cambridgeshire and peterborough nhs foundation trust - … of governors... · • finance report...

Council of Governors Meeting

Open to the public and press

Date: Wednesday 7 September 2016 Time: 15.00 - 17.30 Venue: The Lounge, C3 Centre, Coldhams Lane, Cambridge CB1 3HR Chair of the meeting: Julie Spence

Council of Governors

AGENDA

Time Enclosures

1.0 Opening Business

Questions from the public in relation to agenda items will be taken at the beginning and end of the meeting

1.1 15.00 Introduction , apologies for a bsence and declarations of interest

5 Mins Verbal

1.2 15.05 Minutes • To approve the minutes of the meeting held on

11 May 2016

5 Mins Enclosed

1.3 15.10 Action Log / Matters Arising 5 Mins Enclosed 2.0 Representing the i ntere sts of, and communicating

with the Trust’s membership

2.1 15.15 Chair’s Report (Julie Spence, Chair)

10 Mins

Enclosed

2.2 15.25 Chief Executive’s Report (Aidan Thomas, Chief Executive)

10 Mins Enclosed

2.3 15.35 Judge Business School UnitingCare Report

20 Mins Enclosed

2.4 15.55 Non Executive Director Updat e (Simon Burrows, Non Executive Director)

10 Mins Verbal

2.5 16.05 Lead Governor Update (Elizabeth Mitchell, Lead Governor)

10 Mins Enclosed

2.6 16.15 Appointed Governor U pdate

10 Mins Verbal

2.7 16.25 Governor Leads / Com mittee Leads review (Lauren MacIntyre, Trust Secretary)

5 Mins Enclosed

3.0 Governance

3.1 16.30 Nominations Committee Update (Julie Spence, Chair)

• Board Skills Mix • Non Executive Job Description

10 Mins Enclosed Enclosed Enclosed

3.2 16.40 Fit and Proper Person Declaration (Julie Spence, Chair)

5 Mins Enclosed

4.0 Governor Questions on Performance of the Trust

4.1 16.45 Governor Questions on the Integrated Performance 10 Mins Enclosed

Report (Scott Haldane, Director of Finance; Julian Baust, Business and Performance Committee Chair)

4.2 16.55 Governor Questions on the Financial Update (Scott Haldane, Director of Finance; Julian Baust, Business and Performance Committee Chair)

• Finance report • NHS Improvement Q1 report

10 Mins

Enclosed Enclosed

4.3 17.05 Annual Report and Accounts ( To note) (Lauren MacIntyre, Trust Secretary)

5 Mins Tabled

4.4 17.10 Audit of Accounts and Quality report FY15 (Grant Thornton)

15 Mins Enclosed

5.0 Closing Business

5.1 17.25 Any Other Business 5 Mins Verbal

5.2 17.30 Questions from members of the public 5 Mins Verbal

Date of Next Meeting (Julie Spence, Chair) To note the next meeting will be held on Wednesday 14 December 2016

Julie Spence OBE Chair Role of Governors

• Governors have an important role in making an NHS foundation trust publicly accountable for the services it provides

• Governors represent the interests of Trust Members and public • Governors should be answerable and responsive to the constituency from which they were

elected (public, service user/carer or staff) • Governors hold the Non Executives collectively and individually to account for the

performance of the Board of Directors • Governors should always act in the best interests of the Trust and adhere to its values and

code of conduct Statutory Duties of Governors

• Appointing and removing the Chair and deciding their remuneration and conditions of office • Approving the appointment of the Chief Executive • Appointing and removing Non Executive Directors and deciding their remuneration and

conditions of office • Representing the interests of members and the public • Receiving the Trust’s annual accounts and annual report • Appointing and removing the external auditor • Approving significant transactions • Approving changes to the Constitution

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Minutes of the Council of Governors Meeting held on 11 May 2016 from 17.30 until 20.30

at Conference Hall, Block 20, Ida Darwin, Fulbourn, Cambridge CB21 5EF

Members Present Julie Spence Chair Eric Revell Public Governor, Cambridgeshire Mike Collier Public Governor, Cambridgeshire Chris York Public Governor, Peterborough Jane Powell Staff Governor Lesley Crosby Appointed Governor, Peterborough and Stamford Hospitals NHS FT Lawrence Ashelford Appointed Governor, Cambridgeshire University Hospitals NHS FT Kirsty Trigg Service User Governor, Cambridgeshire Bernie Gold Public Governor, Cambridgeshire Elizabeth Mitchell Lead Governor, Carer Governor Ian Arnott Public Governor, Peterborough Margaret Johnson Public Governor, Cambridgeshire In attendance Jo Lucas Non-Executive Director Simon Burrows Non-Executive Director Stephen Legood Director of People and Business Development Julian Baust Non-Executive Director Scott Haldane Director of Finance Lauren MacIntyre Interim Trust Secretary Louisa Bullivant Assistant Trust Secretary (minute taker) Patrick Sissons Non-Executive Director Mike Hindmarch Non-Executive Director Mel Coombes Director of Quality and Nursing Sarah Hamilton Non-Executive Director Sara Sampson Awaiting Governor ratification Charlotte Paddison Awaiting Governor ratification Ruth Cloherty Awaiting Governor ratification Apologies Aidan Thomas Chief Executive Sarah Warner Chief Operating Officer Deborah Cohen Director of Service Integration Chess Denman Medical Director Diana Wood Appointed Governor, University of Cambridge Emily Gray Appointed Governor, Voluntary Sector Wendy Ogle-Welbourn Appointed Governor, Peterborough City Council

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Lucy Nethsingha Appointed Governor, Cambridgeshire County Council John Cranston Public Governor, Cambridgeshire Melica Martin Public Governor, Rest Of England Keith Grimwade Patient Carer Governor Mark Batey Service User Governor, Peterborough Drury Thomson Public Governor, Peterborough

ITEM DESCRIPTION ACTION BY

Judge Business School – UnitingCare Partnership Review Update Judge Business School was invited to the Council of Governors to provide opportunity for them to engage with Governors. The review process did not, at this stage, have any firm material to bring forward to the meeting. As part of their engagement with Governors, their intention was to get an idea of the Governors perception before, during and through to the end of the contract. Governors were encouraged to contact the Chief Executives’ Executive Assistant, Helen Thomson to arrange an interview with Judge Business School.



There was one question asked by a Mr Lawrence, public member, who requested to ask a question not related to the agenda, the Chair accepted this.

Mr Lawrence asked the Chair if he was able to use the Cambridgeshire and Peterborough NHS Foundation Trust’s library in Fulbourn, Cambridge; based on the fact that he used to be a Governor and was currently a member of the Trust. He thought that this would be adequate enough for him to be able to use the facility. The Chair responded advising that due to the size of the library the Trust could not possibly allow for 14,000 members to use the facility and therefore the library could only to be used by staff and Governors of the Trust.

1.1

Introduction, apologies for absence and Declarations of Interest The Chair welcomed those present to the Council of Governors meeting and noted apologies. Aside from the standing interests held by the Trust Secretary, no other conflicts of interests were declared.

1.2 Minutes The minutes from the Council of Governors on 16 March 2016 were

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presented. They were agreed as an accurate record, with the following amendments: Item 2.2, Governor Questions on the Financial Update Page five, first paragraph, line four should read “was higher mainly because Lord Byron B ward was staffed by agency staff.”

1.3 Action Log/ Matters Arising Action 1 The Governors confirmed that they had not received the letter to commissioners in relation to shortcomings. Action 2 The Governors confirmed that they had not yet received confirmation of the percentage of self-referrals to the Psychological Wellbeing Service. It was agreed that both action 1 and 2 would be picked up by the Chief Executive. All other actions were noted as complete or not yet due.

Chief Executive 20 May 2016 Chief Executive 20 May 2016

2.0 Representing the interests of, and communicating with the Trust’s membership

2.1 Chair’s Report The Chair referred to her report and updated the Council of Governors on the following:

Governor Elections:

She informed the Council of the following successful candidates:

Public; Cambridgeshire: Mike Collier Bernie Gold Charlotte Paddison

Public; Peterborough :

Helen Blythe Patient; Service users living within the electoral areas of Cambridgeshire County Council:

Elizabeth Bannister Staff:

Ruth Cloherty Sara Sampson

The Council of Governors collectively agreed to ratify all new Governors.

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The Chair highlighted the date of the Governor induction day as Thursday 16 June 2016 and encouraged all Executive and Non Executive Directors to come along to meet the Governors during the lunch break. The Chair directed Governors to the timeline of the Well-Led Governance review. The Council were informed that Tricia Amos had returned to the Trust on a temporary basis to help to support the process and that the Director of Nursing was the Executive Lead.

The Chair informed the Council that all Non Executive Directors had been appraised for 2015/16. The Council was asked to decide whether it was content to extend two of the Non Executive Directors terms of office for a further three years based on their performance. The Chair explained that the Trust had advertised Non Executive Director positions externally for the last three years and that the current Board skills mix showed a strong variety of skills and experience. The Council of Governors agreed to extend the terms of office for both Patrick Sissons and Julian Baust.

As per recommendations, the Council of Governors noted and discussed the Chair’s Report, ratifying new Governors and the extension of the two Non Executive Directors.

2.2 Chief Executive’s Report In the Chief Executive Aidan Thomas’s absence, Director of Finance, Scott Haldane, presented the Chief Executive’s Report. He informed the Council of Governors of the significant progress the Trust had made in underpinning the Older People’s Model (formally UnitingCare). The Trust had jointly drafted a letter with the CCG in order to advise GP’s, Integrated Care Staff, Acute Hospitals and Local Authorities of the joint work that was taking place to develop community services within Cambridgeshire and Peterborough CCG, and what it means for services delivered by the Trust in 2016/17. This letter would be circulated to the Council of Governors. In regards to the contracting round, the Mental Health Contract was noted as the only contract which required mediation. The consequence of mediation had meant that the Trust was able to agree part year funding for: capacity to cope with demand in Crisis Teams, Personality Disorder Services, and Community Teams, additional psychology input into acute services, age extension for Early Intervention services and full year funding for safer staffing. He also advised that the Trust would be reviewing the totality of the £50m normally spent by CCG on Adult Mental Health, and if there was any other way in which this could be spent on services which were aligned to the formally known UnitingCare model. Initially, this would be picked by the Board and followed up with Governors as part of planning for the Five Year Strategy. The Director of Finance also updated the Council on the possibility of the National Audit Office arranging interviews to look specifically at NHS

Chief Executive 20 May 2016

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England’s review of UnitingCare. He updated the Council on the current position of the Children’s service, advising that the Trust were preparing for the likely forthcoming tendering exercise across Cambridgeshire and Peterborough. He noted that as part of this process there had been discussions relating to the joint working between Cambridgeshire Community Services Trust who provided universal children’s services and paediatrics services in Cambridgeshire and CPFT who provided both these services in Peterborough, and the Children’s Mental Health Services across Cambridgeshire. Public Governor, Bernie Gold asked if there had been any other agency applying for the Children’s Services tender. The Director of Finance advised that he was unable to confirm this. Lead Governor, Elizabeth Mitchell asked if the Trust was involving the education services, voluntary sector and Cambridgeshire Community Services. It was confirmed by the Director of Finance that all of the services had been involved to ensure a holistic approach. Public Governor, Bernie Gold asked if there was any update relating to the Learning Disabilities services since the Chief Executive had written his report. The Director of Nursing and Quality, Mel Coombes, advised that NHS England had produced a national framework. She described the framework as a good plan led by the CCG. She explained that the Trust’s Learning Disabilities Acute Care - Intensive Assessment and Support Service (IASS) ward was currently closed and there were limited beds available for admission on the Hollies at the Cavell Centre. Public Governor, Bernie Gold queried whether there were any day centres available for Learning Disability services. The Director of Nursing and Quality advised that there were no longer any day centres within the Trust. It was noted by the Council that there was a requirement to eradicate the use of acronyms unless accompanied by their full explanation. The Council of Governors were content with the information provided in the report which they noted and discussed.

2.3 Patient engagement strategy update This item was deferred to 7 September 2016 Council of Governors meeting due to the absence of the Head of Patient of Experience.

2.4 Non-Executive Director update Non Executive Director, Jo Lucas, updated the Council of Governors on her experience, interests and why she decided to join the Trusts Board of Directors.

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Reasons included 40 years experience of Mental Health and its systems, her passion and interest in the NHS, strategic thinking, her interest in patient and carer involvement and being active in the community. Having sat on many Boards within the voluntary sector she acknowledged that the Trust’s Board was one of the most effective that she had seen. She explained that she was the Interim Chair of the Quality, Safety and Governance Committee as well as the Non Executive Director Recovery Champion and Chair of Recovery and Inclusion Board. She informed the Council that all Non Executive Directors were involved in Chairing appeals and that she had been invited to deep dive into Serious Incident reviews. This looked at the learning process of Serious Incidents, how learning was implemented, if learning was taken seriously and what happened as a consequence. She said she had been on many service visits and that she admired and respected the determination of staff to deliver safe, high-quality care even in the face of change. She spoke of her thoughts for the future; highlighting her desire to remain an active member of the Board, contribute further to the development of the Recovery College as well as the Charitable funds activities, open a coffee shop in Fulbourn and to be involved in international opportunities. Lastly she acknowledged the importance of the role of the Governors within a foundation trust and commended the Chair for ensuring the inclusion of Governors in processes, including governance.

2.5 Lead Governor update Lead Governor, Elizabeth Mitchell, presented her report. There had been feedback from 170 people from the Patient & Public Involvement in Research for the Collaborations for Leadership in Applied Health Research and Care (CLAHRC). Governor’s involvement in the Triangle of Care had continued. The Council were updated on the Triangle of Care self-assessment process used across directorates and the challenges that this had faced. It had been decided to organise meetings at the Croft, Darwin and Phoenix Centres to try to resolve these challenges. Lead Governor, Elizabeth Mitchell said that she would feedback to the Council of Governors at the meeting in September 2016. She updated the Council that Public Governor, Bernie Gold, had presented to Hunts Congress on the 10 May 2016 at the Patient Participation Group on behalf of the Medical Director. It was noted that this had gone very well on the day and Public Governor, Bernie Gold was thanked for his efforts.

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The ‘Sharing the Caring’ event on 7 June 2016 was noted as progressing well; there were opportunities for Governors and other members of the public to attend. The day would include the Carers Trust presenting their Pride in Carer’s award, market stalls, guest speakers including Jane Hawking and live singing. The Chair’s appraisal was completed by Elizabeth Mitchell and Sir Patrick Sissons, Senior Independent Director (SID) and Non Executive Director. The appraisal evaluated the following areas; Strategic Direction, Holding to Account, Influencing and Communication, Team Working, Intellectual Flexibility, Patient and Community Focus and Self Belief. Input was incorporated from the Chief Executive and other Non Executive Directors. Following the final appraisal meeting, objectives for the Chair were developed. There would be a large connection with the Chair’s, Chief Executives and the Trust’s objectives. Finally, Elizabeth Mitchell commended the Chair for her successes, in particular the open and transparent process that she had created for Governors and staff. More recently, an example of this was the change to the Board meetings where there was one Public session which would start at 10.00am and a small Private session prior to the meeting. The Private Board meeting would be for commercial and personnel issues, but would not include CCG contracts which would remain with the Public Board meetings. The Council of Governors noted the content of the Lead Governor Update.

2.6 Appointed Governor update The Chair had received 3 updates, from Lucy Nethsingha Appointed Governor, Cambridgeshire County Council, Emily Gray Appointed Governor, Voluntary Sector and Wendy Ogle-Welbourn Appointed Governor, Peterborough City Council. It was noted that these would be circulated to the Council following the meeting. Appointed Governor, Peterborough and Stamford Hospitals NHS FT Lesley Crosby, highlighted how busy the hospital remained especially in respect of the Emergency Department. The hospital had capacity and flow challenges although this was recognised as system wide issue. Early in May the Trust declared an ‘internal critical incident’ due to the amount of admissions outweighing the number of beds available. She informed the Council that the Junior Dr’s strike had not presented the services with any issues; in fact attendance to emergency department had reduced. She advised that there was no definitive decision in respect of the work being undertaken with Hinchingbrooke. Public Board Meetings for both Trusts would be held on 23 and 24 May 2016. Appointed Governor, Cambridgeshire University Hospitals NHS FT,

Trust Secretariat

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Lawrence Ashelford, reported that there continued to be high levels of activity in A&E; and that some of this activity could more appropriately be dealt with by other parts of the NHS such as community pharmacy or primary care. It was noted that the Chief Executive was to attend a series of meetings to look at strategy with the recently appointed Chief Executive from Cambridgeshire University Hospitals NHS FT. This raised a question from the Lead Governor, Elizabeth Mitchell, who asked if it would be appropriate for the Governors of the Trust and Cambridgeshire University Hospitals NHS FT to meet to discuss a way forward. Lead Governor for Cambridgeshire University Hospitals NHS FT, Julia Louden, would be contacted to organise the two way Governor sessions. The Council were reminded that the Director of People and Business Development, Stephen Legood was an appointed Governor for Cambridgeshire University Hospitals NHS FT. The Chair advised the Council that Appointed Governor, Cambridgeshire Police, Kevin Vanterpool would soon be retiring. She advised that the replacement arrangements would be put in place for his successor. Updated following the meeting - it was agreed with the Chair that Superintendent, Laura Hunt, would be the new Police representative.

Elizabeth Mitchell, Lead Governor

2.7 Annual Plan The Director of People and Business Development presented the Annual Plan. He informed the Council that the final plan was submitted on 18 April 2016 and confirmed that feedback received from the Council of Governors meeting on 16 March 2016 had been incorporated into the plan. He advised that the Trust was waiting for formal commentary from NHS Improvement, formally known as Monitor. Public Governor, Peterborough, Ian Arnott referred to Seven Day Services, Safe Place regarding The Sanctuary which is being provided by the voluntary sector (MIND). He asked if the operation of this seven day service could be explained. Non Executive Director, Jo Lucas confirmed that The Sanctuary had been opened in Cambridge on 4 April 2016 to allow people to get practical and emotional support. If The Sanctuary proved successful, the Trust would look to have other similar safe places elsewhere in Cambridgeshire and Peterborough. Public Governor, Peterborough, Ian Arnott referred to Workforce Strategy Key Performance Indicators (KPI’s) regarding the percentage of staff who recommend the Trust to either their family and friends as a place to care for; he thought that the projection for improvement was over optimistic. The Director of People and Business Development confirmed the projection was being stretched using a 5% trajectory over the next five years and he

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supported this outcome as being achievable. Public Governor, Peterborough, Ian Arnott referred to Agency Rules. He asked if the reduction was over optimistic. The Director of Finance felt this was a realistic target on the basis that it related to the cap which had been enforced by NHS Improvement. As part of the number of different initiatives; the Trust would make sure that there was a sensible balance of temporary staffing vs substantive workforce. An example of this was moving away from the high premium agency rates opting for over time for substantive staff instead. The Chair also added that there was a wider project that the Chief Operating Officer was working on and confirmed that agency rates would be appearing on the agenda of every Board meeting. She also applauded the stretched target. A query was raised regarding the cap and what the Trust would do if it reached the cut off point. The Director of Finance referred to the minutes from Council of Governors meeting held on 16 March 2016 where it detailed a higher use of agency due to Lord Byron B ward. He explained that, as part of the contracting mediation for the older people’s mental health service, agency spend for Lord Byron B was included as part of a continued commitment for CCG to fund. Sarah Hamilton referred to ‘Financial Sustainability Risk Rating’ (FSSRR); she asked if the Trust had received a rating of two or three. It was confirmed by Director of Finance that the plan predated the FY15/16 and the rating was confirmed at a three. It was noted that Governors had little time to read through all of the papers when long items such as the Constitution were included. The Interim Trust Secretary, Lauren MacIntyre confirmed that all papers for the Council of Governors meeting had been sent out on time, as outlined in the Constitution, and as paper copies had to go to the printers and in the post, they were received by the Governors later than the electronic papers. It was agreed that if any long documents were ready prior to the paper submission date, they would be sent out electronically. Public Governor, Cambridgeshire, Eric Revell asked for clarity on ‘Risk and Mitigation’ and referred to failure to deliver Cost Improvement Plan (CIP) savings. He asked if this meant that there would be a closure of a service in order to sell properties. The Director of Finance confirmed that as part of the Capital Plan the Trust were looking at optimising estate and were not looking to sell, but to utilise existing properties to optimal effect. Public Governor, Cambridgeshire, Mike Collier asked why he could not see any reference to the Triangle of Care within the plan. The Director of People and Business Development agreed that the Triangle of Care should have been more prominent in the public version. The Council of Governors noted the Operational / Annual plan submission and received assurance that a suitable process had been followed to

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ensure the required plan was submitted before the deadline and in line with guidance. The plan was also driven by the strategic direction set by the Board and the healthcare system.

2.8 Volunteering strategy The Director of Nursing and Quality presented the report on the Volunteering strategy and briefly outlined the background of the strategy as the development of a new framework for volunteering. The strategy had already been through the Quality, Safety and Governance Committee as well as Board. As a result recommendations to provide additional resources had been agreed and work was ongoing regarding governance; in particular supervision of voluntary staff. Non Executive Director, Julian Baust, commented that the strategy had been really well thought through and was a commendable piece of work. The Chair asked for the Volunteering strategy to be presented at the meeting on 7 September 2016, in order for Governors to bring forward ideas that they believe would support the strategy. The Council of Governors noted the content of the volunteering strategy report.

3.0 Governance

3.1 Constitution The Interim Trust Secretary presented the Constitution and a report noting the amendments that had been made. Public Governor, Cambridgeshire, Eric Revell asked for the Interim Trust Secretary to refer to Page 6 of the Constitution. He spoke in relation to section 15.2.4 ‘May hold office for a maximum of nine consecutive years. This may be extended at the Chairs discretion on a strictly case by case basis and without setting any precedents for any further or future decisions.’ He expressed that he thought it should not be at the Chair’s discretion and he also believed that the maximum term as Governor should service was nine years. Interim Trust Secretary responded that best practice guidance did suggest nine years as a maximum. However, the Constitution Steering Group had felt that it would be a shame to lose a Governor whose contributions remained valuable because they had served nine years. She suggested that it was at the Council’s discretion rather than the Chairs. Non Executive Director, Julian Baust, referred to;

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10.1 An individual who has attended any of the trusts hospitals as either a patient or as a carer of a patient may become a member of the trust. He noted that this should read trust’s services. The Council of Governors approved the Constitution subject to any amendments requested.

3.2 Council of Governors self-evaluation The Interim Trust Secretary presented the report on Governor Self-Evaluation. She acknowledged the one week turn around and recognised that this may have impacted on the low number of returns but emphasised the importance of the exercise. Public Governor, Cambridgeshire, Mike Collier noted that it was hard to assess whether the Council of Governors had the right mix of skills without understanding what mix it should have. Kirsty Trigg, Public Governor, Cambridgeshire, queried how the topics for development sessions were decided. Interim Trust Secretary advised that as part of Louisa Bullivant’s role she had written to Governors requesting their feedback in terms of what areas they would like covered in their development days. She explained that the Trust Secretariat also looked at current relevant matters in the Trust and if Governors would benefit from a development session on them, they were added to the programme e.g. CQC, UnitingCare Bid, Well-led Governance review. Non Executive, Sarah Hamilton asked if Governors had individual appraisals. She was advised that they did not but the Chair had an open door policy allowing for informal discussion. The Chair thanked those who had responded and the Council of Governors noted the contents of the report.

3.3 Governors involvement in strategy development The Director of People and Business Development outlined the opportunity for Governor involvement in the development of the Five Year Strategy. In its third year, the Trust was looking to refresh the strategy and involve Governors in this process, by inviting them to a series of meetings. The following timeline was shared with the Council: 13 June 2016 Pre reading Information issued; Market Analysis and System/ National Info 22 June 2016 Board Development Day; Lead Governor attending 20 July 2016 Draft revised Strategy Issued for comment 27 July 2016 Update on revised Strategy to be issued at Governor meeting 28 September 16 Sign off Public Board

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December 16 NHS Improvement planning Guidance issued 7 December 16 Timetable on Trust Business Planning / Commissioning 8 March 17 Review Draft 17/18 Operational Plan 29 March 17 Operational Plan – Board approval April 17 Submission of Operational plan Public Governor, Cambridgeshire, asked if it was known when a decision would be made by the CCG in terms of the commissioner’s strategic direction, and whether this would affect the timeline which had been presented to the Council. The Director of People and Business Development responded that the CCG’s timetable for System One was six months from the 1 April 2016, and he did not think that the timeline would be affected.


4.1 Governor Questions on the Integrated Performance Report The report was presented by the Director of Finance who updated the Council as follows: Service User Governor, Cambridgeshire, Kirsty Trigg asked why the percentage of patients with (HoNOS), Health of the Nation Outcome Score, with Cluster Review Period was outlined as a current issue and the percentage of patients with HoNOS score was outlined as an area with a positive performance. Director of Finance confirmed that HoNOS scoring was currently being reviewed by Head of Performance, Jonathon Artingstall and Clinical Director, Dr Manaan Kar-Ray, who would be looking at the current dashboard in order to improve the process of HoNOS score. Service User Governor, Cambridgeshire, Kirsty Trigg referred to the Early Intervention in Psychosis (EIP) access targets; new monitor measure for EIP and NICE and asked if there was a plan for this work stream to help achieve the target. It was confirmed that there was a two year plan for EIP and the Trust was working in collaboration to develop a three year plan. The Council of Governors noted the report.

