Trust Board Meeting Chief Executive’s Briefing Tom Taylor 27 th November 2008

The Care Quality Commission Ensuring better care for people Touching 50 million lives

What is CQC ?

Registration for the NHS A new concept for the NHS Registration already happens in independent healthcare and social care A “licence to operate” 2009/10: transitional year 2010/11: integrated system for ALL sectors

Steps to improvement Trusts: Review and plan improvements Apply to register CQC: Decides registration status Publishes information Both: Continue to monitor HCAI Expect improvements

Key dates You apply to register 12 Jan – 6 Feb 2009 We cross-check applications and discuss with you our likely decision February – March The regulations come into forceMarch Registration decisions confirmedBy 14 March New enforcement powers can be used From 1 April

Registration classifications We both agree things are OK: Registered We agree there are some things you are putting right quickly: Registered + action plan There are some urgent, serious things to improve: Registered with conditions WE CANNOT REGISTER YOU!

Registration decisions – the weight of evidence Registration Categories Registered - no conditions Registered - with conditions Not Registered No concernsMinor weaknesses: small risk of non-compliance Significant weaknesses: significant risk of non-compliance Evidence of non- compliance: serious failure to protect Beyond reasonable doubtBalance of probabilities

Application form The regulation requirement: (See guidance document page 18)

Application form (continued…) One of the criteria: (See guidance document page 19)

Application form (continued…) Sign-off: (See guidance document page 20)

Clinical Services including Meeting Core StandardsFully Met Existing National TargetsFully Met New National TargetsGood 6 out of 9 “achieved” 3 “under achieved”:MRSA bacteraemia target Reduce health inequalities (with PCTs) Improve long term conditions and reduce emergency bed days through improved primary and community care (with PCTs) 0 “failed” … Quality of Services GOOD 2005/062006/072007/08 Annual Health Check 2007/08

… Use of Resources Use of Resources “FAIR” was the highest score possible given our deficit in 2006/07 Auditors Local Evaluation Financial Reporting123 Financial Management233 Financial Standing122 Internal Control223 Value for Money113 Overall Score112 WEAK 2005/062006/072007/08 WEAKFAIR (7/20)(10/20)(14/20)

Health Care Commission Ratings SaTH have asked for a joint Health Economy monthly report on projected ratings Draft presented at Shropshire and Telford Executive Group (STEG) 26/11/08 Internal SaTH report to be included in Finance and Performance / Trust Board Committee reports

Hospital Activity Unprecedented levels of activity in November – Level 4 Escalation Emergency inpatients/ bed capacity not a simple function of A&E attenders All SaTH capacity fully utilised:- – private patients cancelled – day surgery cancelled – additional ward rounds – staff response has been fantastic

Hospital Activity Over 70 “medically fit” people in community and acute beds Ambulance turnaround times extended A&E target not maintained in month SHA reviewing all Health Economy plans Most of West Midlands under pressure Shropshire Local Health Economy Summit 28/11/08 SHA expressing serious concern re A&E and category A&B ambulance response times SHA confident re waiting times, MRSA, C Diff and financial targets

Hospital Activity All activity – elective inpatients, day cases, emergency inpatients, maternity, outpatients (new and follow up), A&E 2003/4457, /5 464, /6470, /7469, /8475,789 Increase18,572 or 4.1%

Hospital Activity 2008/9 straight line projection based on activity to 31 October: =494,525 =37,308 growth since 2003/4 =8.2%

Last 3 years:- At 4 years? Day cases 62% 80% 82% Day cases 33%+ 40%+ Elective IP 17%- 17%- Emergency IP 0% 3%+ Maternity 5%+ 6%+ Outpatients 0% 4%+ A&E attendances 4%+ 6%+

Hospital Activity 2009/10 Operating Framework delayed because of Pre Budget Report (PBR) was due 31/10/08 now expected 8/12/08 New PCT allocations 8/12/08 New Payment by Results (PBR) tariff 12/01/09 – Unbundling/ A&E/ Market Forces Factor??? Challenge to agree 2009/10 Local Delivery Plan whilst FT HDD being undertaken

Other Issues Mike Hallworth presented with the 2008 Healthcare Scientist of the Year Award by the NHS Medical Director, Professor Sir Bruce Keogh. Primarily for work done to make information about pathology tests accessible to patients through a web site developed by him and a small team Mike Hallworth and Heidi Smith have attended a special Royal Reception at Buckingham Palace for NHS staff

Other Issues Melvyn Birch has received his MBE from Prince Charles Nigel Capps invited to join the CLRN Executive Group 100 th birth at Oswestry Maternity Unit