Checklist for Board papers

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Checklist for Board papers ...

Agenda No: 5

    Paper No: 37


    Trust Board Report Frontsheet

    Title of Report: Chief Executive’s Report

     thDate of Board meeting: 30 April 2008

    Lead Director: Author: Paul Mullin, Chief Executive

    Type of paper: Strategic and National Issues for discussion

Key issues, concerns & risks:

    ? We are reviewing the Sec 75 agreements with the LAs (para1)

    ? A programme of work is underway to reduce our Reference Cost Index (para 4)

    ? A programme of work is being scoped and specified for the redesign of the

    WAMH system (para 5)

    ? We need to confirm our development programme for Service Line Reporting and

    Management (NI 4)

    ? The definition of ‘campus provision’ could now include ATUs (NI 17)

    ? The requirement for and costs of employment checks have changed (NI 39)

Decision required by Board:

    ? Confirm the governance arrangements and discuss any issues

Link to Assurance Framework:

    ? Various, implied in report

Financial implications:

    ? NI 39 will have financial implications initially estimated at ?30 to ?60k in 2008-9,

    depending on speed of implementation

    Governance implications (legal, clinical, equality and diversity or other):

    ? Many and various; described in report

    Board Sub-Committee/Group which will oversee actions arising:

    ? Board and Committees as described in the report

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Chief Executive’s Report to the Board

Strategic Matters

    1. The last PMG agreed in principle to extend the Sec 75 agreements by 2 years to

    give some stability whilst BCC is abolished and replaced by two Unitary Authorities,

    subject to a confirmation of targets, standards, resources and risks. This work will

    complete by end of June and come to the July Board for decision. Lead: Helen


2. Discussions are underway with PCTs regarding the options for the divestment of

    their provider services, such options to include both vertical and horizontal

    integration. The Board is asked to review it’s position on the diversification of our

    service portfolio. Lead: Helen Buckingham

    3. The Board has now received feedback following the recent 360 degree feedback

    exercise conducted with the SHA. The exercise was very positive and it identified

    areas for individual and collective development which will be taken forward in the

    upcoming annual appraisal round and via the Board development Programme.

    Leads: Paul Mullin / Alison Davis / Debbie Dunning

4. A programme of work is underway to address issues raised by our reference costs

    (published in January) to improve our 2007-8 position by at least 6-8 percentage

    points and achieve a reference cost index of 100 or less during 2008-9. Lead Simon

    Davies; onward reporting to the F&E Committee.

5. Directors have been discussing the inter-relationship of changes underway or

    planned within the Trust in working age services, including New Ways of Working,

    the Redesign of CMHTs and the Functional Model. Taken together they represent a

    step change in the way that the WAMH system functions and will lead to improved

    outcomes for service users and increased productivity. Given the importance and

    complexity of this change programme, we have decided to put it onto project status

    and integrate it into the Service Development Strategy and LTFM. Leads: Geoff

    Keats/Ian Fuller; onward reporting to S&BD Committee.

6. I have agreed with Penny Furness-Smith, Director of Community Living at LBC, that I

    will join their soon to be established ‘Health and Wellbeing Board’ which is a great

    opportunity to increase the profile of mental health in Luton. Penny also confirmed

    that there may be some development funding available for mental health during

    2008-9. Lead: Fay Brown.

    7. At the Regional SAGE meeting this month, which directs the national management

    development programmes across the SHA, it emerged that there is likely to be a

    significant expansion in the number of centrally-funded Trainee posts becoming

    available from September 2008. The Trust will build on its established reputation with

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    the SHA for high quality trainee placements to optimise this opportunity. Lead: Ian


National Issues

The following issues have been extracted from the weekly communication from David

    Nicholson, Chief Executive of the NHS in England, to NHS Chief Executive’s, over the

    period since the last Board meeting, as relevant to BLPT. If Board colleagues would like

    to receive further information on any of the items listed below, please let me know.