4.2 Governor Questions on the Financial update The update was presented by the Director of Finance. He informed the Council that he had an Audit Clearance Meeting with the external auditors on 11 May 2016. He reported that the external auditors were very happy with the Trust’s process of the financial accounts and they were content that change was not necessary. He informed the Council that the Trust had been working closely with auditors, legal advisors and NHS Improvement. As a result the Trust had been able to reach a FSSR score of three as opposed to the predicted two.

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He thanked everyone involved for working to achieve this rating. Serco performance The Director of Finance explained that the Trust was working with Serco to refine the second four years of the contract. He advised that there was a four year break point which could only be exercised if Serco had not fulfilled their obligations in the performance metrics. The Trust did not believe that Serco had met those metrics but was prepared to work with them over the second half of the four years subject to getting an agreement of improvement required. The Council of Governors noted the report.


5.1 Any Other Business There was no other business brought forward for discussion.

5.2 Questions from members of the public There were no questions raised by the public.

Date of next meeting Date: 7 September 2016 Location: To be confirmed Time: 15.00 – 17.30

Signed………………………………………………….Dated…………………………..

Julie Spence Chair


ACTION LOG

Action log

number Date of Meeting Agenda

Item Action Due Date Lead Status

1. 1.6 The Governors confirmed that they had not received the letter to commissioners in relation to

shortcomings so this was carried forward to be picked up

by Chief Executive, Aidan Thomas

20 May 2016 Chief Executive

COMPLETE:

Joint letter between CCS and CPFT has been sent to all Governors.

2. 16 March 2016 2.1 Governor Questions on the Integrated Performance Report

To confirm percentage of self-referrals to the Psychological

Wellbeing Service


COMPLETE: Information has been sent out to all Governors.

3. 11 May 2016 2.6 Appointed Governor Update

Lead Governor, Elizabeth Mitchell to liaise with Lead

Governor for Cambridgeshire University Hospitals NHS FT,

Julia Louden, in order to organise a two way Governor

session

12 September

2016

Lead Governor, Elizabeth Mitchell

ONGOING: Confirmation received that Elizabeth Mitchell has the contact details for Julia Louden. Elizabeth has been contacted via email for the date of the meeting.

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Agenda Item: 2.1

COUNCIL OF GOVERNORS MEETING

REPORT

Subject: Chair’s Report Date: 7 September 2016

Author: Julie Spence, Trust Chair

Lead Director: Julie Spence, Trust Chair Executive Summary: This report contains the following items:

• Trust secretariat team update • System Transformation Plan. • Joint Board and Governor Development Event / Wider Leadership Strategy Development -

22 June 2016. • Health and Care Conference, London – 30 June 2016. • Governance Review • Governor update • Non-Executive Director Activity logs

Recommendations:

The Council is asked to note the contents of this report.

•••• Note the contents of this report

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Relevant Strategic Goals and Objectives (please mark in bold )

The development, commissionin g and implementation of a new integrated service strategy from April 2016: We will work with patients, carers and key stakeholders to change our services to deliver innovative, integrated person centred care and support that represents the highest possible standards in safety, effectiveness and personal experience of our services. The design, development and implementation of the future CPFT workforce: Our staff will be a highly engaged, well trained, flexible and productive workforce who are able to deliver more at better value

Maximising the contribution of IT and the Trust estate: We will develop highly innovative and effective ways to use technology and the Trust estate in support of person-centred care and maximising the financial benefit for CPFT A commercial and financial sustainability strategy: We will ensure sustainable services through delivery of a financial strategy based on increased cost effectiveness, value for money, growth and investment by 2019

Links to BAF / Corporate Risk Register Items 2, 4 and 5 discuss topics that are linked to identified risks.

Details of additional risks associated with this paper (may include CQC Fundamental standards, NHSLA, NHS Constitution)

None

Financial implications / impact

The report discusses the negotiations of contracts and the Well Led Governance Review, each which has a financial implication on the Trust.

Legal implications / impact

This report discusses the Well Led Governance review and System Transformation Plan, each of which have legal implications on the Trust.

Partnership working and public engagement implications / impact

Governor and Board working partnerships are discussed throughout.

Committees / groups where this item has been presented before N/A

Has a QIA been completed? If yes provide brief details No

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Chair’s Report

1. Trust secretariat team update Trust Secretary. On the 1 July 2016 a panel including representatives from the Executive, Non Executive

Directors and Governors interviewed shortlisted candidates for the role of Trust Secretary.

We had a strong field of 14 applicants who were shortlisted to 4 individuals. We unanimously agreed to offer the role to Lauren MacIntyre who has accepted the post with immediate effect.

Deputy Trust Secretary On 12th August 2016 a panel, including a service user, interviewed five candidates for the role of Deputy Trust Secretary. It was unanimously agreed to offer the role to Alex Perry who has accepted with immediate effect.

2. System Transformation Plan. The CEO and I agreed, with the other health economy CEOs and chairs, to sign off the System Transformation Plan. This has now been a subject of national level scrutiny and been given a green light; it is now subject to public consultation which is being led by the CCG. (Appendices 2.1.i, 2.1.ii and 2.1.iii)

3. Joint Board and Governor Development Event / Wider Leadership Strategy Development - 22 June 2016.

We had a very positive discussion in the morning which enabled governors to explore

how they could feel comfortable with their role 'to hold the Non Executive Directors and Board to account'.

In the afternoon we explored refreshing the 2014-19 strategy. The workshop enabled us

to reflect on organisational changes, external priority and landscape changes and new challenges that needed to be incorporated into the strategy. Governors considerations and priorities, elicited in the morning, where fed into the discussions alongside those of clinicians, operational and corporate leaders. The feedback has now being pulled together and a next steps developed by the executive lead Stephen Legood. At the July Board we agreed the following strategy development timetable.

DATE ACTION June 2016 Board Development Day – Initial review of the 4 Strategic Work

Streams 18th July 2016 NHSI & NHSE review and challenge Meeting (STP)

September 2016 SWOT/Market/Environmental Analysis Completed

September 2016

Strategy review with CPFT staff supported through existing structures facilitated by Alumni - TBC

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4. Health and Care Conference, London – 30 June 2016. On the 30 June I gave a candid Chairs perspective on the collapse of the Uniting Care contract. On reflection this was the first public utterance from the Provider or Contractor side and

was well received. Afterwards an organisation that runs courses at Churchill College approached me and

asked if I would talk on one of their programmes - from their perspective it filled the gaps of an incomplete picture and unanswered questions currently in the public domain.

5. Governance Review

The Trust has begun its process for a Well-Led Governance Review in line with NHS Improvement’s Well-Led Framework. This is a process that each Trust must complete at least every three years. The review will examine the governance from the boardroom to the frontline - looking at the policies, practices and processes the Trust has in place to ensure services can be delivered safely and to the highest possible standard. The review will look at four areas:

1. Strategy & planning: Does the board have a credible strategy to provide high quality services?

2. Capability & culture: Does the board demonstrate leadership of the Trust? 3. Process & structures: Are there clear lines of accountability? 4. Measurement: Is the information about Trust’s analysed and challenged?

An independent review team will be visiting the Trust this month and in October. They will complete desk top document reviews, service visits and interviews and focus groups with staff, stakeholders and governors.

September 2016 Stakeholder engagement including commissioners, LA, patients,

carers, police, NHS providers and third sector organisations – the scope of this engagement to be agreed by CEO/Chair

7th September 2016

Board of Governors – Outline timeframe and update on Board Development Day

27th September 2016

Executive Team Away Day – Initial Review of first draft

28th September 2016

3 Year Strategy - Initial high level draft plan presented to Board

5th October 2016 Wider Leadership Team – Detailed review with CPFT staff

16th November 2016

3 Year Strategy - Review of draft strategy Board of Governors

30th November 2016

3 Year Strategy – CPFT Board review & sign off

5

We can now confirm that after an extensive procurement exercise, Deloitte were chosen as the Trust’s preferred bidder. We were grateful to John Cranston, Public Governor Cambridgeshire, who joined us on the interview panel. Before the review, the Board of Directors were required to carry out an initial Trust self- assessment, and this was approved at the July Board of Directors meeting and will be used by consultants as the basis for their review.

6. Governor update

Ian Arnott will also be stepping down in September after nine years as Governor I would like to thank him for his valuable and insightful contribution to CPFT. The new appointed Police Governor will be Superintendent Laura Hunt who replaces Kevin Vanterpool who recently retired on 20 July 2016.

We are looking to encourage a new broad range of governors to fill our vacant posts.

This autumn Louisa Bullivant will start a piece of canvassing in order to recruit suitable individuals for the current governor vacancies. If suitable people are identified we will co opt them until the next elections in May 2017 so they can understand what the role entails.

The current, five vacancies are as follows:

It should be noted that unfortunately Elizabeth Bannister decided to step down shortly after she was ratified at our last Council of Governors meeting in May 2016. Constituency Number of Vacancies

Service user living within the rest of England One Service users living within the electoral areas of Cambridgeshire County Council

One

Public Cambridgeshire Three

7. Non-Executive Director Activity logs

Julie Spence June 2016

AM PM EVENING

6th Emails and correspondence

7th Carers Event Telecon: Aidan Thomas 8th Lisa Thomlinson:

Health Conf 30/6

9th Telecon: Scott Haldane 13th CPFT Art @ Hot

Numbers Spirituality Forum

14th Appeals at Anglia Ruskin

Appeals at Anglia Ruskin

15th Meeting Andrea Grosbois

Meeting Chess Denman Citizenship Ceremony

6

16th Governor Induction Visit CPNs @ Police HQ 17th Mtg: Alison Manton Mtg Kathy

Bonney(CCG) Mtg Board/Gov & Strategy Days

21st Strategy day preparation

22nd Board / Governor Development

Strategy Development Call Stephen Moir ( NHSE)

23rd Quality Heros Awards Meeting Chair CCS 24th Meeting Trust

Secretary Presentation Preparation

25th Reading CVs re Trust Sec post

27th Mtg Lead Gov: Rachel Wakefield

Shortlisting Trust Secretary

Meeting re STP sign off

28th Well Led Review - Tricia/ Peter

29th Talk to Leadership programme

B&P & QSG mtg: Venkat Reddy

NED dinner with CEO

30th Speaking Health & Care event

re: collapse of Uniting Care

- Provider Perspective

July 2016 AM PM EVENING

1st Mtg Trust Secretary Meeting CEO Telecon: Chair of CUHP 2nd Finalising Report for

Board

4th E of England Chairs BAF workshop Mtg: COO: Trust Secretary

7th Finalising Board Agenda 11th Email with Exec re

Board

12th Correspondence re Gov Review

13th Approve Board Gov Review paper

20th Emails re CUHP Board clash

25th Emails re Board Agenda 26th Preparation for Peer

Graduation 27th Communication with

CEO Preparation for Board Preparation for Board

28th Board meeting Board Meeting 29th Meeting Lead

Governor Peer Worker Graduation Nominations Committee

August 2016 AM PM EVENING

7

1st Visit MH services - Ormiston

2nd Meeting Trust Secretary

Visit PWS, Cambridge

3rd Meeting re Governance Review

Prep for charitable funds

4th Charitable Funds Committee

Follow up PSW visit: FD&Estates

5th Meeting Lead Governor

Meeting Patrick Sissons

7th Visit report to PSW Report for Council of Governors

8th Call with Trust Secretary

Emails and reports Governance Review meetings

9th Minutes for Nomination Committee

15th Governance Review

29th Review and reply to emails

30th Call with CEO Updating on issues. Board Minutes

31st Meeting Aidan Thomas Mock interview re: Governance Review

Mtg: new CEO of CUHP

Julian Baust

April 2016 AM PM EVENING

6th S2 Visit 8th Meet with S Legood 11th Appeal Prep Appeal Prep 12th Admin Board to CCG 13th Appeal Prep 14th 15th emails/admin

18th UCP telephone interview (no show)

19th A&A Prep A&A Prep 20th A&A Prep 24th QS&G Prep QS&G Prep 25th B&P Prep B&P Prep 26th UCP interview 27th QS&G B&P 28th Admin/emails 11th A&A Prep A&A Prep

May 2016 AM PM EVENING

8

3rd Workforce Strategy review

4th Quality Report review 10th Gov. Meeting prep Gov. Meeting prep 11th Gov Meeting 13th NAO Prep/Meeting

15th B&P Board report/A&A Prep

16th Meet with S Legood STP Meeting 17th Rem. Comm prep

18th Rem Comm./ A&A

prep

19th A&A Prep 20th A&A A&A 23rd Board Prep Board Prep 24th Board Prep 25th Board Board

June 2016

AM PM EVENING

1st Board self evaluation / emails

3rd Appeal Prep 7th Good Gov. Interview

14th Chinese delegation Chinese delegation/emails

15th EM Case read 16th Governors Lunch 21st Dev Day papers 22nd Dev Day Dev Day 26th NAO UCP Report QS&G Prep 27th QS&G/B&P Prep 28th B&P Prep 29th QS&G B&P CEO Dinner


12th Well lead Gov. review meeting

13th A&A 17th B&P Report for Board 26th Board Prep 27th Board Prep 28th Board meeting Board meeting

Jo Lucas

9

June 2016

AM PM

EVENING

21st Reading for development day

22nd Board development day

Board development day

24th responding to mails and follow up from meetings

27th QS&G papers 29th QS&G Inquest discussion

July 2016

AM PM

EVENING

1st reviewing RCE legal structures and work plan

Reviewing RCE work plan and recs for structure

4th BAF workshop 24th board papers Board papers 26th RC Board meeting

preparation

27th Recovery Board preparation

Recovery Board meeting and follow up

28th Board meeting Board meeting 29th Recovery College

graduation

Mike Hindmarch

June 2016 AM PM EVENING

4th Audit Committee minutes

7th Well led Governance review

21st Board development prep

22nd Board development Board development 24th Appeal Hearing prep 27th Appeal Hearing Appeal Hearing 28th Appeal Hearing letter B&P prep 29th B&P committee Dinner NED & Aiden

July 2016

AM PM EVENING

4th BAF workshop 5th RSM- Financial RSM-Financial

10

Governance Governance

7th Audit Committee agenda & papers

12th Audit Committee prep Well led Governance review Audit Committee prep

13th Audit Committee

15th Stakeholder panel AD Children’s

Stakeholder panel AD Children’s

20th Service visit CMHT Peterborough

22nd Annual leave 23rd Annual Leave 24th Annual leave 25th Annual leave 26th Annual leave 27th Annual leave 28th Annual leave 29th Annual leave

Sarah Hamilton

June 2016

AM PM EVENING

6th Sharing the Caring conference

Sharing the Caring conference

9th

Well Led Governance meeting with Tricia and Peter

16th Governors induction lunch

21st Meeting Carol Cole RHFT

22nd Board development day 28th Read QSG papers Read BP papers 29th QSG meeting BP meeting Dinner Aidan and NEDs

July 2016

AM PM EVENING

4th Well Led Governance Review Workshop

19th Amend QSG notes Draft QSG Summary 27th Read Board papers Read Board papers 28th Public Board meeting Private Board meeting 31st Emails and Skills matrix

August 2016

AM PM EVENING

1st NED visit PWS March NED visit PWS March

11

10th Prepare NED visit report

Read tenders from Deloittes and PWC

16th Meet Trish Davies CCS 23rd Breakaway training Meeting Deborah

Cohen

30th Read QSG papers Read B&P papers

Simon Burrows


12th Admin/reading/emails

21st Pre read/prep for Board Dev. Day

22nd Board Development Day Board Development Day

28th Prep for B&P Prep for B&P 29th B&P Committee NED Dinner with CEO

July 2016

AM PM EVENING

12th Prep for Audit & Assurance

Prep for Audit & Assurance

13th Audit & Assurance

Committee

21st Service visit to Fenland Adult Locality

27th Prep for Board meeting

Prep for board meeting/service visit

report 28th Board Meeting Board Meeting

@fitforfuturenhs

fitforfuturenhs

fitforfuture.org.uk

How health and care services in Cambridgeshire and Peterborough are changing

Why do we need to change?Our health and care services face challenges

The population of Cambridgeshire and Peterborough is growing rapidly. People are generally living longer, so we have an aging population, and more people have long term conditions or higher levels of obesity.

In addition, we are facing practical challenges:

• healthcare is not as good in some places as in others, and does not always meet the standards that it should

• recruiting and retaining staff is a challenge for all health and care services

• our health, local authority and other care services are not always joined-up, not always designed to meet people’s individual needs, and do not always balance physical health with mental health and wellbeing

• overall, we spend too much of our time and resources treating illnesses which can be prevented or kept under control in better ways.

In Cambridgeshire and Peterborough we have a total budget of more than £1.7billion for NHS services, but we spend about £150million each year more than that. By 2021, this overspend is set to grow to about £250million if nothing changes.

What you’ve told us so far

During 2015, we held listening events across Cambridgeshire and Peterborough to seek your views on the health and care system. We heard that:

• you want to be empowered to stay healthy

• you want easy access to information about health (you use Google and pharmacies)

• you want to understand how to use the right health and care service at the right time

• when you need care urgently, you would rather use a local service than be sent to A&E

• you want consistent access (e.g. opening hours for services) across Cambridgeshire and Peterborough

• you want care as close to home as possible

• children’s services need to be co-ordinated better (they are currently too fragmented)

• you would be happy to be sent home from hospital sooner if you had visits from a nurse to support you

• you do not want to be sent home too early with no support – you are concerned about needing to be readmitted

• you need better communication and planning before you leave hospital

• you want the people who provide health and care services to collaborate and work more closely together.

This document tells you about our plan, both to meet your ambitions for health and care and to make services financially sustainable.

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The NHS and local government officers have come together to develop a major new plan to keep Cambridgeshire and Peterborough Fit for the Future. Our plan aims to:

• improve the quality of the services we provide

• encourage and support people to take action to maintain their own health and wellbeing

• ensure that our health and care services are financially sustainable and that we make best use of the money allocated to us.

• align NHS and local authority plans.

It has been developed by our health and care organisations. We are working together and taking joint responsibility for improving our population’s health and wellbeing, with effective treatments and consistently good experiences of care.

Local doctors and other clinicians are leading this work, supported by NHS England and NHS Improvement, the organisations that oversee our local NHS - ensuring that the views of patients and local people shape key decisions.

Fit for the Future sets out a single overall vision for health and care, including:

• supporting people to keep themselves healthy

• primary care (GP services)

• urgent and emergency care

• planned care for adults and children, including maternity services

• care and support for people with long term conditions or specialised needs, including mental ill health.

We know that we need to develop improved communication and stronger working relationships across our organisations. We also need a shared culture that means we can learn and make improvements together. We are committed to delivering the healthcare you need - working together as one system with one budget.

We are well placed to make the changes we need and have a lot to be proud of. Cambridgeshire and Peterborough has a committed and expert health and care workforce. We provide some excellent services to which people travel from other parts of the country. We host groundbreaking research and deliver excellent medical education and training. We have a resourceful voluntary sector, strong organisations, active local communities, and we work alongside research and technology industries which are world leaders in improving healthcare.

2 Our five-year plan to make Cambridgeshire and Peterborough Fit for the Future

What are the priorities?Through discussion with our staff, patients, carers, and partners we have identified four priorities for change and developed a 10-point plan to deliver these priorities.

Fit for the Future programme

At home is best1. People powered health and wellbeing2. Neighbourhood care hubs

Safe and effective hospital care, when needed

3. Responsive urgent and expert emergency care4. Systematic and standardised care5. Continued world-famous research and services

We’re only sustainable together 6. Partnership working

Supported delivery

7. A culture of learning as a system8. Workforce: growing our own9. Using our land and buildings better10. Using technology to modernise health

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Priority one – At home is best

People powered health and wellbeing

We will help people to make healthy choices, keep their independence, and shape decisions about their health and care. We will work with community groups and businesses so people of all ages have good health, social, and mental wellbeing support.

Our first aim is to prevent illness and support people to take control of their own health and wellbeing. We will develop health services which work alongside patients and carers, social care, and housing providers, and help to build strong communities.

We want patients to become equal partners with those caring for them, make more decisions about their own treatment and, with advice and support, become increasingly confident to manage their own conditions, supported by technology.

Neighbourhood care hubs

More health and care services will be provided closer to people’s homes and we will help people stay at home when they’re unwell.

We aim to coordinate care better so it is tailored to the needs of the individual, paying close attention to the health and care services necessary to keep people living at home successfully - because we know this is the best way to keep people healthy and to maintain their independence.

When people become unwell, we will take every opportunity to spot warning signs, for example during regular health checks and visits to urgent care services, and focus local support to help people live with long-term health conditions.

We would like to see more joint working between local health and social care, with GPs playing a central role, supported by hospital clinical teams.

Patient story - future scenario Better safe than sorryWhen, on a Sunday morning outing, eight year old Olivia fell off her bike and banged her head, her mother Gemma didn’t know what to do. She thought about driving to A&E or dialling 999 but remembered seeing posters saying that 111 was a better option for injuries that were not serious or life threatening.

She called 111 and they arranged for Olivia to see a GP later that morning. The GP, Martin, examined Olivia and advised Gemma about what to look out for following a head injury, and what to do if Olivia’s condition changed. Martin directed Gemma to the NHS Choices website for further information.

In the afternoon, and using the information that she had been given, Gemma became concerned that Olivia was getting worse, not better. Following the advice that GP Martin had given her earlier she took Olivia to the hospital. The specialist children’s team could access Olivia’s notes and details of what had happened so Gemma didn’t need to repeat her story. Olivia was observed for six hours and discharged fit, well, and keen to get back to playing with her friends.

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Priority two – Safe and effective hospital care, when neededResponsive urgent and expert emergency care

We will offer a range of easily accessible support for care and treatment, from telephone advice for urgent problems to the very best hospital emergency services when the situation is life threatening.

This will be supported by better coordination, for example referral through NHS 111, close working with the ambulance service, and clear information provided to patients about which services are available – and how to reach them - when they have an urgent health need.

We have made a commitment that all urgent and emergency care services must meet the recently revised national standards.

We expect that 24/7 urgent care services will remain on our main three sites: Addenbrooke’s Hospital, Hinchingbrooke Hospital, and Peterborough City Hospital.

Systematic and standardised care

Doctors, nurses and other health and care professionals will work together across Cambridgeshire and Peterborough to use the best treatments and technology available.

We aim to make better use of research evidence – drawn from Cambridgeshire and Peterborough and beyond – to help us to use care and treatments systematically which are proven to be the most effective.

Where it is important to provide services from several sites across the area, we believe we can use our skills and expertise collectively to achieve better results through doctors and nurses working across more than one hospital site and sharing their expertise.

We expect that maternity services will also remain at The Rosie Hospital, Hinchingbrooke Hospital, and Peterborough City Hospital.

Continued world-famous research and services

We have world-class specialised care, but we are always looking for ways to be better. We will work together with our local research organisations and businesses to make this happen.

We believe we can achieve consistently better results for people with more serious needs, such as for heart and lung services, or complex surgery, in fewer, specialist units which make best use of the world-class expertise of our specialist consultants.

Patient story - future scenarioLooking forward – keeping active Mark gave up playing rugby after a broken wrist and had become an armchair fan at the age of 39. He still enjoyed regular evenings out, and was ashamed to admit that his smoking had increased since he gave up sport. But Mark remained convinced he was still fit and healthy – with nothing to worry about.

Aisha, Mark’s GP, was not so sure. Responding to an invitation for a regular check-up, Mark was told that he was significantly overweight, with warning signs suggesting he was at risk of developing diabetes. Aisha knew that persuading Mark to make the lifestyle changes he needed would require both a plan and support.

First, she connected him to the local smoking cessation service, which organised drop-in sessions Mark could easily get to, and put him in touch with a fitness coach who could recommend an exercise programme to suit him. She also realised that Mark’s smartphone was his window on the world, and suggested some websites and a wellbeing app to help him plan and stick to his diet and fitness regime.

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Priority three – We’re only sustainable together

Partnership working Everyone who provides health, social, and mental health care across Cambridgeshire and Peterborough will plan together and work together.

We believe we must work across boundaries: between NHS and local authority social care; GPs and hospital care; and physical health and mental health.

In addition, we aim to support our GPs to collaborate more, and work with them to develop sustainable services. We believe this will enable better access to resources through sharing and specialisation and closer working between GPs and their colleagues in hospitals. Development of the primary care workforce is an important part of this.

We also recognise that people are supported by a network of formal and informal care, and aim to work in partnership with local organisations such as faith groups and the voluntary sector.

Living beyond psychosisJack was becoming increasingly isolated; he had stopped attending school and seeing his friends, and had complained of hearing voices. Following a comprehensive assessment at which he was considered to have developed an early onset psychosis, he was referred to the early intervention service. He began a three-year programme tailored to his needs. The service worked with Jack to deliver a holistic care plan.

Family therapy enabled Jack and his family to understand more about his experiences and to begin to resolve them.

Jack is now aware that he can choose to access a wealth of insight and to share experiences through social media. He is actively involved in monitoring his state of mind, has discussed in advance what he would like to happen in a crisis, and understands what to do if he becomes unwell again. His GP and the practice team are very involved with the care plan and can call on a range of support for Jack. Perhaps the most important connection was with an employment project which supported Jack through his college application. Now, in the second year of his course, Jack can see a much brighter future.

