Supporting all NHS Trusts to achieve NHS Foundation Trust status by April 2014

Transcription

1 TFA document Supporting all NHS Trusts to achieve NHS Foundation Trust status by April 2014 Tripartite Formal Agreement between: Leicestershire Partnership NHS Trust NHS East Midlands Department of Health Introduction This tripartite formal agreement (TFA) confirms the commitments being made by the NHS Trust, their Strategic Health Authority (SHA) and the Department of Health (DH) that will enable achievement of NHS Foundation Trust (FT) status before April Specifically the TFA confirms the date (Part 1 of the agreement) when the NHS Trust will submit their FT ready application to DH to begin their formal assessment towards achievement of FT status. The organisations signing up to this agreement are confirming their commitment to the actions required by signing in part 2a. The signatories for each organisation are as follows: NHS Trust Chief Executive Officer SHA Chief Executive Officer DH Ian Dalton, Managing Director of Provider Development Prior to signing, NHS Trust CEOs should have discussed the proposed application date with their Board to confirm support. In addition the lead commissioner for the Trust will sign to agree support of the process and timescales set out in the agreement. The information provided in this agreement does not replace the SHA assurance processes that underpin the development of FT applicants. The agreed actions of all SHAs will be taken over by the National Health Service Trust Development Authority (NTDA) 1 when it takes over the SHA provider development functions. 1 NTDA previously known as the Provider Development Authority the name change is proposed to better reflect their role with NHS Trusts only. 1

2 The objective of the TFA is to identify the key strategic and operational issues facing each NHS Trust (Part 4) and the actions required at local, regional and national level to address these (Parts 5, 6 and 7). Part 8 of the agreement covers the key milestones that will need to be achieved to enable the FT application to be submitted to the date set out in part 1 of the agreement. Standards required to achieve FT status The establishment of a TFA for each NHS Trust does not change, or reduce in any way, the requirements needed to achieve FT status. That is, the same exacting standards around quality of services, governance and finance will continue to need to be met, at all stages of the process, to achieve FT status. The purpose of the TFA for each NHS Trust is to provide clarity and focus on the issues to be addressed to meet the standards required to achieve FT status. The TFA should align with the local QIPP agenda. Alongside development activities being undertaken to take forward each NHS Trust to FT status by April 2014, the quality of services will be further strengthened. Achieving FT status and delivering quality services are mutually supportive. The Department of Health is improving its assessment of quality. Monitor has also been reviewing its measurement of quality in their assessment and governance risk ratings. To remove any focus from quality healthcare provision in this interim period would completely undermine the wider objectives of all NHS Trusts achieving FT status, to establish autonomous and sustainable providers best equipped and enabled to provide the best quality services for patients. 2

3 Part 1 - Date when NHS foundation trust application will be submitted to Department of Health Application Submitted Re-activation of application 1 st Qtr 2012/13 *NB: We are in a period of postponement with Monitor, who have supported LPT in taking forward both our FT and the TCS transfer. Monitor have asked that we write to them by 18 February 2012 to confirm that either we wish to commence the reactivation of our application, or request an additional period of postponement. A copy of their letter is attached to this Tripartite Agreement. Part 2a - Signatories to agreements By signing this agreement the following signatories are formally confirming: their agreement with the issues identified; their agreement with the actions and milestones detailed to support achievement of the date identified in part 1; their agreement with the obligations they, and the other signatories, are committing to; as covered in this agreement. Antony Sheehan, CEO of Leicestershire Partnership NHS Trust Kevin Orford, Chief Executive, NHS East Midlands Signature Date: 30 March 2011 Signature Date: 31 March 2011 Signature Ian Dalton, Managing Director of Provider Development, Department of Health Date: 6 July 2011 Part 2b Commissioner Agreement In signing, the lead commissioner for the Trust is agreeing to support the process and timescales set out in the agreement. Catherine Griffiths, Chief Executive NHS Leicestershire County and Rutland PCT NHS Leicester City PCT Date: 30 March

