THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST
EXECUTIVE REPORT – COUNCIL OF GOVERNORS
1. Executive Team
Particular attention is drawn to:
i) Service level performance trends.
ii) Management of the PFI estate and all this entails.
iii) Impact of national reach-in/directives and the correlation with Sustainability & Transformation Fund (STF) “footprints” linked to Strategic Transformation Plans (STPs) embracing designated population catchment areas from the perspective of a successful, progressive NHS Foundation Trust.
iv) Paediatric Cardiac and Adult Congenital Heart Disease: NHS England Standards Compliance Assessment and the implications for Newcastle upon Tyne as a leading national centre.
v) Sustaining financial stability without recourse to national ‘crisis’ interventions/funding and the knock-on consequences that arise from such facilitation.
vi) The National Institute for Health Research – Biomedical Research Centre (BRC) Competition and submission for international panel assessment to secure a further five year designation and all this entails in relation to the Newcastle BRC: Ageing and Long Term Conditions. An international panel assessment was held on 19th July 2016 as part of this Newcastle University/Newcastle upon Tyne Hospitals NHS Foundation Trust joint endeavour.
vii) The NHS Improvement requirement to consolidate ‘Back Office’ and Pathology Services and also facilitate reprovision of ‘Unsustainable Services’ via the evolving STF/STP settings and initiatives.
viii) Preparation of the ‘Review of the Year’ incorporating the Annual Report & Accounts 2015/16.
ix) Addressing the risks/benefits of the future strategic/operational status of The Newcastle upon Tyne Hospitals vis à vis the NHS Forward View; NHS Improvement modus operandi; as well as a range of ever evolving agencies and groupings with all this entails.
x) Ongoing collaboration with Gateshead Healthcare NHS Foundation Trust.
xi) Ongoing actions to firm up the next phase(s) of redevelopment of the Royal Victoria Infirmary site and in particular the Multi-storey car park.
xii) Refresh of Education and Training in the North East and North Cumbria.
2. Key Impact Documents/Statements from Government/Regulators/Advisory Bodies/ Others
(i) 2016/17 Financial Position (NHS Improvement)
The following directive has been served on Chairs and CEOs of both Foundation Trusts and NHS Trusts, being disclosed in the as presented format for ease of reference and understanding:
The Chairman shall lead debate on the overall scenario of efficiency and affordability in the context of the direction adopted by NHS Improvement.
(ii) NHS Identity Policy (NHS England)
NHS England has undertaken two phases of ‘robust research and deep engagement’ to try to ensure that the updated NHS Identity Policy is ‘fit for the future and meets the needs of both patients and the public and users’.
It is advised that ‘diversity is creating confusion’ and ‘where the public see alternative logos it causes confusion and concern’.
Examples are provided as to where it is considered there is “confusion and concern” and a “public perception of fragmented and inconsistent services, variable and falling standards, or privatisation”.
Examples of what patients/public are looking for are also provided – citing “the NHS Identity applied in a consistent and uniform way – it reassures them that they can rely on the quality of service being provided”.
In essence the policy is mandatory for all NHS organisations and others commissioned under the NHS Standard Contract.
In addition:
· Third party providers must apply the NHS Identity to information relating to the NHS services they provide and
· Primary Care Contractors are encouraged to use the ‘Providing NHS services’ logo, whilst it is not a contractual requirement – but ‘may be in future’.
The new NHS Identity Guidelines website is to be launched at the end of July into August 2016. It is stressed that all new communications after this date must adhere to the policy with digital and online channels such as websites and social media sites granted a year to be updated. There is no requirement to retrospectively change offline existing materials.
An Identity Helpline shall provide further practical guidance and the NHS England Identity Team can be approached to address ‘very specific or complex queries’.
An update shall be given at the meeting.
(iii) Long-term Sustainability of the NHS
The House of Lords Committee on the long-term sustainability of the NHS held their first public evidence session (12th July 2016) with the following witnesses: Mr Graham Duncan, Deputy Director for Care and Reform, Department for Communities and Local Government; as well as Mr Andrew Baigent, Director of Finance; Dr Edward Scully, Deputy Director, Integrated Care; Mr Gavin Larner, Director of Workforce; Mr Tim Donohoe, Director, Informatics Delivery Management; and Mr Mark Davies, Director, Health and Wellbeing – all from the Department of Health.