Patient stories – future scenariosCare shaped around the patient After she turned 80, Doreen found her health deteriorating. Doreen has diagnoses of diabetes and emphysema (COPD), as well as early stage dementia. She lives with her husband, Roy, who is 82, who also has diabetes but is otherwise fit and cares for her.

Paul, her GP, invited Doreen for her annual assessment. Based on her increasing frailty, he accepted her onto the caseload for complex, case-managed patients who are supported by a multidisciplinary team in the community. Angela, a member of the community team, is her care coordinator.

Paul and Angela worked with Doreen and Roy to create two plans. The first was a care plan which summarised Doreen’s health needs according to her preferences and priorities, and what she and Roy would want in the event of a crisis or deterioration in health. The second, a self-care plan, allowed Doreen to describe her goals and needs for caring for herself safely at home, and identified how she could be supported in doing so by Roy and the health system.

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Priority four – Supported delivery

A culture of learning as a system

We are committed to sharing knowledge across the whole health and care system, so the people working in our health and care organisations know they are part of the big picture.

We want to develop a culture of learning. This means our staff developing a shared understanding of our services, priorities and challenges, a common approach to analysing opportunities and problems, and finding solutions together.

We believe we can share knowledge and expertise from the specialist services in Cambridgeshire and Peterborough, making the most of our world-class medical and healthcare education and training, and using research to drive improvement.

Workforce: growing our own

We have wonderful, talented people working in our health and care system. We aim to offer rewarding and fulfilling careers for our staff with opportunities for them to develop their skills and grow professionally. This way we can develop staff, including for those areas where we have some staff shortages.

We want staff to choose to work here and to see themselves as part of the whole health and care service in Cambridgeshire and Peterborough – not just the organisation which employs them, or their own clinical or professional groups. This will help us where we have services that have staffing shortages.

Using our land and buildings better

We want to bring all our NHS and local government sites up to modern standards. We want to make better use of our out-of-hospital sites, which may mean selling some buildings to invest in other modern, local facilities.

We want to explore how we can work together to get more value from our land and buildings, and bring all our sites up to modern standards.

There is a great deal of building development in Cambridgeshire and Peterborough, so we see opportunities for new strategic partnerships, such as the planned Hinchingbrooke Health Campus.

Using technology to modernise health

Good information and advice helps people take control of their health. We will use apps and online tools to provide more rapid and reliable information.

Shared information will help hospital clinicians, GP practices, community teams, and social care to work together more effectively.

Technology will help us to provide more rapid and reliable information for patients, and our clinicians will make sure technology is built in to new services.

Staff story – future scenarioMaking the right call Joanne supports several people with long term health conditions, enabling them to continue to live independently at home. She has built up a lot of knowledge about signs to look out for and urgent care options, and has always felt that she has valuable insight into how the emergency admission process works and whether it could provide a better experience for patients and carers.

Now working within a larger, multi-disciplinary team she can play a greater role. For example, she has received coaching from a local hospital consultant from whom she can also access immediate support and advice. This includes examples of symptoms which should raise concerns, so Joanne has the reassurance that she knows when it is right to call an ambulance and how she can help to prevent emergencies.

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World-class hospital care – delivered closer to homeVisha, a Geriatrician, has always strived to provide the very best care available anywhere and, although they handle an enormous number of patients, she is proud of the outstanding results achieved by her hospital-based team.

Visha was recruited onto the transition team which managed the set up of a new service running satellite clinics. Working with Paul, one of the GP leads, she realised that this challenging change could mean even better treatment and an improved experience for patients. By setting up a buddying system, Visha’s specialist expertise and Paul’s broader experience were combined and Paul was supported to take on monitoring and care which would previously have required a hospital visit. Visha’s team is now on rota to advise local GPs 24/7 via a hotline, so reducing the number of patients reaching them through A&E.

The practice at which Paul is based proved an ideal location for outpatient clinics. As a community ‘hub’, it is well-equipped and a new IT system enables Visha to access patient records and communicate with specialist colleagues - whether she is in the practice or on her ward.

Hospital care at homeMaqsood leads a newly-established team in St Neots. It helps to keep people living independently by providing intensive nursing input at home - so avoiding hospital admission or enabling earlier discharge.

Maqsood knows that the research evidence is clear. Too often, on admission to hospital the care and support networks on which older people depend fall away and with it their ability to live independently. He helped to co-design the service as part of the Fit for the Future programme and has worked hard to develop his team, which brings together professionals across several organisations and focuses on each individual patient’s needs.

For example, Mrs Barlow was one of the team’s first patients after she was discharged from hospital much sooner than she would have been before it was in place. She was able to recover at home, at first with high-level healthcare and daily contact with support workers, then stepping down to every other day contact with a nurse. She even received home visits from the pharmacist to make sure her medication was correct.

Staff stories – future scenariosJoining up physical and mental healthGreg leads part of the liaison psychiatry service, which joins up mental health and physical health care when people need hospital treatment or urgent care. His team works in hospitals across Cambridgeshire and Peterborough, and is managed jointly by Cambridgeshire and Peterborough NHS Foundation Trust and Peterborough and Stamford Hospitals NHS Foundation Trust.

As well as helping to make sure that the NHS meets its commitment to give mental health the same priority as physical health, Greg believes that his service is based on principles which are fundamental to transforming care services in Cambridgeshire and Peterborough.

When people are admitted to hospital, the liaison psychiatry service focuses on helping them to recover and how they can be supported to return home. This requires a holistic approach - working across mental health and different hospital specialties, in partnership with the patient, and alongside carers, advocates, and social care providers - because keeping people well requires a team effort.

As a clinician, Greg wants to help shape new ways of working and sees his role as a great opportunity – both to help bring better outcomes for patients, and to develop his own professional skills.

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How you can get involved

We have thoroughly reviewed our finances, including making comparisons with national figures, looking for opportunities to secure savings and ways to organise services more efficiently. We continue to look at the demands on services and our costs.

So far, if we deliver all the changes we have described our plan turns the currently projected £250million financial gap in to a small NHS system surplus by 2020/21.

There will be more opportunities for patients, carers, and local people to be involved about specific improvements we would like to make, and we will provide opportunities for staff and local people to help shape proposals for service change.

We also need a shared understanding about how best to use your valuable health and care services, and your priorities.

When we make changes, we aim to involve patients as early as possible - working alongside clinicians to help design services, as well as giving feedback.

You will be able to have a say in key decisions, including formal consultation.

And we want to help you look after yourself and take control of your own health and care.

4 5What these changes mean for our finances

We are committed to being as inclusive and open as possible. We will listen to all contributions and use these contributions to influence the decisions we make.

We will hold engagement events in the coming months and you can find the details on our website www.fitforfuture.org.uk

If you want to be part of the discussion and work with us to develop solutions, please contact us via email on [email protected]

You can also register on our website www.fitforfuture.org.uk

Follow us on Twitter and Facebook for the latest news and developments.

@fitforfuturenhs

fitforfuturenhs

01223 725 304

Produced by Cambridgeshire and Peterborough Sustainability and Transformation Programme. July 2016

Sustainability and Transformation Plan

The views of patients and local people will shape key decisions

In developing Fit for the Future, we’ve already started to work as one system:

Changing the way we meet the health and care needs of our 900,000+ residents

Working differently, and working together

With a joint plan to turn our projected £250m deficit into a small surplus.

The headlines The NHS and local government

officers have come together to develop a plan to keep Cambridgeshire and Peterborough Fit for the Future.

It has been developed by our health and care organisations. We are working together and taking joint responsibility for improving our population’s health and wellbeing, outcomes and experiences of care.

Local clinicians are leading this work, supported by NHS England and NHS Improvement.

Fit for the Future

Priorities 10-Point Plan

At home is best 1. People powered health and wellbeing 2. Neighbourhood care hubs


3. Responsive urgent and expert emergency care 4. Systematic and standardised care 5. Continued world-famous research and services


Supported delivery

7. A culture of learning as a system 8. Workforce: growing our own 9. Using our land and buildings better 10. Using technology to modernise health

Through discussion with our staff, patients, carers and partners we have identified four priorities for change and developed a 10-point plan to deliver these priorities.

This diagram summarises how integrated health and care neighbourhood teams can provide proactive care stratified by different levels of need, as determined by both their medical and psychosocial conditions. This brings together previously disparate work on healthy ageing, long term conditions management and mental health for the first time.

Model being developed for adults with long term conditions and older people

Integrated health and care

Finance Cambridgeshire and Peterborough is one of the most challenged

health systems in England. We have a total budget of more than £1.7billion for NHS services,

but we spend about £150million each year more than that. By 2021, this overspend is set to grow to about £250million if nothing

changes. We have explored all opportunities for savings across the system. We believe we can make the savings set out in the Sustainability and

Transformation Plan - but also recognise the scale of change required is significant and delivery will be challenging.

-27.5

-29.1

-70.8

-55.9

-170.3

-520.7

-20.0

-250.7

-464.8

-26.1

-106.3

-332.4

-13.4

-600

-550

-500

-450

-400

-350

-300

-250

-200

-150

-100

-50

0

50

100

20/21 C&P System Deficit

CPFT CUHFT

-1.3

CCS 20/21 Provider

’Do Nothing’ position

C&P CCG Specialised Commissioning

Gap

Cost pressure - 7DS & STP PMO cost

HHCT Papworth PSHFT

£m

Social care gap

20/21 C&P system ’Do

Nothing’ position

20/21 Health

system ’Do Nothing’ position

BAU Efficiences

270.0

SOURCE: NHSI analysis.

6

Our financial position if we did nothing

We can get back to balance, if we capture all saving opportunities

15.8

-7.6

-55.9

-700

-600

-500

-400

-300

-200

-100

0

100

20/21 Health system position

-2.7

4.9

Additional procurement opportunity

External funding

45.9

S&T funding

55.0

Estates

15.0

Reduce system support

costs

29.5

Reduce unit cost of care

151.2

135.8

Shift care to lower cost

setting

59.4

44.4

Reduce variation

£m

Additional unit cost of care stretch

opportunities

40.0

34.2

Demand mgmt

67.0

56.2

34.0

20.9

19.8

20/21 System deficit

-520.7

-464.8

Income growth

Social Care

NHS

SOURCE: NHSI analysis NOTE: All figures are presented in 20/21 prices, assuming local STP analyses of activity growth and national inflation rates. Figures include QIPP/CIP as appropriate to calculating the opportunity to mitigate double counting, eg where an opportunity benefits from demand management.

Inclusive of £43.5m recurrent investment

Sustainable clinical services – the best chance for staff to provide improved patient care.

Sustainable employers – able to provide job security. Collaborative leadership and a system delivery unit that will work with and

across all organisations to achieve change. A positive, single culture, improved communication and IT, and better use of

technology. Better opportunities for specialisation, learning and professional development

through networking and being part of a larger system. Opportunities for new roles (e.g. nurses in multi-disciplinary Neighbourhood

Teams), or to work in a team which covers several hospital sites. Additional staff residences and student accommodation (e.g. Hinchingbrooke

Health Campus) Improving patient care with a growing reputation – of which we can all be proud

What we see as benefits for staff

Developing our people Working with Health Education England, we will develop a long-term

system workforce plan, develop a common set of behaviours system-wide, and develop our organisations to support a culture of learning.

The system workforce plan will: Identify the skills mix we need for the future Develop the skills of existing staff Streamline recruitment into all the organisations in our new system

which will enable us to ‘grow our own’ staff Attract the best staff to join us.

We also want all staff to contribute to the plans for organisational and individual development which will be needed to support them in new ways of working.

A single set of system behaviours

We know that patients are not attached exclusively to a single NHS organisation or service.

As we move to work more closely together as a system, resources will increasingly be shared along with the responsibility for delivery and outcomes.

We want staff to see themselves as part of the Cambridgeshire and Peterborough system, not just the organisation that employs them or their clinical specialism or role.

We will increasingly refer to providers as part of the Cambridgeshire and Peterborough system, though we want to build on the worldwide reputation of our hospitals and share in our collective achievements.

Clinical leaders across the system will continue to be encouraged and supported to work collaboratively across organisational boundaries, and hold each other to account.

We will move as quickly as possible to align employment practices (recruitment, training and reward) – both to bring efficiencies and improved outcomes through standardising on the best approach.

Networks We aim to work as operational networks for planned, unplanned,

routine and specialised care. This means:

Some clinicians working across sites Single process management systems across providers Standardised patient pathways Quality and clinical governance shared across

Cambridgeshire and Peterborough. For all specialties, including those where physical consolidation does not make sense such as ophthalmology, the service will increasingly be run as one across the acute sites to make the most of the expertise we have in some providers. Networking will address unwarranted variation and we are considering opportunities including: e-referrals, offering GPs direct access to a consultant opinion, streamlining pathways, and the potential for more nurse-led care.

1.Submit STP

7.Start formal public consultation, as needed

30 June

6. System Delivery Unit established (the local team that will implement the STP)

Oct

1

2.NHSI & NHSE review and challenge STP

18 July

July - Oct

4.Secure resources for implementation phase

19 & 20 July

3.Launch staff & public engagement, including website

5.Clinical Senate Panels*

6

3

Nov

4

2

27 & 28

Sep

5

7 Timeline

* Clinical Senate Panels provide independent, strategic clinical advice to stakeholders to help them make the best decisions about healthcare for their populations

Plan to 2021 • Build capacity to make changes, by creating

a [System Delivery Unit], updated governance & aligning financial incentives from 2017/18

• Reduce non-elective activity on PSHFT & CUHFT, by evaluating range of tactical investments

• Fully specify care models for ‘home is best’ and ‘safe & effective hospital’

• Comprehensive staff engagement to embed proposed changes

• Finalise long term system plans: finance, workforce, estates, back office, FBC

• Networking proof of concept(s) (ophthalmology)

• A focused approach to support GPs • Prevention Strategy funding and delivery

models agreed / some workstreams in early implementation

• Reduce over-head costs through PSHFT HHCT merger (subject to FBC), community estates co-location and collaborative procurement

• Contain demand growth through locality by locality ‘home is best’ roll out

• Implement improvements to frailty & stroke pathways (subject to public consultation)

• Shift care to lower cost setting by reviewing urgent care and rehab, and the configuration of orthopaedics (all subject to public consultation)

• Develop ambulatory paediatric care by establishing a PAU at CUHFT, making PAUs at HHCT and PSHFT 24/7, and enhancing community service provision

• Improve provision of perinatal mental health services

• Commence development of system-wide clinical networks

• Implement patient choice hub • Prevention Strategy

implemented

• Standardise ‘home is best’ across the patch, through sharing what works

• Consolidate cardiology in Cambridge at new Papworth; consider further integration with CUHFT

• Complete networking roll out • Enhanced career offer: new roles, rotations • Consider shifting more outpatients to GP • Continued quality improvement to

standardise services and reduce harm • Embed clinical networking • Consider further integration w/ councils • Primary care operates at scale (via

networks, federations, super-partnerships) • Prevention opportunities maximised

Phase 1: Scaling Up (2016/17)

Phase 3: Continuous Improvement

(2020/21 and beyond)

Phase 2: Embedding

Change (2017/18 – 19/20)

We want you to be involved There will be more opportunities to be involved about specific improvements

- we will provide opportunities for staff and local people to help shape proposals for service change.

We are committed to being as inclusive and open as possible. We will listen to all contributions and use these to influence the decisions we make.

When we make changes, we aim to involve staff as early as possible - to help design services, as well as giving feedback.

We are planning to hold engagement events in the coming months… Find out more on our intranet or the website www.fitforfuture.org.uk Contact us on [email protected] Follow us on Twitter & Facebook fitforfuturenhs

How health and care services in Cambridgeshire and

Peterborough are changing

The NHS and local government officers have come together to develop a major new plan to keep Cambridgeshire and Peterborough Fit for the Future. Our plan covers hospital services, community healthcare, mental health, social care and GP services. Our plan aims to:



• ensure that our health and care services are financially sustainable and that we make best use of the money allocated to us


We are working together and taking joint responsibility for improving our population’s health and wellbeing, outcomes and experiences of care.

You are at the centre of this plan.

Health and care professionals will work with you to help you look after your own health and make decisions about your care. We also want to make sure you can easily use local health, social care and mental health services when you need them.

We have four priorities for change and a 10-point plan for how we will achieve it. See inside for information.

We want to hear your thoughts on this proposed plan. We will be holding listening events in the coming months.

To find out more and be part of the discussion, please register on our website or email us.

[email protected]

fitforfuture.org.uk

@fitforfuturenhs

fitforfuturenhs

01223 725 304

Contact Us

Produced by Cambridgeshire and PeterboroughSustainability and Transformation Programme.July 2016









Priority four - Supported delivery

Partnership working

Everyone who provides health, social and mental health care across Cambridgeshire and Peterborough will plan together and work together.

Priority three - We’re only sustainable together

Priority one - At home is best Priority two - Safe and effective hospital care, when needed


We will help people to make healthy choices, keep their independence, and shape decisions about their health and care. We will work with community groups and businesses, so people of all ages have good health, social, and mental wellbeing support.

Responsive urgent and expert emergency care








1

Agenda Item: 2.2


REPORT

Subject: Chief Executives Report Date: 7 September 2016

Author: Aidan Thomas

Lead Director: Aidan Thomas Executive Summary: This report informs and updates the Council of Governors about a range of matters affecting the Trust.

Recommendations:

The Council of Governors is asked to note the contents of this report.

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The development, commissioning and implementation of a new integrated service strategy from April 2016: We will work with patients, carers and key stakeholders to change our services to deliver innovative, integrated person centred care and support that represents the highest possible standards in safety, effectiveness and personal experience of our services. The design, development and implementation of the future CPFT workforce: Our staff will be a highly engaged, well trained, flexible and productive workforce who are able to deliver more at better value


Links to BAF / Corporate Risk Register This report covers all of the strategic goals and objectives.


None.


The report discusses the negotiations of contracts and a control total, each which has a financial implication on the Trust.

Legal implications / impact None.


The report contains the Trust’s Collaborative and Collective Leadership Strategy which discusses how CPFT will become more responsive to patients, carers and partners. It also discusses the STP which looks at how the whole system will work together.

Committees / groups where this item has been presented before None


3

Chief Executives Report

1. Contracting

The Trust settled the 2016/17 Mental Health contract following mediation (the last report to the council referred to arbitration but mediation was the first step in that process). The agreed contract included roughly £1m to address the significant demand problems in mental health services. Apart from this the Trust, in common with the other local Trusts, has still not agreed the final elements of the CQUIN agreement. This requires the Trust to make agreed quality improvements in order to secure a percentage part of our baseline funding. The outstanding element relates to final quarter payments for a CQUIN target which commits the Trust to the local Strategic Transformation Plan. All parties have agreed to resolve the disputed elements which are worth circa £300k. The Trust is in dispute with the Learning Disability Partnership which commissions services on behalf of the CCG and the County Council for Cambridgeshire (not Peterborough). The LDP has not paid bills relating to £2.2m worth of service provided in 2015 and 2016. The LDP has not offered any reasonable justification for this, and the Trust can evidence the service was provided. The Trust is now considering formal action.

2. UnitingCare

The draft report from the Judge Business School is available for approval by the Governors. The national Audit Office report has been referred to the Public Accounts Committee and a hearing will be held on 14th September. I have been asked to attend.

3. Sustainability Transformation Plan

Monitor and NHS England continue to take a strong lead in this programme. The Trust has agreed (subject to formal Board approval) a Memorandum of Understanding (MOU) setting out how organisations across Cambridgeshire will work together to deliver the Sustainability Transformation Plan (STP). The Trusts Services are affected by all of the workstreams, and we are engaged in all of them. In particular we have a significant leadership role in the Proactive care and prevention stream which picks up much of the work started by UnitingCare, and in the “Vanguard” Urgent and Emergency Care stream where JET, Case Management, Long Term Conditions and Mental Health are addressed. All the workstreams have parent and carer representation either planned or already engaged. The plan was presented for approval in July by the CEOs of all relevant organisations in Cambridgeshire to a panel of the most senior NHS officials in England. It was approved and Cambridgeshire will now commence implementation. The plan includes significant investment (c£40m over 5 years) in community, and primary care services including long term conditions and mental health. The Trusts programme management is linking closely with the STP delivery Board. An engagement programme is planned.

4. Control Total

At the time of writing the Trust was in the process of agreeing a “Control Total” with NHS Improvement (Monitor). This would set an absolute target surplus for the Trust (not hitherto required of FTs, and not a legal requirement). The Trust has resisted agreeing a Control Total until now because the level of surplus originally suggested for us would have severely limited our ability to support local services in the coming year, and so outweighed the incentives the Trust would receive for accepting the total which include access to Vanguard funds and the creation of an additional surplus in the Trusts accounts.

4

NHS Improvement has accepted a negotiated reduction of the required target surplus, although at the time of writing the figure had not been finalised.

5. Children’s Services

The Trust has signed an MOU with Cambridge Community Services Trust to work together on developing children’s universal services, community paediatrics, and Childrens Mental Health. The MOU includes an agreement to jointly appoint a Programme Director with the councils and the CCG and to manage the services together. A copy is attached for information. An appointment process is underway for the Programme Director. This approach has all but removed the threat of competitive tendering for the service.

6. Directorate Restructure As result of the implementation of this the Trust has decided to rename the Integrated Care

Directorate and the merged Specialist and Adults Mental Health Directorates. The names are yet to be agreed.

7. New Appointments Jackie Gough has been appointed to the post of Associate Director of Operations - Adult &

Specialist Mental Health following the restructure of the Directorates.

Dr Ben underwood has been appointed to the post of Clinical Director of the Integrated Care Directorate.

Nicholas White has been appointed to the post of Associate Director of Children’s Services.

Rachel Gomm will be acting into the role of Deputy Director of Nursing for the Trust.

8. Cavell Centre Fire safety work continues to cause disruption at the Cavell centre at the time of writing. The work is due to be completed on 20th August.

9. Neighbourhood Team Bases The relocation programme continues. Eight of the neighbourhood teams have been established into either new bases or consolidation within existing premises as follows: Cambridge East Cambridge South Villages Cambridge City South Isle of Ely Fenland Wisbech St Neots Peterborough Borderline Central.

10. Collaborative and Collective Leadership The Trust has agreed a Strategy for Collaborative and Collective Leadership, which is attached. 11. Staff Engagement

A series of engagement events have been set up during August and September to enable staff to discuss the issues they face with me and other Directors and to engage on future Strategy. Dates and venues have been circulated separately to Governors.

12. Service Visits I paid a number of short visits to different services this month, but did not work a shift due to leave.

5

13. Communications Update Kit Connick has been appointed Interim Associate Director of Corporate Affairs, and has taken on the communications department as part of her portfolio. She will be working closely with Andréa Grosbois and the team on the development and implementation of the GP engagement strategy and set up of the CPFT Charity. From October, management of the Trust’s membership will transfer from the Trust Secretariat into the Communications Team where it will sit alongside the CPFT charity and public engagement.

External communications The focus has been launching new services as part of the Vanguard programme and preparing for phase 2, which is set to launch in September. Developing the GP engagement strategy and working on recruitment promotion remain the team’s top priority. The team are also launching an integrated marketing campaign called “Pride in our care,” which aims to reposition CPFT as an integrated provider, by improving awareness of the services now provided and referral pathways. The campaign will be promoted through video, social media, press and print content, and the public-facing website will be redeveloped as part of this. Media activity: 21 -March – 22 August Total media hits : 90 - broadcast: 19, print: 71 (Target: 2 per week – averaging 4 per week) Top positive stories:

- Sanctuary opens to support people locally – BBC Radio Cambridgeshire, Cambridge TV, Cambridge News

- Opening of the Hobbit house at Darwin Nurseries – BBC Radio Cambridgeshire, Cambridge News

- Dietitians offer healthy eating advice – Ely Standard, Wisbech Standard

- Silver Cloud course helps people suffering stress, depression or anxiety –Cambs Times, Wisbech Standard, Peterborough Telegraph

- Mental health research innovations – BBC Radio 4 There has also been widespread local and national coverage of the National Audit Office and NHS England reports into the termination of the UnitingCare contract.

Social media: 21 March – 22 August

Facebook New likes: 166 to 328 (Target 10 p/w – average 7.5 p/w) Total posts: 370 (Target 10 p/w – average 17.5 p/w) Audience reach: 39,306

Twitter New likes:1660 to1861 (Target 10 p/w – average 9.5 p/w) Total Tweets: 435 (Target 10 p/w – average 20.7 p/w) Total interactions: 1,716 Audience reached: 250,893

LinkedIn New likes: 687 - 776 LinkedIn is managed by the recruitment team. A new Instagram account has also been launched.

Internal communications The communications team continues to support key internal projects, including; the Collaborative Leadership Strategy; nursing revalidation; Patient Engagement Strategy; PRISM; agile working; and estates. A new branding policy is due to be published by the Department of Health this year. The team will review the existing CPFT brand in light of these guidelines.

In-hou se design and branding service May-July: Design hours: 138 hours Publications/graphics: 73 Total cost saved over the year from providing the service in-house: £27,600

AT 21/08/16

Media hitsTotal value of print and broadcast coverage :

£66,931

Positive

Neutral

Negative

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Typewritten Text

Agenda Item 2.2.i

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Typewritten Text

1

DRAFT - Our strategy for collective and collaborative leadership

1) Introduction

This strategy sets out our approach to collaborative leadership, to enable CPFT to become more responsive to patients, carers and partners, and to help the organisation respond to the current health and social care environment.

