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WEST MIDLANDS AMBULANCE SERVICE NHS FOUNDATION TRUST REPORT TO BOARD OF DIRECTORS MEETING. AGENDA ITEM 07 MONTH January 2016 PAPER NUMBER 04

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WEST MIDLANDS AMBULANCE SERVICE NHS FOUNDATION TRUST REPORT TO BOARD OF DIRECTORS MEETING AGENDA ITEM 07 MONTH January 2016 PAPER NUMBER 04 Title Sponsoring Director Author(s)/Presenter Purpose Previously
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WEST MIDLANDS AMBULANCE SERVICE NHS FOUNDATION TRUST REPORT TO BOARD OF DIRECTORS MEETING AGENDA ITEM 07 MONTH January 2016 PAPER NUMBER 04 Title Sponsoring Director Author(s)/Presenter Purpose Previously Considered by Executive Summary Chief Executive Officer s Report Chief Executive Officer Dr Anthony C Marsh QAM Chief Executive Officer This report provides an update from Chief Executive on national matters and an update on key issues within the organisation as listed under the Executive Summary Not Applicable, except for items and actions arising from the Executive Management Team. This report includes: 1. Review of the Trust Performance Dashboard 2. Board Assurance Framework Version 6 3. NHS England Emergency Preparedness, Resilience and Response Framework November 2015 (Version 2) 4. Care Quality Commission New Certificate of Registration 5. Delivering the Forward View: NHS planning guidance 2016/ /21 6. NHS nine 'must dos' during NHS Providers Summary reports 8. Machinery of Government Change Fire and Rescue Policy transfer to Home Office 9. Letter from Jim Mackey and Sir Mike Richards about how we're working together to support you /16 Outturn and 2016/17 Plan including Sustainability and Transformation Fund 11. New framework arrangements to tackle agency costs and support staff back into substantive and bank roles Monitor and Trust Development Authority 12. Chief Executive Officer Meetings Related Trust Objectives / National Standards Strategic Objectives: Achieve Quality and Excellence Accurately assess patient needs and direct resources appropriately Establish our market position as an emergency healthcare care provider Work in partnership Page 1 of 10 WEST MIDLANDS AMBULANCE SERVICE NHS FOUNDATION TRUST REPORT TO BOARD OF DIRECTORS MEETING AGENDA ITEM 07 MONTH January 2016 PAPER NUMBER 04 It is clear that the NHS is facing financial challenges, and the Trust needs to ensure it has robust arrangements in place to meet it financial targets and obligations in line with its strategy direction. Risk and Assurance Legal implications/regulatory requirements Financial Planning Workforce Implications Assurance can be provided through discussions and evidence provided at the Board of Directors through its pillar committees. The Board Assurance Framework and three Significant Risks cover many of the aspects in this report. No legal advice has been sought or required in the construction of this report. There are no immediate financial planning implications arising from this report, apart from those already in place (budget / CIPs etc) which have been agreed at the Executive Management Board meetings. None in relation to this paper. Communications Issues Equality and Diversity Implications Quality Impact Assessment To ensure relevant items from this paper are communicated as appropriate to internal and external stakeholders. Not Applicable No new QIAs required at this time. Data sources are available from the Chief Executive Officer on request. Data Quality The data quality of some the High risks rated 12 and above is unknown due to many of the risks and assessments lacking a timely review. Action required by the Board: 1. The Board of Directors is asked to receive and note the contents of the paper seeking clarification where necessary. 2. Approve Tony Yeaman as the nominated Emergency Preparedness, Resilience and Response Emergency Officer Non-Executive Director. Page 2 of 10 WEST MIDLANDS AMBULANCE SERVICE NHS FOUNDATION TRUST REPORT TO BOARD OF DIRECTORS MEETING AGENDA ITEM 07 MONTH January 2016 PAPER NUMBER Trust Performance Dashboard The performance dashboard up until December 2015 is shown at Appendix 1 and a verbal commentary will be given at the Board of Directors meeting. There have been a number of minor adjustments to the dashboard which include: the Monitor governance rating moving to Financial, the addition of the number of Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR) reports, Verbal & Physical assaults and Incident Report Forms (IRFs / WMAS 54). 