4 CM/11/14/04 Chief Executive s report to the Board

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1 Meeting PUBLIC BOARD MEETING Date 19 November 2014 Agenda item Paper Number Item title Sponsor Author 4 CM/11/14/04 Chief Executive s report to the Board Chief Executive Naomi Paterson PURPOSE OF PAPER: This is a paper for the Board to note. Introduction The report this month provides an update on the following matters: CQC updates: 1. Values 2. Update on recruitment 3. Update on Staff Development and the Academy 4. Financial forecast 5. Update from the Primary Medical Services and Integration Directorate 6. Update from the Adult Social Care Directorate 7. Update from the Hospitals Directorate Wider health and care sector updates: 8. Regulations 9. NHS England s Five Year Forward View report 10. One year on from Hard Truths 1. Values As I noted in my report last month, the new CQC values and behaviours were launched on 1 October October was a period of reflection, a time to discuss and absorb the new values. An information pack was also sent out to line managers, to prepare for discussions within teams. This month we have begun on the work to embed the values in the organisation, bringing each value to life through a series of events. At the time of writing, the focus this week is Caring (10-14 November), which has followed on from Excellence (3-7 November), which included Page 1 of 6

2 a talk from David Macleod entitled Engaging for success. Integrity and Teamwork will follow for the remaining two weeks of this month. CQC s values and behaviours are a key part of the corporate induction for staff. 2. Update on recruitment CQC has invested in building the capacity and capability of the internal recruitment team and we have already started to take back some of the work that Penna were previously delivering on our behalf. We continue to review the attraction and assessment strategies with each of the Directorates and will adopt a more bespoke approach to reflect the specific requirements of each sector. Staff are under considerable pressure in responding to an increased volume of safeguarding alerts and concerns, coping with a high level of vacancies and delivering the new style inspections. However, inspectors and their managers are reporting that the new approach is much better and enabling them to do a much more thorough inspection. Feedback from providers has also been positive - they have valued the rigour and thoroughness of the inspection. Current recruitment for inspectors The campaigns for mental health and acute hospital inspectors continue to run. CQC has launched further attraction for Mental Health Inspectors this week, with a letter from Paul Lelliott, Deputy Chief Inspector, to appropriately targeted organisations and some further advertising. These campaigns will run until 7 December 2014, in line with the Penna service end date. Assessments for both roles are now managed and delivered by the in house recruitment team, rather than Penna. To date, 25 mental health inspector offers have been made and accepted (23 permanent offers, two secondees), seven acute hospital inspector offers made and accepted (all secondments), and a further 170 candidates for acute hospitals who are currently in the assessment process - assessments continue throughout November, December and into the New Year. CQC has also launched four further campaigns this week (Monday 10 November): 1. For Primary Medical Services inspectors, a letter has gone out from Steve Field to the Practice Nurses and Practice Managers on CQC s list of Specialist Advisors. 2. There is focused work to attract Children s Services Inspectors, utilising Deputy Chief Inspector networks including NHS England and Royal Colleges. 3. A targeted letter has gone out to local authorities and other organisations in the geographical areas with the biggest recruitment gaps for adult social care inspectors. 4. Likewise for Registration Inspectors, CQC has targeted organisations in those areas with the biggest deficits These campaigns will run until 7 December, when the Penna service provision is due to end, ready for contract award to new suppliers on 10 December Assessments for these roles will begin the week of 5 January Page 2 of 6

3 Arrangements are underway for the new function of market oversight for corporate adult social care providers to be in operation from April Intelligence Recruitment From the end of March this year, CQC has been running volume recruitment campaigns for Senior Analysts and Analyst Team Leaders. Recruiting to these roles has been challenging 22 Senior Analysts (of 50 posts) and 15 Analyst Team Leaders (of 26 posts) have been recruited so far. Further work will take place in the New Year with our new suppliers on creative strategies including social media campaigns and other targeted routes. 3. Update on Staff Development and the Academy Relevant staff will be trained on the duty of candour and fit and proper person requirement before 27 November 2014, when those requirements come into force for NHS bodies (as noted in item 8 below). Guidance on the requirements being introduced in the fundamental standards regulations (including the fit and proper person requirement and the duty of candour for all sectors), training and support for staff is being developed, and training for staff across CQC. New inspection staff continue to complete their six week role-specific induction. Current inspection staff have also been undertaking methodology training relevant to their directorate at the time of writing, approximately 40 further staff are required to undertake this training for adult social care, and 20 for primary medical services. 4. Financial forecast The current financial position and forecast is reported to CQC s Executive Team and Board via the performance report, and to the Audit and Corporate Governance Committee (ACGC). At the October Board meeting, discussion took place over the financial commitments that are in place for the remainder of 2014/15. An action coming out of this was for ACGC to consider the re-forecast at its next meeting to assure itself that the schedule of planned expenditure was appropriate. For the 6 months to 30 September 2014, CQC is 7.9m underspent on the recurring revenue budget. CQC s Finance team have broken down the forecast, showing: the current run rate of spend (factoring assumed recruitment timescales) - this projects to a 15.6m underspend; the commitments that exist either as a new priority or work that was budgeted in the second half of 2014/15, increasing the current run rate - these equates to 9.8m of identified financial commitments; and the financial forecast for the year, taking the current run rate and known commitments: this is projected as a 5.8m underspend. ACGC has reviewed the financial commitments and noted that these are expenditure items which were originally included in the business plan, or new emerging priorities which utilise the underspend in other areas. ACGC have Page 3 of 6