The Kings Fund defines collaborative leadership as;

“…everyone taking responsibility for the success of the organisation as a whole – not just for their own jobs or work area.”

To further develop our strategy of Integration, Recovery, and developing Specialist Services, we need to take further strides in our approach to partnership working both internally and externally. Developing an engagement strategy that includes staff, patients, carers and key stakeholders will be vital, to ensure a consistent approach as to how we engage people and respond as an organisation.

The NHS in recent years has experienced the greatest growth in demand set against the most limited increase in funding since its inception. This has had a huge impact on our services and has required us to transform how we support patients.

Our partners in the statutory and voluntary sectors, are also facing significant challenges including, increases in demand as a result of the ageing population, strictures on the welfare system and increased cuts to social care.

This means that integration with our partners and a focus on empowerment, independence, resilience and optimism (collectively known as “Recovery” in mental health) is the only realistic approach we can adopt if we are to do the best by our patients in the current climate

2) Collective leadership, and collaborating internally

In order to engage effectively with external partners and commissioners, we will need to ensure that individual managers and clinicians are supported to work flexibly so that they can represent the whole organisation and not just their service or area of expertise.

The sheer size of CPFT, our geographical spread and the number of key partners, mean that to work effectively we have to enable decision making to take place at more local levels, with managers engaging directly.

Changes in Primary Care in particular will require us to devolve decision making and engagement to local staff and managers who will need to be empowered to represent all our services.

The development of integrated services in all parts of the Trust and the adoption of recovery and resilience principles across the entire organisation, together with the universal nature of many of the cost improvement programmes, mean that a less hierarchical and more collaborative approach to management will be needed.

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Typewritten Text

Agenda Item: 2.2.ii

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How can this be achieved? The traditional culture of CPFT’s directorates (previously called divisions) has been one of competition, and hierarchical silo management. To change this there are a number of things we could do:

a) Broaden the membership of the formal executive meetings to include key senior managers, bringing more informed and engaged decision making.

b) Step up engagement of directors with directorates beyond the directorate management team meetings, with directors regularly engaging with teams.

c) An education programme for staff should be introduced to help people understand how to represent CPFT successfully and not defensively, and to provide insights into the key issues faced by partners to ensure effective collaborative working.

d) A two-way information system linking the Executive with local managers needs to be introduced to ensure we can respond to partners sensitively and positively wherever possible. This should be held centrally but collected verbally to not introduce new bureaucracy.

e) Clinical staff and local managers such as neighbourhood managers and team leaders should be supported to liaise with key stakeholders and empowered to represent the Trust as a whole and not just their own service.

f) We should clearly define the range of things we can do to support other partners and stakeholders and the ways in which services could benefit from the support of partners. This will help to support managers and clinicians working with them.

g) The work that has started to develop leaders and a corporate culture should be extended, including succession planning, the development of the Alumni programme and the introduction of secondments to and from key partners.

h) We should resolve arrangements for specialist services within directorates and how they relate to generalist services such as neighbourhood teams or locality mental health services.

i) Opportunities for staff and managers to shadow and better understand other areas across CPFT and partner organisations.

j) The Trust’s senior leadership should concentrate on working with directorates and support functions to break down barriers between directorates wherever possible.

k) Planning should start and end with the patient, and partners should be encouraged to take the same approach concentrating on a patient’s journey or care pathway, as it will make the needs of organisations and professions subordinate.

l) We should ensure that Membership, Governor, and Board representation reflects the full range of CPFT services.

m) There should be more opportunities for staff to show case what they do.

3

n) We should ensure that more influence in decision making is given to staff with support in place to enable people to do this.

o) We should set an example in collaborative working to partners in the health economy. We must work at developing stronger relationships and arrangements with General Practice, recognising that this could mean different models of care developing.

p) The Trust should provide coaching on style and approach to management, to allow teams to support each other better and work more collaboratively.

Accountability Collaborative leadership is about creating a supportive culture where staff continue to take responsibility for leading and managing their areas of influence, whilst developing stronger working relationships with colleagues across CPFT and external partners.

This doesn’t remove the need for people to be individually accountable for performance in their service, however to maintain our success in the current climate we need to adopt a culture, which also encourages collective support for improvement.

3) Collaborating with patients and carers

The value of feedback We depend on patient and carer feedback to improve care and ensure we meet their needs. Feedback can also have a wider impact on the organisation such as;

1) Influencing our commissioners. The more our commissioners become primary care focussed, the more direct patient feedback will influence them. The current environment is increasing the influence of primary care (Five Year Forward View for Primary Care) so this is key.

2) Influencing our regulators. The CQC and increasingly NHS Improvement (a new organisation that brings together Monitor, NHS Trust Development Authority etc) respond directly to evidence of poor patient experience and take note of good patient experience.

3) Improving our services. Our strategy of focusing on empowerment, independence, resilience and optimism (collectively known as “Recovery” in mental health) for people with long-term conditions and people with serious and enduring mental health needs will help people manage their lives and gain or improve their independence of the service, but it cannot work without understanding and involving the patient in the service.

4) Co-production and involvement. Co-production of plans and policies with patients and carers for services will lead to better quality services. This is also acknowledged by the Kings Fund in its various reports on collaborative leadership.

5) Developing our services. Most importantly both the basic quality and effectiveness of our service when dealing with complex long-term illness can only be developed if we involve the people who receive it, in service development.

4

Current situation We have a number of great initiatives and are ahead of other Trusts in several ways; many teams have patient and carer involvement groups; we have two Recovery Colleges and advise the Department of Health on recovery; we have trained and recruited dozens of staff with lived experience of mental health; the Promise project, which was co-produced with patients, is having a massive impact on the use of restraint and the general quality of patient care; we have worked with CLAHRC to involve young people in developing a programme to address transitions between adult and children’s care; we have signed up to the Carers Trust Triangle of Care Initiative; and patients and carers are present on some of our interview panels.

Patient engagement and co-production was also praised in our recent CQC report.

At the same time there is still more that we can do. There is no systematic Trust-wide approach to patient and carer engagement or involvement, and no feedback or metrics regularly reviewed by managers, senior clinical staff or the Board to help address this.

All providers across health and social care collect data and feedback in a very insular way for example, questions such as “how was your experience on our ward” are captured rather than looking at the bigger picture around patient experience using a variety of services and transitioning between them.

Patient and carer experience and engagement aren’t the same thing – there is a clear rela-tionship between the two and you can’t have one without the other but they require different skillsets so it will be important to review the skills required to fulfil the strategic requirements and review our structures for engagement and patient and carer experience.

Improving patient and carer engagement and involvement Our strategy to address this should include;

a) Formal feedback from engagement activity involving patients, carers, public and stakeholders, considered at executive and Board level. This will help to give a realis-tic “temperature check” of how people perceive our services and their experience of using them.

b) Systematise efforts to ensure feedback from patients and carers is encouraged and influences our service developments. We should introduce more effective ways of enabling feedback that is representative of our diverse population both in terms of ethnicity and sex.

c) Improve patient experience data by working collaboratively with our partners to better understand patient experience with transitions to or from our services from other pro-viders. Data is not being collected in this way by any other providers so it could be an opportunity for us to create a template for good practice.

d) Systematise patient and carer engagement in each directorate with dedicated sup-port in each, linking to Trust-wide co-ordination.

e) Establish a network or forum for patient engagement and experience leads across

providers to meet and discuss opportunities and share learnings.

5

f) Re-order representation in the Trust governance to reflect all the services we now provide. This includes recruiting more diverse Members; changing non-executive di-rector arrangements to reflect the new services; recruiting new Governors; and re-structuring directorate management arrangements.

g) Co-production at all levels should be improved – for example we don’t have a con-

sistent approach to involving patients and carers in service redesign. There should be patient representatives on all project groups and proper engagement at the start of the project not as a token at the end.

h) Patient and carer representatives should play a role in all staff interview panels – many other Trusts already do this. We already do this in some but not all direc-torates.

i) Reintroduce patient and carer ambassador roles for CPFT to ensure easy and quick

access to patient and carer feedback.

j) Establish a patient council with members who have specific interest areas for our business and who can support projects ensuring meaningful engagement. For exam-ple a diabetes patient representative to support the development of the diabetes pathway.

k) We should link with existing organisations that already do patient engagement well

and work in collaboration with them to get feedback – it will be important also to con-sider seldom heard communities in this. Organisations include Healthwatch, Peter-borough CVS, Gladca, SUN etc.

l) Develop an engagement log to capture engagement activity, what the feedback was

and how the feedback is being used. This would make it easier to share feedback and ensure actions are followed up.

4) Collaborating with partner organisations

Our partner organisations whether statutory, voluntary or private, provide vital services which support the same people we care for. Many of our partner organisations are under serious financial pressure, some more severe than our own.

Local Authorities Despite facing significant reductions in funding, both Peterborough City Council and Cambridgeshire County Council are investing resources into more preventative services to keep people independent for as long as possible and reduce the chances of relapse.

By working in a collaborative way with them we can improve the experience of people using our services and their families. We can also contribute to the Councils’ agenda to build individual, family and community resilience that benefits all.

We are well placed to do this. We have section 75 agreements in place for mental health social workers, and some other staff and we are working hard to align the services in the integrated care directorate with the councils’ social work teams. This requires the principles in this paper to be put into practice.

Police and Fire Services You may not know that over the last year (2015-16) we have put in place a service within the

6

county Police control room to reduce the numbers of people unnecessarily taken to places of safety under section 136, and a major piece of work on hoarding has been carried out with the Fire Service. These pieces of work show the power of what can be achieved by working in a collaborative way.

Private sector The impact of cost pressures and heightened regulation is also being felt by nursing and care homes and domiciliary care. We know that there is a shortage of these services across Cambridgeshire and Peterborough. We also know that if we can offer targeted support we can prevent hospital admissions for the elderly, which otherwise can lead to a significant deterioration in the health of individuals as their dependency increases.

Third sector and voluntary organisations These organisations are often dependent on Local Authority funding, which means that their budgets are under similar pressures. Cuts to Local Authorities and the voluntary sector will reduce the support available to those who use our services significantly, and will directly increase demand for our services.

Health providers NHS providers including acute hospitals (especially those in Cambridgeshire) are in serious financial trouble. Changes to their payment tariff, and strain on capacity (possibly exacerbated by pressures in social and primary care) have meant that there is now an opportunity to influence and support the move of medical services out of hospitals to establish more community-focussed services.

This will require us with our expertise in community services, emphasis on patient engagement, and commitment to fostering independence, to support local acute hospitals to improve their services and manage their crises through the development of service in these ways.

In the current financial climate we also have an obligation to minimise costs and we should do everything in our power, in line with recent guidance, to work with partners in the acute sector, ambulance services and Cambridgeshire Community Services, to share and pool support functions to maximise efficiency wherever it makes sense.

Primary care GP practices across the County are facing significant challenges including a crisis around GP recruitment, a preference amongst new GPs to become salaried rather than enter a partnership, and a general loss in practice income due to the end of Personal Medical Services Contracts of an average of 10%. Federation and merger are therefore being considered and this is being encouraged through the Five Year Forward View for Primary Care NHS strategy document.

GPs provide care to almost all our existing patients and their services are critical. Therefore we need strong general primary care locally if our own services are to survive and provide the best support for our patients.

Education sector Education is also facing financial pressures, which are affecting capacity. The Trust needs its research links to attract staff and additional funds into the system as well as to ensure a

7

high quality service. Training is also very important not just for its own benefits but as an aid to recruitment and retention. We must work in close partnership to influence decision making and help alleviate the impact of these pressures and cuts.

Business sector It may benefit our services and would certainly benefit public understanding of the pressures in health and issues such as stigma in mental health if we can strengthen relationships with local businesses. We should link with the business sector tapping into their desire to demonstrate corporate social responsibility and to support their workforces and improve awareness.

Why is all of this important? We know that care provided to patients often breaks down at the point where responsibility is transferred from one organisation to another or when care requires co-ordination across multiple organisations. Financial pressure often encourages organisations to pull apart from collaboration and try to place cost on organisations perceived to be better off.

Two points are really important;

1) Most older people or those with long-term conditions in our area are supported by more than one organisation, and maybe by as many as seven.

2) There is considerable cost duplication across organisations trying to provide care to the same person.

How can we improve collaborative working? It can only make sense to collaborate closely with partners at times of financial stress, both in terms of cost, and for the benefit of patients.

NHS policy, set out in the Five Year Forward View, is now placing more emphasis on integration, with slightly less emphasis on competition as an ideology. Locally competition, which also can threaten collaboration, is unlikely to be a major feature of commissioning for some time following the collapse of UnitingCare. In any case successful bids in complex fields such as health care are usually more successful as partnerships and collaborations. These developments have important implications for us and will create big opportunities to collaborate, and integrate. The risks will be loss of our services if we fail to collaborate well.

a) We must collaborate effectively with partners to deliver services in order to reduce cost on a mutual basis, and to effectively provide care.

b) We must collaborate to protect and develop joined-up services in the long term.

c) It will be important to establish clear relationship management arrangements with each partner including GP practices and federations, key voluntary organisations, Local Authorities and NHS partners.

d) To support collaboration we must develop a simple system of partner information and metrics to help the executive directors, senior management and Board understand the position and view of partners. This means putting the needs of the patient and not organisation first, and giving up some power to enable improved service and more.

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Agenda Item: 2.3


REPORT

Subject: Judge Business School UnitingCare Report Date: 7 September 2016

Author:

Brian Cox, Feryal Erhun and Stefan Scholtes on behalf of Cambridge Judge Business School, Centre for Health Leadership and Enterprise.

Lead Director: Aidan Thomas, Chief Executive Executive Summary: Cambridgeshire and Peterborough NHS Foundation Trust (CPFT) commissioned this report to provide analysis and insight into the UnitingCare Partnership (UCP). In particular this report summarises events surrounding the creation and collapse of the UCP contract for the Governors and Board of Directors. Recommendations:

The Council of Governors is asked to note and discuss the contents of this report.

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Relevant Strategic Goals and Objectives (please mark in bold)



Links to BAF / Corporate Risk Register BAF Risk ID: 2179


N/A

Financial implications / impact N/A

Legal implications / impact N/A


Stakeholder, staff, public, GP and MP engagement.

Committees / groups where this item has been presented before

None


Cambridge Judge Business School Centre for Health Leadership and Enterprise Review of the UCP Contract Termination, August 2016

Commissioned by Cambridgeshire and Peterborough NHS Foundation Trust Research Team: Brian Cox, Feryal Erhun, Stefan Scholtes

Review of CPFT’s Role in UnitingCare and the Impact of Terminating the UnitingCare

Contract

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Agenda Item: 2.3.i

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LIST OF TABLES 3

LIST OF ACRONYMS 4

SUMMARY REPORT 6

Competitive tendering and risk sharing 7

Partnering and collaboration during contract execution 9

Cost and salvaging created value 10

MAIN REPORT 12

1. INTRODUCTION 12

2. METHODOLOGY AND DATA SOURCES 13

3. BACKGROUND AND CHRONOLOGY 14

4. NARRATIVE 19 4.1 Rationale for OPACS 19 4.2 The tender decision 20 4.3 Urgency 21 4.4 Realistic objectives and expectations 22 4.5 Uncertainties and renegotiation 23 4.6 The role of the UCP 24 4.7 Communication, consultation and governance 25 4.8 Competition and trust 26 4.9 Regulation 28

5. ANALYSIS 29 5.1 Competitive tendering and risk sharing 29 5.2 Partnering and collaboration during contract execution 34 5.3 Cost and salvaging created value 36

6. CONCLUSION 38

ACKNOWLEDGEMENTS 40

APPENDICES 41 Appendix A. CHLE INTERVIEW OUTLINE 41 Appendix B. UCP SAVINGS AND IMPROVEMENT PROPOSALS 43

BIOGRAPHIES 45

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LIST OF TABLES

SUMMARY REPORT Table A: Three key themes that emerged 6

MAIN REPORT Table 1: Three key themes that emerged 13 Table 2. Timeline of event 15 Table 3. Immediate cash shortfall estimation 18 Table 4. Terms of reference for LLP board 34 Table 5. Total costs of the UCP 37

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LIST OF ACRONYMS

C&P CCG: Cambridgeshire and Peterborough Clinical Commissioning Group CCG: Clinical Commissioning Group CCS: Cambridgeshire Community Services NHS Trust CHLE: Centre for Health Leadership and Enterprise, University of Cambridge Judge

Business School CJBS: University of Cambridge Judge Business School CPFT: Cambridgeshire and Peterborough NHS Foundation Trust CQC: Care Quality Commission CUH: Cambridge University Hospitals NHS Foundation Trust GP: General Practitioner ISFS: Invitation to Submit Final Solutions ISOS: Invitation to Submit Outline Solutions IT: Information Technology JET: Joint Emergency Teams LLP: Limited Liability Partnership MAR: Medication Administration Record OPACS: Older People’s and Adult Community Services PQQ: Pre-Qualification Questionnaire SPT: NHS Strategic Projects Team UCP: UnitingCare Partnership


SUMMARY REPORT

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SUMMARY REPORT

Commissioned by Cambridgeshire and Peterborough NHS Foundation Trust (CPFT), this report provides an account and analysis of the creation and collapse of the UnitingCare Partnership (UCP). The main purpose of this review is to provide independent insight into the events surrounding the UCP contract for the governors and board of CPFT. The report is based on:

• a detailed study of the documentation relating to the tender process, operation and closure of the UCP, including board reports, financial analyses, confidential material and minutes as well as material publicly available from the trusts’ and the Cambridgeshire and Peterborough Clinical Commissioning Group’s (C&P CCG) websites;;

• interviews with senior leaders and board members from across the system;; • a group meeting with the Council of Governors;; • expertise and knowledge from across the health economy (e.g. national policy guidance, reports produced by other bodies on the UCP and national examples of good practice in contracting, integrating services and reducing demand on acute hospitals);;

• expertise and knowledge from within University of Cambridge Judge Business School (CJBS).

Following guidance from CPFT, we investigated a series of questions that fell naturally into three main themes that emerged during the course of the study (see Table 1). Table A: Three key themes that emerged

(1) Competitive tendering and risk sharing

T1. Could the partners have done anything differently during contract negotiations to prevent its failure? T1(a) Should or could the trusts have put money into the UCP up front to enable its

survival? T1(b) Should parent boards have owned the UCP debt? T1(c) Why was a parent company guarantee for the limited liability partnership (LLP) not put

in place? T2. Did the commissioners raise specific concerns about how the negotiations and contract

process were carried out? T2(a) Were the overheads for the UCP higher than expected? T2(b) Was C&P CCG concerned about performance issues in relation to service delivery? T2(c) Was there a conflict of interest in the cross-membership of the trusts’ and the UCP’s

boards, and if so, were the arrangements for managing this conflict adequate? (2) Partnering and collaboration during contract execution

P1. What were the roles of CPFT and Cambridge University Hospitals NHS Foundation Trust (CUH)? Could the trusts have been more proactive in developing, implementing and supporting the contract, especially given that it was one of the NHS pioneers programmes?

P2. Once the funding gap had been identified, what more could have been done to ensure the continuation of the contract or was termination inevitable?

P3. Was there any guidance or commercial advice not identified by the UCP or its partners that could have enhanced the ability of the new organisation to deliver a complex health contract?

(3) Cost and salvaging created value

C1. Were the losses to the health economy greater than the cost of keeping the contract going? If so, why, and could the trusts have prevented this?

C2. What were the wasted costs for CPFT? C3. What could be done to build on the apparent initial successes of the UCP and keep the

integration benefits in terms of better care provision at a lower cost?

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It is limiting to study the creation and collapse of UCP without understanding the wider system and organisational context. Therefore, we extend the scope of the analysis when it is relevant to our brief and provide a whole system account of the UCP story. Within this context, we draw out what we consider to be the key learning points for the whole system and what might have been done differently in the context of the health economy in Cambridgeshire and Peterborough.

Competitive tendering and risk sharing

Even with the benefit of hindsight, it is difficult to identify anything substantial that could have been done differently once the tender process had begun. The tight and overly structured rules set out for competitive procurement and bidding against the private sector led CPFT and CUH to focus on the risks and benefits for their own organisations rather than to find common goals with C&P CCG and to share the system-wide risks and benefits. Given this context, as well as the tight financial positions of CPFT and CUH, it would be unrealistic to expect the trusts to invest substantial funds in the UCP up front to ensure its survival, to own the UCP debt or to engage a parent company guarantee for the LLP. Such commitments would have adversely affected core services and programmes provided by the trusts;; in CPFT’s case in particular, this could have negatively affected the development of mental health services and had a significant impact on users and carers. However, it is possible that a concerted push by the provider organisations prior to the competitive tendering decision being made might have persuaded C&P CCG to develop a more organic and developmental approach to Older People’s and Adult Community Services (OPACS). CPFT and CUH could have argued more strongly for a phased implementation of the changes as well as for the establishment of the necessary infrastructure up front;; the integration of complex services cannot be successful without the appropriate information- and data-sharing infrastructure to support collaboration and help clarify shared objectives and develop shared analyses and progress measures. The trusts could have insisted on more time being taken to build a workable information- and data-sharing platform as well as to establish conditions for successful integration before full service delivery commenced. Such an approach might have been particularly effective if combined with a pilot programme for a suitable sub-population in the initial phase. During contract negotiations, there was a sense of urgency to develop the new service and maintain impetus that outweighed the need for a comprehensive understanding of the operational and financial details of the service transformation and the relationships necessary for its successful delivery. The feeling was that taking time to understand the details was a distraction from the task in hand. The negotiations moved forward rapidly, often without the necessary degree of clarity – something that is not viable in competitive contracting and complex procurement. More time and effort should have been invested to obtain the relevant information and build clarity ahead of contracting. The scale of the savings that were realistically achievable with the OPACS programme and the costs of integrating and delivering the care model were highly uncertain at the time of negotiation. C&P CCG effectively insured itself against these risks by setting a tender price that incorporated savings targets from the start – without conducting a proper analysis of whether these targets were realistic – based on optimistic estimates of the transformation and delivery costs. Therefore, the providers and UCP were left with the considerable downside risks of below-target savings and higher-than-estimated costs. These risks were not balanced by any financial upsides beyond the contract value. From a risk-sharing perspective, this was a one-sided contract framework. Given that C&P CCG had insured

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itself against the risks, the parent companies of the UCP had no choice but to insure themselves likewise by creating an LLP. This returned the risk of contract failure largely to C&P CCG and, importantly, made contract failure more likely because the parties who could trigger it had already limited their losses. A procurement deal with an embedded degree of shared responsibility and risk from the outset could have provided the basis for a more sustainable contract and improvement programme – and the partners should have pushed harder for such an agreement. Given the uncertainties and lack of effective risk sharing that became apparent during contract negotiation, CPFT and CUH could have seriously considered withdrawing from the tender when it became clear that the timescale, detail and clarity of the contract process were problematic. While the partnership collapsed before there was any certainty about performance issues in service delivery, documentation and interviews reveal that there were concerns that the contract negotiations and subsequent mobilisation discussions were a source of conflict between the UCP and the commissioners and that there was a lack of trust between the contracting parties. For example, frustration was generated by a difference in views on the nature of the contract, specifically, to what extent further negotiation after the contract was let was normal and to be expected or went beyond what was reasonable. In addition, the UCP took on some of the system improvement and service monitoring and management work that was also the province of C&P CCG. This created a measure of doubling up – and hence a burden on the health system through duplicated costs – and led to the role ambiguity that was a further source of conflict between C&P CCG and the UCP. If trust cannot be built between the parties in complex procurement, an adversarial relationship is inevitable, and focussing on rapid, large-scale, ‘radical’ change is dangerous in contexts where trust and collaboration are underdeveloped. In this case, rather than chasing complex procurement and mobilisation, a smaller-scale pilot programme could have been set up to test the ideas and operational realities and, importantly, to enable the contracting parties to build a culture of partnership with well-defined roles and responsibilities. The UCP’s position as neither solely a commissioner nor a provider but a hybrid organisation focused on system improvement challenged the rigid purchaser–provider divide that is the dominant modus operandi in NHS commissioning. Wider and more sustained negotiation and consultation on the UCP’s hybrid role would have been necessary for a shared understanding to emerge. The UCP partners’ extensive expertise in service development and organisational change could have been used more forcibly during the start-up period to build a more grounded understanding with commissioners about the UCP’s role and what was realistically achievable in the early years of the contract. While it is not apparent that any conflicts of interest in terms of governance arose during the operation of the UCP, it is likely that such conflicts would have emerged in time, particularly as the UCP assumed greater responsibility for performance and service development and took up its role in the health economy more fully. Specifically, the UCP’s narrowly scoped board membership may have compromised the role of the UCP as an integrator. The UCP should have developed a wider consultation and engagement governance structure to allow it to draw on the expertise and opinions of a greater breadth of stakeholders in relation to OPACS, particularly in primary care and social services. Developing links at board level with the wider health economy and with citizens and patients would have strengthened the UCP’s governance and could potentially have broadened its capacity to develop strategies to address the problems it faced. In time, the relationship between the governance of the UCP and that of CPFT and CUH would have needed to be resolved more clearly.