4 Part 3 NHS Trust summary Short summary of services provided, geographical/demographical information, main commissioners and organisation history. Required information Current CQC registration (and any conditions): Unconditional registration Financial data (figures for 2010/11 should to be based on latest forecast) 2009/ /11 Total income EBITDA 9,075k 8,616k *Operating surplus\deficit CIP target 4,424k 5,211k CIP achieved recurrent 2,452k 5,100k CIP achieved non-recurrent 1,972k 111k *(with)/without impairments Control Total ( delivered ) 1732k 1700k The NHS Trust s main commissioners; Our key commissioners are NHS Leicester City (NHS LC) and NHS Leicestershire County and Rutland (NHS LCR), and the East Midlands Specialised Commissioning Group. Summary of PFI schemes (if material) (Not applicable) Trust overview Established in 2002, we are one of the larger specialist mental health and learning disability Trusts in England. We currently employ 2,506 whole time equivalent staff, manage 192 Local Authority staff and have around 200 active volunteers. We operate over many sites, both inpatient and community, and currently have 525 inpatient beds We receive over 44,189 referrals a year to our community services. We admit around 3,800 people to our inpatient services per annum. The communities we serve are culturally diverse and the geographical area we cover is environmentally varied with market town, inner city, rural and suburban areas. As a large teaching Trust we work in partnership with a range of educational establishments to deliver effective pre- and post-registration education. Our main links are with the University of Leicester and De Montfort University, but we also work with other universities including Loughborough, Derby, Northamptonshire and Sheffield Hallam. We play an important role in the Heart of England Mental Health Research Hub, and played an active part in the successful bid for a local National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Our ambition is to become a Wellbeing Trust and in support of this, as of April 1 st 2011, we will acquire the majority of community health services for the PCTs of Leicester City and Leicestershire County and Rutland respectively, growing from a turnover of 140m to 250m; and employing over 7000 staff 4

5 Part 4 Key issues to be addressed by NHS trust Key issues affecting NHS Trust achieving FT Strategic and local health economy issues Service reconfigurations Site reconfigurations and closures Integration of community services Not clinically or financially viable in current form Local health economy sustainability issues Contracting arrangements Financial Current financial Position Level of efficiencies PFI plans and affordability Other Capital Plans and Estate issues Loan Debt Working Capital and Liquidity Quality and Performance QIPP Quality and clinical governance issues Service performance issues Governance and Leadership Board capacity and capability, and non-executive support 5

6 Foundation Trust application As outlined in Monitor s letter of postponement dated 18 February 2011 we have committed to the following; Progress and develop further the Trust s estates strategy and programme, by preparing a detailed business case covering the next steps of this programme Provide more information on the delivery of the Trust s efficiency programme and more planning detail about the Trust s cost improvement plans Strengthen the Trust s data collection systems and information presented to the Board Approve the Trust s quality strategy and ensure that it is working fully in the organisation Integration of Community Services - In addition to the issues identified above, LPT will need to successfully complete the integration of community services as part of the TCS transfer from NHS Leicestershire County and Rutland and NHS Leicester City (PCTs). The services transferring to LPT under Transforming Community Services (TCS) will increase the annual turnover of the Trust by approximately 89%, with an increase in value terms from 138m to approximately 261m. The transaction therefore represents one of the largest TCS transfers, relative to current organisational size, within the NHS Robust programme management, led by the Chief Operating Officer as Programme Director is in place to deliver this transfer. The programme is focused on the transactional and transformational plans to successfully integrate these services LPT remains on track to achieve the transfer of TCS service bundles by 01 April 2011 The overall time period for organisational integration/transformation is expected to be between six and nine months from transfer, with the majority of changes occurring in the first six months Board Capacity & Capability Appointment of new Chair: Having successfully led the Trust Board for 4 years, the current LPT Chair has decided not to accept a further 4 year term The Chair post has been advertised and interviews take place in April We expect the timely appointment of Board Chair to enable influence and leadership over the development of our IBP and to provide opportunity to develop appropriate relationships with Monitor Appointment of interim CEO: Current CEO has been awarded a prestigious Fellowship to study for a year from July 2011 at the Institute for Health Improvement at Harvard. His proposal is to use the experience, best practice and evidence available to inform the integration of TCS services into LPT He will return as CEO at the end of the Fellowship period. During the Fellowship period he will be in regular contact with the Trust and support the development of the Trust s vision and strategic direction An interim CEO will be appointed to discharge the duties of Accountable Officer whilst our CEO is away. We expect the interim CEO to be appointed in the latter part of April This will provide clarity in terms of leadership for both Chair and CEO well in advance of our current CEO s Fellowship commitments 6

