Paper BC E Report April 2012 by vSTnB6


									Agenda item      8                            Enclosure          Paper B

Report to:                      2gether NHS Foundation Trust Board on 30th April 2012
Author:                         Shaun Clee – Chief Executive
Presented by:                   Shaun Clee - Chief Executive

SUBJECT:                        CHIEF EXECUTIVE’S REPORT

This Report is provided for:
Decision              Endorsement                Assurance            Information

The paper provides the Board with:
a) an update on key national communications via the Department of Health’s Chief Executive
b) a summary of key progress against organisational major projects and
c) a summary of Board visits undertaken in the last month and scheduled in the month ahead.

The Board is asked to note the contents of this report.

Corporate Considerations
Resource implications:
Equalities implications:
Risk implications:

Quality and Safety        P     Skilled workforce               P
Getting the basics right  P     Using better information
Social inclusion          P     Growth and financial efficiency
Seeking involvement       P     Legislation and governance

Seeing from a service user perspective
Excelling and improving             P  Inclusive open and honest                        P
Responsive                             Can do
Valuing and respectful              P  Efficient

Reviewed by:
Executive Team                                            Date
Where in the Trust has this been discussed before?

What consultation has there been?

Explanation of acronyms

1.      CONTEXT

1.1     National Context

1.1.1   Mental Health Network - Publication of 2 significant documents

        On 18th April the Mental Health Network launched the publication of two significant documents.

        The first relates to Mental Health and Homelessness. This briefing paper is the culmination of
        partnership work between the Mental Health Network and St Mungo's and details the significant
        difficulties that many homeless individuals experience in accessing services and goes on to
        showcase several examples of good practice. The complexity with which many individuals who
        are homeless present, requires a response that is accessible, flexible and has effective
        partnership working between different provider organisations. Where this exists, evidence
        shows significant gains in quality and significant whole system economic gains.

        The second document relates to Long Term Health Gains, investing in emotional and
        psychological wellbeing for patents with long term conditions. This document and the evidence
        within it is potentially even more significant than the publication a few months ago of the
        independent economic evaluation of the Birmingham RAID services. This is a document that
        a) must inform our service developments
        b) individual copies must be given formally to the CCG Chairs and MH leads, Wellbeing Chairs
        c) be formally placed on the agenda of the Gloucestershire Whole System working forum and
        the Herefordshire QIPP Board.

1.1.2   New health maps to drive children’s health improvements

        The NHS Atlas of Variation in Healthcare for Children and Young People maps out the variation
        in healthcare for 25 different child health issues across England, including asthma, epilepsy and
        diabetes. The Atlas will help hospitals, community services, PCTs and emerging clinical
        commissioning groups see how their area compares to others around the country, and put
        plans in place to make improvements if needed.

        For further information, go to:

1.1.3   Plan to help pupils get more help from the school nurse

        A new report on school nursing sets out an ambition for visible, accessible and confidential
        services that provide early help and extra support to children and young people. School nurses
        have a crucial role to play in healthcare during school years providing advice on obesity,
        teenage pregnancy and the harms caused by drugs and alcohol.

        The report, Getting it right for children, young people and families, includes plans to raise the
        profile of the school nurse and give them a greater role in improving care for children and young

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        For further information, go to:

1.1.4   The Electronic Staff Record (ESR) re-procurement

        The Department of Health has set up a project team to undertake the re-procurement of ESR.
        NHS leaders have a key role in shaping the requirements to ensure the re-procurement of a
        sustainable integrated workforce solution from 2014.
        Link: (Select Re-procurement from the menu)
        Action: The Chief Executive has asked the Director of HR and OD to advise on implications.

1.1.5   NHS Continuing Healthcare Close Down of Assessment Process 2004–2012

        This letter from David Nicholson explains the introduction of a close down of new cases to the
        system which require assessment of eligibility for NHS Continuing Healthcare (CHC) funding
        from the period 2004–2012, which have not previously been assessed for eligibility.
        Action: The Chief Executive has asked the Chief Operating Officer to ensure that Service and
        Clinical Directors are provided with process.

1.1.6   NHS Continuing Healthcare Introduction of Timescales for Review Process

        The Department of Health is introducing timescales which will apply to the review process for
        NHS Continuing Healthcare (CHC) eligibility decisions from 1 April 2012.
        Action: The chief Executive has asked the Chief Operating Officer to ensure that Service and
        Clinical Directors are provided with process.