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Partnering and collaboration during contract execution

The UCP – and its potential as an innovator – lacked powerful and truly committed advocates. When difficulties emerged with the contract and operational deficit, it was therefore easier to let the contract fold than to push ahead into year two and beyond. Transformation projects at the scale of the UCP target multiple objectives that are often conflicting. Resolving these tensions for the greater good requires a cadre of strong leaders across all parties to develop shared values, a clear vision, a sense of mission and long-term measurable goals that create a willingness to compromise when risks materialise. External support and constructive challenges further enhance the collaborative nature of such transformations. The local health economy as a whole should have invested more in developing both these leaders and a leadership system, creating a united, broadly based collective to champion the initiative and sustain improvements over time. At the time of contract closure, the partners had no alternative besides termination. The contract negotiations and pressure to deliver improvements in admission figures had taken the organisations involved as far as they could go. There was a strong sense that managers and leaders – commissioners and providers alike – had been fenced in by the negotiation process they had created themselves and that there were no options left to them other than closure. We believe that, started earlier, a more engaged and collaborative approach to service improvement and risk management could have provided a wider range of possible futures for the UCP. Evidence suggests that the contract was insufficiently funded and that the OPACS programme was loaded onto a local system facing serious financial pressure. This lack of funding made reactive risk management extremely difficult. It is also the case that groundbreaking programmes such as the UCP generally face a great number of systemic and cultural challenges and are more likely to uncover serious financial and cost issues. In the wider commercial environment, organisations often manage short interruptions to cash flow by drawing on emergency funds. A transformation with the scale and complexity of OPACS would have benefitted from access to specific transitional emergency funds set aside by NHS England, over and above the local dissemination of general transformation funds, which are often over-subscribed and subject to multiple demands. A well-governed national contingency fund could also have ensured greater engagement from NHS England and helped overcome the impediments and governance requirements that lone organisations naturally face. The key lesson that can be drawn from commercial enterprises and public and private experiences of integration nationally and internationally is that major projects should be viewed as long-term collaborative endeavours. Evidence suggests that the cultural changes, organisational development and personal relationships that underpin successful integration can take 10 years or more to develop before sustainable, high-quality outcomes are delivered. Building clear and effective partnerships takes time based on trust and robust understanding of each other’s positions. Competition, urgency and constrained resources tends to undermine these facilitative factors in the development of successful integration. In addition, without integrating information systems and developing accurate and focused data on integration – which are long-term and significant projects – it is impossible for organisations to identify the levers for delivering higher quality at lower cost and establish a culture of evidence-based interrogation, innovation and improvement. Major procurement and change programmes – such as the OPACS contract and UCP creation – create a momentum and internal logic of their own that often drives project planning and decision-making along linear pathways. Perhaps the greatest challenge for leaders and public representatives is to find opportunities and mechanisms to take a step back from the inexorable process of bidding, mobilisation, implementation and contract

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monitoring and ask the big questions about whether the programme is working and whether there is a better way of delivering improvement. This becomes harder as the scale of the transformation project increases. An alternative is a less ‘radical’ and more incremental, organic approach to service transformation that enables learning and adaptation, with scale being achieved over time.

Cost and salvaging created value

The total cost of the UCP – as calculated by CPFT and CUH – was an estimated £18.6 million. This includes £12.4 million in costs for CPFT and CUH, split evenly between the two partners;; the lion’s share of this – £7 million – was in inherited payments to contractors and providers above the contract price for OPACS and was used to support existing OPACS services. The cost of the UCP to the local health system, over and above what would have been spent in the normal provision of services had the tender exercise not been undertaken, was estimated at £10.3 million. It is impossible to assess the opportunity costs with any degree of accuracy. However, given the considerable problems facing the local health economy, it is reasonable to assume that substantial positive outcomes could have been achieved for the health economy had the considerable talents and efforts of the NHS staff and trusts been focused in different ways. The positive legacy of the UCP for the health system is that there is now a genuine movement towards integration, a clearer understanding of how payments and rewards can be brought together through improved patient pathways and a better infrastructure for older people's and adult services that is already being built upon. The contracting process has also brought into sharper focus the details of the complex services that provide community care and support. We have also observed a fresh desire to drive integration and service improvement in OPACS as well as greater commitment to collaboration and shared working in the interest of the system as a whole. To maintain this momentum, local health economy leaders must take care not to fall back into their secure positions within individual organisations but to see the UCP experience as an opportunity to learn and develop more robust models, a greater degree of mutual understanding and solid shared objectives for the delivery of integrated care in the future. Furthermore, as a result of the OPACS tender, CPFT's service and cost base has expanded, and the trust has been able to introduce a degree of integration for mental health and adult services, resulting in greater efficiencies in its management and operational overheads. Consequently, CPFT has been able to manage its cost savings targets more easily;; it has become a more sustainable organisation overall, and its impact within the region has become more significant. The UCP marked the starting point for the development of integrated information infrastructure, which has now been put on hold. This is perhaps the greatest foregone salvage opportunity. International experience has shown that sustainably successful integration is impossible without reliable integrated information systems that can identify and prioritise change opportunities and, importantly, evaluate service changes at both the level of patient journeys through all of the service touchpoints in a local health and social care system and the level of a population’s long-term health and service costs. Successful examples are emerging from elsewhere in the world, and the Cambridgeshire and Peterborough local health economy should learn from these as it continues to develop its integrated care services.


MAIN REPORT

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MAIN REPORT

1. INTRODUCTION

The Centre for Health Leadership and Enterprise (CHLE) at the University of Cambridge Judge Business School (CJBS) was commissioned by the Cambridgeshire and Peterborough NHS Foundation Trust (CPFT) to undertake a review of the tendering, procurement and eventual collapse of the Older People’s and Adult Community Services (OPACS) contract between the Cambridgeshire and Peterborough Clinical Commissioning Group (C&P CCG) and the UnitingCare Partnership (UCP), a limited liability partnership (LLP) between CPFT and Cambridge University Hospitals NHS Foundation Trust (CUH). The main purpose of this review is to provide independent insight into the events surrounding the UCP contract for the benefit of CPFT’s governors and board members. The goal is not to identify individual or organisational failures but to draw out the lessons that can be learnt for the benefit of the local and national health economy. As part of this review we examined: 1. the tendering process, its operationalisation through a competitive tender and how

operational and financial risks were handled throughout;; 2. the effectiveness of partnerships and collaboration during contract execution;; 3. the costs of the failed partnership for CPFT and the local health economy as well as

effective salvaging of the value created by the partnership.

We investigated a series of questions within these three main themes (Table 1). This report has been published in the context of a number of other enquires and investigations commissioned by the NHS and other national bodies, including enquires by internal audit for C&P CCG and Monitor, NHS England and the National Audit Office.1 While these reports help improve public understanding of the UCP case, none looks across the system at the lessons that can be learnt;; instead, they focus on the particular concerns of their commissioning agency. Indeed, the system today is characterised by the lack of a general regulatory or development body with a remit to examine the healthcare system as a whole or how integrated services could be developed and operated across organisations or localities. This fragmented structure was quick to emerge in our study as an important factor in the UCP story. In answering the questions in Table 1, we looked particularly at the processes and decisions surrounding the creation and operation of the UCP and the relationships between the people, organisations and systems involved;; we examined how the UCP story developed and what could have been done differently in the context of the health economy in Cambridgeshire and Peterborough. Overall, this report seeks to provide a whole-system account of the UCP for the benefit of the local and national health economies.

1 Review of Procurement, Operation and Termination of the Older People’s and Adult Community Services (OPACS) Contract;; Internal Audit Final Report: CPCCG15/23, March 2016;; NHS England Review of UnitingCare Contract: The Key Facts and Root Causes Behind the Termination of the UnitingCare Partnership Contract;; NHS England Publications Gateway Ref 05072, April 2016;; The Collapse of the UnitingCare Partnership Contract to Provide Older People’s and Adult Community Services in Cambridgeshire and Peterborough;; National Audit Office Report, Work in Progress, Summer 2016.

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Table 1: Three key themes that emerged


T1. Could the partners have done anything differently during contract negotiations to prevent its failure? T1(d) Should or could the trusts have put money into the UCP up front to enable its survival? T1(e) Should parent boards have owned the UCP debt? T1(f) Why was a parent company guarantee for the limited liability partnership (LLP) not put in

place? T2. Did the commissioners raise specific concerns about how the negotiations and contract process

were carried out? T2(d) Were the overheads for the UCP higher than expected? T2(e) Was C&P CCG concerned about performance issues in relation to service delivery? T2(f) Was there a conflict of interest in the cross-membership of the trusts’ and the UCP’s







C2. What were the wasted costs for CPFT? C3. What could be done to build on the apparent initial successes of the UCP and keep the integration

benefits in terms of better care provision at a lower cost?

2. METHODOLOGY AND DATA SOURCES

This analysis was produced from an in-depth study of the documentation relating to the tender process and the operation and closure of the UCP. We were afforded unique access to the rich documentation generated by the process, including board reports, financial analyses, confidential material and minutes. We also made use of material that is publicly available from the trusts’ and C&P CCG’s websites. We interviewed 20 senior leaders and board members from across the system and attended a CPFT Council of Governors meeting. We also examined national policy guidance, the reports produced by other bodies on the UCP and national and international examples of good practice in contracting, integrating services and reducing demand on acute hospitals. Finally, in producing this report we made use of the expertise and knowledge within CJBS, drawing in particular on evidence from sectors and economies beyond healthcare. We are acutely aware that when reviewing processes and decisions with the benefit of hindsight, reviewers can be guilty of applying judgements and evidence that fit the timeline of events but convey a predictable sequence of decision-making by key people. The complexity and nuances faced by decision-makers can easily be lost or given insufficient weight in retrospective studies. In reality, and particularly in the often-confusing and urgent context of major change, decisions are seldom straightforward or linear;; participants in the drama lack perfect knowledge and make the best judgements they can given the situation they are in and the incomplete and often conflicting information that they must draw upon. We recognise that leadership and decision-making are often gritty, messy and taxing tasks and have made strenuous efforts to understand the context, possibilities and systemic influences that shaped the UCP case.

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We have attempted to account for the realities of decision-making by conducting interviews with key participants in which we encouraged them to think back to the decision-making context and recall their experiences and motivations in that moment (see Appendix A for interview questions). We have also taken into account the national policy context and directives operating within the NHS at the time. Our interviews were structured to interpret the decisions made before, during and after tendering in order to address themes (1) and (2) in Table 1. To respond to the third theme, we relied on financial analyses.

3. BACKGROUND AND CHRONOLOGY

We begin by providing a timeline of the events leading to the collapse of the UCP, starting from the pre-tender stage (Table 2). Following the Health and Social Care Act of 2012, clinical commissioning groups (CCGs) were established to provide clinical leadership of the planning, procurement and monitoring of local NHS services. CCGs replaced the broader commissioning and locality focus of primary care trusts. Their mandate was to address the rising cost of and demand for healthcare, the increasing number of older people with chronic and multiple conditions and the need for improved quality and response speed and greater accountability of general practice. CCGs were established in the context of a nationally protected NHS budget that was, given continuing demand growth, among the tightest funding settlements that the NHS had ever faced. Government policy statements at the time made it clear that CCGs could not simply continue in the same vein as previous commissioning organisations: radical change was encouraged to meet the challenges faced. The legislation stated that competition and integration should be central to this change:

‘In acting with a view to improving quality and efficiency in the provision of the services the relevant body must consider appropriate means of making such improvements, including through— (a) the services being provided in a more integrated way (including with other health care services, health-related services, or social care services), (b) enabling providers to compete to provide the services, and (c) allowing patients a choice of provider of the service.’ The National Health Service (Procurement, Patient Choice and Competition) (No. 2) Regulations 2013, p 2

C&P CCG was formed within this policy context in April 2013. The largest CCG in England, it serves a registered population of over 900,000, with over 100 primary care practices. Following consultation with member general practitioners (GPs) and the general public, C&P CCG determined three key priorities: reducing inequalities in coronary heart disease, end of life care and services for older people. Given these priorities and in the face of growing demand and costs for older people’s services, C&P CCG commenced the procurement of OPACS for the area.

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Table 2. Timeline of event

Date Event

April 2013 C&P CCG formed. Three key priorities determined: inequalities in coronary heart disease, end of life care and services for older people.

3 July 2013 C&P CCG begins competitive procurement process for OPACS. • 12 completed pre-qualification questionnaires (PQQ) received and

evaluated

9 September 2013

Invitation to submit outline solutions (ISOS stage). • 10 bidders invited to submit outline solutions

8 October 2013 ISOS documentation due. • original due date 26 August 2013 • further delay occurs (until 9 November 2013) in bidders receiving more detailed

information Invitation to submit final solutions (ISFS stage).

• four suppliers asked to prepare and submit final bids

28 July 2014 Closing date for competitive procurement process. • three final bids submitted

July–November Government holds Gateway review on safety, robustness and legal and policy compliance of contract and submitted bids.

11 November 2014

Contract signed between C&P CCG and UCP with a start date of 1 April 2015. Contract value £725.5 million plus £10 million in non-recurrent government transformation funds.

November 2014–April 2015

Intensive contract amendments and negotiations up until start date. • joint discussions in January 2015 based on estimated outturn for 2014/2015

lead to increase in total contract value from £735.5 million to £784 million • contract commences April 2015, at which time more than 30 significant issues

are still open

21 May 2015 UCP and C&P CCG exchange respective assessments of financial implications. • UCP identifies £34.3 million gap in budget (of which £23.2 million is recurring

expenditure) • funding gap disputed by C&P CCG

5 August 2015 Negotiations on £34.3 million gap continue over summer and culminate in C&P CCG offering UCP £782.5 million plus £11.2 million in non-recurrent transformation funding for 2015/16, bringing total contract value over £793.7 million.

21 August 2015 UCP rejects offer on basis that it is insufficient to meet revenue gap.

Late summer Care Quality Commission (CQC) inspection of CUH leads to change of chief executive in Autumn 2015 and creates instability and change in CUH priorities (see Sections 4.3- 4.4).

September 2015 Actual cost of transferring staff and services from Cambridgeshire Community Services NHS Trust (CCS) calculated by UCP. Negotiations continue throughout September without resolution. C&P CCG informs NHS England of UCP’s request for additional funding of £23.4 million for 2015/2016 and £15 million for 2016/2017.

23 November 2015

Meeting held with NHS England and Monitor.

27 November 2015

C&P CCG asks trusts to provide financial support for remainder of 2015/2016. Trusts reject request on grounds of financial position and legal basis of LLP.

1–2 December 2015

Conference calls between UCP, CPFT, CUH, C&P CCG, NHS England and Monitor fail to resolve funding issues or identify any other source of financial support. Termination letter sent from UCP to C&P CCG on grounds of risk of insolvency.

Tender events

Pre-tender events

Events leading to collapse of UCP

Collapse of UCP

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C&P CCG summarised its intentions for the tendering process thus:

‘The CCG has identified that the current model of commissioning services for older people has serious shortcomings including: fragmentation;; non-aligned incentives;; is a reactive illness service;; focusing on the measurement of specific processes rather than outcomes;; and, is subject to local issues such as delayed transfers of care, high hospital occupancy and challenges around sharing information.

Accordingly the commissioning of older people’s services through integrated service transformation is an opportunity to make significant improvements and to introduce innovative solutions.’ C&P CCG PQQ, July 2013

Following extensive consultation with the public and key stakeholders, C&P CCG resolved that a competitive tendering process for OPACS was appropriate. This was partly because it envisaged that engaging a range of providers, including the private sector, could introduce fresh thinking and challenges as well as new expertise and capabilities. Following legal advice, C&P CCG submitted its proposed procurement for approval through the Department of Health’s Gateway process. It was assisted by NHS England’s Strategic Projects Team (SPT) and legal advisors. C&P CCG set the contract period as a minimum of five years with the option to extend for a further two. The services covered included all community care for people over the age of 18, acute emergency care for people over the age of 65 and older people’s mental health services in the Cambridgeshire and Peterborough area. The costs for these services and the savings potentials were highly uncertain, with some estimates suggesting costs of up to £800 million over five years. C&P CCG set a maximum contract value of £752 million. It is clear that C&P CCG recognised that the improvements and integration needed for these services were complex and would require an extended period to implement. The longer contract period also allowed for the planned costs savings – linked to better aligned incentives around prevention and community support for older people – to be realised in time. It was the efficiency gain through prevention and community intervention that C&P CCG felt would be attractive for potential bidders. The competitive procurement process commenced on 3 July 2013 with the publication of a contract notice in the Official Journal of the European Union and Supply2Health. The notice invited expressions of interest from parties wishing to submit a PQQ to deliver integrated care pathways for older people and a range of community services for adults. The targets were parties with an interest in testing their capacities, capabilities, financial standing and eligibility to take part in the procurement process. C&P CCG received and evaluated 12 completed PQQs. On 9 September 2013, C&P CCG issued a press release announcing that 10 bidders had progressed to the ISOS stage: (1) Albion Care Alliance Community Interest Company, (2) Capita with CCS, Circle and Oxford Health NHS Foundation Trust, (3) Care UK with Lincolnshire Community Health Services NHS Trusts and Norfolk Community Health and Care NHS Trust, (4) CUH and CPFT, (5) Interserve with Central Essex Community Services, (6) North Essex Partnership University NHS Foundation Trust, (7) Northamptonshire Healthcare NHS Foundation Trust, (8) Serco, (9) United Health UK and (10) Virgin Care. The ISOS documentation was due to be issued to bidders on 26 August 2013 but was delayed until 8 October 2013. There was a further delay in bidders receiving more detailed information as the SPT did not make the ‘data room’ available to bidders until 9 November 2013. The documentation made it clear that:

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‘There should be a clear Lead Provider(s) which is accountable for delivery of the defined service scope for older people and adult community services. The Lead Provider(s) may comprise a consortium or other collective arrangement. The Lead Provider(s) must directly provide services for older people and adults requiring community services and they must be capable of coordinating care both at individual patient level and through contracts with provider organisations.’

After evaluating the ISOS submissions, C&P CCG asked four suppliers to prepare and submit final solutions (ISFS stage), with a closing date of 28 July 2014. After one bidder withdrew, the three submitted bids (Care UK with Lincolnshire Community Health Services NHS Trusts and Norfolk Community Health and Care NHS Trust, CPFT and CUH, and Virgin Care) were subjected to evaluation. This evaluation was thorough and included extensive GP engagement in evaluating the proposed service models, clinical quality and care outcomes. The Government held a Gateway review of whether the contract was safe to proceed and ruled that the procurement was robust and complied with legal and policy requirements. The contract was signed with the winning bidder – CUH and CPFT – on 11 November 2014. The business case was reviewed by Monitor before approval was given to CPFT to proceed with the contract. The value of the contract was £725.5 million plus £10 million in non-recurrent government transformation funding over five years, with a value in Year 1 of £152.3 million (2015/2016). This value was significantly below C&P CCG’s maximum value of £752 million. The contract was heavily caveated with provisions for further adjustment due to information shortfalls, contract values and payments from national tariffs. At this time, there was considerable ongoing negotiation and intense pressure to meet the April 2015 start date. This was driven in large part by the need to give assurance to staff transferring to the new service from CCS and ensure that the anticipated savings could begin to be made. In particular, there was recognition on both sides that the contract value would need to be amended to take into account the activity outturn for 2014/2015 once the value of this rebasing had been quantified. In January 2015, C&P CCG rebased the UCP’s 2015/2016 maximum contract value in light of the estimated outturn for 2014/2015. This led the total contract value to increase from £735.5 million to £784 million, including an increase from £152.3 million to £161 million for 2015/2016. Many issues were unresolved at the time of contract signing;; resolution of these issues was earmarked for the subsequent Mobilisation and Transition Planning arrangements between C&P CCG and the UCP. By April 2015, there were over 30 outstanding items for agreement and clarification, some of which had considerable cost implications – not least the actual cost of transferring staff and services to CPFT from CCS. There was still uncertainty at this time about the exact specification of services to be included in the contract. On 21 May 2015, the UCP and C&P CCG exchanged assessments of the financial implications of the data received by C&P CCG up to that point. The UCP had uncovered higher costs of the services it was inheriting from CCS as well as costs resulting from the delayed start of the programme. These costs were in excess of the price quoted in the tender. The UCP estimated that for 2015/2016, these costs would be £34.3 million higher than the amount offered by C&P CCG in January 2015 (£161 million). This comprised an additional £23.2 million in recurring expenditure and from non-recoverable VAT as well as costs resulting from higher-than-predicted rates of frailty and illness (acuity), delays in commencing the improvement programme and the final outturn figures for OPACS for 2014/2015. The claim by UCP was based on the calculations displayed in Table 3.

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Table 3. Immediate cash shortfall estimation

£M (nominal) 2015/2016 Comment

Acuity 6.0 5.2% pa (previously 1.5% pa)

VAT 4.9 Irrecoverable VAT

Delays 9.4 Lost savings (£8.4M), mobilisation costs (£1M)

Technical Adjustments 2.1 National Tariff changes etc.

Outturn Spend in 2014/2015 11.9 Based on information available

34.3

Recurring 23.2

Nonrecurring 11.1

Negotiations on this funding gap continued over the summer and culminated in an offer from C&P CCG on 5 August 2015 of £793.7 million, including £782.5 million in recurrent funding and £11.2 million in non-recurrent transformation funding. This equated to an additional £9.2 million in funding for 2015/2016. The UCP rejected this offer on 21 August 2015 on the basis that it was insufficient to meet the £34.3 million funding gap it had identified. It was acknowledged that £10.9 million of this amount might not in fact arise, leaving a confirmed gap of £23.4 million for 2015/2016 – £8.4 million related to savings delays and £15.2 million in recurrent funding. In September, the UCP calculated that the actual cost of transferring staff and services including subcontracts with other providers from CCS was £8.2 million higher than C&P CCG’s estimate of £61.6 million. Negotiations continued through September without resolution although some issues were clarified including the actual VAT costs following negotiations with HMRC. In an escalation meeting, the chief executives finally agreed that as the financial gap could not be closed, C&P CCG would inform NHS England that the UCP had requested additional funding of £23.4 million for 2015/2016 and £15 million recurrent annually from 2016/2017. A meeting was held between the UCP, C&P CCG, NHS England and Monitor on 23 November 2015. On 27 November 2015, C&P CCG wrote to the UCP partners requiring them to provide working capital facilities to support the UCP’s revenue position and cash flow requirements for the rest of 2015/2016. The trusts rejected this on the grounds that their financial position could not support a transfer of funds and that this was outside the legal basis of the LLP. Conference calls between the UCP, CPFT, CUH, C&P CCG, NHS England and Monitor on 1 and 2 December failed to resolve the funding issue or identify other sources of financial support. Following an emergency LLP board meeting, the UCP sent C&P CCG a termination letter on the grounds of risk of insolvency.

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4. NARRATIVE

4.1 RATIONALE FOR OPACS

At the time in question, the entire health and care system was facing increased and higher-intensity demand that was not expected to subside and was extremely constrained in terms of resources. For C&P CCG, the issue of increased demand, rapid population growth and resource scarcity was – and still is – particularly acute. C&P CCG predicted that if it did not make changes, it would face a £250 million deficit by 2018/2019. Previous initiatives to improve quality and reduce costs had been inadequate for the scale of the problem, driving the view that dramatic change was needed. As such, C&P CCG embarked on a tendering process for OPACS as a way of significantly altering how innovation, demand and resources were reconciled. This change would involve recasting service structures and relationships entirely. At its heart was the need to divert care, and particularly care for the elderly, away from expensive hospital treatments towards lower-cost and more integrated care in the community. C&P CCG identified that it could alleviate some of the problems facing the health economy by identifying patients in the community, and particularly those at high risk of hospitalisation, and bringing services closer to them, thus avoiding the need for escalation and crisis response. Integral to this was the belief that quality and patient experience would naturally improve as people were being treated in their community or family setting, maintaining social structures and delivering less disruptive and more integrated care around the person. The view that greater integration could be achieved and more people diverted from acute care by aligning the rewards and costs of services for older people was backed up by evidence from the field and shared by other parties to the tender, including CPFT and CUH. The tendering process for OPACS was therefore designed with the view of creating one overarching agency that would be able to balance costs in one part of the system with the potential savings of better treatment in another: having one agency to both support older people in the community and bear the cost of their in-hospital care would better align incentives to prevent hospital admissions and avoid lengthy hospital stays. The agency providing this integrated care model would be required to operate within the C&P CCG budget for these services, including assumptions about future cost improvements. There was, however, considerable uncertainty about the actual operational costs of these services as well as a lack of detailed knowledge about some of the community services involved, which were being packaged together for the first time. In response to this challenge and to support the commissioning process, C&P CCG compiled evidence on what appeared to be working in other health systems.2 In particular, C&P CCG set out to develop a detailed outcomes framework with 33 domains and over 100 outcome measures to measure and shape the new service interventions. It was recognised that this focus on outcomes and the shift in payment systems would deliver more than just ‘tweaking and tinkering at the edges’, as one respondent described it, and would align long-term goals with shorter-term tariffs and payments. It was suggested to us that C&P CCG’s approach reflected the expertise and focus of GP-led commissioning at the time.