7 Part 5 NHS Trust actions required Key actions to be taken by NHS Trust to support delivery of date in part 1 of agreement Strategic and local health economy issues Integration of community services Financial Current financial position CIPs Other capital and estate Plans Quality and Performance Local / regional QIPP Service Performance Quality and clinical governance Governance and Leadership Board Development Other key actions to be taken (please provide detail below) Describe what actions the Board is taking to assure themselves that they are maintaining and improving quality of care of patients. Our IBP and existing strategies agreed by the Board have enabled significant investment in improving the quality of inpatient care supported by our capital programme, along with investment in the quality of our community services. Following TCS we have great opportunities for improvement in the quality of care via the work being undertaken on our integrated care pathways. This has resulted in more positive feedback from our users via the patient survey. Our Quality Strategy approved by Board in March 2011, is aligned to our Annual Plan and Integrated Quality & Performance Report. Our IQPR has a strengthened focus on quality and patient experience. We have a Patient Experience pilot within the Learning Disabilities and CAMHS services due to be rolled out to Adult MH Services May 2011; with an investment of 200k. Investment is being made in data quality, with all data now collected through one single point MARACIS; we have no manual data collection Our Healthy Organisation Group, established November 2010, has objectives to; - Improve the health and wellbeing of people working for the Trust - Improve organisational health through delivery of an organisation development plan - Connect improvement systems, process and relationships across LPT to increase focus and improve outcomes to the experience of both service users and staff. We have planned walk-abouts for NEDs, with focused Board development sessions which include patient feedback. Please provide any further relevant local information in relation to the key actions to be taken by the NHS Trust with an identified lead and delivery dates: Monitor postponement & Actions Progress and develop further the Trust s estates strategy and programme, by preparing a detailed business case covering the next Key Actions An outline strategic case supported by Trust Board in January Board will sign off business case at it s March Board. In addition, 7