1.1.7   Sustainability reporting in the NHS

        The Sustainability Reporting Framework, which was available to use on a voluntary basis in
        2010/11, is a mandatory part of the annual reporting requirements for 2011/12 onwards. The
        NHS Manual for Accounts is being updated to reflect this.
        Action: The Chief Executive asked the Director of Finance and Commerce to action.

1.1.8   Publication of Organisation Patient Safety Incident data

        On 14 March 2012, the National Patient Safety Agency (NPSA) published the Organisation
        Patient Safety Incident Report 2011. High levels of incident reporting provide an indication of an
        increased safety culture within the organisation.
        Action: The Chief Executive asked the director of quality and Performance to build this into the
        Safety report.

1.1.9   NHS Staff Survey results for 2011 published

        The published 2011 NHS Staff Survey results include a summary and full survey reports for all
        trusts along with summary tables showing trust, regional and SHA cluster level results, plus
        results by staff group and demographic group. Guidance on responding to survey results is
        available from NHS Employers. Trusts should also involve their local Social Partnership Forum
        in responding to the survey.

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       For further information, go to:

1.1.10 General Medical Council - routes to the medical registers are changing

       The General Medical Council (GMC) has reviewed the processes for awarding Certificates of
       Eligibility for Specialist/GP Registration (CESR/CEGPR). The review reflects a commitment to
       ensuring these routes provide a fair, efficient and robust evaluation of doctors seeking entry to
       the registers. Proposals from the review include changes that may have significant implications
       for doctors and employers.
       Action: The Chief Executive asked the Medical Director to advise on any response to the

1.1.11 First steps towards quality improvement: simple guide to improving services
       This publication aimed at all healthcare professionals provides the information, tools, resources
       and practical examples taken from the NHS Improvement project sites and support needed to
       guide the first steps towards making quality service improvements and the best possible
       chance of sustained success.
       Action: The Chief Executive asked the Director of Quality and Performance to review and
       share where appropriate with Professional Leads.

1.1.12 Future ownership and management of PCT-owned estate

       Further to the announcement on 4 August 2011 regarding the future ownership and
       management of estate in the ownership of primary care trusts in England, the Department has
       now published guidance on accounting treatment and standard form templates for the transfer
       order and schedule.
       Action: The Chief Executive asked the Director of Finance and Commerce to review.

1.1.13 Controlled Waste Regulations 2012

       The Controlled Waste Regulations 2012 replace and update the Controlled Waste Regulations
       1992. They will come into force on 6 April 2012. These 2012 Regulations give local authorities
       powers to charge for waste disposal from a wider range of non-domestic premises (i.e.
       hospitals) than the 1992 Regulations allowed.

       Action: The Chief Executive asked the Director of Internal Customer Services to review and

1.1.14 All staff letter from the Secretary of State

       Andrew Lansley has written to all NHS staff following the Royal Assent of the Health and Social
       Care Bill this week. The Health Secretary reinforces that the new legislation supports the core
       principles of the NHS, cuts tiers of bureaucracy and empowers staff to determine services that
       meet the needs of their patients. He describes this as the ‘beginning of a journey’ for the NHS
       that will see a more stable, clinically-led health service delivering the best possible care.

       For further information, go to:
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1.1.15 The Prime Minister’s challenge on dementia

       This document sets out the Prime Minister’s challenge on dementia, which was launched on
       Monday 26 March. It is an ambitious programme of work to push further and faster to deliver
       major improvements in dementia care and research by 2015, building on the achievements of
       the existing National Dementia Strategy.
       For further information, go to:

1.1.16 Introducing the NHS Patient Feedback Challenge

       Improving the experience of patients is a key aim for all NHS organisations and this year’s NHS
       Operating Framework places a clear responsibility on the NHS to actively seek out, respond
       positively and improve services in line with patient feedback.

       This is why the NHS Institute is launching the NHS Patient Feedback Challenge - backed by a
       £1 million challenge fund - to identify, share, spread and implement excellent patient
       experience work across the NHS.

       NHS organisations interested in taking part should contact their SHA Patient Experience lead.
       A free national seminar on the Challenge will also take place on 23 April in London.

       For further information go to:

1.1.17 Public health workforce strategy

       Published on 27 March, the public health workforce strategy consultation sets out proposals for
       a workforce strategy that would support highly qualified, motivated public health specialists who
       will be employed in a range of settings including local authorities, the NHS and Public Health
       England. The consultation will run until 29 June.