     1) Extra care housing funds (Gateway reference number: 9526)

    This document sets out the bidding process for the ?80 million funding for

    extra care housing to be made available over the next two years. Lead Fay


    2) NICE guidelines for schizophrenia (Gateway reference number: 9578)

    In preparation for the upcoming Healthcare Commission audit relating to the

    NICE guidelines for schizophrenia (ROCR-Lite/07/013), all providers of

    specialist adult community mental health services are required to nominate a

    lead. This data collection will be used to inform a new indicator in the 2007/08

    annual health check, to give a more rounded assessment of mental health

    providers and the follow up to the 2005/06 joint review of community mental

    health services. Lead David Robinson; onward reporting to P&Q


    3) General Medical Council reforms (Gateway reference: 9339)

    The Department of Health (DH) launched a public consultation asking for

    views and comments on three proposed reforms in the Medical Profession

    (Miscellaneous Amendments) Order 2008, which will enable the General

    Medical Council to take forward some measures in the White Paper Trust,

    Assurance and Safety. This is part of the department’s ongoing process to

    update and reform the system of regulation in order to maintain and improve

    public confidence. Lead Hameen Markar

    4) NHS foundation trust status (Gateway reference number: 9574)

    Monitor, the independent regulator of foundation trusts, has released a

    summary of responses to their consultation on introducing service line

    reporting (SLR) to the assessment process. The publication provides details

    on how the responses have been taken into account in arriving at the outlined

    approach. Lead Sue Simmons; onward reporting to F&E Committee.

    5) Disease Management Information (Gateway reference number: 9577)

    This version of the DMIT (disease management information toolkit) updates

    the first version, which was published in May 2007, with the latest available

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HES data. DMIT is aimed at commissioners of health and social care services

    and provides evidence on emergency bed days and interventions. Lead

    Sue Simmons

6) Patient safety information trends (Gateway reference number: 9584)

    The National Patient Safety Agency (NPSA) has issued its quarterly

    publication that sets out the number of patient safety incident reports received

    and describes patterns and trends. It contains two thematic reviews: ‘Focus

    on mental health’ and ‘Medication incidents in primary care’. Lead Debbie Dunning / Karen Brooks; onward reporting to P&Q Committee

7) Personalising social care (Gateway reference number: 9576)

    A new tool will help councils better understand how to transform social care

    systems to a ‘self-directed support‘ model. It is the first in a suite of products to be launched in spring 2008 that brings together lessons learnt from

    implementing direct payments, the individual budget pilots and In Control.

    Lead Fay Brown; onward reporting to S&BD Committee.

8) New contracts for non-acute services (Gateway reference number: 9598)

    This letter, and the attached guidance note, set out the requirement for PCTs

    to give notice to service providers to terminate existing contracts. This is to

    enable the introduction of new standard contracts for mental health,

    ambulance and community services from 2009. Lead Helen Buckingham; onward reporting to FT Programme Board.

9) Drug safety update (Gateway reference number: 9599)

    This is a new monthly electronic bulletin from the Medicines and Healthcare

    products Regulatory Agency (MHRA) and the Commission on Human

    Medicines. It aims to bring all healthcare professionals the latest information

    and clinical advice to ensure the safe use of medicines. Lead Hameen Markar/Steven Squires; onward reporting to Drugs and Therapeutics


    10) Risk management for medium secure patients (Gateway reference number: 9611)

    Following a recent incident involving the absconding of a medium secure

    service patient whilst receiving treatment in an acute hospital, Ministers have

    urged commissioners to assure themselves that providers are aware of the

    risks inherent when a patient is escorted out of the secure environment, and

    they are taking appropriate actions to mitigate the risks. Lead Geoff Keats; onward reporting to the Risk Management Group

    11) Achieving best outcomes for health and social care (Gateway reference number: 9485)

    The Care Services Improvement Partnership (CSIP) has launched its High

    Impact Changes for Health and Social Care. They are designed to help

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    achieve the seven positive outcomes for people using health and social care

    services as set out in the Our health, our care, our say White Paper, and

    further developed in Putting People First 2007. Lead Fay Brown/ Geoff

    Keats; onward reporting to S&BD Committee.