2 NHS C&P CCG website. Older People’s Programme. http://www.cambridgeshireandpeterboroughccg.nhs.uk/older-peoples-programme.htm

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4.2 THE TENDER DECISION

Our interviews suggest that prior to the tender decision, local providers, including CPFT and CUH, had discussions with C&P CCG leaders about achieving the desired service integration without the need for competitive tendering. However, C&P CCG rejected such an organic transformation option in favour of a competitive tender, with the inclusion of private sector bidders. This decision had a profound effect on the bid made by CPFT and CUH. The trusts felt that their need to win was greater as they knew that their operational and financial models would be substantially affected and potentially put at risk, if an external party were to win the OPACS contract. For CPFT, losing the contract would result in it losing the provision of older people’s mental health services – a substantial source of activity and income – and would threaten the trust’s viability in the medium term. CPFT estimated at the time that the reduced cost base would require an extra £6 million in savings. By contrast, winning the bid would expand the trust’s budget and cost base – relieving pressure on costs and overheads – and achieve the much-desired expanded community service model. Faced with the possibility of outsourcing to a new provider, CPFT staff and unions were also strongly in favour of a CPFT bid. Given that many hundreds of staff would be directly affected under this possibility, CPFT felt an additional compulsion to bring forward a bid. From CUH’s perspective, there was recognition that highly fragmented community services were leading to high admission rates for older people as well as a high level of delayed discharges;; transfer delays and patient referrals, which were outside CUH’s control, were placing particularly severe pressure on beds. As such, CUH was anxious to be involved in shaping community provision such that patients could be cared for in the most appropriate setting, releasing capacity for its elective patients. As such, there is clear evidence that the competitive tendering process forced the local NHS organisations to consider their own survival first and foremost;; winning became an imperative when the alternative would be a weaker organisational position and a narrower service base. In this way, the competitive tender introduced a measure of gaming that was unhelpful in terms of achieving the ultimate objective of better care at a lower cost. In addition, CPFT and CUH’s view was that the local experience of private sector provision had been one of failure, with the NHS being ‘left to pick up the pieces’. Being part of the change was therefore seen as the only way of keeping the health economy viable and retaining control over what was evidently seen as the trusts’ service space – ‘it was our business’, as one respondent described it. There was also a sense from some of the people we spoke to that NHS leaders, who had long careers in the service, were acting on their professional and ethical duty by leading bids on behalf of NHS organisations. These leaders broadly shared the view held by NHS England and C&P CCG that radical change was necessary and saw it as their responsibility to be part of the change process in order to safeguard the local NHS system. Taken together, these factors led CPFT and CUH not only to feel unable to seriously consider withdrawing from the bidding process but also to offer a price (£726 million) that was significantly below the CCG’s maximum – and the amount bid by competing bidders – of £752 million. This low bid value, combined with the significant risk inherent in any major contract to provide a radical, new solution, led CPFT and CUH to emulate private providers in protecting their interests and to enter an LLP arrangement. While this arrangement protected the providers’ financial risk – something the providers were legally obliged to do – it left a substantial part of the default risk with C&P CCG, as any contract with a private provider would likely have done.

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4.3 URGENCY

A distinctive feature of the UCP contract is the speed at which it was developed and implemented as well as at which the UCP was required to achieve service improvements and cost savings. C&P CCG clearly initiated the contract and its implementation rapidly to reflect the urgency of the financial situation and pressing need to shift demand away from acute hospitals. There may well have been the view that speed would generate the momentum for change that the system required – that a sense of urgency would be productive. This attitude was encouraged by a broader national emphasis on rapid change and had a number of key consequences. Firstly, it made Year 1 very challenging for the UCP, requiring complex organisational and operational changes within a short time frame: the UCP had to develop its role and authority within the system and develop an understanding of the services it had inherited, staff transfers to the new service had to be completed and services within the scope of the tender, including back office functions such as information technology (IT) and personnel, had to be developed. Delays were inevitable as subcontractors had to be sourced and contracted, operational procedures agreed upon and partnership work developed. As such, the essential complexities of setting up a new organisation significantly affected the UCP’s ability to focus on its contractual goal – to make rapid savings through diverting patients to community services. Secondly, new ways of commissioning and managing services demand a new culture and understanding of new conditions as well as capacity and capability changes, which take time to develop. There is evidence that the culture within the local health economy has shifted since the procurement of OPACS, possibly as a result of the broad involvement and consultation exercises undertaken by C&P CCG and the UCP. For instance, we found widespread understanding of the objectives of the OPACS tender and UCP model as well as recognition that this kind of integration was desirable. Similarly, some of the roles and relationships created by the new care model appear to have begun to work well, despite there being no clear productivity improvements so far. Nonetheless, during its short period of operation, the UCP experienced a great deal of turbulence in the local system that might have been mitigated by having a longer development period. Thirdly, a number of new services and configurations had to be developed and implemented including joint emergency teams (JETs) and locality teams. The training, operational and inter-agency aspects of these developments were complex and new for the area. Protocols, procedures and resources had to be aligned to make these services effective. While the plan was that staff would be co-located within 18 months, this has still not been achieved. Similarly, agile IT is still being implemented, and configuration, training and care management were still in a state of development 14 months after the UCP contract commenced. Finally, the UCP was required to begin the process of establishing how it would work with its partner trusts, its stakeholders and C&P CCG in a system that had not experienced anything remotely similar before. This task seems huge given the state of the health economy and broader national context, where so much was in flux and the risks of instability were great. For example, a CQC inspection of CUH in late summer 2015 created huge instability and a change in priorities for one of the UCP partners. Similarly, at the time of moving together with the UCP, CCS was already in partnership with other organisations and putting together its own bid for the OPACS tender. This competitive situation precluded the possibility of a partnership across existing providers and made it more difficult to assess the costs of integration. External stakeholders found the timescales equally challenging as they were facing challenges of their own. For instance, social care had declined to join the partnership partly because of past experiences with pooled budget arrangements that began in 2004 but

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collapsed in 2012/2013;; this made elected members cautious about entering into new agreements, particularly given the service cuts they were already having to make. The negative effects of the perceived urgency of the contract negotiations were further amplified by delays in decision-making. It was suggested to us that C&P CCG found it difficult to commit to activity and decision-making at the pace required by the UCP: being accountable to its members (GPs), C&P CCG often needed the endorsement of its membership before confirming key decisions and actions. Consideration could have been given to a slower timetable and softer launch of the contract, allowing the UCP to deal more effectively with individual elements of its start-up and giving CPFT and CUH more time to deal with pressing operational and financial difficulties. Alternatively – or perhaps simultaneously – a gentler introduction of the UCP’s performance and savings targets could have been considered, with results being back-loaded more towards the end of the five-year contract.

4.4 REALISTIC OBJECTIVES AND EXPECTATIONS

The details of the UCP’s proposal are included in Appendix B, but the key objectives were thus:

• to deliver a savings programme of £178 million over the life of the contract;; • to reduce spending on acute hospital care by £116 million over the life of the

contract;; • to use IT to link hospitals and the community, making care plans and key clinical data

available to clinicians to support clinical decision-making;; • to reduce prescribing costs;; • to reduce outpatient attendances in the acute setting;; • to reduce demand for residential and long-term care.

These projections and targets were drawn from the examination of case studies from across the UK, including models from Kingston, North West London, East London and the City and Torbay. Many of these saving objectives appear extremely difficult to achieve;; some were unlikely to have resulted in savings, while others were likely to have involved higher costs as the scale and intensity of specialised community services increased. For example, the bid proposed increasing contact with vulnerable older people from 1,200 to 2,400 individuals, effectively doubling the number of people under care management. This move aimed to identify older people whose risk of requiring more intensive services could be reduced through earlier intervention and prevention measures at home. In terms of quality and good practice, this was a sensible and enlightened proposal that would lead to better quality care for the elderly. However, earlier contact with more coordinated services could also result in the discovery of hitherto unmet need or alert patients to new, additional services, resulting in additional demand and higher costs. The improvements that were envisaged in the flow and allocation of resources to patient care were too focused on NHS interventions. Although the model developed by UCP included non-NHS interventions such as the social care element in the JET staffing and about £1 million to be spent for voluntary sector support in neighbourhoods, overall the commission from C&P CCG and the UCP model was predicated on the assumption that costly hospitalisation can be reduced by strengthening community-based health services to provide better rehabilitation after hospitalisation and early intervention at home. This is a good ambition and one that is in line with the choices that older people themselves make about their care. However, while adjusting the NHS treatment pathway may have some

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impact on the need for hospitalisation, this effect may be marginal compared to the much greater forces that are creating the demand for care in the first place. There is evidence to suggest that wider community support beyond NHS services – developing stronger societal bonds, greater levels of voluntary and self-help activity and the provision of quality material assets such as good housing, transport and leisure activities – has a long-term impact on health and well-being. While these are long-term policy issues that require the engagement of partners beyond the NHS, none of these levers for cost savings were included in or facilitated by the OPACS procurement. Importantly, the expertise and integration potential of social care services – which have a major impact on healthcare for the elderly – were outside the remit of this contract. There were also severe financial constraints on the health economy in Cambridgeshire and Peterborough at the time, as evidenced by underfunding compared to acuity and population growth, a financial crisis in acute services and growing deficits across the local health economy. These conditions became worse over the period of the UCP tender. The scale of the financial challenges was something that all respondents commented upon during our review. For CUH, the financial pressures were huge: the winter of 2014/2015 was particularly critical, with demands for elderly care creating contingency beds and delayed discharges. The trust was declared in financial distress and lost its chief executive in autumn 2015 following a CQC inspection. In addition to reducing its deficit, C&P CCG was required by national legislation to generate 1% savings and was facing a £250-million funding gap for the coming five years. This crippling financial pressure heavily influenced the thinking of key leaders and managers, firstly by encouraging them to drive the contract forward with almost no regard for the financial risks involved in the hope that drastic improvements could be made and secondly by driving them to terminate the programme so rapidly as there was no financial buffer for funding gaps. Overall, the cost and service improvements put forward by the UCP were highly ambitious and, given that this was a new service, necessarily speculative. However, as early as January 2014, CUH and CPFT had produced a clear and, as it transpires, highly accurate summary of the risks involved. These included risks associated with insufficient cash flow, the transfer of staff, the inadequate budget for inherited liabilities, the lack of agreement with C&P CCG on financial assumptions, delays in achieving cost savings and the capital costs of the IT system. In terms of financial risk, the tender documentation and evaluation made it clear that the provider ‘should not assume any additional funding from the CCG over and above the budget’ and C&P CCG appeared to expect the UCP to manage the costs and transfers of services in line with its role as a prime contractor. In light of this, it is unsurprising that the UCP was established as an LLP, insuring the trusts against a highly likely downside.

4.5 UNCERTAINTIES AND RENEGOTIATION

When the contract was signed, it was heavily caveated with complex and unresolved financial conditions. In this case, there was an expectation that the full costs and execution of these services would be derived over time. This may be explained in part by the shift in contracting and commissioning processes when the CCGs were created. Prior to this, NHS contracts had been based largely on historical calculations of costs for entire services, with payments made to providers for large blocks of care. Under the CCG regime, the new procurement process for OPACS, which was based on outcomes and payments for performance, required an entirely different level of specificity and detail that had not been experienced before.

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After the contract was signed, a number of changes were made to the scope of the services included in the package and further details of existing services emerged that required new subcontracts. For instance, changes made after the fact made the UCP responsible for a contract with Cambridge Nursing Centre amounting to £1.1 million a year as well as for £330,000 in annual payments to GP practices to support community care. These changes make it apparent that the contract specification was incomplete at the time of signing. Moreover, given the complexity of community services, and particularly the details of subcontracts with the third sector and specialist providers, it is questionable whether a reasonably complete specification could have been achieved at that time. A number of risks are inherent in such uncertainty, and a fundamental problem in this case was that the parties did not know enough at the contract stage to specify the costs of providing the services. Nonetheless, there was a general expectation that the full costs and execution of these services would be derived over time. Having accepted the tender on the basis of the caveats, it is unsurprising that the UCP expected to negotiate with C&P CCG further about the contract content and price;; it appeared that the UCP wanted to achieve a fully accurate costing in Year 1 and expected to engage in continued negotiations on these issues. On the other hand, while C&P CCG recognised the contract uncertainty, it failed to cost in any headroom for these factors. When contracts are incomplete, renegotiation is inevitable and such renegotiation tends to hold up speedy execution;; the contract then falls behind schedule and a vicious cycle ensues. In this case, there is little evidence to suggest that the renegotiations that took place during 2015 were close to resolving the underlying financial risks in the contract: the prevalent approach focused on short-term mitigation rather than a fundamental resolution of the problems. For instance, the £34.3 million funding gap for 2015/2016 identified by the UCP on 21 May had been reduced to £23.4 million;; however, it remained the case that even if the UCP had been supported through its cash flow crisis over October–December 2015, it is clear that this would have had no effect on the financial gaps that would likely have emerged in 2016/2017 and beyond. There are examples of successful partnering in the context of incomplete contracts in other industries from which the NHS could and should learn. One notable example is the £4.3 billion construction of Heathrow’s Terminal 5.3 The fundamental factor that drives the successful execution of incomplete contracts is a culture of trust that allows difficulties to be resolved collaboratively and fairly if and when they arise. The development of a genuine, trust-based working relationship between C&P CCG and the UCP partners could have fundamentally altered the contract’s chances of success. Without it, the uncertainty around the contract made it impossible to succeed.

4.6 THE ROLE OF THE UCP

At the national level, there are examples of one organisation taking on an overarching role in arranging and planning services, and a range of different models for this have emerged, including prime contractor arrangements, lead providers and accountable provider roles as well as commissioning and arranging through prime integrator models. The creation of the UCP resulted in one organisation charged with overseeing and delivering integrated services for adults and older people. However, it was not clear what the exact purpose of the UCP was, and there is evidence that different partners saw its role differently. Our interviews with key leaders and a review of the documentation show there was an

3 Procurement of Heathrow T5. http://www.designingbuildings.co.uk/wiki/Procurement_of_Heathrow_T5

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apparent lack of clarity about the place of the UCP in the local system. For some, and particularly for the staff employed directly within the UCP, there was the view that the UCP should have played a lead role in service integration and system reconfiguration, driving other organisations and services into alignment and leading and challenging reform. At the same time, C&P CCG, CPFT and CUH appear to have had different and more limited expectations. For C&P CCG, there was the apparent expectation that the UCP would primarily be a lead provider, responsible for the operational delivery of the clinical outcomes set out in the tendering process within the block budget agreed. C&P CCG did not seem to regard the UCP as a commissioner and retained its existing staff and budget for commissioning adults and older people’s services, estimated to account for 20% of its overheads. This created a situation where there was some doubling up and caused frustration for UCP staff, who wanted discussions with providers to take place primarily through the UCP. For CPFT and CUH, the UCP was primarily a vehicle for transacting with C&P CCG and for transferring funds for service delivery. In this context, establishing the UCP as an LLP was a pragmatic way of containing the risks associated with the contract. One respondent described what they saw as a flat refusal to change the old architecture of the system after the UCP had been established: monitoring meetings and relationships between providers and C&P CCG remained in place, by-passing the role the UCP saw for itself. This is not surprising as C&P CCG remained responsible for its commissions and their performance and the trusts were still accountable to their boards and regulators. For the UCP to function – and in the absence of a large degree of trust between parties – some rationalisation of these management and governance arrangements would have been necessary. We are left with the view that the UCP was something of a paper tiger: owned by the trusts as an LLP, it was principally a mechanism for reducing and isolating risk. For C&P CCG, the UCP was a convenient vehicle for reducing transactional complexity. Overall, the UCP had little leverage: it was not empowered to make a difference by either the trusts – for whom the LLP was principally a risk-reducing vehicle for handling the contract – or C&P CCG, who failed to transfer the resources or authority needed to enable it to take up system leadership and a transformational role. While this may have suited local organisations tactically, it was a major flaw in the specification, procurement and contract negotiations.

4.7 COMMUNICATION, CONSULTATION AND GOVERNANCE

There is plenty of evidence that C&P CCG and the delivery partners made strenuous efforts in terms of consultation. Similarly, the UCP, CUH and CPFT involved their members and the Council of Governors in proposals as they developed. Board members appear to have been well briefed and engaged in both the bid process and shaping the services. In particular, the consequences for CPFT in terms of risk appear to have been well understood by the board and governors;; this was significantly aided by confidential briefings and a high degree of engagement with Monitor as the contract constituted a significant transaction for the trust. The general public and trade unions were engaged at a number of points in the process, and while the nature and scale of the contract clearly worried some participants, the consultations did not generally reveal any concerted opposition to the procurement and development of the UCP. In addition to holding briefing meetings for staff and stakeholders, the UCP itself published 15 bulletins between December 2014 and November 2015, and the engagement and involvement activities undertaken by C&P CCG and the UCP were given high priority and appear to have been effective. Overall, we are impressed with the efforts made by C&P CCG and the trusts to engage the public and ensure proper governance and accountability. However, two issues stand out.

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Firstly, the degree of public engagement in tendering for and establishing the UCP was not matched by the same engagement at its closure. The risk of insolvency of the UCP in December 2015 required rapid action by the partners, and a sequence of decisions and communications had to be delivered urgently. However, we are struck that there was not an attempt to gauge public support for the continuation of the UCP as part of a rescue strategy. As a public service provider, the UCP was accountable to the public, and consultation on the future of the organisation would have simply been good governance. There is also the risk that the public will become jaded by NHS calls for engagement when it is used to support major change or legitimate a new service but overlooked when major decisions have to be made at the system level to rescue failing transformation attempts. Secondly, in our discussions we became aware that while board members reported high levels of engagement and information and being engaged fully at key moments in the process, there was a sense of dissatisfaction and unease;; some governors reported finding the whole business deeply uncomfortable. This appears to stem from the sheer complexity of the contract and the feeling that the process itself had put the governors in a difficult position. As a consequence, we have to question whether traditional governance and board processes were adequate for such a complex, large-scale development or the rapid pace of its execution. The nature of board reporting, with officers presenting material for approval, limited time for debate and chairs needing to achieve a resolution, made it difficult for concerns to be formulated and aired and forward plans to be revised. Added to this were the numerous unknowns and need to access external advice and support – something that the governors may have benefitted from at the time. It may be helpful in cases such as these to introduce key break points in the governance process, akin to the Gateway process, at which governors can pause, undertake a fundamental appraisal (or reappraisal), seek alternative input from outside the routine governance model and generally form a more detached view of the risks and whether or not to proceed. Acknowledgement of these shortcomings and a more customised governance process may not have altered the UCP outcome but would have provided a higher level of governance quality and confidence.

4.8 COMPETITION AND TRUST

It has been interesting for us to note the impact that competitive tendering has had on relationships and behaviours across the healthcare system. It has generated more rigid and demarcated organisational silos and attitudes towards risk. The protracted and legalised context of competitive tendering has also had a paralysing effect, creating prolonged uncertainty for staff and making it more difficult to invest or innovate in joint working. Overall, organisations have become more conscious and careful when it comes to resource management, the risk of legal challenges from other competitors and commercial confidentiality. Under competitive tendering, organisational protectiveness and self-interest – not factors normally associated with the healthcare sector in the UK – have become paramount. For C&P CCG, organisational protectiveness manifested as anxiety to ensure that the resources absorbed by the tendering process and letting of the tender did not add to the financial challenges it already faced. For CCS, it meant attempting to safeguard the viability of the organisation through the transition process. For CPFT and CUH, it meant ensuring that they, as public providers, were not asked to provide more resources than those stated in the contract, which was to their overall detriment.

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Competitive tendering has brought about a shift in local health systems from partnerships to clearly delineated commissioner–provider relationships, with resultant restrictions on the flow of key information. For example, we were told that C&P CCG had never seen the UCP business plan developed for Monitor, despite having made a number of requests to do so. Similar issues were highlighted with a joint bid for the OPACS contract by Capita and CCS, many of whose staff and resources would be transferred to CPFT under the new model. In the UCP case, competition created additional delays in implementation since the details of staffing costs, timescales and so on could not be provided until after the contract was signed, but at the same time, signing could not take place until the costs were understood. There is evidence to suggest that the tendering process reduced trust, transparency and the sharing of intelligence. Some of this was the result of legal and regulatory restrictions. More specifically, the legal advice and NHS England rules around competitive tendering seriously reduced the scope for flexibility – particularly for C&P CCG. However, at the same time, we would suggest that this lack of flexibility also stemmed from the style of the tendering process itself, the prevailing culture and players’ conceptions about how tendering and competition works. As was said to us on more than one occasion, would a successful private sector bidder have been willing to subsidise the contract by putting its own resources into the operating costs? What is significant about such comparisons is that the ‘private sector approach’ may have entered into the thinking of NHS providers as a result of engaging in a competitive process. As questions of trust and transparency became more apparent within the local system, players tended to second-guess others’ intentions rather than maintain an open dialogue. For instance, there was a view among the UCP partners that C&P CCG hoped to hold back resources from the contract in order to fund services elsewhere;; in reality, C&P CCG was facing a growing deficit. Similarly, the UCP thought that CCS was holding back resources from the transfer arrangement, while others thought that the UCP could have been funded by CUH and CPFT, even though the trusts’ financial positions were deteriorating. This misreading of partners’ intentions and capabilities proved disastrous for the contract and subsequent renegotiation process. We do not mean to suggest here that decision-makers were being unreasonable – quite the reverse is apparent. It is the responsibility of directors, boards and governors to safeguard the assets and resources of their organisations and to provide fair employment and protection for their staff and quality care and treatment for their patients – and this is what they did. Instead, what we noted was that the organisations had become more acutely aware of their boundaries and more concerned with delivering narrower governance priorities to meet their own responsibilities. This meant that at crucial times – such as when trying to discover the true cost of Transfer of Undertakings (Protection of Employment) Regulations (TUPE) services from CCS or to find ways of covering the operating deficit – there was a tendency to mask activities and decision-making to protect organisational interests. It could be argued that the competitive process and clearer (or rigid) boundaries that emerged from the contracting process made decision-makers more acutely aware of the inherent risks. However, this came at the cost of reduced sharing and balancing of risks across the system. There was a clear sense that the notion of all being part of one NHS service had diminished and been replaced by a greater focus on separate organisational responsibilities.

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4.9 REGULATION

The fragmented nature of the healthcare system means that chief executives and board members are primarily responsible for their respective organisations’ financial health and quality of provision. Chief executives need to ensure that they deliver the financial and performance goals set out by their respective regulators. It was said to us on a number of occasions and by different players in the system that these factors heavily hamper integration and joint working. While chief executives may want to commit to collective system change in local partnership or commissioning meetings, this is hard to implement back in the operational and regulatory environments of their trusts. The role of regulatory bodies in the commissioning, procurement and operation of the UCP was prominent and significant but not generally positive. We have mentioned that in the system operating at the time there was no regulatory oversight or developmental support for service integration of the kind being pursued by C&P CCG and the UCP. Instead, each element of the local system was regulated separately and had distinct performance and quality criteria to meet. To make matters worse, the regulatory regime focused on the viability and financial health of foundation trusts, NHS trusts and CCGs individually. There was no possibility of managing and allocating the considerable risks associated with fundamental system change within such a fragmented regulatory infrastructure. This fragmented regime further entrenched the narrow organisational focus introduced by the competitive tendering process. Ensuring that their regulators were satisfied and that the procurement process or delivery contract met with their approval were the organisations' primary concerns. For boards and chief executives, this was because an unfavourable or unsupportive response from a regulator could provoke an existential crisis for their organisation. This was overlaid with heightened concerns among provider trusts about commercial confidentiality and, for C&P CCG, the possibility of a legal challenge on the basis of unfair procurement and contracting practices. A good example is that C&P CCG maintains that it never saw the business case for UCP developed by the partnership and submitted as part of due diligence by CPFT to Monitor. It seems incredible to us that the commissioner would not have access to the detailed evidence and plans for cash flow, risk handling and income generation for the prime contractor to whom it was paying considerable sums for the delivery of a contract. This, however, is the inescapable logic of a competitive process and fragmented regulatory environment. In short, we have a system where each component organisation can pass its individual regulatory and governance tests but an integration project of considerable significance is very likely to fail. There is also evidence to suggest that even the regulators’ internal processes were not up to the task of evaluating programmes such as the UCP. For instance, Monitor’s regulatory oversight of CPFT and the UCP used its existing mergers and acquisitions framework, which was the closest evaluation framework that was available. Monitor’s primary concerns were the risks and costs of CPFT absorbing new services and the risks associated with the LLP. There is no evidence to suggest that a commensurate effort was made to understand the risks inherent in the integration effort itself. As a change and integration vehicle within the wider health economy, the UCP had a role that was beyond the capacity and competency of the mergers and acquisitions framework. Finally, it is clear that the involvement of regulators slowed the entire process down and added to delays and costs: approval for CPFT to enter into the UCP process was finally given by Monitor on 31 March 2015 for a contract that was due to start on 1 April 2015.

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5. ANALYSIS

In this section, we return to the three key themes and eight questions posed at the start of the inquiry.

5.1 COMPETITIVE TENDERING AND RISK SHARING

T1. Could the partners have done anything differently during contract negotiations to prevent its failure?