2. Board Assurance Framework Version 6 The attached Board Assurance Framework has been revised since its last submission to the Board of Directors in October. Since then it has been to the Quality Governance Committee on the 18 November and 13 January, it has also been to the Health, Safety & Risk Committee (extra-ordinary meeting) held on 30 November Through the Well Led review there have been contextual changes to support the main document and enforce the governance arrangements. The High Risks rated 12 and above are under review as part of the refresh and collation of a centralised risk register, and are therefore not included in Version 6 of this Board Assurance Framework. The 3 x significant risks and High risks rated 12 and above are to be an area of review and discussion at the Board Strategy & Development day in February A review of the management of all risk registers is underway. Each Directorate / Department has been assigned a Risk Lead who will offer advice and support in the review and management of the local risks, and will attend meetings to advise on information pertaining to each risk. All risk registers are being collated and in future will be managed on Share Point, an online software programme widely used within the Trust, this includes a transfer of the supporting information and risk assessment documentation. At the time of writing this report Fleet are still required to transfer their risks to the central risk register. Through this process the opportunity to ensure all risks are reviewed and up to date has been taken. The new Risk Management Strategy is in draft and will be available at the Board meeting in March Currently Risk management is included in the Quality Strategy which will be amended in line with the recommendation from the Well Led review. Page 3 of 10 WEST MIDLANDS AMBULANCE SERVICE NHS FOUNDATION TRUST REPORT TO BOARD OF DIRECTORS MEETING AGENDA ITEM 07 MONTH January 2016 PAPER NUMBER 04 Appendix 2 shows Version 6 of the Board Assurance Framework. 3. NHS England Emergency Preparedness, Resilience and Response Framework November 2015 (Version 2) first published March 2013 The purpose of this document is to provide the framework for all NHS funded organisations in England to help with meeting the requirements of the Civil Contingencies Act 2004 (CCA 2004), the NHS Act 2006 as amended by the Health and Social Care Act 2012 (NHS Act 2006 (as amended) and the NHS Standard Contract. In essence, this document seeks to describe how the NHS in England will go about its duty to be properly prepared for dealing with emergencies. As the Board are aware I am the Accountable Emergency Officer (AEO) responsible for Emergency Preparedness, Resilience and Response (EPRR). The AEO will be supported by a Non-Executive Director (NED) or other appropriate Board member to endorse assurance to the Board that the organisation is meeting its obligations with respect to EPRR and relevant statutory duties under the CCA 2004 and the NHS Act 2006 (as amended). This will include assurance that the organisation has allocated sufficient experienced and qualified resource to meet these requirements. I am pleased to confirm that Tony Yeaman has agreed to take the role of the Emergency Officer NED. Section 9.1 page 17 outlines key responsibilities of the roles. The document can be found at: Mr Yeaman will work closely with the relevant Assistant Clinical Officer/Director, Steve Wheaton and myself. Appendix 3 shows the assurance document relating to the key changes relevant for the Trust. Appendix 4 shows the updated Trust Executive and Non-executive Director roles. 4. Care Quality Commission New Certificate of Registration On the 9 th of December 2015 a new certificate of registration was sent to the Trust. This was a result of the Care Quality Commission (CQC) ongoing review of data quality, and in response to feedback about navigation difficulties around the CQC website, the CQC Data Management team identified a small number of registered NHS Trusts with slightly misleading, inconsistent or duplicate location names. Page 4 of 10 WEST MIDLANDS AMBULANCE SERVICE NHS FOUNDATION TRUST REPORT TO BOARD OF DIRECTORS MEETING AGENDA ITEM 07 MONTH January 2016 PAPER NUMBER Delivering the Forward View: NHS planning guidance 2016/ /21 The latest planning guidance was published on 22 December 2015 by NHS England, in partnership with the five arm s length bodies (NHS Improvement, [Monitor and TDA], Health Education England, the National Institute for Clinical Excellence, Public Health England and the Care Quality Commission). This year s guidance has been published in the context of the recent spending review announcements, and is explicitly positioned to set out how the sector is expected to deliver the Five Year Forward View by 2020, restore and maintain financial balance and deliver core access and quality standards for patients. This year, organisations within the NHS will be required to produce two plans: 1. All local health and care systems will be required to develop a five year sustainability and transformation plan (STP), covering the period October 2016 to March 2021 subject to a formal assessment in July 2016 following submission in June All NHS foundation trusts and trusts are required to develop and submit one year operational plans for 2016/17. These plans will need to be consistent with the emerging STP and in time to enable contract sign off by end of March Future information will be provided through the reports of the Director of Clinical Commissioning and Service Development, through the NHS England website at: https://www.england.nhs.uk/tag/planning-guidance/ 6. NHS told to achieve nine 'must dos' during