Correspondence

Foundation trust bulletin: December 2014

Published 1 December 2014

Applies to England

1. For Action

1.1 Annual planning review 2015/16: guidance for foundation trusts

Monitor, alongside NHS England and the NHS Trust Development Authority (NHS TDA), has launched a suite of planning guidance for 2015/16.

This includes:

• ‘The Forward View into action: partnership and planning for 2015/16’, a joint publication by Monitor and 5 other national organisations which describes the approach to be taken to make a start in 2015/16 towards fulfilling the vision set out in the ‘NHS Five Year Forward View’
• ‘Guidance on the 2015/16 annual planning round for NHS foundation trusts’, which is Monitor’s guidance for foundation trusts specifically, and addresses our expectations, requirements and process for the 2015/16 planning round
• specific guidance for commissioners and other NHS providers (authored by NHS England and the NHS TDA respectively) and guidance on an optional contract dispute resolution process

We have also published a joint national health partner report on making local health economies work better for patients. This report summarises the findings of NHS England, Monitor and the NHS Trust Development Authority’s joint project to support 11 local health economies to develop clinically and financially sustainable 5-year strategic plans.

Changes to the process

Section 3.3 of Monitor’s guidance sets out 2 major changes to Monitor’s requirements following the initial planning timetable published in November’s FT Bulletin, namely:

• period of financial projections reduced to one year only (2015/16)
• introduction of high-level draft plan submission on 27 February 2015, against which we will be able to provide meaningful feedback to foundation trusts ahead of the final plan submission in April

By focusing on forecasts for 2015/16 only, and by introducing this additional assessment and feedback phase into the planning cycle, we hope to enable final plans to be more robust and better aligned with those of local health partners, as well as obtaining an earlier view of risks in the sector.

Templates

Both full and draft financial templates will now be available in your MARS portal.

1.2 Have your say on the proposed changes to the NHS payment system for 2014/15: deadline for responses immediately before midnight 24 December

Last month Monitor and NHS England published the 2015/16 National Tariff Payment System: A Consultation Notice setting out the prices, rules and methods we propose to include in the 2015/16 national tariff.

We are seeking your views and responses to this and you can find out more about this, including how we will calculate any objections, in the consultation document.

We strongly encourage all foundation trusts to respond to this consultation.

Please note:

We have sent the consultation response form via a unique link to your trust’s nominated representative. Please use this link to respond.

If you use the response form on our consultation webpage you will not be identified as a relevant provider and your response will not be used in Monitor’s calculations under this statutory process.

1.3 Updates to Monitor’s Risk Assessment Framework: share your views by 18 February 2015

We have proposed changes to the Risk Assessment Framework (RAF), including new mental health targets being put in place by the government.

We are seeking views on Monitor’s approach to making sure NHS foundation trusts are well run and can continue to provide good quality services for patients.

You can either respond online or by emailing us at raf@monitor.gov.uk.

1.4 FAO board secretaries and finance directors: you can now use the 2014/15 annual reporting manual

We have published the manual that you should use when producing your 2014/15 annual reports and accounts.

Read this summary of your feedback on the changes we proposed to the manual.

1.5 Our proposals for transforming NHS costing processes: share your feedback by 17 January 2015

We have published proposals highlighting the need for the NHS to get better at collecting accurate cost, activity and outcome data at an individual patient level. We are keen to hear from NHS providers, commissioners and others involved or interested in the costing of NHS services.

You can either respond online or by emailing us at costing@monitor.gov.uk.

1.6 Exploring international acute care models – join our online debate

As set out in the Five Year Forward View, exploring new models of care is increasingly important in delivering the services patients and service users need. To support this, we are inviting interested parties to join an online debate where you can anonymously discuss:

• how Monitor’s regulatory approach may create real or perceived barriers to the adoption and spread of new health and care models, and how we might address this
• new care models identified by our research into international models of care that the NHS might wish to adopt

Following the debate, your contributions will help to inform and influence our thinking and actions around how best we can support local organisations to deliver new models of care.