1.1.18 Deadline for publishing equality objectives – 6 April 2012

       The deadline for public sector organisations to publish their equality objectives, in order to
       comply with the public sector Equality Duty, is 6 April 2012. See the links for guidance and the
       Equality Delivery System (EDS), which can also help with compliance.

       Links: Equality objectives and the equality duty: A guide for public authorities:
       NHS Employers:
       Action: The Chief Executive has asked the Director of HR and OD to ensure compliance with
       the duty and publish equality objectives by 6 April 2012.

1.1.19 New services to be added to the portfolio of nationally commissioned services

       The National Health Service (Functions of Strategic Health Authorities and Primary Care Trusts
       and Administration Arrangements) (England) (Amendment) Regulations 2012 (SI 2012 no. 417)
       will come into force on 1 April 2012. The Regulations will add eight new services to the list of

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       nationally commissioned services from 1 April 2012. These services will be commissioned at a
       national level by NHS London.

1.1.20 New GMC website promotes better care for patients with learning disabilities

       The GMC has launched a new website to guide doctors treating patients who have a learning
       disability. This website will increase doctors’ understanding of care of patients with learning
       disabilities and help to improve their skills in supporting them.

1.1.21 New toolkit shows use of allied health professionals can improve care and reduce costs

       A new, online system has been launched which demonstrates how optimum use of allied health
       professionals (AHPs) improves care and saves money. The system takes commissioners and
       clinicians along patient pathways, demonstrating at each stage how AHP interventions improve
       care and outcomes while reducing costs.

1.1.22 Secretary of State letters to health and social care providers

       The Secretary of State for Health, Andrew Lansley, has written to clinical commissioning
       groups, local authorities, NHS trusts and NHS foundation trusts to outline what the new Health
       and Social Care Act will mean for the future. The Health Secretary highlights the new powers
       and freedoms in the Act and explains how these will help to shape a clinically-led NHS, with
       patients at its heart.

       For further information, go to:

1.1.23 The NHS, the Mental Capacity Act and deprivation of liberty safeguards

       The Care Quality Commission has published a report showing the NHS needs better
       awareness of when and how to apply the Mental Capacity Act – deprivation of liberty
       safeguards (MCA-DOLS) safeguards for patients. The safeguards apply in all hospitals. PCTs
       continue to receive MCA-DOLS resources to make sure there are effective safeguards,
       appropriate training and independent 'supervisory body' functions.

1.1.24 2011/12 quality accounts audit guidance

       The Department has published guidance for NHS acute and mental health trusts and the Isle of
       Wight PCT about the audit of their 2011/12 quality accounts.
       Action: The Chief Executive asked the Director of Quality and Performance to review and
       ensure the Quality Accounts audit was compliant with guidelines.

1.1.25 Joint supplementary accounting guidance - Department of Health and Monitor

       This letter from Janet Perry, NHS Chief Financial Controller and Miranda Carter, Monitor
       Assessment Director, provides clarification on agreement of intra-NHS balances, to facilitate
       the year-end process.
       Action: The Director of Finance and Commerce has actioned this.

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1.1.26 Adult Social Care Outcomes Framework (ASCOF) 2012/13

      The Adult Social Care Outcomes Framework (ASCOF), first launched in March 2011, has been
      updated for 2012/13 and was published on 30 March 2012. The framework is a set of outcome
      measures, which forms part of the national picture, of how well local authorities are delivering
      better outcomes for people who use adult social care services and carers.
      Action: The Chief Executive asked the Director of Quality and Performance to share with South
      West colleagues.

1.1.27 Launch of the drugs and alcohol recovery payment by results pilot

      The drug strategy 2010 Reducing demand, restricting supply, building recovery: Supporting
      people to live a drug free life set out an ambition to explore how payment by results (PbR)
      might incentivise the sector to deliver on recovery outcomes. Eight pilot areas in England have
      launched new payment by results models to test the PbR approach. The pilots will run for two
      years and will be independently evaluated.
      Action: The Chief Executive has asked the Director of Strategic Development to ensure
      information from the pilot is built into the evolving model with partners in our SMS tender.

1.1.28 End of life care co-ordination: core content information standard (ISB 1580)

      The Information Standards Board for Health and Social Care has approved an information
      standard for the core data for an individual nearing the end of life. Developed by the National
      End of Life Care Programme and the Department, the standard and associated implementation
      and record keeping guidance should be helpful when used with Electronic Palliative Care Co-
      ordination Systems (EPaCCS).
      Action: The Chief Executive has asked the Director of Quality and Performance to take via

1.1.29 Arrangements for health emergency preparedness, resilience and response from April

      This document describes the principles that will underpin emergency preparedness, resilience
      and response, and sets out the roles and functions of the Secretary of State for Health, the
      Department, the NHS Commissioning Board, Public Health England and Directors of Public
      Health working in local authorities.
      Action: The Chief Executive has asked the Chief Operating Officer to review and recommend
      any changes to our emerging preparedness to ensure compliance.