A report in the Health Service Journal published on 22 December 2015 stated the following: NHS providers across a quarter of England must meet four out of 10 clinical standards for seven day services during Local areas told they must achieve nine must dos including eliminating NHS deficit Focus on achieving waiting time and care access targets Every local health system has been issued with nine essential priorities that have to be achieved during along with a specific ambition linked to the delivery of seven day services. The nine key targets issued by the six national NHS organisations include a focus on local system-wide planning, eliminating the NHS deficit and meeting key waiting time targets in acute and mental health services. Page 5 of 10 WEST MIDLANDS AMBULANCE SERVICE NHS FOUNDATION TRUST REPORT TO BOARD OF DIRECTORS MEETING AGENDA ITEM 07 MONTH January 2016 PAPER NUMBER 04 The NHS planning guidance document, published in December, also demands local NHS areas work to reduce the number of excess deaths across England by increasing consultant cover on hospital wards and improving access to diagnostic services at weekends. By the end of March 2017 NHS providers covering a quarter of England will be expected to meet at least four out of the 10 clinical standards for seven day services, which were originally published by NHS England in December Half of the country will be expected to meet the standards by 2018 ahead of complete coverage across England by In August providers were told to focus their efforts on four targets including all emergency admissions being reviewed by a consultant within 14 hours; access to key diagnostics; consultant-led decisions across seven days and twice daily reviews for all high dependency patients. Originally NHS England had expected all 10 clinical standards to be achieved by March 2017 but this target has been relaxed following the spending review and timetable for the Five Year Forward View. The guidance also demands better access to primary care services at weekends and evenings where patients need it through increased capacity in future years. Access to out of hours care will also be expected to be enhanced through better integration and redesign of NHS 111, minor injuries units, urgent care centres and GP out-of-hours services. The nine must dos for include: 1. Produce a sustainability and transformation plan for the health economy. 2. Return to aggregate financial balance with secondary care providers delivering savings through the Lord Carter productivity programme and caps on agency spending. CCGs will be expected to save money through reducing variation and implementing the Right Care programme in every area. 3. Develop and implement a local plan to address the sustainability and quality of general practice, including workforce and workload issues. 4. Achieve waiting time targets for A&E patients and ambulance response times. 5. Improve and maintain performance against the 18 week RTT target. 6. Deliver the 62 day cancer waiting time target, including the two week referral and 31 day treatment targets. The guidance also calls for progress in one year survival rates by increasing the proportion of cancers diagnosed early. Page 6 of 10 WEST MIDLANDS AMBULANCE SERVICE NHS FOUNDATION TRUST REPORT TO BOARD OF DIRECTORS MEETING AGENDA ITEM 07 MONTH January 2016 PAPER NUMBER Achieve and maintain new mental health waiting time targets which include more than 50 per cent of people experiencing a first episode of psychosis being treated within two weeks of referral and 75 per cent of people with common mental health conditions being referred to talking therapies within six weeks of referral, with 95 per cent treated within 18 weeks. Areas will also need to diagnose two thirds of their estimated population that has dementia. 8. Improve care for people with learning disabilities including improved community services and reducing inpatient facilities. 9. Providers will be required to publish avoidable mortality rates annually. 7. NHS Providers the Association of Foundation Trusts and Trusts The board papers include updates on the implications of the spending review, operational planning, planned changes to the way the national tariff is set and commissioning allocations Summary updates of the board papers for Monitor, NHS England, Care Quality Commission and Health Education England meetings can be found at: https://www.nhsproviders.org/topics 8. Machinery of Government Change Fire and Rescue Policy transfer to Home Office On the 5 th of January 2016 the Government formally confirmed that responsibility for Fire and Rescue Policy for England will transfer from the Department for Communities and Local Government to the Home Office. The Government is committed to closer collaboration between the police and fire and rescue services and state that greater joint working between the emergency services can deliver better local accountability, an improved service for communities and significant savings for taxpayers. Similarly the Government believes that central policy making, as well as local delivery, can