Please email jointhedebate@monitor.gov.uk today to request an invitation.

1.7 Monitor’s review into increased agency staff expenditure: share your examples of effective management of temporary and agency staff

During 2012/13 expenditure on non-permanent staffing in the NHS reached £2.4 billion. This figure will continue to increase unless action occurs at all levels within the NHS.

We will shortly release a mandatory information request to all foundation trusts seeking more detailed data on their agency spend. We are currently working with the Cabinet Office Implementation Unit to identify ways to reduce the number of agency staff at trusts.

In addition to the information request if you have any examples of initiatives that have helped to reduce the usage of agency staff we would be keen to hear from you.

Please contact James Aker: James.aker@monitor.gov.uk.

See the toolkit mentioned below in this bulletin.

1.8 Savile Legacy Unit: reminder to review your safeguarding procedures, and contact for advice

In July’s FT Bulletin we advised you of the Savile Legacy Unit, which has been set up in light of the Jimmy Savile investigations. We also urged you to review your safeguarding procedures.

The unit is primarily there to perform the following duties:

• co-ordinate all NHS-related allegations with regard to the activities of Savile
• quality assure and support the investigation by NHS trusts of such allegations
• act as a channel between NHS trusts, the police and partner organisations, as necessary and appropriate
• review and quality assure trust reports and recommendations

If your trust needs to investigate an allegation relating to Savile you should, in the first instance, contact the Legacy Unit on 0113 254 5502 or savileinvestigations@dh.gsi.gov.uk.

1.9 Use of the independent sector for additional activity: December 2014 – March 2015

You will have recently received a letter jointly signed by NHS England, Monitor and the NHS TDA about using the independent sector for additional activity throughout the rest of the financial year. We expect that using this increased capacity will enable patients to be treated sooner, and will also give trusts more flexibility in managing capacity to deliver urgent care standards, which we appreciate to be under significant pressure this year. Foundation trusts should engage with the Programme Management Office established by NHS England on this process.

1.10 Future Focused Finance – Seeking volunteers for pilot

We are supporting the Future-Focused Finance (FFF) initiative, alongside other national bodies in NHS finance, to recruit organisations or health economies to pilot a decision-making framework that we would like to roll out across NHS finance and more widely. The types of decision might include:

• choosing strategic improvement programmes
• resource allocation across care settings
• how to invest in integrated care
• service re-designs
• how to determine innovation funding
• innovation roll out

The aim is to provide a case-study based resource that the sector can draw from in making better value-based decisions across a range of contexts.

If you would like to be involved with this work by either sharing the learning from a successful/significant decision, or potentially to access professional support with a forthcoming decision, please contact Mark Redhead at mark.redhead@monitor.gov.uk by 5 January 2015 for details.

2. For information

2.1 Operational resilience update

Foundation trusts will be aware that there continues to be significant pressure nationally on urgent care systems, and the delivery of core non-elective and elective standards, such as Referral to Treatment (RTT), cancer, and diagnostics. We appreciate how hard local systems are working to ensure that the additional resource which has been arranged to support operational resilience is being spent effectively, and that available capacity is maximised.

We are working closely with NHS England and the NHS TDA to ensure that we can co-ordinate our interventions and actions appropriately to provide support to areas most under pressure. To achieve this, we need to be able to understand performance at a local level at a much more granular level of detail, and more frequently, than is usual for Monitor.

We appreciate that we have made a number of short notice requests for information recently, which can be difficult for you to respond to, and we are considering whether we should introduce more frequent regular reporting, which can be systematised better.

We are not changing our approach to regulatory intervention, and the current RAF triggers will continue to apply. With the increased pressure on the system Monitor is seeing an increasing number of breaches of the RAF triggers. As such the provision of additional information is important to allow us to make a more informed and faster judgement as to where a formal investigation may, or may not, be appropriate.