4 reviewed the financial commitments at their November meeting and noted the contents. ACGC have suggested that future reporting of commitments is shown as a value range rather than a firm figure (unless known) which will be factored into future reporting. ACGC also reviewed the contract position for the commitments, noting that the main new contract would be for the future recruitment campaign. It is recommended that the Board note the current financial position which will be refreshed and reported on a rolling monthly basis. 5. Update from the Adult Social Care Directorate The new inspection approach for adult social care has now been rolled out since 1 October Training for all staff has been delivered with arrangements made for those staff who have not been available due to long term absence. We have started to publish our first ratings from the Wave 2 inspections. As at 11 November, 32 services were rated as good; 11 as requires improvement; and 5 as inadequate. Given that this is such a tiny sample of the 25,000 locations in adult social care it is too early to draw any firm conclusions from these early reports. Andrea Sutcliffe together with Rachael Dodgson (Head of Adult Social Care Policy), the Deputy Chief Inspectors and other members of the team, an extensive programme of engagement continues to explain the new methodology and start work on other areas, for example special measures and supported living. 6. Update from the Primary Medical Services and Integration Directorate Intelligent Monitoring for GPs On 1 October 2014 we began our new approach to inspecting GP practices. As part of that approach, and in line with our commitment to transparency, on 17 November we will launch our intelligent monitoring tool, which helps our inspectors to prioritise when, where and what they will focus on when they inspect. This tool draws on existing national data sources (such as the Quality and Outcomes Framework and the GP Patient Survey), and includes indicators covering a range of GP practice activity and patient experience. Based on 39 indicators, each GP practice will be categorised into one of six priority bands, with band 1 representing the highest priority for inspection. Good and outstanding care Since 1 October, we have found many examples of good and outstanding care being provided by GP practices. The reports for two outstanding practices Irlam Medical Practice and Salford Health Matters will be published on 17 November. 7. Update from the Hospitals Directorate Trusts inspected to date Page 4 of 6

5 77 of 160 acute trusts have now been inspected, 16 of 56 mental health trusts, 11 community health services trusts and two ambulance services (North West and South Central). We have also now completed our first independent health care provider inspections; Spire Southampton Hospital, The London Welbeck Hospital, Baddow Hospital and Spire Wellesley Hospital. Mental Health Intelligent Monitoring Mental Health Intelligent Monitoring is due to go live on the website 20 November. This will enable the public to see our list of tier one indicators which are used to prioritise our inspection planning, in addition to knowledge from operations and information from other stakeholders such as Monitor and the Trust Development Authority. Concerns Ten never events have been reported at Colchester NHS FT since our inspection in May, but these were not reported to us. An unannounced responsive inspection has been undertaken. The Chief Executive of Heart of England NHS FT resigned on 11 November. Separately, CQC is following up concerns related to A&E and management issues. 8. Regulations The House of Lords debated the new regulations setting out the fundamental standards of care on 5 November - a delay to the original date on 23 October owing to Lord Hunt of King s Health tabling a motion of regret. Following the debate, Lord Hunt withdrew his motion and the regulations were cleared. The regulations were published on 11 November, with the duty of candour and fit and proper person regulations to come into force for NHS bodies (NHS trusts, Foundation Trusts and in specific cases, special health authorities) on 27 November. Guidance on the fit and proper person requirement and duty of candour is discussed separately on the agenda. The new regulations will come into force for all care providers on 1 April The regulations are available here: 9. NHS Five Year Forward View Report On 23 October the NHS Five Year Forward View report was published, setting out what actions the NHS should take over the next five years to make sure that everyone receives high-quality care and that their health needs are met. Among other things, it calls for services to work more closely together, including between general practices and hospitals, health and social care, and physical and mental health, so that the NHS is truly person-centred. As the regulator of health and adult social care services across England, we support this vision for improvement. As set out in the State of Care report published last month (available, with an infographic, on CQC s website: Page 5 of 6

6 CQC s inspections are continuing to tell us that there is too much variation in the quality and safety of health and adult social care. The Five Year Forward View for the NHS sets out how the service needs to evolve, so that the needs of patients can be met and so that the care gap can be closed. Implications for CQC are primarily continuing to work with others on the delivery of the Forward View and ensure that quality regulation enables transformation, and, in particular, contributing to taking forward actions on how across the system providers can improve quality and reduce variation of quality. The report is available on CQC s website: F 10. One year on from Hard Truths In the coming weeks the Government will be publishing its one year on update from the Hard Truths report. Hard Truths: the journey towards putting patients first, published on 19 November 2013, was the Government s response to the final report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, chaired by Sir Robert Francis QC, and set out how system partners, including CQC, would work together to respond to the report s recommendations. CQC has contributed to the one year on update, which will take the form of a narrative report plus an update against each of the 290 recommendations in the Francis Report. The Board is asked to note these items. Name: David Behan Title: Chief Executive Date: 11 November 2014 Page 6 of 6

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