Creating an NHS Foundation Trust

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Creating an NHS Foundation Trust

• Peter Shanahan
• Deputy Chief Executive
• Chief Financial Officer

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(No Transcript)
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Structure

• University Hospital Birmingham
• Strategy
• Governance
• Financial Planning
• Whats it really like?

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University Hospital Birmingham

• 340 Million Turnover - 6,000 staff
• 1,050 beds across 2 sites (SOH QEH) in outdated
  facilities up to 106 years old
• General hospital services for c. 500,000 people
• Highly Specialist (Tertiary) services for c. 6
  million
• More than half a million patients each year
• All major acute specialities ex. Paediatrics and
  Obstetrics
• Major regional services - heart, lung, liver and
  kidney transplants, neurosurgery, burns and
  plastic surgery, regional cancer centre
• Home to the Royal Centre for Defence Medicine

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University Hospital Birmingham

• From 195m pa to 340m pa in six years
• Over 1,000 new jobs over the past three years
• Among shortest waits in the NHS
• - less than 12 month inpatient wait (90 wait
  less than 6)
• - 6 months for day case
• - 13 weeks for outpatients
• - 98 treated or admitted under 4 hours in AE,
  most under two hours
• An NHSFT wef 1 July 2004

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Creating a Foundation Trust

• Carefully consider why you want to be an NHS
  Foundation
• Its not about a new name or badge
• Its about delivering Strategic Direction
• Its about using the freedoms
• Its about engaging the communities we serve
• Its about improving patient care

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Strategy
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Whats Shaping The Future Of Health Care?
UHBT FUTURE STRATEGY

• Globalisation and localisation
• Demographic, epidemiological and
• social change
• Scientific and technological advances
• Workforce supply and development
• Structure, governance and funding

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GLOBALISATION AND LOCALISATION
Role of national bodies in health declining -
future influences mainly local and global

• Increasing influence of international and
  European agencies and legislatures - e.g. EWTD
• Regionalisation within EU and devolution within
  UK
• Global and European movement of professional
  staff - international competition
• Global and European movement of patients - choice
  beyond national boundaries

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DEMOGRAPHIC, EPIDEMIOLOGICAL AND SOCIAL CHANGE
Rapid and dramatic changes in public needs and
expectations

• Population Ageing
• Diversity and ethnicity
• Changing patterns of disease
• Consumerism in healthcare

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WORKFORCE
Immense Challenge Demographics, service growth
and international competition

• New focus on recruitment from local and
  non-traditional (esp. ethnic) communities
• New focus on developing staff into NHS careers
  via links with education, cadetships and other
  methods
• Creation of effective skills escalators and
  extended role opportunities
• Improving the quality of the work experience to
  reduce turnover

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SCIENTIFIC AND TECHNOLOGICAL ADVANCEMENT
Advancement centralises and decentralises
simultaneously

• New complex interventions centralised in few
  centres
• Minaturisation localises of imaging and
  diagnostics
• Self diagnosis and home self care grows
• Genomics and pharmacogenomics drives illness
  prevention and lifestyle management
• Communications technology allows remote
  consultation and monitoring via telemetric links

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STRUCTURE, GOVERNANCE AND FUNDING
Localisation of direction and accountability
performance scrutiny, pluralism, investment
twinned with reform

• NHS Foundation Trust status
• Private DTC provision
• Clinical governance and performance measurement
• Public investment (Wanless)
• Continued efficiency questions

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OUR 7 YEAR STRATEGY
1. Localise general services by unpacking
chronic disease and elderly care into local
settings via PCT partnerships
Drivers Demographics, disease, technology,
consumerism
2. Drive specialist service development via
research and development partnerships
Drivers Technology, regulation, consumerism
3. Improve access and facilities via capacity
expansion and public/private joint ventures
Drivers Consumerism, technology, funding,
pluralism
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4. Train and develop future staff via community
partnerships
Drivers Demographics, workforce, globalisation
5. Use skills escalators and national and
international partnership programmes to develop
careers, establish new roles and retain staff
Drivers Demographics, workforce, globalisation
6. Assure service quality by performance
measurement, peer review and national and
international benchmarking
Drivers Consumerism, regulation, globalisation
7. Improve our patient focus to become involving
at both individual and collective levels
Drivers Consumerism, regulation, technology
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Governance
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WHATS DIFFERENT? ACCOUNTABILITY

