Leadership Briefing

3 February 2016Lance McCarthy

Content

• CQC • headlines• ratings• good & beyond

• Performance• general• workforce• finance

• System / PSHFT work• Urgent Care

CQC - key headlines

• ‘Requires Improvement’ overall – improvement from ‘Inadequate’• Improving - CQC saw material improvements had been made since

their previous inspection• Caring – ‘Good’ rating achieved in all of the service areas• Leadership – CQC feel the leadership team is able to continue with

the implementation of the improvements required• 14 Must Do’s• No compliance issues• Recommendation that we remain in special measures to ensure

ongoing additional support to further embed improvements• Re-inspection soon (date tbd)

Ratings after October 2015 visit

Material improvements over time31 March 2015

Return to NHS management 2 February 2016

Today

2013/14 2014/15 2015/16

January 2015CQC re-inspection

September 2014Initial CQC inspection

October 2015Second CQC re-inspection

Good & Beyond

• Identification of what ‘Good’ is in every domain for all 7 services• Integrated composite quality action plan including all relevant

actions (finance, performance, quality)• Linked to refreshed values and behaviours (Feb – May)• OD and Leadership programmes to support this (Feb onwards)• Supported by patient and staff smartphone apps (April) and

Schwartz rounds (implementation in April)• Progress managed through the performance meetings with oversight

at HMC and board committees – reinforcing governance structure

• Programme focusing the whole organisation on getting to good and then to outstanding

Workforce information

Current I&E position

• Control Total (April 2015) (£12.9m)• Revised control total (Sept 2015) (£11.4m)

• M9 actuals (£15.1m)• Variance from plan at M9 (£4.3m)• Variance from revised forecast (£2.2m)

• Forecast year end (£16.6m)• Variance from plan (-£11.4m) (£5.2m) (46%)• Overspend as % of turnover (14.5%)

• Huge under recovery against CIP plan AND against revised CIP plan

• Unsustainable and unacceptable position

Is there opportunity to reduce costs?

• Forecast overspend as % of turnover is 14.5%

• This compares with national benchmarks:– Reference costs = 114

(IE: we are 14% more expensive than the national average)– Carter efficiency potential = 18%

(IE: could reduce costs by 18% - the 2nd highest of all 136 Trusts in the country)

– Admin costs benchmarked as being 40% higher than expected

• Material opportunity to reduce our costs

2016/17 and credibility

2016/17• Financial support available if we hit targets (financial and clinical)• +£4m with £13.8m deficit = £9.8m deficit

Importance of achieving 15/16 and 16/17:• Sustainability• Legal responsibility to breakeven• Responsibility to deliver VfM – taxpayers’ money• Politically with regulators and commissioners – we need credibility; they

need confidence in us. Otherwise no ability to influence:– System service reconfiguration (ED, urgent care, maternity, paeds)– Elective hub for Cambridgeshire– Health Campus

Sustainability

HHCTBaseline

Health Campus

Collaboration

• CIPs• Carter efficiencies• CQC – green +• Productivity• Elective efficiency• SLR

• PSHFT• Other Trusts• CCG / system• Public bodies

• Back office• Clinical services• Estate / place

• SEP• Leasehold income• SLA income• Wider public service offer• Solution to other issues

Actions (now) 2015/16

• Need to minimise/reduce forecast deficit of £16.6m (as close as possible to £12.9m original control total and <£15m)

• Delivery of CIP schemes as planned and agreed originally• Delivery of revised CIP schemes as agreed• Maximise all income (elective especially)• Short term actions from today including:

– Non-clinical non-pay ban– Non-clinical recruitment freeze and qia for all posts. Existing posts to be justified– National agency caps and interim guidance adhered to - plans delivered

• Capital to revenue transfer of up to £0.7m – impact on medical equipment purchase and IT (no choice)

• Review all budget statements and report on actions by 29/01

14

We have agreed refreshed working groups

Pathway redesign: prevention, demand management, pathway standardisation and reconfiguration

Deliver system wide efficiencies (without

quality impact)

Plan for incremental org form changes at

HHCT/PSHFT

Financial incentives alignment

PD Office (planning, risk, OD, resourcing, methodology)

1 2 3 4 5

FDs Forum (modelling & contract design,

system control total)

UEC Vanguard SRG (+ 5 workstreams)

Health Executive (Chair CCG AO)Programme Director (CP)

National Tripartite (SH, PB, BA)

Elective Care Design Programme ( workstreams on referral management, orthopaedics, cardiac, etc)

Children and Young People CWG

Maternity & Neo-natal CWG

x6 workstreams Support Services: HR (monthly update)

Regional Tripartite (Chaired by PW)Individual governing

bodies

PSHFT-HHCT Project Board

Clinical Advisory Group (demand projections, care models, service standards, co-location, configuration, MH strategy)

Proactive Care & Prevention (LTCs, SMI & primary care)

Out of Hospital Estates (bi-monthly update)

System Modelling Group (shared

demand, capacity & cost assumptions &

forecasts)

Comms & engagement: telling the story to staff, patients & the public (comms working group, drafting & editorial)

Decision-making remains with each organisation until / unless authority delegated to HE

Stakeholder Group(s)

Key

Assurance / steering group

ESDP Work Area

Working Group

Group to be set up

Group requires TOR refresh

Reports into

Provides information to

Sustainability & Transformation Planning (writing & Benefits Realisation Design)

C A B

Ai

Aii

Aiii

Aiv

Av

D

E

Bi

F

G

Healthy Child Joint Commissioning

SeenNear final draft

Collaboration with PSHFT

• Latest development of system wide work

• HHCT and PSHFT working collaboratively to:• reduce duplication and costs of back office functions• support the future sustainable of services• review potential organisational form

• Timeline:• communications (early January)• back office and sustainability review by March end• outline Business Case to both Boards at April end• discussions with regulators in May

We are not having any conversations as part of this work with PSHFT about urgent care provision.

• We have made a very clear and intentional decision not to include these services in the programme of work, which is focused on:

1. back office efficiency potential2. clinical service sustainability locally 3. potential organisational form as a result.

• There will be urgent care provision on this site going forward. • We are working with the CCG and the whole system to

implement the ‘safer, faster, better’ guidance from NHS England and achieve designation for the most relevant urgent care service form.