Key points of note include Mr Larner indicating Health Education England’s commissioning will be exploring the need to train specialists who are “flexible and able to adapt to meet new technologies and circumstances to make services more sustainable”. In addition, Mr Donohoe added that “digital maturity across the system is a Department of Health priority and leaders need to be aware and skilled in emerging technologies”.
(iv) General Medical Council – new Chief Executive
The Department of Health’s Director General for Strategy and External Relations, Mr Charlie Massey, has been appointed as the General Medical Council’s new Chief Executive. He will replace the current Chief Executive Mr Niall Dickson, who will be stepping down from the role at the end of 2016 following seven years in the role. Mr Massey was appointed Director General at the Department of Health in 2012 and has served across a number of Whitehall departments including Downing Street.
(v) NHS Specialised Services (Public Accounts Committee)
The Public Accounts Committee published their report and recommendations on specialised services on 15th July 2016 and which serves to warn that the disproportionate growth in spending on specialised services poses a risk to the wider financial sustainability of the NHS. As such, NHS England will need to “make tough decisions” if it is to remain within its budget for specialised services, and set out a series of recommendations, including:
· By October 2016, NHS England should set out publically how specialised services fit within: the NHS Five Year Forward View; £22bn efficiency challenge; and transformation funding.
· NHS England must improve the transparency of its decision-making by publishing a document by September 2016 which clearly outlines the role of its advisory and decision-making bodies.
· By 2017, NHS England should use its enhanced data collection to link spend by: service provided; service quality; patient outcomes; patient experience; and value for money. Of particular interest is the Shelford Group being footnoted with regard to the following statement: “NHS Trusts, including those Trusts providing specialised services, are finding it increasingly difficult to remain financially sustainable – at the end of the third quarter of 2015-16 about 80% of acute hospital Trusts were in financial deficit”.
(vi) Clinical Commissioning: GPs in charge? (Kings Fund and Nuffield Trust)
The King’s Fund and Nuffield Trust jointly published a paper on 12th July 2016 which explores the progress Clinical Commissioning Groups (CCGs) have made in implementing clinically led models, including lessons learnt thus far and recommendations for the future.
Of particular note:
· Three national barriers are identified in limiting effective clinical involvement: lack of autonomy to take decisions to meet local needs; budget and resource restraints; and a lack of support for tough prioritisation decisions.
· Calling upon NHS England to publish a vision for the future of NHS Commissioning which recognises overlapping planning and delivery structures across the country, and the promotion of commissioning as a rewarding career option.
(vii) The Role of Vanguards in the Development of New NHS Commissioning Structures (NHiS)
A new report from NHiS Commissioning Excellence, which helps the NHS plan and commission patient services has published findings that serve to suggest NHS Vanguards are successfully demonstrating the value of re-designing patient pathways and assessing new ways of working. The report is based on a recent advisory panel discussion, organised by NHiS and involving eight different Vanguards, including four multi-speciality community providers, a GP “super practice” and an acute care collaboration.
It shows how some Vanguards have integrated healthcare and social care services, while others have seen GP practices widen their activities to incorporate more specialist roles, or link with other GP services to create “super-practices”.
(viii) Budget Summary 2016 (Association of Director of Adult Social Services)
The Association of Directors of Adult Social Services (ADASS) has released its annual analysis of the state of adult social finances. This is based on the results of their survey which was sent to every Director of Adult Social Services in the 151 English Local Authorities with adult social care responsibility, and provides intelligence on how the sector is responding to multiple challenges of meeting increased expectations and need, whilst managing reducing resources in a fragile provider and labour market.
The report concludes that Social Services Directors are increasingly unclear where the funding needed for social care will come from, and that the quality of care is being compromised as a result of the savings being made.