8 steps of this programme Provide more information on the delivery of the Trust s efficiency programme and more planning detail about the Trust s cost improvement plans. Strengthen the Trust s data collection systems and information presented to the Board. Approve the Trust s quality strategy and ensure that it is working fully in the organisation the Board has declared a major asset surplus to requirements and the Towers site is up for sale as a result. Processes in place to continually manage, monitor and update CIPs. Future CIP plans firmly embedded in the Business Unit planning process and have just undergone a financial and quality/safety review again as part of the 11/12 annual planning process. Investment made in the 11/12 plan in improving Data quality. External review of the Integrated Quality and Performance Report, with a refreshed version ready for use in 11/12. All data to be collected electronically by 01/04/11 The direction of the Trust s Quality Strategy was confirmed at January 2011 Trust Board. Processes in place to embed the strategy in the integrated organisation. The Quality Strategy will be ratified at the March Board. Next Steps Prior to being re-assessed, Monitor expects the Trust, in common with all Trusts, to have addressed all the issues in its postponement request letter; Action Required Developed a robust, transparent and accurate long term financial model aligned with the trust s business plan (IBP) and estates strategy Key Actions Delivery expected by October/November 2011 for the new integrated organisation. Addressed areas for development identified in the quality governance assessment, in particular in domains as referenced in Monitor s Guide to Applicants Provided sufficient evidence that all clinical and safety issues, including SIs, are being appropriately addressed, that action plans have been appropriately progressed as confirmed by key stakeholders and any reviews triggered by the Trust or external stakeholders, including the Care Quality Commission have concluded satisfactorily, Reviewed board capabilities to ensure that they are fit for purpose in line with the Trust s integrated business plan. To be incorporated into the Transformational plan for the organisation as part of integrating Community Health services Action Plans in place; implementation underway for all independent inquires and SIs, these are monitored internally/externally by the PCT commissioners; action plans shared with the SHA. No significant risk issues identified in this area. The Trust is currently subject to a planned CQC review commencing March The Trust achieved NHSLA level 1 accreditation in December A review of Executive Director capacity and capability now completed; a review of NED capacity and capability is underway. A new Chair will be appointed in May, and Interim Chief Executive Officer in April/May. Support will be sought to take the Board Development issues forward promptly. Paper to March Board outlining proposals. Complementary to this will be a review and implementation of Trust Board governance arrangements with effect from 1 st July. 8

9 Integration of Community Services On target for 01 April 2011 transfer Robust Programme Management in Place; Programme Director Chief Operating Officer Key milestone to be achieved during first 3-6 months from transfer of an integrated organisation (in no particular order). These are supported by a more detailed Post Transfer Plan. Integrated governance structure in place Integrated information governance function and systems in place Integration of Professional Advisory structures Finalised new Business Unit configuration Business Unit senior leaders and sub-structures in place Implementation of leadership for change programme Integrated strategies in place e.g. IM&T, Quality, OD, Communications & Engagement Integrated HR function and structure developed, agreed and implemented Integration of HR policies and procedures Integrated finance functions and structures developed, agreed and implemented Integration of finance policies and procedures Integrated business development and planning functions and structures developed, agreed and implemented Integrated business planning process in place Integrated communication function and structure agreed and in place Integrated stakeholder engagement plan approved Board Capacity & Capability Appointment of new Chair - May 2011 Appointment of Interim CEO April / May

10 Part 6 SHA actions required Key actions to be taken by SHA to support delivery of date in part 1 of agreement Strategic and local health economy issues Local health economy sustainability issues (including reconfigurations) Contracting arrangements Transforming Community Services Financial CIPs\efficiency Quality and Performance Regional and local QIPP Quality and clinical governance Service Performance Governance and Leadership Board development activities Other key actions to be taken (please provide detail below) Please provide any further relevant local information in relation to the key actions to be taken by the SHA with an identified lead and delivery dates. The SHA recognises the need to both support and hold to account Trusts and, where appropriate, PCTs for the delivery of both the high level, and more granular milestones and timelines agreed in this document. 10

11 Part 7 Supporting activities led by DH Actions led by DH to support delivery of date in part 1 of agreement Strategic and local health economy issues Alternative organisational form options Financial NHS Trusts with debt Short/medium term liquidity issues Current/future PFI schemes National QIPP workstreams Governance and Leadership Board development activities Other key actions to be taken (please provide detail below Please provide any further relevant local information in relation to the key actions to be taken by DH with an identified lead and delivery dates: Part 8 Key milestones to achieve actions identified in parts 5 and 6 to Achieve date agreed in part 1 Date Milestone March 2011 HDD complete Final decision to acquire TCS taken March 2011 Review of Board Capacity & Capability underway March 2011 Quality Strategy to be approved at Trust Board By 31 March 2011 Transactional transfer of Community Health Services April June day plan plus engagement on the integration plan April 2011 Review of NED Capacity & Capability (report for Chair in May) April / May 2011 Interim CEO appointed April 2011 CHS Advice to Board strengthened May 2011 New Chair appointed May 2011 Director of Commercial & Business Development appointed May 2011 Director of HD & OD appointed (interim in place for March) 1 st Qtr 2011 Financial repositioning July 2011 Implementing new Corporate Governance structure July Sept 2011 Implementing the integration plan and new Business Unit structures 2 nd Qtr 2012 Financial repositioning October / November IBP / LTFM to reflect newly integrated organisation 2011 Oct 2011 March 2012 Embedding the new culture operating as an integrated organisation February 2012 Write to Monitor regarding re-activation of FT application 1 st qtr 2012/13 Potential re-activation of FT application Impact Considerations: Consideration needs to be given to the impact of having a new Chair and the timing of our re-activation of our FT application. We have been advised by Monitor that our new Chair needs to be in place for at least a minimum period of 6 months. Taking this and all other factors as described above, by way of organisational integration creating new governance systems, putting new leadership particularly at Business Unit level in place, and developing a new IBP and associated LTFM, we will therefore be likely to ask Monitor for a further period of postponement not exceeding 3-4 months. 11

