed locality teams involving Executive and 5

6 Group Directors, Clinicians and managers to ensure that we have a coordinated approach in each locality. Sunderland are testing a multi-specialty provider model and have set up an integration board to oversee its development. This is chaired by South Tyneside Healthcare NHS FT who provide community services in the area, but has representation from NTW, City Hospital Sunderland NHS FT, the Local Authority and Clinical Commissioning Group (CCG). The aim is to develop an integrated model of community care delivery based around five GP localities. It is not currently proposed that there will be any change to organisational structures, but changes to commissioning and contracting and care delivery to ensure that services are wrapped around the needs of patients. To support this the CCG and Local Authority have agreed to pool funding for all community services across health and social care. Gateshead are testing a model integrating care around care homes, looking specifically at the elderly and frail population in Gateshead. The concept is to create virtual wards in care homes and the community, with effective medical nursing and social care input to detect deterioration early, intervene more quickly and to prevent hospital admission and to enable people to move on quickly from hospital admission. The Trust are involved in the steering group, which has recently been re-constituted. Northumberland are exploring the development of an Accountable Care Organisation, with a proposal for Northumbria Healthcare NHS FT to take over commissioning responsibilities from the CCG, and to be the system leader in creating integrated health and care services. They already have delegated responsibility for Social Care funding, which was transferred on the dissolution of Northumberland Care Trust. NTW have raised a number of concerns about the level of engagement to date and the measures in place to ensure parity of esteem for those living with mental health learning and neuro-disability conditions. These discussions continue at a local and national level, but the Trust is committed to working with all partners to develop an integrated approach to care across Northumberland, within an accountable care system. This development is moving at pace and is currently proposed to operate in shadow form from 1 April Urgent and Emergency Care Vanguard as reported to the Council of Governors last meeting, the North East bid for an urgent and emergency care vanguard, looking at the development of an integrated approach supporting a population of 2.61m people was 6

7 supported and will now be moving forward to implementation. Mental health features prominently in the bid and work is now ongoing on developing the approach across the region. The Trust is working to be an integral part of all of these vanguards to ensure that the interests of the people that we serve are equally met, and to ensure that we take the opportunity to break down the barriers between mental and physical health care, which result in poorer life expectancy and poorer health outcomes for the people that we support. There are strong indications (from Simon Stevens, Chief Executive of the NHS) that next year all health and care systems will be required to develop integrated plans for delivering sustainable provision and better outcomes over the next five years. It is essential that our organisation plays a critical part in the development of these plans, and we will keep the Council of Governors informed of progress. 5. Newcastle Academic Health Partners As previously reported NTW has joined with Newcastle University and Newcastle Hospitals NHS Foundation Trust in a formal partnership called Newcastle Academic Health Partners. This partnership has been meeting since March 2015 and was launched in the local press on Friday 9 October The partnership aims to harness worldclass expertise, ensuring patients in the region benefit sooner from new treatments and earlier diagnoses and hopes to deliver pioneering healthcare through scientific research, education and patient care. The new alliance will be focusing on leading the way in scientific advances to tackle common diseases such as dementia. It will also specialise in improving understanding and treatment of cancer, diseases that affect the brain and those affecting children. The partnership has a web presence which links to partners organisational websites, and has also published a brochure providing some case studies. A copy of the brochure can be made available on request via the Chief Executive s Office. Trust issues 6. Staff Survey The staff survey has been distributed to all staff to enable the Trust to get the maximum amount of feedback from our workforce about what it feels like to work in NTW. It also provides the Board and leaders 7

8 across the Trust to engage with staff in supporting them to deliver the best services possible, especially in these challenging times for the NHS. 7. Community Transformation Update Over the summer months, work has been underway to finalise the community transformation plans for Northumberland, North Tyneside, Newcastle and Gateshead. This includes proposed plans on all the pathways that we provide which include non-psychosis, psychosis, older persons services and learning disabilities. It is anticipated that the roll out for the new staffing structures will commence in April 2016, and will be fully operational with the correct staffing numbers by the end of March This gives a period of months to work towards the new staff skill mix in line with our workforce plans. This approach has been agreed following the lessons learned from the introduction of new pathways in Sunderland and South Tyneside. Formal staff consultation for Allied Health Professionals started on 12 October 2015 and a wider staff consultation for other community staff commenced on 9 November The rationale for the Allied Health Professionals consultation being carried out separately is that some Allied Health Professionals staff cover both inpatient and community services. Other workstreams include estates and accommodation; integration within each locality; and admin support. In Sunderland and South Tyneside, the Initial Response Service (IRS) has made good progress and patient flow has significantly improved. This service has gained national attention as a new and effective way of supporting access into mental health services. The IRS along with their consultant colleagues in local community teams are also piloting the concept of Virtual Multi-disciplinary Teams (MDT). This means that community consultants are able to join the IRS MDT by video conference. They are finding that this approach is more flexible and saves valuable time that would otherwise be spent travelling. It means that community consultants are able to provide support to IRS for those new patients who have recently accessed NTW services, getting them onto the right pathway to meet their needs 8

9 as quickly as possible. It is hoped that psychology and other disciplines will be able to join the virtual MDT in due course. 8. Positive Practice Awards On Wednesday 14 October 2015 the Trust hosted the national Positive Practice in Mental Health Awards in Gateshead. The awards are organised annually by the multi-agency patient led Positive Practice Mental Health Collaborative and we were pleased to provide sponsorship for the first time this year to enable the awards to be staged in the North East. We had six of our services shortlisted for awards at the event. 9. Governor Elections Governor roles will become vacant on 30 November 2015 and the election process commenced on 29 September At the deadline for submission of nominations 9 of the 15 vacancies have been filled unopposed. There will be 1 election in the Service User, Neuro Disability Services constituency, with a poll closing date of 27 November The remaining 5 unfilled vacancies are 4 Governors in Adult, Learning Disability, Neuro Disability and Older People s Services Carers constituency and 1 Staff Governor in the Medical constituency. It is proposed that a new election campaign commences early in Nominations for the Annual Plan Working Group 2016 The Trust values the contribution the Council of Governors make each year to the development of the Operational Plan and Strategic Plans, including through their membership of the Annual Plan Working Group. The Guidance relating to Monitor s requirements for next years Operational Plan is scheduled to be published in December, following which the Trust will prepare a timetable of tasks to ensure that the Plan is developed and submitted by the specified dates. As in previous years an Annual Plan Working Group will be established to include representatives from the Council of Governors. Fiona Grant has already expressed an interest in joining 9

10 the Group and further nominations from the Council of Governors are invited for the Annual Plan Working Group The first meeting of the Group is likely to be in January. John Lawlor Chief Executive November

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