    12) Electronic staff record moving forward (Gateway reference number: 9621)

    The NHS Electronic Staff Record (ESR) project is moving into a new and

    exciting final phase. Supporting NHS organisations in successfully using all

    the rich potential in the integrated system to realise the benefits is the primary

    focus going forward. Lead Ian Fuller; onward reporting to W & OD


    13) Second wave patient safety events (Gateway reference number: 9616)

     Twenty-three chief executives signed up to the first Leading Improvement in

    Patient Safety programme. Applications are now invited for the second wave.

    This is a nine-month series of events to ensure you reduce harm in your trust.

    Lead Debbie Dunning; onward reporting to P&Q Committee.

    14) IT savings to reach ?1 billion First-ever NHS benefits statement

    The new IT systems in the NHS are on course to deliver better care and an

    estimated ?1.14 billion in savings by 2014, according to the first annual

    benefits statement published by the Government.

    It shows that since its introduction, the National Programme for IT has already

    delivered a total of ?208 million in savings by providing quicker, more efficient

    and convenient patient care. The figures from 2006/07 represent a forecast for

    an annual saving of ?120 million. Lead Sue Simmons; onward reporting

    to PARIS Implementation Board

    15) New choice code of practice Rules set out on promotion

    From April 2008, patients will have much greater choice of where they wish to

    be treated. Patients and referrers need accessible and reliable information

    about services to make informed choices. Providers are encouraged to make

    this available.

    A new code of practice for the promotion of NHS-funded services, published

    this week, will ensure that this information is not misleading or unfair, and that

    public money spent on promotional activity is not excessive. It sets out new

    rules around the promotion of NHS-funded services, as well as the existing

    advertising codes administered by the Advertising Standards Authority. Lead

    - Helen Buckingham

    16) Having a say in local spending (Gateway reference number: 9654)

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A draft national strategy on Participatory Budgeting, launched for consultation

    on 19 March by Communities Secretary, Hazel Blears, sets out how to

    encourage the uptake of this approach in all local authority areas. How the

    strategy can be used in the delivery of health funding is discussed in Chapter

    4. Responses are sought by the closure date of 10 June 2008. Lead Helen


    17) NHS campus definition change (Gateway reference number: 9549) From 1 March 2008, the definition of NHS campus will include those in

    assessment and treatment units who are not compulsorily detained or

    undergoing a recognised evidence-based treatment programme, and who

    have been in the unit over 12 months - a reduction in time from 18 months.

    Lead Geoff Keats; onward reporting to P&T Committee.

    18) Consortium chosen for world class commissioning (Gateway reference

    number: 9588)

    The 10 SHAs, in association with the Department of Health (DH) have

    selected an innovative consortium to develop and implement the World

    Class Commissioning (WCC) assurance system. Kaiser Permanante,

    Humana, Dr Foster Intelligence, Mental Health Strategies and Ernst &

    Young - led by McKinsey - have been selected to work with all PCTs and

    SHAs over the next year or so, to finalise the system and support

    implementation. Lead Helen Buckingham

    19) Health inequalities progress report (Gateway reference number: 9548) This status report provides a review of developments using Office of

    National Statistics (ONS) data since publication of the Programme for Action

    in 2003. It considers progress against the national health inequalities PSA

    target, the national headline indicators and against government

    commitments. The report highlights the challenging nature of the health

    inequalities PSA target for 2010. Lead Helen Buckingham

    20) Free Choice roll out for patients (Gateway reference number: 9634) From April 2008, the Free Choice policy will give patients much greater

    choice of where they wish to be treated. This means that GPs will be able to

    refer to any clinically appropriate provider, PCT commissioning

    arrangements will not restrict where patients are offered a choice, and

    Choose and Book and the NHS Choices’ website will change to support this

    roll out. {Acute services only at present} Lead Helen Buckingham

    21) User-led organisations become action sites (Gateway reference number: 9635)

