1. Governor Focus Conference 20th April 2016
NHS Providers
Governor Focus Conference
20th April 2016

2. Aim of the Conference:
To increase the understanding of the key national issues facing Foundation Trusts in 2016/17 and to recognise and value the contribution Councils of Governors make in providing local accountability for quality services.

3. Context National Policy Update
Most challenging period for the NHS in 40 years.
Financial challenges & uncertainty
Unprecedented provider sector deficit (£2.8 billion) and loss of financial control
Gap in available funding and required funding
Increasing operational instability
Changing regulatory landscape
Beginning of sector-wide transformation

4. NHS 5 Year Forward View
Provide a longer term strategic policy framework for the NHS
Close the health and well-being gap.
Close the financial gap.
Close the quality gap.
Move to new integrated models of care.

5. NHS funding increases 2016/17 3.6% 2017/18 1.4% 2018/19 0.4%
2016/ %
2017/ %
2018/ %
2019/ %
2010/ %
2016/17 dubbed ‘the year of plenty’

6. Operational pressure growing
Providers consistently missing operational performance targets against a range of target areas.
Impact of pressure on primary and secondary care
Increasingly elderly and ‘sicker’ population with more complex co-morbidities.

7. (continued)
Providers operating at capacity levels which other advanced Western nations wouldn’t dream of.
Tax payer funding: advantages of equity versus having party politicians in charge who find it difficult to acknowledge a gap, especially when they can’t afford to close it.

8. Workforce challenges growing
Staff bearing the brunt of the finance/service gap and under increasing pressure.
Large structural workforce shortages with no real plan to address them.
Central workforce planning which is no longer fit for purpose.
Unsupportive ‘top down’ culture which impacts negatively on senior leaders

9. NHS Improvement
April 1st 2016, Monitor and the Trust Development Authority became one body.
Simpler, clearer measures of success
Delegating resource and individual provider insight to regions.
What works; not what a complex regulatory body says.
More emphasis on support and building leadership capability

10. What this means in practice
Quality – a CQC ‘good’ or ‘outstanding’ rating; no Trust in ‘special measures’
Finance/resources – realise the ‘Carter’ savings and return to surplus.
Access/operational performance – deliver core NHS standards and targets.
Strategic change – help lead transformation of local health and care systems and move to new care models.

11. Characteristics of existing model.
Fragmentation – primary and secondary, physical and mental, health and social.
Medicalisation – treating illness as opposed to health and well-being; preponderance of medical professionals.
Hospitalisation – dominance of hospitals in local health/care system. Illness-hospital-intervention-wellness.
Specialisation – hospital care dominated by increasingly specialised specialists.
History – historic service structure and patterns, importance of/attachment to existing buildings and institutions.

12. Vanguards New models to integrate care.
£116 million allocated in 2015/16.
14 multi-speciality community providers.
9 integrated primary & acute care systems.
6 enhanced health in care homes.
8 urgent and emergency care.
13 acute care collaboration.

13. Key features
Local accountability: balanced with engagement and local accountability as well as accountability to regulators, commissioners and Parliament.
Provider autonomy: boards need feedback and flexibility to manage the organisation in a tough climate.
Engagement and constructive challenge from Governors is fundamental.

14. NHS Providers view
The two pillars of Foundation Trust status – board autonomy and local accountability – remain fundamental.
A Council of Governors is fundamental in providing local accountability and routes to involve members, staff, patients, carers, service users and the public.

15. Support for Governors Being clear about the challenges going forward
Involvement in key consultations and task groups
Focus on sharing good practice
‘Bespoke’ and ‘open’ support such as the National Development Programme
Newsletter, dedicated website, online services, tools
Advocating on tariff and payment systems to ensure providers are resourced to deliver high quality care

16. Governor role
179 providers (75% of sector) forecasting an ‘in year’ deficit
156 providers (65% of sector) forecasting a full year deficit
54 Trusts ‘require improvement’
18 Trusts are in ‘special measures’
8% of Trusts are deemed ‘inadequate’

17. NHS Improvement 1,000 staff 4 regional offices of 100 staff each
Balance between support and regulation
Collaboration between health and social care systems should become instinctive
Encourage boards not to enter into contracts which give all the power to Commissioners
Support delivery of the 5 Year Forward View

18. (continued) Drive up quality (no Trust in ‘special measures’)
Leadership support, development & succession planning
Improve financial controls, productivity, efficiency
Help providers to return to ‘earned autonomy’
Local decisions, free of constraints
Fewer data and monitoring requirements
Simpler process for transactions
Recognition and support to share success

19. NHSI support for Governors
No change to the roles set out in the Health & Social Care Act: Governors must hold the Non-Executive Directors to account and represent patient & public interest
Governors have a role in Sustainability & Transformation Plans
No plans to change the role of the Governor in the near future

20. CQC current approach
Teams of clinical experts, specialist inspectors and ‘experts by experience’
Concentrate on core services
5 key areas: are services safe, caring, effective, responsive, well-led
Strong focus on listening to staff & patients
Reports to not seek to apportion blame
Rating help compare services and highlight specific focus areas
Quality improvement process; stakeholders & provider

21. Findings by the CQC Wide range in quality between Trusts
Some Trusts have marked variations between services or within a service.
Day to day crisis management often replaces long-term planning
In some services, staffing is a concern
Safety culture is not embedded in many services
Unacceptable variation in the rigour of clinical risk management and quality assurance
Formal and informal leadership is often in denial about problems or they blame ‘the system’

22. (continued)
Blame and bullying are widespread in some Trusts
Variable leadership at clinical or directorate level was often a critical factor in safety and quality
20% of Trusts scored ‘good’ for safety; none were ‘outstanding’
60% of Trusts need to improve their leadership

23. Governors’ meetings with the CQC
The CQC wants to hear the views of the Governors as a Council, as a group, as a few individuals provided that the views expressed are those of the Council of Governors.
The CQC also wants from Governors an assessment of the leadership and the quality of care

24. (continued)
The CQC also wants to know how the Board functions:
does it seek and listen to the views of patients and staff?
does it ensure services are well-led and efficiently run?
does it have a grasp of the important quality issues for the Trust and make sure appropriate action is taken when necessary?
does it promote a culture of learning, safety, quality improvement and transparency?

25. CQC – new approach from 2017
Greater use of focused & unannounced inspections
Only occasional use of comprehensive inspections
Requirement for Trusts to provide quality information annually
At least one core service inspection every Trust year
Report on how well a Trust uses its resources
Single shared view of quality
Demonstrate improvement as well as detecting problems
Well-led review of each Trust annually together with a review of the Trust’s overall rating

26. Summary Time of many and major changes
Financial constraints and uncertainty
Safe, quality, responsive services
New ways of delivering services
Changes in remit of regulatory bodies
Involvement of Governors still crucial
No plans to change the role of Governors
Governors must be involved & informed

27. Information and full set of slides
Visit the website:
Telephone:
Write: NHS Providers
1 BirdcageWalk
London
SW1H 9JJ