(ix) Implementing The Five Year Forward View for Mental Health (NHS England)
The implementation plan details a roadmap for delivering on the commitments of the Five Year Forward View for Mental Health, published in February 2016. Central to the implementation plan’s commitments are allocation of funding across elements of the programme – the report details how new funding pledged in response to the Five Year Forward View for Mental Health, rising to £1bn a year by 2020/21 in addition to the cumulative £1.4bn already committed for children, young people and perinatal care, will be made available for CCGs year on year. It also shows how the workforce requirements will be delivered in each priority area and outlines how data, payment and other system levers including investments and savings will support transparency.
(x) Ministerial Reshuffle – Department of Health
− Rt Hon Jeremy Hunt MP
Secretary of State for Health
Retains overall charge of all areas of health policy “with a particular focus on financial control and oversight of all NHS delivery and performance”. Notably taking on formal responsibility for all aspects of mental health and “championing patients”.
· Philip Dunne MP
Minister of State for Health
Portfolio
o Hospital Care
o NHS Performance and Operations
o NHS Workforce
o Patient Safety
o Maternity Care
· Nicola Blackwood MP
Parliamentary Under Secretary of State – Public Health and Innovation
Portfolio
o Public Health
o Health Protection
o Life Sciences
o Innovation
o Data and Security
· Davis Mowat MP
Parliamentary Under Secretary of State – Community Health and Care
Portfolio
o Adult Social Care, Carers
o Cancer
o Dementia
o Learning Disabilities
o All elements of Primary Care – including Dentistry and Pharmacy
o 7-day Services
o Overseeing Allied Health Professionals
− Lord Prior of Brampton
Parliamentary Under Secretary of State – Health for NHS Productivity
While Lord Prior remains as a Health Minister, his portfolio has been substantially changed from his previous focus on NHS productivity.
New Portfolio
o Cancer Drugs Fund
o Migrant Access to the NHS
o NHS Commercial Issues
o Blood and Transplants
· Note: new appointments.
It is also to be noted that George Freeman MP, previously Parliamentary Under Secretary of State for Life Science & Innovation has become the Chair of the Prime Ministers Policy Board at Number 10 albeit with no replacement announced.
(xi) Durham University’s School of Medicine, Pharmacy and Health
Arising out of extensive consultation with school staff and students, Durham University has agreed to tranfer its School of Medicine, Pharmacy and Health to Newcastle University. The transfer has been approved by both Governing councils and shall see relocation of the School from the Stockton campus to Newcastle as of the start of the 2017/18 academic year.
A Project Board, Team and Working Groups are being established to manage the transition of Durham’s staff and students.
(xii) Strengthening Financial Performance & Accountability in 2016/17 (NHS England/NHS Improvement)
Received on 21st July 2016 and serves to inform and set out action to (a) stabilise NHS finances in 2016/17 (b) provide further detail on access to the Sustainability and Transformation Fund (STF) in 2016/17 (c) outline the proposed basis for assessing the financial performance of provider organisations and (d) introduce
new programmes of financial special measures for both providers and commissioners that are unable to ensure sufficient financial discipline.
An ‘accelerated process of two year integrated planning, designed to build on both the financial recovery to be achieved in 2016/17 and the collaborative transformational strategies being developed through Sustainability and Transformation Plans (STPs) in 44 local health economy footprints’ is most distinctly promulgated.
In addition the actions being promoted are considered to “complement a wider set of existing measures to support the NHS in achieving financial Sustainability, including”:
− setting financial controls for each and every provider and Clinical Commissioning Group (CCG).
− rigorous implementation of tighter agency controls.
− accelerated deployment of Right Care to all health economies during 2016/17.
− national action to implement the Carter recommendations on operational efficiency.
− the creation of efficiency improvement and intervention capability within the NHS Improvement domain.
− transformational efficiency programmes being developed through STPs.
The full document does require Board level consideration in the context of the extant trading position and the STP/STF scenarios ie over and beyond the envisaged 2016/17 ‘financial reset’ and the intended ‘transformation footprints’ encompassing Final STP Delivery Plans (October 2016) across the 44 population catchments that shall in turn secure by the end of December 2016 provide greater certainty and stability for the coming two years hence included for ease of reference and deliberation under Agenda Item B3(vi).