    The recently launched cross-government Independent Living Strategy will

    enable disabled people to have more choice and control and greater access

    to employment, transport, health and housing opportunities. User-led

    organisations (ULOs) are vital to this work and 12 received a share of

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?750,000 to become action and learning sites in 2008/09. Lead Helen


    22) Updated early years programme (Gateway reference number: 9640)

    Launched on 17 March 2008, the Child Health Promotion Programme

    (CHPP) guide focuses on pregnancy and the first five years of life. It builds

    on the national service framework for children, young people and maternity

    services published in 2004 and is intended to provide services tailored to the

    individual needs of children and families. Lead Geoff Keats

    23) Antivirals not needed for flu (Gateway reference number: 9644)

    The most recent surveillance data available indicates that the overall rate of

    influenza reports has now fallen below the threshold at which the National

    Institute for Health and Clinical Excellence (NICE) guidelines on the use of

    antiviral drugs is triggered. Lead Theo Clark/Steven Squires

    24) Views sought on registering providers GPs and community covered A new consultation on registering health and adult social care providers

    recommends covering primary care services, including GP surgeries. Views

    are being sought by the Department of Health over which services will be

    required to register with the new regulator, the Care Quality Commission,

    and the requirements that they will need to meet.

The proposals extend to primary care as far more services are now provided

    in GP surgeries and community settings. The consultation closes on 17 June

    and the new registration system will take effect from April 2010. Lead

    Helen Buckingham/Fay Brown

     25) ?2 million survey to test dignity Older people’s care will be looked at

    A new research project looking at the safety of older people in hospitals and

    care homes has been announced by the Government. The ?2 million joint

    initiative between DH and Comic Relief will investigate the dignity and safety

    of older people being cared for in institutional settings. It is part of a package

    of measures designed to improve protection for vulnerable adults.

    Consideration will also be given to amending the Health and Social Care Bill

    currently going through Parliament to make care homes directly subject to

    duties under the Human Rights Act, reversing the effect of a recent court

    decision. Lead Geoff Keats/Liz Hurst; onward reporting to P&Q


    26) Specialist alcohol treatment (Gateway & ROCR reference number: 9657 & ROCR/0072/002)

    The remit of the National Drug Treatment Monitoring System (NDTMS) has

    been extended to collect treatment data from all specialist alcohol providers

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    via the National Alcohol Treatment Monitoring System (NATMS). Lead

    Helen Buckingham

    27) Delivering child obesity goals (Gateway reference number: 9625)

    This guidance for local areas sets out what actions PCTs and local

    authorities could take to deliver their child obesity goals as part of the NHS

    Operating Framework, and deliver Local Area Agreement (LAA) targets as

    part of the Local Government National Indicator Set. Lead Paul Rix

    28) Working Time Directive compliance (Gateway reference number: 9656)

    National Workforce Projects is offering trusts the opportunity to engage with

    a programme of targeted support that will enable them to achieve Working

    Time Directive 2009 compliance for doctors in training. Lead Hameen

    Markar/Ian Fuller; W&OD Committee

    29) Patient safety in mental health (Gateway reference number: 9469)

    The National Patient Safety Agency (NPSA) has launched good practice

    guidance to help improve and standardise independent investigations of

    serious patient safety incidents in mental health services. Lead Debbie

    Dunning; onward reporting to P&Q Committee

    30) Severe mental illness support (Gateway reference number: 9148)

    Updated policy guidance on the Care Programme Approach aims to help

    mental health services ensure people with severe mental illness are

    supported across the range of their needs. It supports services to deliver

    consistency in applying national policy on assessment, planning, care

    coordination, and risk and crisis management. Lead Geoff Keats;

    onward reporting to P&Q Committee

31) Healthcare travel costs scheme (Gateway reference number: 9602)

    Updated guidance clarifies the scope of the Healthcare Travel Costs

    Scheme and the legal obligations of NHS organisations in connection with

    the scheme. It applies also to independent sector providers contracted to the

    NHS. Lead Theo Clark/Fiona Benson

    32) NHS pension modernisation (Gateway reference number: 9669)

    The NHS Pension Scheme is being revised from 1 April 2008. Scheme

    benefits and employee contribution levels are changing. NHS Pensions has

    provided employing authorities with guidance to ensure these changes are

    correctly implemented. Such material is available from the attached link.