2.2 FAO HR directors: increasing agency staff expenditure? New toolkit available

To help the NHS manage temporary staffing, a toolkit has been prepared for providers by the NHS Commercial Alliance. The toolkit is currently stored on the NHS Centre for Procurement Efficiency portal. However, The Department of Health (DH) is exploring how it can be made more accessible to a wider audience. In the meantime HR directors should contact their head of procurement to access the toolkit.

2.3 Winter sitreps

Trusts are reminded to be clear in the language they use in daily sitreps. If you are experiencing significant operational difficulties, please provide sufficient detail to ensure it can be easily understood by regional and national colleagues who may not be familiar with local terminology.

For example, a statement such as; ‘Currently 15 escalation beds open. No bed availability. 28 medical outliers. Message sent via CCG to all GPs to consider alternative care pathways. Step down care and intermediate care capacity being expanded’ is more helpful than ‘Hospital is in black due to capacity issues’.

In addition, if a trust has experienced a 12 hour breach in the reporting period then a brief explanation of the causes of that breach – accepting that a full root cause analysis is not likely to have been completed at that point – is required.

2.4 Reforming the payment system for NHS services: supporting the Five Year Forward View

This paper sets out several payment approaches that Monitor and NHS England want to develop further with NHS providers and commissioners, including those in social and primary care.

Get involved

If you would like to find out more or get involved in our payment development programme, please email paymentsystem@monitor.gov.uk.

2.5 Licence review update

Earlier this year we sent out a survey to all NHS foundation trust company secretaries, inviting them to share their views on our provider licence since its launch in April 2013. The main aim was to identify any areas that were inadvertently effecting beneficial change for patients and/or having a negative effect on the behaviour of NHS foundation trusts.

A consistent theme from the responses received was that very little progress has been made by commissioners in identifying and confirming Commissioner Requested Services (CRS). The main challenges identified by foundation trusts in this regard related to the lack of commissioner awareness of the issues and potential benefits of CRS.

Monitor places great importance in identifying CRS ahead of any problems that could occur for providers and therefore we will be doing more work with our national partners to encourage NHS commissioners to view the designation of CRS as a local priority.

2.6 Ebola update

Foundation trusts are asked to note the 2 recent communications from NHS England about the current Ebola outbreak in West Africa, and to ensure that required actions from these and earlier communications are underway. NHS England is co-ordinating the NHS response to Ebola through its Emergency Preparedness, Resilience and Response (EPRR) arrangements.

Monitor is represented on the NHS England Ebola Programme Board, and is fully supportive of the actions agreed by that board and those agreed by the NHS England national Ebola EPRR team. Should any issues arise over the Christmas and New Year periods these will be handled through normal on-call arrangements and foundation trusts should ensure that their on-call directors are fully aware of local response plans.

3. Events

3.1 Strategic development briefing events, 28 January 2015 (London) and 4 February 2015 (Leeds)

For: Executive directors at foundation trusts and NHS trusts.

Why attend? For an opportunity to improve your organisation’s capability in strategy development through informative presentations and practical sessions on relevant topics, including Monitor’s strategy development toolkit.

You will discuss how the Five Year Forward View, Dalton review and national policy may influence your local strategy and will hear about good practice on both strategic and operational components including:

• deciding on the best organisational form to support delivery of your strategy
• understanding the financial impact of new models of care and international best practice
• workforce planning across a whole health economy
• improving patient level costing
• developing an effective commercial strategy for your trust
• making use of innovation contracting mechanisms to deliver your strategy Your peers will also share how they have addressed strategy development within their local health economies.

Book your place.

Resources:

Dalton Review Strategy Toolkit Board guide for developing strategy

3.2 Monitor and NHS Providers: joint induction programme for new non-executive directors, 19 to 20 February 2015, London

For: New NHS foundation trust non-executive directors and NHS trust non-executive directors nearing completion of the foundation trust application process.

Why attend? To get an overview of the NHS, foundation trust governance and more.

The programme includes:

• an overview of the NHS and the role of foundation trusts
• foundation trust governance, risk and assurance
• Monitor’s regulatory regime and how we work with the CQC
• foundation trusts, governance and the law
• governors, stakeholders and the public
• patients, quality and safety
• finance

Find out more and sign up.