12 Provide detail of what the milestones will achieve\solve where this is not immediately obvious. For example, Resolves underlying financial problems explain what the issue is, the proposed solution and persons\organisations responsible for delivery. Describe what actions\sanctions the SHA will take where a milestone is likely to be, or has been missed. The SHA will apply its existing escalation policy for the delivery of the timeline detailed in this document. Key Milestones will be reviewed every quarter, so ideally milestones may be timed to quarter ends, but not if that is going to cause new problems. The milestones agreed in the above table will be monitored by senior DH and SHA leaders until the NTDA takes over formal responsibility for this delivery. Progress against the milestones agreed will be monitored and managed at least quarterly, and more frequent where necessary as determined by the SHA (or NTDA subsequently). Where milestones are not achieved, the existing SHA escalation processes will be used to performance manage the agreement. (This responsibility will transfer to the NTDA once it has been established). 12

13 Part 9 Key risks to delivery Risk Mitigation including named lead Ensuring a safe and A clear implementation plan effective transfer and BTA giving us the warranties & indemnities integration of community Robust programme management arrangements health services Regular Board review New organisational structure, systems Responding effectively to the uncertain and changing nature of the commissioning environment and market Maintaining operational performance and standards Lead Chief Operating Officer New Board appointment; Director of Commercial and Business Development Engagement plans with consortia in development Client management responsibilities through Executive Directors Strong links to Health & Wellbeing Board Lead: Director of Commercial & Business Development Continued focus on service performance (review through Business Units and governance Data quality improvement strategy Quality Strategy to March Board Revised IQPR and management arrangements Lead Chief Operating Officer Improving staff experience Post TCS implementation plan (importation of good practice) Board appointment of Director of HR & OD Management representation in OD & Leadership Programme Lead: Director of HR & OD Ensuring continuity of organisational leadership and ongoing development of the organisation s culture. Achievement of Foundation Trust status Service level structures in place by July 2011 Next level structures in place by October 2011 New Chair appointment Lead: Chair / CEO Board development activities including facilitated sessions and developing through doing (real-time strategic change). These sessions will include selfdiagnostics based on best practice and session to refocus on current organisational risks Decision support identifying information requirements at Board, sub-committee, executive and business unit levels and prototyping reports at each level; resequencing meetings to eliminate redundancy and optimise information assurance and efficiency of decision making processes Informatics production/revision of information systems strategy and plans, resolution of data quality issues to enable effective decision-making and assurance at the optimal level Strategic plans production of revised LPT strategy, IBP and FT application in light of the revised focus on strategic initiatives and outcomes Lead: CEO NB: These risks will be developed and further reviewed at the Board Development session scheduled for April 28 th and can be expected to be seen in the April risk reports. They will be incorporated into the 2011/12 BAF. The significant risks identified from City and County Community Health Services BAF s will be encompassed in this review and will also inform the BAF 2011/12 13