    Lead Ian Fuller

33) Bercow report on children (Gateway reference number: 9714)

    John Bercow MP was asked by Ed Balls and Alan Johnson to conduct an

    independent review of services for children with speech, language and

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communications needs. The interim report was published on 20 March. The

    final report will be delivered to the Government in July. Lead Geoff

    Keats/Linda Hiscott

    34) Flu immunisation letter (Gateway reference number: 9570) This Chief Medical Officer, Chief Nursing Officer and the Chief

    Pharmaceutical Officer’s letter on Influenza Immunisation is aimed at health

    professionals who take part in the flu vaccination programme. The letter

    contains details of the annual 2008/09 influenza immunisation campaign,

    influenza immunisation for health and social care staff, and the poultry

    worker immunisation programme. Lead Ian Fuller

    35) Corporate manslaughter legislation (Gateway reference number: 9699)

    On 6 April the main provisions of the Corporate Manslaughter and Corporate

    Homicide Act 2007 come into effect. All the indications are that the NHS is

    well placed to deal with its provisions, and that current risk management

    procedures, if properly implemented and regularly reviewed, will enable that

    to continue. Lead Debbie Dunning; onward reporting to Audit and

    Assurance Committee

    36) Annual staff survey results Clear improvements identified

The results from the 2007 survey of NHS staff provide an overall positive

    picture of employment in the NHS with some clear improvements since the

    2006 survey. It found that staff were generally satisfied with their jobs and

    identified high levels of access to training, learning and development,

    appraisals, strong support from line managers, and access to flexible

    working opportunities. It found encouraging improvements in responses

    around the promotion of good hygiene, infection control and the reporting of


The survey identified the need for action on levels of violence, harassment

    and bullying against staff and these issues are being vigorously addressed

    locally and nationally. Lead Ian Fuller; W&OD Committee

    37) Pension Scheme modernisation Increased flexibility on offer

Major changes to the NHS Pension Scheme were introduced on 1 April

    2008 and chief executives are encouraged to make sure their staff have full

    information. One of the key messages includes using the strategic benefits

    of the scheme to not only support general recruitment and retention but also

    offer significantly increased flexibility to staff as they plan for retirement.

    Take-home pay could be affected at a time when income tax rates are

    changing and this may result in additional queries for local payroll

    departments. Lead Ian Fuller

    38) Partnering Children’s Trusts (Gateway reference number: 9746)

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    This new guidance on the duty to co-operate reflects the thrust of the

    Children’s Plan to develop greater cultural change within children’s trusts, so

    they better understand and increase focus on children’s needs. The

    guidance will also help key stakeholders and service providers, including,

    PCTs, SHAs, and others become more active partners in children's trusts.

    Lead Geoff Keats/Paul Rix

    39) Fees for employment checks (Gateway reference number: 9729)

    Independent Safeguarding Authority (ISA) checks will start from October

    2009. NHS and social care staff who work with children or vulnerable adults

    will have to be checked prior to employment. The cost will be ?64 which

    includes ?36 for a CRB check and ?28 for an ISA check. Lead Ian Fuller;

    W&OD Committee

    40) Climate change health guidance (Gateway reference number: 9603)

    Two months after the Department of Health (DH) launched its climate

    change report with the Health Protection Agency, guidance documents for

    the healthcare sector are now available. Lead Simon Davies/Bruce



    Board Members are invited to:

    1. Confirm the lead / onward reporting arrangements;

    2. Comment on / discuss any issue raised in this report.

     thPaul Mullin 20 April 2008

    Chief Executive

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