Agenda item

(To receive a report from Jim Heys (Locality Director (Midlands and East (Central Midlands) – NHS England) and Jeff Worrall (Portfolio Director – Trust Development Authority) which asks the Committee to consider and comment on the content of the report and, in particular, focus on the extent of the positive outcomes of the Lincolnshire Recovery Board to-date.  Jim Heys (Locality Director (Midlands and East (Central Midlands) – NHS England) and Jeff Worrall (Portfolio Director – Trust Development Authority) will be in attendance for this item)

A report by Jim Heys (Locality Director (Midlands and East (Central Midlands) – NHS England) and Jeff Worrall (Portfolio Director – Trust Development Authority) was considered which asked the Committee to consider and comment on the content and, in particular, focus on the extent of the positive outcomes of the Lincolnshire Recovery Board to-date.

Jim Heys (Locality Director (Midlands and East (Central Midlands) – NHS England) and Ian Hall (Senior Delivery and Development Manager – Trust Development Authority) were in attendance for this item.

The Lincolnshire Recovery Programme (LRP) was developed to provide a senior level coordinating programme structure, which supported performance improvement and the further development of a clinically safe and financially sustainable health and care model, across Lincolnshire.  The aims of the LRP were to:-

·       Improve the performance of United Lincolnshire Hospitals NHS Trust (ULHT) against the NHS Constitutional standards so that all required targets were achieved;

·       Continue to improve quality within ULHT and across the health community;

·       Develop a financial strategy and plan to deliver improvements to the financial position across Lincolnshire; and

·       Design an underpinning workforce/Organisational Development strategy and plan.

The Lincolnshire Recovery Programme Board was jointly chaired by NHS England and the Trust Development Authority. 

With effect from April 2016, the TDA would merge with Monitor whose role included regulation and performance management of NHS Foundation Trusts.  This new organisation would be known as NHS Improvement.

The purpose of the Lincolnshire Recovery Board was:-

1.    To oversee achievement of the programme aims for an initial period of twelve months from July 2015, following which those responsible for health and care system delivery would be in a position to no longer require this level of intervention;

2.    To agree a programme structure which held senior leadership from all represented organisations to account and oversee high level intervention and support;

3.    To ensure that the boards of each organisation represented were signed up to the LRP aims and programme structure;

4.    To accept recommendations from the Operational Programme Group with regards to the scope and expected outcomes from the programme work streams;

5.    To act upon exception reports and items for escalation from the Operational Programme Group in order to ensure the programme aims were achieved;

6.    To ensure that dependency issues between the LRP and the Lincolnshire Health and Care (LHAC) Programme were managed in a manner which avoided duplication between the programmes or adverse impact on either programme; and

7.    To identify the need for additional support to facilitate achievement of the Programme aims and agree approaches to secure the support;

Outcomes of the programme to date included:-

·       The delivery of the Referral to Treatment (RTT) incomplete standard from 92%.  The Department of Health had introduced this operational standard in April 2012.  Incomplete pathways were the waiting times for patients waiting to start treatment at the end of a month and were also often referred to as waiting list waiting times and the volume of incomplete RETT pathways as the size of the RTT waiting list;

·       ULHT was on track to deliver the 62 day cancer standard with a 12% improvement from 70% achievement (September) to 82% (November) against a national standard of 85%;

·       The A&E standard of 95% within 4 hours varied by site and was the subject of intense support from all parties.  A revised trajectory for delivery was being developed.  The current year to date delivery was 88%;

·       ULHT was currently forecasting a deficit position of £59 million against the planned deficit of £40 million, which was a £19 million adverse variance.  The system was developing plans to be presented to the LRP Board on 8 January 2016 to address the current deficit position; and

·       The LHAC programme reported on progress to the LRP although this was subject to a separate governance and decision making structure.

Members were invited to ask questions, during which the following points were noted:-

·       Clarification of the difference between the Lincolnshire Recovery Programme Board and the Operational Board Programme Group.  The operational group had a slightly broader membership and the board was an opportunity for the accountable officers of each organisation to agree the action plan for the forthcoming 30 days.  This groups proved helpful as the members were in a position to ensure what was agreed was delivered and, if not, could be held to account by NHS England and the TDA;

·       NHS England and the TDA felt that this structure was the best way for progress to be monitored, through the programme board, on a temporary basis until back on track;

·       As a recovery board, it was asked if they were confident that this would be the position in July 2016, following the 12 month Recovery Programme, and would no longer require this level of intervention.  The Board were confident that it had been set up for 12 months as it needed to be time limited and not become a substantive part of the management process.  It had been clearly stated that this was an interventional recovery programme but the challenge remained around constitutional standards, etc.  There was a confidence that those standards would be delivered and expected that all actions would be met although acknowledged that financial sustainability would be ongoing;