Even with the benefit of hindsight, it is difficult to identify anything of substance that could have been done differently once the tender process had begun. The competitive procurement was bound by the rules set out by NHS England, the Department of Health and the Government, and this procurement adopted a particularly tight approach to agreeing contracts and services. One of the consequences of private sector involvement is that public sector providers adopt a similar approach to private providers to make themselves more competitive. In this case, this approach led to a focus on the risks and benefits to each organisation rather than on emphasising common goals and the efficient and fair sharing of system-wide risks and benefits. Given the substantial nature of the transaction, CPFT was under particular pressure to ensure that the partnership and contract arrangements kept its own financial survival separate from the fate of the UCP. The C&P CCG procurement demanded the creation of one umbrella body where there had been more than one organisation in partnership. This, combined with the internal pressure on CPFT and CUH to limit the financial risks to their organisations, led to the formation of the LLP. It is possible that a concerted push by the provider organisations prior to the competitive tendering decision being made might have persuaded C&P CCG to develop a more organic, local solution and developmental approach to OPACS. Although the chief executives and chairs of the trusts approached senior figures in C&P CCG to halt the tendering process before it began, we believe that even more could have been done. A focused attempt to develop a different strategy might have removed the need for the tender process altogether or adapted it into a more incremental model. The complexity of the changes proposed by the UCP for OPACS, including transferring staff, establishing new services and building new IT systems, was such that a slower pace of implementation and incremental approach would have been realistic and advantageous. Using their provider expertise and strong positions in the local health economy, CPFT and CUH should have argued more strongly for a phased implementation of the changes. We acknowledge that the pressure on C&P CCG and national policy emphasis on competitive procurement and radical system change at the time would have made this a difficult argument to win. In addition, a vigorous response by providers always risks alienating commissioners and undermining trust, particularly in a competitive environment. Given the commissioning atmosphere, the providers were clearly conscious of these risks. The financial pressure on the local health system and their own organisations also meant that CUH and CPFT had a shared interest in making rapid progress: a slower, less risky strategy was unlikely to find much support among the partners. Nevertheless, this would have been a more sustainable alternative. The partners should have acknowledged that although the programme they put together contained innovative, promising and tested modules, there was no credible evidence that these elements would work effectively when put together in the local system, especially on the scale proposed. It was evident that configuring the range of measures proposed for the local context would be challenging, even in the best of conditions. It also became clear early

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on that the financial details of the contract were insufficiently clear. Therefore, an alternative strategy would have been to withdraw from the tender when it became clear that the timescale, detail and clarity of the procurement process were problematic. The prevailing view, however, was that NHS providers had an obligation to bid. In fact, CPFT (and to a lesser extent CUH) saw its business model being threatened if an external party, and specifically a private provider, were to win this contract;; thus, winning became a matter of survival. We have not found any evidence that the underlying assumption that CPFT and CUH had to win this contract was seriously challenged at any point. Competing against other bidders for whom the contract was only ‘nice to have’ led to underpricing from the start – something that the contract parties never recovered from. In terms of the way risk was handled throughout the tender process, the scale of the realistically achievable savings and costs of delivering the care model were highly uncertain at the time of negotiation. C&P CCG effectively insured itself against this risk by incorporating savings targets in the contract value, without properly analysing whether these targets were realistic. The winning bidder was therefore left with the considerable downside risks of lower-than-expected savings and higher-than-expected costs, which were not balanced by the potential of upside benefits beyond the agreed contract value. From a risk-sharing perspective, this was a one-sided contract framework. In managing the substantial operational and financial risks, the UCP did not have access to two basic tools. First, the size of the contract and significant interdependencies between the various operational projects meant that the UCP and its partners were not able to diversify the risk across independent activities. Second, while incorporating flexible response mechanisms that allowed the UCP to respond if and when downside risks materialised would be the natural risk management approach for such a large-scale, undiversified project, this strategy was not pursued;; in fact, it is difficult to see how it could have been pursued within the tight procurement regime and under competitive pressure from other bidders, with an emphasis on maximising the notional savings incorporated in the contract value. This left the UCP partners with the least desirable risk management option: to respond to C&P CCG’s insurance mindset in kind by limiting their own liability through an LLP and returning the risk of failure to C&P CCG. This made the collapse of the contract more likely as it limited the UCP’s headroom for continuation. It is not clear whether it would have been possible to negotiate a more mature risk management strategy as the transfer of risk was at the heart of the rationale for procurement. However, a procurement process with a greater level of shared responsibility and risk embedded and a contract that included explicit flexible response mechanisms might have provided the basis for a more sustainable programme of improvement. The partners should have pushed harder for such an agreement. T1(a) Should or could the trusts have put money into the UCP up front to enable its survival? Given the complexity of procurement and development, major projects such as the OPACS programme normally include the provision of substantial contingency funds to enable effective risk response;; however, C&P CCG did not require this provision contractually. In addition, none of the organisations in the local system had the resources to underwrite such a fund. If the contract had been constructed differently, with a greater risk-sharing element, it might have been possible for the commissioners and providers to create a joint contingency fund, potentially with the help of private partners and on an invest-to-save basis. However, given the tight financial position of all partners, this would have been very difficult to achieve even with the inclusion of a private partner and the involvement of NHS England would have been necessary.

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T1(b) Should parent boards have owned the UCP debt?

The debt faced by the UCP was principally the gap between the amended price offered in the tender and the costs of the services inherited as part of the OPACS programme. C&P CCG’s position was that the partners should have borne and managed this debt. The discussions about closing the funding gap, which foundered without reaching agreement, were concerned with the shortfall in operational funding in Year 1. However, there was also the question of an ongoing deficit of £15.2 million for the following years of the contract. The UCP’s parent boards sought assurance that the gap for 2015/2016 and any subsequent years could have been bridged through further efficiencies, system rationalisation and performance rewards. The funding gap had two fundamental sources: (i) the competitive environment had led the UCP’s bid price to be too low;; and (ii) the cost of services was highly uncertain at the time of contracting. It could be argued that the UCP partners should own the debt arising from bidding too low. However, we could also argue that C&P CCG should own the debt that arose from a lack of information about the cost of service provision prior to contracting. The problem is that the relative magnitudes of the two factors are difficult to identify. The partners opted for the LLP model precisely to protect their core services from the well-acknowledged risks associated with the UCP. Shouldering the UCP debt would have had an adverse effect on CPFT’s and CUH’s core services;; for CPFT in particular, this could have depressed the development of mental health services and had a significant impact on users and carers. At the same time, the trusts’ regulators needed assurance that the strategy of owning the UCP shortfall from the outset was sound and would have been repayable later. It is unlikely that Monitor would have supported this position given the longer-term shortfall and overall financial position of the trusts;; the financial climate for CUH worsened significantly during 2015, and CPFT was facing pressure to identify efficiency savings in the longer term. Realistically, it was highly unlikely that the parent boards would have been able to subsidise the UCP in Year 1, and this would have done little to resolve the longer-term structural debt inherited with OPACS. T1(c) Why was a parent company guarantee for the LLP not put in place? There has been much comment in our enquiry and in reports by other bodies about the nature of the LLP created by CUH and CPFT and, in particular, whether the parent organisations should have provided additional financial guarantees for the UCP. This was a particular focus of the internal audit report, which suggested that C&P CCG should have conducted a further assessment of the UCP tender when the LLP proposal first became known. While it has been suggested that the LLP arrangement was made relatively late in the contracting process, the evidence we have seen suggests that CPFT and CUH made their intention to create an LLP clear in the competitive dialogue process in October 2013. Furthermore, the trusts were never required to provide a parent company guarantee by the contracting process nor were they required to commit to put additional monies into the operation of the service. Indeed, had that have been so, it is unlikely that Monitor would support CPFT proceeding with the contract because of the risk that this would have involved for the trust. The trusts took extensive legal advice about the impact of creating an LLP and its usefulness in limiting liabilities for the parent bodies. CPFT and CUH were clear that they would be happy to provide short-term capital to ensure the UCP had the cash flow to operate but that

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the LLP existed specifically to limit their exposure to ongoing deficits in operational funding. When it became clear to the directors that the UCP was at the risk of insolvency, the legal advice was that it was their duty to act primarily in the interests of the LLP's creditors. In this context, C&P CCG’s suggestion on 27 November 2015 that CPFT and CUH provide working capital to support the UCP’s cash flow for 2015/2016 merely brought this risk into sharper focus. In our view, creating the LLP was a sensible move to isolate the problems associated with the UCP from the trusts’ wider service responsibilities. The competitive procurement process and involvement of private sector organisations changed the terms of engagement for all partners. In this new environment, it would have been highly unlikely that a private company would have committed its own resources to the contract over and above the contract value. This view became dominant among public sector bidders, who consequently felt that it was legitimate to limit their financial exposure to the headline values in the contract. T2. Did the commissioners raise specific concerns about how the negotiations and contract

process were carried out? In some of our interviews it was intimated that the contract negotiations and subsequent mobilisation discussions were a source of conflict between the UCP and the commissioners. These negotiations were weighty and highly significant: a great deal of money, reputations and organisational viability were at stake. In addition, a measure of frustration was generated by a difference in views about the nature of the contract and whether further negotiation after the contract had been signed was normal and to be expected or went beyond what was reasonable. Such frustrations hindered stakeholders’ ability to start building a culture of partnership with well-defined roles and responsibilities early on, and this later contributed to the collapse of the partnership. Finally, the ambiguity surrounding the UCP’s purpose in the health economy and its role as integrator, commissioner and provider remained unresolved. T2(a) Were the overheads for the UCP higher than expected?

As we have seen, the operating costs for the inherited OPACS were significantly higher than the tender price. The operating overheads for the UCP itself, however, were low, at around 1% of operating costs, and did not significantly impinge on the UCP’s operational deficit: the UCP was designed to be a lean organisation. There were, however, increased costs for the health system as the UCP took on some of the system improvement and service monitoring and management work that was also the province of C&P CCG. This created a measure of double up and was a further source of dispute between C&P CCG and the UCP. A difference in views about the role of the UCP, which could have been clarified during the mobilisation discussions, was once again at the heart of this dispute. To avoid this double cost to the system C&P CCG would have needed to devolve responsibility for contract monitoring and system improvement and transfer costs and resources to the UCP – a course of action that would have constrained its responsibility for system oversight and affected its capabilities, exposing it even more to the risk of UCP failure. Conversely, the UCP could have relinquished its system improvement role. This would have removed the impetus for improvement and placed the key cost and efficiency gains of pathway reform outside the UCP’s control, increasing the risk for the UCP and its parent trusts. An alternative could have been a joint approach to system improvement that required a collaborative effort between C&P CCG and the UCP and an understanding by CPFT, CUH and other providers in the system. All in all, this would have required a level of trust and sharing that was not present at that time.

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Resolving this duplication of expertise and resources would have been essential if the UCP contract had continued. The position of the UCP as neither solely a commissioner nor a provider but a hybrid organisation focused on system improvement proved to be a challenge for the NHS and the rigid purchaser–provider split that operated at the time. Wider and more sustained negotiation and consultation about this role would have been necessary for a shared understanding to emerge. T2(b) Was C&P CCG concerned about performance issues in relation to service delivery? In our review we found no evidence that C&P CCG was concerned about service outputs and outcomes. Indeed, given the early development of the contract and relatively limited amount of outcome data available, any concrete observations about service performance would have been premature. Performance and reward estimations were largely based on the outcome measures developed by C&P CCG, but these were not sufficiently flexible or fine-tuned to support definitive in-year contract performance assessment in Year 1. There were some indications that the UCP services were starting to have an effect on patient pathways and prevention. For instance, by July 2015, the UCP was reporting a reduction in expected emergency bed days for people over the age of 65 of 9.7%. However, with the limited available data it is difficult to ascertain whether this reduction was due to UCP interventions, and other indicators showed increases in incidents and demand. In any case, it would have been too early to make robust inferences about significant performance trends. Nonetheless, the documentation and interviews showed that there were contextual concerns. The continued disputes over costs and contract values appear to have been a distraction from service outcomes and outputs and weakened the signals in the system around admission avoidance and integration. During contract negotiation and mobilisation there were a succession of delays and barriers to implementation that slowed the development of the UCP and the delivery of service outputs against targets. Some of these barriers were imposed on the local system through the interventions and assurance processes of the Government and regulators. Others were a consequence of the complexity of the tender and mobilisation negotiations. However, delays in implementation and the necessarily slow start to new service provision and configurations of staff and processes built into C&P CCG’s concerns. The expertise of the UCP partners in service development and organisational change could potentially have been used more forcibly during the start-up period to build a more grounded understanding with commissioners about what was realistically achievable in Year 1. T2(c) Was there a conflict of interest in the cross-membership of the trusts’ and the UCP’s boards, and if so, were the arrangements for managing this conflict adequate?

The board of the LLP was established in April 2015. It was comprised of two non-executive directors (chair, CUH, and deputy chair, CPFT), a chief executive officer (CPFT), a director of service integration (CPFT), a director of finance (CUH) and a chief operating officer (CUH). Board meetings were attended by the UCP chair, chief executive and finance director, and there were subcommittees for audit, business and performance as well as a clinical advisory committee. The terms of reference for the LLP board are listed in Table 4.

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Table 4. Terms of reference for LLP board

1. To ensure that the UCP has an effective executive management team in place with a clear mandate to deliver the UCP objectives, including an overseeing strategy, vision, mission and values.

2. To ensure that there are robust and appropriate governance, financial strategy and risk management arrangements in place.

3. To provide approval and sign off for service-level agreements.

4. To provide high-level performance reviews in relation to the contract and the delivery of the services.

5. To provide guidance, remove blockages, assist with significant issue resolution and to support the UCP executive team in delivering the UCP contract.

6. To work collaboratively and to present a corporate approach across the health and social care system in Cambridgeshire and Peterborough, resolving disputes between members as appropriate.

During the UCP’s operation, it is not apparent that any conflicts of interest arose. The focus of the board at this time was on mobilising UCP services, developing contracts and the ongoing negotiations with C&P CCG on budget and funding. However, it is likely that conflicts of interest would have emerged between the UCP and CUH and CPFT, particularly as the UCP assumed greater responsibility for performance and service development and took up its role in the health economy more fully. In time, this conflict may have compromised the UCP’s role as an integrator. However, this could have been balanced by bringing together the mutual interest of the UCP, CUH and CPFT in service improvement. Board membership was confined to UCP, CUH and CPFT executives. This is a narrow base for a complex organisation. Although a number of discussions took place about enlarging the board to include other provider partners and social care early on, financial and clinical governance issues of potential partners limited UCP’s ability to do so. The intention was to revisit this issue once the contract was let and running. Indeed, we would expect some measure of independent and external representation to be built into such a board’s membership. The opportunity to develop links at board level with the wider health economy and with citizens and patients would have strengthened the UCP’s governance and potentially broadened its capacity to develop strategies to address the problems it faced. In time, the relationship between the governance of the UCP and that of CPFT and CUH would have needed clearer resolution.

5.2 PARTNERING AND COLLABORATION DURING CONTRACT EXECUTION

P1. What were the roles of CPFT and CUH? Could the trusts have been more proactive in

developing, implementing and supporting the contract, especially given that it was one of the NHS pioneers programmes?

We have highlighted the difficulties faced by CPFT and CUH in negotiating this contract and how it would have been unrealistic to expect the parties to act any differently to private bidders in the procurement process. In our opinion, the question whether CUH, CPFT and the UCP could have done more to mobilise other stakeholders and users to support the OPACS transformation from an earlier stage remains open. It would have been difficult for them to step outside the tight constraints of the tender and contracting process;; their capacity to do so was also limited as the intense and heavy workload associated with establishing the UCP was consuming so much of staff

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members’ time and energy. In addition, the lack of a formal relationship between the UCP partners and NHS England made direct communication between these parties impossible. Instead the partners had to rely on the third party communication with NHS England (via Monitor and C&P CCG) making communication ineffective and slow. While it would have been desirable for the UCP partners to collaborate with C&P CCG in bringing NHS England and other stakeholders further into the integration programme, it is difficult to ascertain whether this would have been feasible or effective. As we note in our narrative, some interviewees expressed the view that the UCP and its potential as an innovator lacked powerful and truly committed advocates. When difficulties emerged with the contract and operational deficit, it was easier to let the contract fold than to continue the battle into years two and beyond. P2. Once the funding gap had been identified, what more could have been done to ensure

the continuation of the contract or was termination inevitable? Evidence suggests that the contract was insufficiently funded and that the OPACS programme was loaded onto a local system that was in serious financial distress. This lack of funding made reactive risk management extremely difficult. Groundbreaking programmes such as the UCP generally face a great number of systemic and cultural challenges and are likely to uncover serious financial and cost issues. In the wider commercial environment, organisations often handle short interruptions to income and expenditure by drawing on emergency funds. It is our opinion that transformations with the scale and complexity of OPACS – or indeed any NHS pioneers programme project – would benefit from access to transitional emergency funds set aside by NHS England, over and above the generic transformation funding that is available to the whole system. Such national contingency funding would also help overcome the impediments and governance requirements naturally faced by lone organisations.

At the time of termination, there were no alternatives left to the partners. The contract negotiations and pressure to deliver improvements in admission figures had taken the organisations involved as far as they could go. There was a strong sense that managers and leaders – commissioners and providers – were fenced in and that there were no options other than closure. We believe that, started earlier, a more engaged and collaborative approach to risk management could have provided a wider range of possible futures for the UCP. More focus on a representative set of scenarios for the development of OPACS could have provided a clearer picture of ‘what if’ alternatives. As we have noted, this would have required a level of partnership and collaboration as well as accurate data and information that was not available at the time. As this contract was the biggest NHS procurement of its type to date and followed earlier procurement failures in the local health system, we feel that NHS England, as the ultimate parent organization, should have been more closely involved in this transformation programme. NHS England was made aware of the financial problems in September 2015, three months after the first signs of financial trouble had emerged. Had NHS England been more closely involved, alternative short- and long-term solutions, including necessary funds to keep the programme going, could have been generated. Importantly, NHS England could have played a key role in improving relationships and trust between the parties by reminding them of their social obligation to find workable solutions for the healthcare system as a whole.

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We have highlighted a number of ways in which changes to the contracting and design of the UCP could have assisted with its survival and success. Similarly, the provision of emergency or contingency funding might have helped smooth out the cash flow problems during start-up and provided more support in the difficult first year of operation. We have also suggested that sharing risk, as well as data and information that could help with the assessment of specific risks, could have provided a fairer basis for development and created incentives for problem resolution and successful development across the purchaser–provider divide. As it stood, the contract largely insulated C&P CCG against financial risk up until the point when the contract failed, after which the LLP protected the partner trusts from the risk of continuing with a loss-making operation.

A key lesson that can be drawn from commercial enterprises and public and private experiences of integration nationally and internationally is that major projects of this kind should be viewed as long-term joint endeavours. Evidence suggests that the cultural changes, organisational development and personal relationships that underpin successful integration often take 10 years or more to deliver high-quality outcomes.

Without robust and timely data, system integration efforts are ‘shots in the dark’ and it is impossible to identify what needs to change and to develop and evaluate new processes, leveraging innovation and enterprise. High-quality data is crucial for developing a shared view of systems and where they can and should be improved;; it is what replaces anecdotes with evidence. The integration of complex services therefore requires the development of infrastructure that can support collaboration and help develop shared analysis and objectives, and the integration of information systems and development of accurate and focused data on integration are significant, long-term projects. Without reliable data for measuring costs and desired outcomes, integrated care cannot be managed. This aspect should have been given much more emphasis at the start of the procurement process. While the UCP contract included some elements for the development of this scaffolding – and particularly the development of a shared IT platform and some organisational and leadership development work – the timeframes for these developments were unclear. Overall, more could have been done to build the conditions for integration before service provision began;; for example, by establishing an initial workable, integrated IT infrastructure for a suitable subpopulation before the contract commenced. Finally, we feel that more could have been done to develop formal governance by broadening the base of the UCP’s board, potentially including a clearer distinction between the organisational and operational governance of the UCP and the legal and financial responsibilities of the LLP. At the same time, the UCP would have benefited from formally developing a wider consultation and engagement governance structure to allow it to draw on the expertise and opinions of wider stakeholders in relation to OPACS, particularly in terms of primary care and social services. The difficulty for UCP was that a large set of stakeholders were introduced during the initial implementation phase to monitor the contract, which hampered the engagement on the model;; a slower timetable that gave CPFT and CUH more time to deal with pressing operational and financial difficulties rather than focussing on performance and savings targets could have improved the engagement.

5.3 COST AND SALVAGING CREATED VALUE

We were tasked with responding to the following three questions:

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C1. Were the losses to the health economy greater than the cost of keeping the contract

going? If so, why, and could the trusts have prevented this? C2. What were the wasted costs for CPFT? C3. What could be done to build on the apparent initial successes of the UCP and keep the

integration benefits in terms of better care at a lower cost? We consider these three questions together since the identified costs need to be offset against any benefits. We were asked to attempt to estimate the costs for the public purse of the tendering and collapse of the OPACS contract. This is a complex calculation, much of which is dependent on access to details that are internal to the organisations involved. Identifying the extra costs of the OPACS tender distinct from the costs of services that would have otherwise been provided by CCS, CPFT, CUH and C&P CCG is particularly difficult as C&P CCG did not have an accurate cost baseline for these services. The final calculation produced by CPFT and CUH for the total costs of the UCP to the health economy is in excess of £18.6 million, as detailed in Table 5.4

Table 5. Total costs of the UCP

(in £ 000s) A) Procurement and termination costs for C&P CCG* 1,430 B) UCP costs (paid within the contract price) 4,807

Comprising post-contract set-up costs 3,155 management costs 1,614 termination costs 38 C) Trusts’ pre-contract bid costs 2,686 D) Trusts’ termination costs 9,700

Comprising payments to providers 7,000 C&P CCG–provider contract costs 1,300 VAT and legal costs 1,400

TOTAL 18,623 * Figure taken from C&P CCG submission to National Audit Office. There are two calculations from these figures that are relevant for this report: (1) the cost to CUH and CPFT of the failure of the UCP and (2) the additional cost to the health economy. (1) Cost to the trusts: The costs that fell to CUH and CPFT were C) £2,686,000 and D) £9,700,000, totalling £12,386,000. This money was split evenly between CUH and CPFT. The lion’s share of this – £7 million – was in inherited payments to contractors and providers above the contract price for OPACS. This money was used to support existing OPACS services. As such, it is a clear indication of the gap between the actual cost of the commitments inherited with the contract and the contract price set at the project’s commencement. (2) Cost to the health economy: This is a more complex calculation that has to take into account costs that were over and above the ‘normal’ costs of system operation if the UCP

4 Different reports estimate the cost of the tendering and collapse of the OPACS contract for the public purse from different trusts’ perspectives. For example, NHS England's report only considered the costs for C&P CCG over and above its baseline cost for the contract, which was estimated at £6 million. Since our focus in this enquiry was not on C&P CCG's costs, we are not able to verify how this figure was arrived at.

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had not been created. Some of the UCP’s expenditure went to supporting patient services;; therefore, this cannot be considered an additional cost to the health economy. The true additional costs include the procurement and termination costs for C&P CCG, A) £1,430,000, the UCP’s costs, B) £4,807,000, the trusts’ pre-contract bid costs, C) £2,686,000, and the VAT and legal costs (£1,400,000). This totals £10,323,000. There are additional costs of the effort and energy involved in the process of tendering, contract negotiations, awarding the contract, managing the mobilisation and transition, running the services and closing the contract, not only on the part of local organisations and citizens but also on the part of regulators, government agencies and other failed bidders. Calculating these inputs is impossible, but they are likely to be substantial. The energy and focus that the OPACS contract adsorbed also had an opportunity cost for the health system as this effort and expertise could have been deployed elsewhere, potentially to better effect. It is impossible to say with any confidence what could have been achieved if the organisations involved had devoted the time, energy and, indeed, funds to something other than OPACS and the UCP. The problems facing the local health economy were considerable. As such, it is not unreasonable to assume that positive outcomes might have been achieved if the considerable talents and efforts of the NHS staff and trusts had been focused in a different way. The OPACS tender also had costs in terms of the reputational damage caused to both local and national organisations along the way. We also recognise that certain individuals carried a heavy burden throughout this process and that the stress and attrition on key personnel in the local health economy was significant. The impact of such high-profile, highly contested commissioning and contracting processes upon the people involved can be detrimental to both individuals’ health and, through people leaving their posts, the talent base and capacity of the local health economy. Importantly, however, as we have noted elsewhere in this report, the OPACS tender and creation of the UCP also had a positive impact on the local health economy. The legacy of the UCP is that there is now a genuine movement towards integration and a clearer understanding of how payments and rewards can be brought together through improved patient pathways. There is also a new infrastructure for OPACS that is being built upon. The contracting process has also brought the details of the complex services that provide community care and support into sharper focus. We have observed a real willingness to learn from the UCP experience, a strengthened desire to drive integration and service improvement in OPACS and a greater commitment to collaboration and shared working in the interest of the system as a whole.

