Trust Board MeetingChief Executive’s Briefing

Tom Taylor 27th November 2008

The Care Quality Commission

Ensuring better care for

people

Touching 50 million lives

What is CQC ?

Registration for the NHS

• A new concept for the NHS

• Registration already happens in independent healthcare and social care

• A “licence to operate”

• 2009/10: transitional year

• 2010/11: integrated system for ALL sectors

Steps to improvement

• Trusts:• Review and plan improvements• Apply to register

• CQC:• Decides registration status• Publishes information

• Both:• Continue to monitor HCAI • Expect improvements

Key dates

You apply to register12 Jan –

6 Feb 2009We cross-check applications

and discuss with you our likely decision

February – March

The regulations come into force March

Registration decisions confirmed By 14 March

New enforcement powers can be used

From 1 April

Registration classifications

We both agree things are OK: Registered

We agree there are some things you are putting right quickly:

Registered

+ action plan

There are some urgent, serious things to improve:

Registered

with conditions

WE CANNOT REGISTER YOU!

Registration decisions – the weight of evidence

Registration Categories

Registered - no conditions

Registered - no conditions

Registered - with conditions

Not Registered

No concerns Minor weaknesses: small risk of non-compliance

Significant weaknesses: significant risk of non-compliance

Evidence of non-compliance: serious failure to protect

Beyond reasonable doubt

Balance of probabilities

Application form

The regulation requirement:

(See guidance document page 18)

Application form (continued…)

One of the criteria:

(See guidance document page 19)

Application form (continued…)

Sign-off:

(See guidance document page 20)

Clinical Services

including

• Meeting Core StandardsFully Met

• Existing National TargetsFully Met

• New National TargetsGood

• 6 out of 9 “achieved”

• 3 “under achieved”: MRSA bacteraemia targetReduce health inequalities (with PCTs)Improve long term conditions and reduceemergency bed days through improved

primaryand community care (with PCTs)

• 0 “failed”

… Quality of Services

GOOD GOOD GOOD

2005/06 2006/07 2007/08

Annual Health Check 2007/08

Annual Health Check 2007/08… Use of Resources

Use of Resources

“FAIR” was the highest score possible given our deficit in 2006/07

Auditors Local Evaluation• Financial Reporting 1 2 3

• Financial Management 2 3 3

• Financial Standing 1 2 2

• Internal Control 2 2 3

• Value for Money 1 1 3

• Overall Score 1 1 2

WEAK

2005/06 2006/07 2007/08

WEAK FAIR

(7/20) (10/20) (14/20)

Health Care Commission Ratings

• SaTH have asked for a joint Health Economy monthly report on projected ratings

• Draft presented at Shropshire and Telford Executive Group (STEG) 26/11/08

• Internal SaTH report to be included in Finance and Performance / Trust Board Committee reports

Hospital Activity

• Unprecedented levels of activity in November – Level 4 Escalation

• Emergency inpatients/ bed capacity not a simple function of A&E attenders

• All SaTH capacity fully utilised:-– private patients cancelled– day surgery cancelled– additional ward rounds– staff response has been fantastic

Hospital Activity• Over 70 “medically fit” people in community and acute

beds• Ambulance turnaround times extended• A&E target not maintained in month• SHA reviewing all Health Economy plans• Most of West Midlands under pressure• Shropshire Local Health Economy Summit 28/11/08• SHA expressing serious concern re A&E and category

A&B ambulance response times• SHA confident re waiting times, MRSA, C Diff and

financial targets

Hospital Activity

All activity – elective inpatients, day cases, emergency inpatients, maternity, outpatients(new and follow up), A&E

2003/4457,2172004/5 464,8252005/6470,5872006/7469,1552007/8475,789

Increase 18,572 or 4.1%

Hospital Activity

2008/9 straight line projection based on activity to 31 October:

= 494,525= 37,308 growth since 2003/4= 8.2%

Last 3 years:- At 4 years?Day cases 62% 80% 82%Day cases 33%+ 40%+Elective IP 17%- 17%-Emergency IP 0% 3%+Maternity 5%+ 6%+Outpatients 0% 4%+A&E attendances 4%+ 6%+

Hospital Activity

• 2009/10 Operating Framework delayed because of Pre Budget Report (PBR) was

due 31/10/08 now expected 8/12/08• New PCT allocations 8/12/08• New Payment by Results (PBR) tariff

12/01/09–Unbundling/ A&E/ Market Forces Factor???

• Challenge to agree 2009/10 Local Delivery Plan whilst FT HDD being undertaken

Other Issues

• Mike Hallworth presented with the 2008 Healthcare Scientist of the Year Award by the NHS Medical Director, Professor Sir Bruce Keogh. Primarily for work done to make information about pathology tests accessible to patients through a web site developed by him and a small team

• Mike Hallworth and Heidi Smith have attended a special Royal Reception at Buckingham Palace for NHS staff

Other Issues

• Melvyn Birch has received his MBE from Prince Charles

• Nigel Capps invited to join the CLRN Executive Group

• 100th birth at Oswestry Maternity Unit