·       When asked how the deficit would be rectified and when the two authorities would be confident that intervention was no longer required, it was advised that this would need two elements, Trust specific and broader.  For the Trust, a number of escalation beds had been opened which increases agency costs (it was stressed that this was not the reason for the increased deficit alone but was a significant contributing factor).  Part of the work of NHS England and the TDA was to close those beds both quickly and efficiently which was both challenging and complex but would assist with reducing the increased deficit;

·       Links to other organisations were being developed to reduce the necessity for patients to resort to a hospital setting and this was being monitored as part of the Recovery Board;

·       It had become clear through the Recovery Programme Board meetings that recent planning guidance and understanding about what was driving the increasing deficit was being reinforced.  Although the deficit was apportioned to ULHT, it was acknowledged that there was a number of contributing factors for consideration and the Recovery Programme Board were undertaking a full analysis to ascertain the key issues to be addressed;

·       It was reported that the LHAC could make a lot of progress due to its foundation elements but it was not designed to include guidance on how to reach financial viability.  It was suggested that the LHAC could be the first step on the five year plan to reach financial viability;

·       Unless secondary care providers were able to reduce delivery costs, the gap would continue to broaden as the NHS Tariff changed each year, generally reduced although there had been some address of that within recent guidance.  An additional £1.8bn to the NHS would allow providers to become balanced but there was no more funding after that.  Years 2, 3 and 4 would require transformational change to reach financial and clinical sustainability;

·        Quarter 3 had started to see the overspend run rate diminish which had been assisted by work done on the immediate management control of the organisation.  Fortnightly meetings were ongoing with ULHT in relation to agency staff and the reduction of costs in that area;

·       NHS England and the TDA were not aware of the maximum amount of deficit which ULHT could reach without severe implications.  The two organisations were in frequent contact with the Department of Health and were unaware that a level had been set at this stage;

·       The complexity of the health services was acknowledged and stressed that to get through the recovery programme would require more joined up working between organisations to ensure delivery was more meaningful to patients and users and to provide a simple navigation process for patients;

·       The Committee were unclear as to the solutions set out to rectify or improve the situation ULHT were in.  It was explained that the LHAC provided guidance for the 50k population within Lincolnshire linking neighbourhood teams, GP practices, etc, which would cover the countywide services but what it did not include was how they linked with other, regional, organisations;

·       Having been included within the ECIP issues, South West Lincolnshire had witnessed the flow in wards at Pilgrim Hospital, with commissioners, ECIP, social care, etc, and agreed where improvements could be made to allow safe discharge and streamline the process.  Despite being from different organisations, all the right people came together at the same time to improve service delivery and this was the ethos required to sustain improvement within the health service;

·       Concern was raised regarding the Comprehensive Spending Review (CSR) and the cuts to the preventative work currently undertaken by local Councils impacting back on to the NHS.  It was explained that the NHS made representations about how funding was allocated, for example the Better Care Fund.  Although consideration could be given to certain issues, it was reported that this could not be influenced at this level but that they were issues which would require collective resolution;

·       Individuals treated for preventable diseases could save the NHS a considerable amount if they took responsibility for their own personal health and wellbeing.  Further suggestions was to widen this responsibility to supermarkets and what they make available (i.e. high sugar content) or pharmaceutical companies;

·       Opportunities to improve efficiency whilst improving quality within large complex organisations were always available and the improvements made so far were a good example.  The increased spend on agency staff was linked to urgent care flow, reduction of escalation beds and consideration of the budget and any genuine savings which could be made;

·       Some patients were brought in to hospital to be told face to face that they had a negative test result but it had been suggested this could be done over the telephone or by post, in the most appropriate way deemed for that particular department.  This would then save money and free up appointments for patients who require treatment thereby reducing waiting times.  Although a relatively small change, it could see a large difference;

·       Winter pressure planning within the NHS usually ran until the end of March therefore plans were in place should services become overwhelmed by escalation procedures;

·       Government policy in relation to agency workers was to reduce the number employed and to reduce the cost significantly so that it was comparable with NHS workers;

·       A suggestion to open two empty wards within hospitals by Lincolnshire Community Health Services to assist with DTOC rates was made and this was acknowledged as something which the Recovery Programme Board would give consideration too.  Patients should be directed to the right place of care the first time and it was the role of the Board to consider all options as part of the wider recovery programme;

·       Care and convalescent homes were discussed and encouraged to be reinstated to relieve pressure on hospitals.  A range of packages were being made available for individual needs but the range of requirements for individuals was complex.  Although there were a number of options within the voluntary sector, it was acknowledged that a number of volunteers were elderly themselves and were not being replaced by younger volunteers thereby causing concern that the voluntary sector may be unable to sustain service delivery in future years;

At 3.35pm, Dr B Wookey left the meeting and did not return.

RESOLVED

1.    That the report and comments be noted; and

2.    That the outcomes and final submissions be presented to the Committee at its meeting in May 2016.