1.1.30 A&E data sharing audit

      The sharing of de-personalised violence data between A&Es and relevant partners is a key
      Coalition Government commitment. An audit is being conducted of Type 1 A&Es to determine
      the extent and quality of data sharing that is taking place to inform work by the Department to
      further promote data sharing.
      Action: NHS chief executives will wish to ensure the relevant data leads complete and return
      the survey by 14 May 2012. Further information can be obtained from:

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1.1.31 From Transition to Transformation – new public health resource

       The Department, together with the Local Government Association has developed a web-based
       resource to support the transition of public health to local government. The resource brings
       together fact sheets, case studies, a glossary and policy summary to assist local authorities and
       public health to develop a local public health system that is designed to have the greatest
       potential for improving health, not just in councils but with all local partners.
       Action: NHS and local authority chief executives may wish to go to the link for further
       information or contact

1.1.32 NHS Operating Framework 2012/13 and Secondary Uses Service

       Best practice guidance has been published relating to the content on Secondary Uses Service
       (SUS) in the NHS Operating Framework for 2012/13. It provides clarification and guidance for
       providers and commissioners on how to use SUS to support local contract reconciliation and

1.1.33 Building Recovery in Local Communities

       This joint letter from the Department of Health, Home Office and Ministry of Justice informs how
       newly elected police and crime commissioners will be responsible for cutting crime and
       improving community safety from 22 November and from April 2013, upper tier and unitary local
       authorities will take on responsibility for commissioning drug and alcohol prevention, treatment
       and recovery services.

1.1.34 Direct access to diagnostic tests for cancer - best practice referral pathways

       Actions to improve earlier diagnosis of cancer are set out in Improving Outcomes: A Strategy
       for Cancer (2011). Work has been underway to support more direct access to diagnostics tests
       for GPs. The Cancer Diagnostics Advisory Board was established to provide expert and clinical
       advice on key diagnostics across different cancer types. These best practice pathways
       commissioned by the Board provides information on direct referral by GPs to specific diagnostic
       tests for the assessment of particular symptoms where cancer may be suspected but urgent
       GP referral (two week wait) is not applicable.

1.1.35 Time to Change – too many young people ‘suffering in silence’ with mental health

       Up to £22 million will be pumped into a pioneering programme to give children with mental
       health problems access to the best available services in a wider range of places, Deputy Prime
       Minister Nick Clegg announced. The new investment in the Children and Young People’s
       improving Access to Psychological Therapies (IAPT) project will be spent over the next three
       years to expand state-of-the-art psychological therapies and extend training for people working
       with youngsters outside of health settings, such as in schools or youth groups.

       The Department of Health is also providing up to £16 million funding over the next four years to
       the longstanding Time to Change social marketing campaign to tackle mental health stigma
       and discrimination.
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1.2     Local Context

1.2.1 Gloucestershire Safer Stronger Justice Commission

        At a meeting of the Gloucestershire Safer Stronger Justice Commission, which acts as
        the accountable body for the Drug and Alcohol Action Team within Gloucestershire, it
        was noted that performance data has shown a significant improvement in the number
        of service users who leave the treatment system in a planned way. Gloucestershire's
        performance is now above National average and for the more complex opiate and
        crack users, Gloucestershire's performance has risen to the top of the range of the
        National top quartile cluster.

1.2.2   Board visits

        The following Board visits took place in March.

         28th March            Shaun Clee and Charlotte Hitchings visited the Memory Clinic
                               at 30 Commercial Road, and the PMHT DASH/CAS Team at
                               Monkmoor Court, Hereford

1.2.3   Patient Safety Walkrounds

        The following Patient Safety Walkrounds took place in March

         1st March             Sally Ashton and Kay Harrison visited Laurel House
         6th March             Sally Ashton and Trish Jay revisited the MH Liaison Team at
         12th March            Sally Ashton and Trish Jay revisited Priory Ward at Wotton
                               Lawn Hospital
         13th March            Trish Jay and Sally Ashton revisited Abbey Ward at Wotton
                               Lawn Hospital
         20th March            Shaun Clee and Trish Jay revisited Dean Ward at Wotton
                               Lawn Hospital
         28th March            Sally Ashton and Paul Winterbottom revisited Chestnut Ward
                               at Charlton Lane Hospital

1.2.4   Major Project update – April 2012

        Herefordshire Transformation
        We are pleased to announce that the refurbishment work to Cantilupe Ward in the
        Stonebow Unit is on schedule. The work completed in conjunction with Commissioners
        enables Cantilupe Ward to provide 12 beds that are fully compliant with maintaining
        privacy and dignity. The ward will be opened by the Chair Baroness Fritchie on 17th
        May 2012.