3.3 CEO and chair induction day – 19 March 2015, London

For: Newly appointed chairs and chief executives of NHS foundation trusts without previous experience of our foundation trust authorisation process.

Why attend?

To learn about:

• Monitor’s role, including an overview of pricing and competition
• the NHS foundation trust legal framework
• the regulatory regime, including how we assess risk and our enforcement processes
• current issues in the NHS
• quality and quality governance
• foundation trust governance, including working effectively with governors

If you’d like to attend this event or be kept informed of future dates, please contact mel.baldwin@monitor.gov.uk. Places are limited.

4. External updates

4.1 FTN becomes NHS Providers

On 1 December 2014, the Foundation Trust Network changed its name to NHS Providers, the association of foundation trusts and trusts. The change was made to better reflect what the organisation does and who it represents. Email addresses have changed to @nhsproviders.org and the website to http://www.nhsproviders.org/home/.

4.2 NHS resilience: share your stories

DH has set up an online feed where they are posting useful information to show how the NHS is performing under increased demand throughout winter. The feed is updated with graphics, screen shots, mini film clips and pictures and is being used by medical colleges and think tanks.

If you or your trust have any examples of innovative work you are carrying out, then get in touch with the DH at press.office@dh.gsi.gov.uk.

4.3 Academy of Medical Royal Colleges – Protecting resources, promoting value

The Academy of Medical Royal Colleges has published ‘Protecting resources, promoting value: a doctor’s guide to cutting waste in clinical care’ written by doctors, for doctors.

The document provides a waste reduction toolkit, as well as patient stories and examples of good and bad practice to help promote efficiency within medical NHS practices. The primary aim is to improve clinical care, while making financial (and environmental) savings.

4.4 Decisions relating to cardiopulmonary resuscitation (DNACPR)

An updated version of Decisions relating to cardiopulmonary resuscitation was published in October 2014 by the Resuscitation Council (UK), the British Medical Association and the Royal College of Nursing. The new edition takes into account developments in clinical practice and developments in the law regarding anticipatory decisions. It also emphasises the importance of involving people (or their representatives) in the decision-making process.

The DH recommends the new edition as a basis for local DNACPR policies.

4.5 New peer support programme for senior clinicians

NHS Improving Quality (NHS IQ) and the Faculty of Medical Leadership and Management (FMLM) are piloting a strategic peer support programme designed to help senior clinicians in NHS trusts. Peer support will be offered to clinicians with directorate or board level responsibility who need expertise and guidance to deliver significant service change and have a strong commitment to, and interest in, quality improvement.

Senior clinical leaders who need support in delivering service transformation in their trusts, and those who wish to become expert peers, should apply by midnight on Wednesday 14 January 2015. For more information please contact Liz Maddocks-Brown, NHS IQ Senior Manager, liz.maddocks-brown@nhsiq.nhs.uk, or visit the NHS IQ website.

4.6 Update from the Secretary of State for Health

Read the latest update here.

4.7 National Commissioning Group for Blood update

The National Commissioning Group for Blood (NCG) has now completed its consideration of NHS Blood and Transplant’s (NHSBT) commissioning intentions for the financial year 2015/16, and the summary has been published.

This should be shared with financial accountants and planning teams supporting hospital directorates or divisions which use the specialist services from NHSBT, in addition to hospital transfusion teams.

4.8 NHS procurement and efficiency programme update

The latest updates for NHS procurement staff are now available on the Centre for Procurement Efficiency portal.

5. Get in touch

5.1 Our latest job opportunities

For more information or to apply, please visit our recruitment website joinmonitor.com.

5.2 Queries or feedback

If you have any queries about the information in this bulletin, please contact your relationship manager at Monitor.

5.3 News alerts

You can subscribe to Monitor’s news update service and receive relevant information direct to your inbox.

5.4 Publications

All of our publications are available to download from our publications section.