28 November 2006

1

CHIEF EXECUTIVES BRIEFING Tom Taylor Chief
Executive

• 28 November 2006

2
2006/ 07 Position

• Achieving most targets but not MRSA and Finance
• Healthcare Commission ratings
• Quality of Services good
• Use of resources - weak

3
Healthcare Commission Ratings

• UHBFT SaTH
• Core Standards Fully Met Fully Met
• National Targets Fully Met Fully Met
• New National Standards Good Good
• - Fair - Fair
• - Fair - Fair
• - Good - Excellent

4
MRSA

• Staff testing policy to be agreed today
• Isolation ward at both sites being identified
• DoH MRSA team invited to review our procedures
• Serious Untoward Incident and Root Cause
  Analysis required by SHA for every bacteraemia

5
Financial Position

• Month 7 2.268 million deficit forecast when
  the effects of additional in-year pressures are
  accounted for.

6
Additional in-year pressures(Unidentified (May
Board) 2.2 million )

• M
• PWC 0.360
• Doctors Funding 0.692
• Procurement 0.500
• AfC 0.553
• 2.105

7
Financial Savings forecast v actual (as at
month 7)

• See P Spilsbury slide

• Note
• The total savings reported to date 1,268,210
  vs. forecasted position 1,550,529. Financial
  gap of 282,319.
• The operational savings delivered were above
  plan by 70,000
• The programme savings delivered were below plan
  by 353,008 (70 approx. are procurement
  savings)

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RAG Financial Savings identified at risk (as at
13.11.06) Programme
As at 2nd October 06
As at 13th November 06
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Staff/ Public/ MPs/ OSC/ LA/ Trade Union
objections

• PWC Turnaround proposals
• Patient car parking charges
• Staff car parking charges
• Skill mix review
• Bed reduction (through efficiency)
• Manpower reduction
• Overtime restrictions
• Non-pay restrictions
• Clinical/ managerial restructure
• Strategic Service Plan Proposals

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• That leaves 60 organisations that will not
  remain in their current form, which leads to the
  issue of how you reconfigure

Andrew Cash Director General Provider
Development Department of Health
11

• Does this County want a Solihull/ Good Hope
  solution?

12
National Context a critical year

• 2007/8 is a turning point. Why?
• 2007/8 Operating Framework
• sort the money out
• achieve recurrent stability
• limited national priorities
• devolved central budgets
• 2008/9
• free choice
• waiting in effect eliminated
• full PbR in operation
• and

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Financial requirements

• All organisations to at minimum break-even with
  general expectation of surplus
• 2006/07 in-year deficits recovered by
  organisations
• All cash support will be interest-bearing via
  national loans/deposits scheme with SHA as
  gateway
• PCTs to demonstrate the creation of an
  uncommitted reserve of at least 2 in 2007/2008
  plans
• PCTs to demonstrate a bottom-line shift in
  activity from hospital to community and place a
  value on that

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Cost improvement and efficiency

• We will expect cost reductions to be a minimum of
  3.5 on top of any local issues
• Henceforth we will distinguish between
• Cost reduction plans
• Business improvement plans
• We will expect further reductions in workforce
  costs headcount for all secondary care
  providers as part of CIPs and as necessary
  preparation for 2008/09
• We will set up a Regional Clearing House service
  to support shifts across organisations 2?1
  care

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Other key assumptions

• The full cost recovery principle will apply to
  PCT provided services and to be demonstrated in
  2008/09
• Much greater scrutiny of prescribing plans
• - Keele analysis shows potential for major
  savings on statins and other drugs not being
  realised
• PCTs to adopt 30-day payment limits in all
  transactions with NHS Trusts track in FIMs
• All capital will be accessed through
  interest-bearing debt
• - SHA will publish tests shortly (including
  ROI criteria)

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Payment By Results

• Tariff uplift of 2.5
• Emergency threshold of 50 at 2005/06 outturn
• PPA 50 ? 25 and will be removed in 2008/09
• Capping existing rules apply but may be local
  flexibility for biggest impact (7.5 of turnover)
• Unbundling Presumption in favour

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Some absolute standards for March 2008

• 5 weeks maximum wait for outpatients
• 6 weeks maximum wait for MRI/CT/Other diagnostics
• 11 weeks maximum wait for inpatients
• 18 weeks RRT 85 unplanned, 95 planned
• GUM maximum wait of 48 hours for urgent
  appointment
• MRSA 60 reduction on 2003/04 base or nlt12
• 5 reduction in emergency beddays on 2003/4 base

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Our Key Test of Local Delivery Plans

• Are Boards signed up to plans?
• Are plans based in a long-term financial
  strategy?
• Are plans based in a strategic commissioning
  vision?
• Can PCTs set out a public statement of what will
  be achieved this year?
• Do plans address national priority areas and
  achieve national targets?
• Are plans internally consistent (esp. links of
  activity, workforce, expenditure)?
• Are plans shared across a health economy?
• Are plans consistent with scale of challenge?
• Are plans realistic and deliverable?
• Do plans use opportunities provided by System
  Reforms?

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Outline Timetable
NB We are four months ahead of last year