        Significant progress is being made on Statutory and Mandatory training provision and
        thanks to all staff, managers and the training department for their commitment to
        achieving our internal targets.

        When we commenced service provision in Herefordshire in April 2011, part of Learning
        Disability service provision transferred into 2gether NHSFT. The rest of the Learning
        Disability provision transferred into Wye Valley NHS Trust. Together with
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Commissioners and Wye Valley colleagues, we believed that individuals with a
Learning Disability would benefit from a single integrated provision. Following
expressions of interest by both Wye Valley NHS Trust and ourselves, Herefordshire
Local Authority determined that provision would best sit within Wye Valley NHS Trust. I
can report that all Herefordshire Learning Disability staff TUPE transferred to Wye
Valley NHS Trust on 1st April 2012. We would like to thank all those colleagues who
worked within 2gether NHSFT during 2011/2012 for all of their hard work and for the
progress that was made in establishing progressive practice supported by professional
supervision and managerial leadership over the year.

We are pleased to inform the Board that the deployment of RIO, our clinical information
system, into Herefordshire is complete. This is an important aspect of integration
bringing clinical governance benefits, enabling clinicians to have access to up to date
information to support decision making 24 hours a day 365 days a year.

Fair Horizons

A working group has been set up to report on a ‘Review of Fair Horizons Workforce’, as
it was recognised that Fair Horizons is a new way of working and we want to ensure
appropriate staffing to deliver services.

The review will cover an assessment of the patient pathway, clustering of patients in
One Stop Team and Primary Mental Health Team’s, activity and caseload
management. Primary Mental Health and Learning Disability services will be further
defined in detail as well as a review of assumptions on profession specific activity and
needs analysis based on initial modelling for Fair Horizons. The Review will be
completed in October this year.

The Management of Change for staff was formally completed on 9th April with more
than 90% of staff allocated their first preference. Where we were unable to
accommodate colleagues first preferences, second preferences have been mainly
achieved. A small number of staff have not been placed into a post, these relate to
Occupational Therapy posts and health care assistants. A small number of appeals
were received and the appeals process has now completed. Management of Change
for Psychological Therapy Services will be completed shortly, functioning as part of the
One Stop Teams with a lead manager in each locality.

We recognise the importance of providing accurate and timely information for
colleagues participating in change and so fortnightly briefings will be produced for
colleagues in One Stop Team and Primary mental Health Care Services. Future
briefings will include information from Community Service and Team Managers who will
share progress and updates from their own localities.

To support ongoing communication Future Fair Horizons Road shows are planned
within the next 6 weeks.

Our number one priority in managing change is to ensure continuity of care and
effective communication with service users and carers. To this end detailed planning to
support effective service user transition continues. It is anticipated that staff will begin to
move into their new teams from April 2012. This will be a gradual process over several
months to ensure that the transition process is managed safely for both service users
and staff.
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Information will be circulated via the Fair Horizons newsletter, including a feature Notice
Board with a timeline for transition, and on the micro site

Substance Misuse

We continue to prepare to respond to the anticipated tender for the provision of
Substance Misuse Services in Gloucestershire. We have established a Partnership
Board, with our partners the Independence Trust and Nelson Trust, which the Chief
Executive will chair. Simon Thompson, Director of Strategic Development will provide
Executive leadership and will chair the Project Board. The project has been set up with
roles and responsibilities identified across the partners. The first team meeting was on
20th April.

Prior to the issue of the Tender which is due on 1st May, the project will concentrate on
the development of a partnership Memorandum of Understanding and work on potential
service model.

We are keen to ensure that all colleagues within Substance Misuse Services have the
opportunity to contribute their skills and thinking to responding to the tender
specification from commissioners and that effective mechanisms exist to keep
colleagues well informed over the next few months. Weekly briefings for managers will
commence from 1st May 2012.

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