• Not accountable to Secretary of State and DoH
• Not performance managed by SHA
• Accountable to Parliament, Regulator and
  Governors/Members
• Able to take local decisions contrary to national
  guidance, but
• Still subject to CHAI, Star Ratings etc

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WHATS DIFFERENT? ACCOUNTABILITY

• Board of Governors
• Represent membership/community views
• Shape strategy
• Appoint Chair NEDs and approve CEO appointment
• Appoint auditors
• Are the Trusts link to its communities

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FOUNDATION TRUST GOVERNANCE
BOARD OF GOVERNORS
BOARD OF DIRECTORS
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UHBT FT Board of Governors
37 Governors Chair

• Stakeholder (13)
• Birmingham City Council
• South Birmingham PCT (2)
• University of Birmingham
• University of Central England
• Learning and Skills Council
• Regional Development (AWM)
• Chamber of Commerce
• Secondary Education
• Further Education
• Faith Leaders Group
• South Birmingham MP
• Royal Centre for Defence Medicine

• Patient/Public (19)
• 14 patient/public governors living inside
  Birmingham
• 5 patient governors living anywhere in UK

• Staff (5)
• 1 Consultant
• 1 AHP/Clinical scientist
• 2 Registered/auxiliary nurses
• 1 Ancilliary/admin

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WHATS DIFFERENT? ACCOUNTABILITY

• Board of Directors
• Manage the Trust
• Set strategy, plans and budgets
• Take account of the views of the Governors
• Effectively Govern the Organisation

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THE INDEPENDENT REGULATOR

• Appointed by SoS, accountable to Parliament
• Issues, and can revoke, FT license to operate
• Any constitutional changes require IR approval
• Any change to protected services requires IR
  approval
• Is principally interested in FT ability to
  operate legally and financially soundly as a free
  standing going concern commercial organisation
• Is not really assessing clinical issues and
  quality that is CHAIs function

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Issues to Consider

• Be Clear about the role of Governors viz
  Directors
• Carefully consider the Constitution
• Are your SOs,SFIs and SoD fit for purpose
• Review Arrangements for Corporate Risk Management
• Assess the balance of skills of the Directors

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Financial Models
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Creating a Business Model

• Timescales
• More detail in short term eg monthly
• Less in longer term eg quarters
• Longer the timescale greater use of assumptions

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Consult and Communicate

• Ownership
• Internal
• External
• Education
• FCEs Spells
• Grouper
• Contract Management

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Short Term Model

• 2 year (27months)
• Focussed on Working Capital
• Capable of being tested for key sensitivities
• Needs to be able to pass the show me test
• NHSFTs may be better to create a model to meet
  local needs which feeds the Assessment model

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Short Term Model

• Data Sources
• Management Accounts
• Balance Sheet Reports
• PL SL
• Cash Flow Forecasts
• Activity Monitoring Systems

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Short Term Model

• Cash is king so.
• Over-performance is an issue
• Think carefully about creditor terms
• Review debtor performance
• Think about linkages
• Start early discussions with Banks
• Test for reasonableness

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Short term Risks

• Pay Modernisation
• Over and Under Performance
• Capital Expenditure
• Interest Rates

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Longer Term Model

• Regulator requires 5 years
• Embrace local circumstances eg PFI
• Aims to demonstrate longer term viability
• Needs to be consistent with
• Short term model
• Service Plans
• LHE Plans

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Longer Term Model

• Data Sources
• Service Strategy
• Economic Forecasts
• PCT Growth Assumptions
• Comprehensive Spending Review
• Wanless
• Known Cost Drivers eg A4C
• History eg CIPs

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Management Issues

• Good Coding
• Supports Governance
• Needs Transparency
• Requires Clinical Input
• Activity Based Budgets
• How do you budget
• How do you share gains/losses

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Management Issues

• Business Cases
• More Transparent
• Focus on Risks
• Dis-Investment Strategy
• Flexibility of Delivery
• Support Service Issues

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Risk

• Risk Assessment Crucial
• Think of downside
• Volatility of Tariff
• Incentives/Dis-incentives
• CDM
• Prescribing
• Technology Introduction

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Whats it really like?

• Read Section 23 of the ACT!
• Early days.
• Skirmishes.
• Role of the NEDs
• Risk and Governance
• Monitor the light touch