benefit from a more joined up approach and that this can be best achieved by transferring responsibility for fire and rescue policy from the Department for Communities and Local Government to the Home Office. The Home Office and Department for Communities and Local Government have been working closely together in support of this commitment. A consultation on Emergency Service Collaboration was published on 11 September and closed on 23 October The responses are currently being reviewed and further details will be announced shortly. Page 7 of 10 WEST MIDLANDS AMBULANCE SERVICE NHS FOUNDATION TRUST REPORT TO BOARD OF DIRECTORS MEETING AGENDA ITEM 07 MONTH January 2016 PAPER NUMBER Letter from Jim Mackey and Sir Mike Richards about how we're working together to support you All English NHS Trusts were jointly written to on 15 January 2016 by Jim Mackey, Chief Executive, NHS Improvement, and Professor Sir Mike Richards, Chief Inspector of Hospitals, Care Quality Commission (CQC) to ask them to consider quality and finances on equal footing in their planning decisions. NHS providers have been under great pressure over recent years to make quality improvements within the resources available. It is recognised that there has been a perception that NHS trusts could only achieve their financial targets at the expense of quality, or that improving quality was more important than staying in financial surplus. The joint letter asks that financial performance and quality must work together, and be considered as combined and equal priorities. It recognises the role that NHS Improvement and the CQC have in supporting trusts to deliver the right balance between quality and finances. A copy of the letter can be found at: https://www.gov.uk/government/news/financial-performance-and-quality-mustwork-together /16 Outturn and 2016/17 Plan including Sustainability and Transformation Fund On 15 January 2016 a letter was sent to Linda Millinchamp, Acting Director of Finance and myself from Bob Alexander, Deputy Chief Executive of the NHS TDA and Stephen Hay, Deputy Chief Executive of Monitor. The letter relates to the recent Spending Review, whereby the government has committed to provide an additional 8.4 billion real-terms funding for the NHS by 2020/21. This includes a Sustainability and Transformation Fund (S&T Fund) for the provider sector during 2016/17. The general element of the fund will be targeted at providers of acute emergency care. The outcome of this work will be used to allocate acute emergency care providers with an indicative payment from the S&T Fund and all providers with a control total for 2016/17. The Trust is asked to confirm by 8 February 2016 that we accept the control total stated in the key assumptions and the detail for the Trust shown at Appendix 3 of their letter. A copy of the letter is available at appendix 5. Page 8 of 10 WEST MIDLANDS AMBULANCE SERVICE NHS FOUNDATION TRUST REPORT TO BOARD OF DIRECTORS MEETING AGENDA ITEM 07 MONTH January 2016 PAPER NUMBER New framework arrangements to tackle agency costs and support staff back into substantive and bank roles On 15 January 2016 a letter was sent to all NHS and Foundation Trusts from Jim Mackey, Chief Executive of NHS Improvement, giving an update on progress during the eight weeks since Monitor and TDA introduced price caps for agency staff, to complement the other agency rules. The letter said that there is much more to do to reduce spending further and ensure that workers move back in large numbers to substantive and bank roles. The price caps will be further reduced on 1 February 2016, as previously proposed. This will significantly reduce maximum rates for doctors and nurses and help achieve further savings. All agency procurement for doctors, nurses and all other staff groups will be via approved frameworks. These frameworks will embed agency worker pay rates in line with standard NHS terms and conditions. 12. Chief Executive Officer Meetings (19 October January 2016) Staff Union Meeting Operations Planning Meeting Resources Committee Strategic Commanders Meeting Council of Governors Meeting Professional Standards Group Electronic Patient Record Project Team meeting Quality Governance Committee Meeting Winter Planning/Christmas/New Year Planning National Meetings Bill Sivewright, Chair, Association Air Ambulances (AAA) Professor Keith Willett & Lady Helen Hamlyn Raghuv Bhasin, Deputy Director, NHS Delivery Team Association of Ambulance Chief Executives (AACE) Management Meeting Association Air Ambulances ALL Party Parliamentary Air Ambulance Group Dame Gill Morgan Association of Ambulance Chief Executives Board Meeting Association of Ambulance Chief Executives Council Meeting The Ambulance Service Charity (TASC) Open Event Professor Ian Cumming, CEO, Health Education England Page 9 of 10 WEST MIDLANDS AMBULANCE SERVICE NHS FOUNDATION TRUST REPORT TO BOARD OF DIRECTORS MEETING AGENDA ITEM 07 MONTH January 2016 PAPER NUMBER 04 Professor Paresh Wankhade, Edge Hill University NHS Providers with Simon Stevens NHS England Plann
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