6. CONCLUSION

This report describes the unique and fascinating story of the UCP, an attempt to build a model of integrated services for adults and older people at a rapid pace. One of the overriding realities that proved insurmountable for the partnership was the severe squeeze on resources experienced by C&P CCG, CUH, CPFT and the local health economy year in, year out. Without adequate resourcing, competitive tendering was never likely to produce sustainable innovation, and without adequate funding, no organisation can survive, particularly in the difficult first year of start-up. Given the competitive nature of the procurement environment, we were unable to identify how the UCP contract and collaborative working relationship, or rather lack thereof, could have been turned into a long-

39

term success story and therefore believe it was best to cancel the contract early and start afresh. Nonetheless, as this report has shown, there were things that CPFT and CUH as well as other stakeholders could have done differently during the contract negotiations and execution, and several lessons can be learnt from this experience for the good for the health economy. For us, three lessons stand out: 1. Urgency and risk: Although the ambition and scale of the programme was admirable, it was too much, too soon. In particular, there was very little evidence and data on which to base the contract. A slower, staged approach with a smaller initial contract for a subset of the services for a subpopulation may have allowed the parties to learn over time and better prepare for large scale system transformation. 2. Competitive tendering: The tendering, and specifically the inclusion of bidders from the private sector, amplified the risk by putting substantial pressure on the local NHS providers to win the bid, which was felt to be only possible by underbidding the competition in terms of contract value and emulating the risk protection strategies of the private sector bidders, leading to a LLP without parent guarantee. Given the scale of the integration and transformation programme, it is unlikely that the C&P CCG, which was still in its infancy, had a sufficient understanding of the financial, operational and legal implications of the complex contract, including how to interact with an LLP. While the NHS providers, and in particular CPFT, had developed strategies to limit their exposure in case of failure of the partnership, little thought had gone into processes to proactively mitigate and manage the risk of unforeseen operational and financial difficulties at the level of the C&P CCG-UCP relationship. 3. Partnership and collaboration: Projects of this size and complexity are always based on incomplete contracts;; it is impossible to specify what each contract party is required to do in every future contingency. Inevitably, unforeseen circumstances will arise that can only be resolved through genuine trust-based partnering in the interest of the jointly agreed purpose of the contractual relationship, rather than the letter of the contract itself. This requires strong leaders on all sides of the contract, who are aware of this challenge and lead decisively to overcome the fall-back onto secure positions. Unfortunately, this was not the case. Local relationships between the C&P CCG and the trusts, and between the trusts themselves, were not strong to start with and there was no phase that would have allowed the parties to develop greater trust and understanding. When the first signs of trouble emerged, the parties fell back to legal arguments and created an adversarial relationship rather than a true partnership. Although NHS England bodies could have played a unifying role during the hardship, their involvement was too little, too late. Complex integration projects should be viewed as long-term collaborative endeavours;; cultural changes, organisational development and personal relationships that underpin successful integration can take a decade or more to develop before sustainable, high-quality outcomes are delivered. Integrating information systems and developing accurate and focused data are key to a successful integration. Without these, it is impossible for organisations to identify the levers for delivering higher quality at lower cost and establish a culture of evidence-based interrogation, innovation and improvement.

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ACKNOWLEDGEMENTS

We are grateful for the help we received from across the health economy in completing this review. In particular, we would like to thank all of those who generously gave their time to be interviewed;; everyone approached the conversations openly and frankly. We are grateful to those who completed the detailed timeline and documentation;; access to this level of detail is unusual and extremely valuable. Particular thanks go to Helen Thomson at the Cambridgeshire and Peterborough NHS Foundation Trust for her patience and forbearance. Without her help in timetabling interviews and meetings, this review would have taken much longer. Finally, we would like to thank Christine Dentten for her help with copy-editing the manuscript. The Centre for Health Leadership and Enterprise at the University of Cambridge Judge Business School was pleased to take up this commission on two counts. Firstly, the story of the UnitingCare Partnership is a particularly fascinating account of the reform process within the NHS, and there is much that can be learnt from this case study. Secondly, the Centre is part of the locality of Cambridgeshire and its wider region and we are committed to contributing to the development of sustainable quality healthcare in our own locale. If, through this analysis, we have contributed to learning and discussion in our health economy, we will have met one of our prime objectives.

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APPENDICES

APPENDIX A. CHLE INTERVIEW OUTLINE

The CHLE has been commissioned by CPFT and CUH to undertake a rapid enquiry into the tendering, negotiations, contract agreement and termination of the contract for OPACS, which resulted in the creation of the UCP. In particular, we have been asked to consider what could have been done differently, how risk was handled and the role that the public voice played in the process. The intention is to learn from the process but also to maximise its successes for the benefit of the wider health economy. Our intention, and that of CPFT and CUH, is to publish in full. Preamble

• We are undertaking a review into the circumstances and not making an enquiry or investigation. The goal is not to apportion blame to individuals or organisations but to capture learning points for the future. We intend to interview 20–25 people across the health system.

• This interview is confidential, but CPFT intends to publish the final report. • We will not include interview quotes in the report unless this is agreed with the

interviewee. • The interview will be recorded for accuracy and verification. • The interview will take no more than one hour. • We will frame the discussion around key themes but want interviewees to feel free to

raise issues that are important to them. • We will examine:

o the underlying intentions of the tender and contract negotiations;; o how risk was handled and shared;; o the nature of the partnership and collaboration during the negotiation and

execution phases and how these were affected by the tendering process;; o whether there could have been other, better ways of achieving the

commission’s objectives.

Interview framework 1. Can you explain your current role and what engagement/role you had with the

tendering process/UCP? (Prompt on dates and times.) 2. Commissioning process

• How did the concept of procuring OPACS arise – what do you know about the relevant history of C&P CCG and the local health economy?

• What were the aims – how did these emerge? (How clear was the vision and how was it shared?)

• How did you see a private provider contributing to the objectives and/or the local health economy?

• What evidence was taken into account, specifically from successful services elsewhere? (Evidence of diversion and prevention is thin nationally – what examples did C&P CCG learn from?)

• What was the rationale for the UCP model? Why were the services bundled in this way? (There is a complex set of services and patient groups here – some of the costs and demands in this sector are uncontrolled – was any attempt made to balance risk by creating a balanced service package?)

• The timescale appears to have been tight – why was this the case? Who/what was driving the urgency?

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3. Tendering and contracting process • How were the public/patients/governors/etc. involved in consultation? • It appears that contract negotiations were still taking place eight months after

the commencement of the service – was this unusual in your view?

4. Construction of the UCP • The UCP signed up to an ambitious set of changes and savings – what is

your view on this and how robust where the changes and savings? • How were the risks shared here – clearly investment needed to take place

while also maintaining and making savings in services in from the start? • Social care chose not to participate in the partnership – why, and what efforts

were made to include local government? • The LLP was proposed at an early stage – what were the reasons for this? • Was the absence of a parent company guarantee a deal-breaker in the end?

What would have been the effect of raising this in the tender negotiations? Would it have brought about a crisis earlier?

5. Budget, targets and risk • Original risks identified at the ISOS stage do not seem to have been

bottomed – what was the partners’ understanding at the start of the contract about how these risks would be mitigated?

• What were the financial drivers for your organisation? How did you see this tender working for your organisation? How did the business case set out the monetary flow?

• There appears to have been a difference in views between commissioners and providers about the nature of the contract and the extent to which variation and negotiation were possible – what is your view?

• How were the public and board members engaged in the management of the contract risks? Was there an opportunity to escalate or to review?

• The contract costs never seem to have been bottomed – what was the real gap in your opinion?

• What were the levels of trust and common purpose between stakeholders throughout the operation of the UCP? Where are they now?

6. Operation – service effectiveness • What happened to services during the tender negotiations and during the

contract? Did you see improvements? • Some of the service changes implemented by the UCP are still being

supported – do we have a picture of the costs and benefits of these services?

7. Termination and aftermath • What hangover is there from the tender, operation and demise of the UCP? • How would you have done things differently? • Is there a different approach across the health economy?

8. What would have been the alternatives to tendering these services to gain the same objectives?

• Could it have been packaged differently or over a different timescale?

9. Close and final thoughts • What are your reflections on risk and its management? • What could have been done differently? Are there any key moments that

could have been deciding factors for the failure in retrospect? • What are your reflections on accountability and public engagement?

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• What are your thoughts on the roles of Monitor, SPT, CQC and NHS England?

APPENDIX B. UCP SAVINGS AND IMPROVEMENT PROPOSALS

• To deliver a savings programme of £178 million over the life of the contract. • To reduce spending on acute hospital care by £116 million over the life of the

contract. • To deliver a significant programme of investment in community services, including

mental health and the third sector. • To move away from acute PbR (payment by results) to contracts that incentivise

outcomes and control cost and demand. • To streamline the response to crisis through the UnitingCare Centre and JET. • To use IT to link hospitals and the community and make care plans and key clinical

data available to clinicians to support decision-making. • To work with patients, carers and the appropriate services, supporting them to

develop plans and strategies to help patients deal with their condition and crisis without needing admission.

• To enhance end-of-life services so that people can die where they want. • To embed ambulatory care pathways to give prompt assessment, treatment and care

without admission. • To introduce a risk-based case management approach that provides:

o intensive case management for the 10,000 (rising to 40,000) patients with the highest clinical need;;

o supported self-management and care planning for 250,000 patients with elevated risk of admission to prevent progression of their conditions and support them to stay healthy.

• To develop mental health services that better meet the needs of older people with dementia and other mental health problems.

It was also proposed that the UCP would grasp other opportunities as the contract proceeded:

• Primary care prescribing: Through regular and comprehensive medication reviews, to improve formulary compliance and reduce prescribing costs. A single patient record, including electronic medication administration record (MAR) charts, would enable prescribers to view patient compliance with medication in real-time. This would allow prescribers to make more informed decisions about which prescriptions should be altered or stopped based on which were actually being taken and when, allowing repeats that are not used to be amended or cancelled. MARs would be accessible on a mobile app, allowing patients to share this information with community pharmacists to support them with community medication usage reviews.

• IT portal and integration: IT solutions would make care plans and key information instantly accessible to patients, carers and professionals to facilitate the delivery of the UCP's clinical vision for adults and older people. These systems and the integrated portal would be flexed up to include systems beyond the current scope of the bid. This would extend access to clinicians, carers and other involved professionals and, with it, the potential to shape more effective, efficient and patient-focused services.

• Primary care and general practice: By working in an integrated way with general practice, the UCP would support practices to:

o better manage many of their most complex and resource-intensive patients, reducing the frequency and duration of attendance at practices and the associated prescription costs;;

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o develop more effective and efficient pathways for patients with complex needs and long-term conditions, ensuring the achievement of the maximum associated QOF (quality and outcomes framework) points;;

o provide easy access to clinical information and care plans for patients, allowing practices' clinical and administrative staff to be more productive, thus avoiding wasted time chasing up records, results and other information.

• NHS England commissioned services: By developing specialist neurology services in the community, the UCP would reduce outpatient attendances in the acute setting. It would also integrate with general practice to support continued improvement in services.

• Social care: o reducing demand for residential and long-term care;; o brokerage around personal care budgets:;; o developing the integrated care worker role.

• Other budgets outside of the core scope of services:

The UCP would remain keen to discuss NHS continuing care, community hospital outpatient attendances and specific planned community services with C&P CCG. The UCP feels that there are significant opportunities for synergy and additional savings in these areas.

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BIOGRAPHIES

BRIAN COX Brian is a consultant in health and social care specialising particularly in whole system development aimed at shaping demand and aligning objectives, strategy and delivery. He has a background in education, development and workforce strategy with a particular emphasis on system leadership, the leadership of networks and health and social care integration for users and patients. As a consultant he has worked as the workforce lead for the national Putting People First Programme, was the Director of Leadership at the National Skills Academy for Social Care and has led reviews of commissioning and operations in health and social care. He has written widely on social care, leadership and the NHS.

Brian has over 35 years of experience in operational management, research, local government, and health services. Originally studying as community worker in Birmingham, he has practiced as a social worker, mental health social worker, lecturer, researcher and senior manager. He led a national research project on inequality and ethnic minority take up of care services, managed a community development unit in Nottingham and delivered social regeneration and anti-poverty schemes in Birmingham. He was Assistant Director Commissioning in Nottingham City Social Services for 9 years and a Regional Director for the NHS University. He also served as an elected member in Derbyshire. Brian currently works as a part-time Senior Lecturer on NHS Leadership Academy programmes at the Health Services Management Centre and is an associate with CHLE. Brian is particularly interest in support the development of effective integration of services, supporting users, carers and patients to exert more control over the service they use and developing system leadership that is fit for purpose.

FERYAL ERHUN Feryal Erhun received her Ph.D. in Business Administration, with a concentration in Production and Operations Management from the Graduate School of Industrial Administration, Carnegie Mellon University in 2002. She holds a B.S. and a M.S. in Industrial Engineering from Bilkent University, Turkey. She was a faculty member in the Management Science and Engineering Department of Stanford University from 2002 until 2013, and a Research Fellow at Clinical Excellence Research Center of Stanford University from 2013 until 2015. Dr. Erhun’s research interests are in the strategic interactions

between stakeholders in supply chains. In this context, Dr. Erhun has studied topics related to supply chain contracting, capacity, and inventory decisions. More recently, she has turned her attention to socially responsible operations: today, both for-‐profit businesses and nonprofit organizations aim to create the highest value for their shareholders, employees, partners, and the environment. Her research on nonprofits, healthcare operations management, and sustainable supply chains has informed the development of theory

46

addressing the unique challenges arising for these organizations and has extended traditional operations management theory to these new and important settings. Dr. Erhun is a strong proponent of practice-based research. Through collaborations with Intel Corporation, Cisco, Stanford University Medical Center, etc., she has been able to combine her academic interests with firms’ needs to deliver insights for both communities. Her work has been selected as one of the finalists in the 2012 Franz Edelman Award, which recognizes outstanding examples of innovative operations research that improves organizations, and Dr. Erhun has been inducted as an Edelman Laureate. Dr. Erhun is a recipient of 2006 NSF CAREER Award with her project titled “Moving from Risks to Opportunities: An Exploratory Study of Risk Management in Supply Chains.” She is an associate editor on the Production and Operations Management journal.

STEFAN SCHOLTES Following undergraduate studies in Industrial Engineering and doctoral and post-doctoral studies in Applied Mathematics in Germany (Karlsruhe Institute of Technology) and the USA (Cornell University), Dr. Scholtes took up a joint faculty appointment with Cambridge’s Engineering Department and Judge Business School in 1996. In 2003, he was appointed Professor of Management Science at Judge Business School, where he has been Director of the PhD Programme, Director of Research and Subject Area Head for Management Science. Following his appointment to the Dennis Gillings Chair in Health

Management in 2010, Dr. Scholtes founded CHLE to connect the capabilities of Judge Business School with the needs of the local and national health economy. Jointly with Cambridge University Health Partners (CUHP), CHLE offers as its flagship programme the Cambridge Chief Residents’ Leadership and Management Programme to senior registrars and GPs in the East of England, with a current intake of 70 clinicians per annum. Dr. Scholtes’ research focuses on hospital management and service transformation of local hospital systems and is embedded in a long-term collaboration with CUH. Dr. Scholtes teaches operations management and business analytics on the Cambridge MBA programme and leadership courses for clinicians. He has been a board member of JBS Executive Education Ltd, the Management Board of the Institute for Public Health at Cambridge University, the Cambridge Collaboration for Leadership in Applied Health Research and Care (CLAHRC), and has served as a UK representative on the International Federation for Information Processing. He has been a member of the EPSRC Peer Review Panel, the EPSRC Science and Innovation Awards Selection Panel, special advisor on the Operational Research and Statistics Panel of the RAE 2008, and is or has been associate editor on the Journal of Operations Management, Operations Research, Mathematics of Operations Research, SIAM Journal on Optimization, and the IMA Journal of Numerical Analysis. He has published four books and over 40 peer reviewed journal articles.

Cambridge Judge Business School University of Cambridge Trumpington Street Cambridge CB2 1AG United Kingdom T +44(0)1223 339700 F +44(0)1223 339701 [email protected] www.jbs.cam.ac.uk

1

Agenda Item: 2.5


REPORT

Subject: Lead Governor Update Date: 7 September 2016

Author: Elizabeth Mitchell, Lead Governor

Lead Director: Julie Spence, Trust Chair Executive Summary:

• New Governors Induction • Strategy development • Governor Priorities • Governor networking • Diversity workshop • Carers • Thanks

Recommendations:

The Council of Governors are asked to note and discuss the contents of this report.

2




Links to BAF / Corporate Risk Register N/A


N/A




Partnership working and public engagement is discussed throughout. In particular the relationship between Governors, the public and the Board. It is the role of the Governors to represent the views of the public to the Board of Directors.



3

Lead Governor’s Report New Governors Induction An induction day for new governors was held on 16 June. It offered a good mix of information and discussion on the roles and responsibilities of governors in relation to Non Executive Directors and Executive directors; an overview of business strategy; a simple and informative guide to financial issues; discussion on how to reflect patient experience; the important role of governors in relating to Trust members; and how governors can be part of wider external communications. Not all new governors were able to attend but there are also opportunities for training through the Govern well programme. Strategy development Governors attended a joint governor and board development day on 22 June which explored the future for the Trust within the wider health economy. Governors brought a range of public, service user and carer perspectives to the discussion which we agreed was very ably facilitated by Christina Youell. Governors identified nine priorities for action which they would like CPFT to make progress on or achieve over the next three years. Governor Priorities:

1. Workforce Reduce dependency on and re-engage disengaged staff/leavers

2. Create partnerships with employers to enable greater understanding of mental health and long term condition problems and enable more people to be employed. A crucial part of delivering the recovery model of care which CPFT is committed to.

3. Invest in a sponsorship champion.

4. Hear the experiences of our service users/patients, especially those who are in transition from

secondary to primary care services

5. Develop income streams through trading & tendering beyond our boundaries; and access S106 funds.

6. Invest more in prevention and work with partners (Public Health) to achieve this.

7. Deliver the aspirations set out in the Uniting Care approach.

8. Map the routes into and around CPFT services, who does what.

9. Map CPFT Partnerships so that Governors can plug in via their own networks and influence.

It is encouraging that progress has already been made on key issues around communications, sponsorship, and through the engagement strategy more systematic interaction with service users and carers. There is still a lot to do. Governor networking Governors continue to use their networks to hear about concerns about services and identify communication gaps. Patient Participation Groups are particularly relevant groups to engage with. Governors have been part of the System Transformation developments with varying degrees of involvement and influence. Diversity workshop I attended the Board workshop on Diversity which enabled discussion of what needs to change in relation to truly reflecting the diverse population of Cambridgeshire and Peterborough. There are some actions we

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can help with during the next round of governor elections to ensure Council of Governor reflects the make up of our population and the wider health services CPFT now provides. Carers Governors continue to be involved in the Carer Programme Board and engage with the continuing work on promoting Triangle of Care in community services. The Sharing the Caring event in June was effective in linking with Carers Trust and a wider number of carers. Some of the information and activities available on the stalls will be repeated at the Annual Members Meeting on 7 September. Thanks Thanks go to all governors who are contributing to making sure there is a systematic public voice in CPFT. In particular, thanks go to Ian Arnott who has served his full term of nine years and so has invaluable insight into how CPFT has developed. Elizabeth Mitchell

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Agenda Item: 2.7


REPORT

Subject: Governor Leads / Committee Leads review Date: 7 September 2016

Author: Lauren MacIntyre, Trust Secretary

Lead Director: Julie Spence, Trust Chair Executive Summary: This report is in line with the Council of Governors’ decision in 2014 to have ‘governor leads’ for different subject areas and subcommittees. The scheme was implemented to enable involvement from all, allowing governors to focus on particular areas of interest and feedback relevant information to the rest of the Council of Governors. Please find attached the current list of governor leads for review; we are currently looking for one governor to fill the position of Recovery College Lead and one to fill the position of Business and Performance Committee Lead.

Recommendations:

The Council of Governors is asked to discuss this report and decide upon the new governor leads.

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Links to BAF / Corporate Risk Register As above


N/A


It is the duty of Governors to hold the NED’s to account to ensure that decisions are made in line with the Health and Social Care Act 2012 and in the best interests of the public. Without this level of assurance there could be Financial implications to the Trust.


It is the duty of Governors to hold the NED’s to account to ensure that decisions are made in line with the Health and Social Care Act 2012 and in the best interests of the public. Without this level of assurance there could be Legal implications to the Trust.


Council of Governors represent the views of the public.


Board of Directors


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Appendix 1

Area

Lead Deputy Lead Staff Lead NED Lead

Estates David Over John Cranston Alison Manton Children’s David Over Sarah Spall Sarah Hamilton Communications and Marketing Elizabeth Mitchell Andrea Grosbois Simon Burrows

Social Media and Website Elizabeth Mitchell Andrea Grosbois

Membership Margaret Johnson (Cambs) and Chris York (Peterborough)

Mark Batey Communications Team from October 2016

Food group/ patient experience Lesley Crosby Annie Ng

Recovery Vacant Mark Batey Sharon Gilfoyle, Tracey Tingey and Deborah Cohen

Jo Lucas

Carers Keith Grimwade Mike Collier Elaine Young I.T Bernie Gold John Cranston Richard Matt Research Elizabeth Mitchell Bernie Gold/ Margaret

Johnson Illiana Rokkou Patrick Sissons

Mental Health Act Mark Batey Orna Clark Simon Burrows

Committee Lead Deputy Lead Executive Lead Ned Lead

Audit and Assurance Committee John Cranston Margaret Johnson Scott Haldane Mike Hindmarch

Business and Performance Committee

Vacant Bernie Gold Scott Haldane Julian Baust

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Quality, Safety and Governance Committee

Elizabeth Mitchell Bernie Gold Melanie Coombes Sarah Hamilton

Charitable funds Margaret Johnson John Cranston Scott Haldane Simon Burrows

Nomination Committee Elizabeth Mitchell, Diana Wood, Eric Revell, John Cranston

Bernie Gold, Margaret Johnson

Lauren MacIntyre Julie Spence

Membership Group Chris York, Margaret Johnson, Mark Batey, Bernie Gold, Elizabeth Mitchell, Kirsty Trigg

Anyone can come along to this group.

Communications Team from October 2016

Appointment of External Auditors (every 5 years)

Jane Powell, John Cranston, Chris York, Elizabeth Mitchell

Scott Haldane Mike Hindmarch

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Agenda Item: 3.1


REPORT

Subject: Nominations Committee Update Date: 7 September 2016

Author: Julie Spence, Trust Chair Lead Director: Julie Spence, Trust Chair Executive Summary: This document includes a summary of the Nomination Committee Meeting held on 29th July 2016. Included as appendices are the following documents: Appendix i: The updated Board of Directors Skills Matrix document. Appendix ii: The following seven, proposed Non Executive Director Job Descriptions:

The Trust Chair Non Executive Director, The Deputy Trust Chair and Chair of the Business and

Performance Committee Non Executive Director and Senior Independent Director (SID) Non Executive Director and Chair of the Quality, Safety and Governance Committee Non Executive Director and Chair of the Audit and Assurance Committee Non Executive Director and Chair of the Charitable Funds Committee Non Executive Director

Recommendations:

The Council of Governors is asked to do the following: • Note the content of the Nominations Committee Summary • Review and comment upon the updated Board Skills Mix (Appendix i) • Review, comment upon and approve the updated Non Executive Director Job

Descriptions. (Appendix ii)

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The development, commissioning and implementation of a new integrated service strategy from April 2016: We will work with patients, carers and key stakeholders to change our services to deliver innovative, integrated person centred care and support that represents the highest possible standards in safety, effectiveness and personal experience of our services. The design, development and implementation of the future CPFT workforce: Our staff will be a highly engaged, well trained, flexible and productive workforce who are able to deliver more at better value. Maximising the contribution of IT and the Trust estate: We will develop highly innovative and effective ways to use technology and the Trust estate in support of person-centred care and maximising the financial benefit for CPFT A commercial and financial sustainability strategy: We will ensure sustainable services through delivery of a financial strategy based on increased cost effectiveness, value for money, growth and investment by 2019

Links to BAF / Corporate Risk Register Strategic Goal and Objective two.


The Non Executive Director job descriptions and the Board Skills Matrix are linked with the following documents: The Constitution. The Scheme of Delegation


Without assurances having been satisfied as set out within the committee. Individuals may not posses the capabilities to undertake their role which could impact upon the Trusts finances.


Without assurances having been satisfied as set out within the committee. Individuals may not posses the capabilities to undertake their role which could impact upon the Trusts legal standing.


Without assurances having been satisfied as set out within the job descriptions. Individuals may not posses the capabilities to undertake their role which could impact upon the Trusts public relations.

Committees / groups where this item has been presented before Nominations Committee

Has a QIA been completed? If yes provide brief details N/A

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Nominations Committee Summary, 29th July 2016

Non Executive Director (NED) Job Descriptions The Committee approved the seven Non Executive Director job descriptions which had been developed in line with best practice. It was noted that the documents were created according to the current filled positions and that if the responsibilities of individuals altered the elements of each responsibility could easily be mixed and matched to create new combined job descriptions. Board Skills Mix The Committee approved the Board Skills mix document subject to amendments. It was noted that the document was developed in line with best practice and would serve as a tool to provide opportunity for the identification of gaps in skills and diversity as well as the strengths of the Board of Directors. Cycle of Business and Terms of Reference Both updated documents were presented to the Committee who approved them. It was noted that the Terms of Reference will now be reviewed annually rather than every three years. The Committee have also invited the Director of People and Business Development to the Nominations Committee meeting in November to present a benchmarking paper on Non Executive Director pay.

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Agenda Item: 3.1.i

Board of Directors Skills Matrix As set out in the Constitution; 8.2 ‘The Board of Directors should have the appropriate balance of skills, experience, diversity, independence and knowledge to discharge its duties and responsibilities effectively’ When used correctly the Skills Matrix should provide opportunity for considered reflection and productive discussion by the Board of Directors ensuring that the following is achieved:

Identification of gaps in skills and diversity; Highlighting the strengths around the boardroom table to enable the directors’ skills to be

utilised to their fullest potential; Identification of potential professional development opportunities for board members; and Informing the recruitment process for future board members.

KEY: The Board of Directors is asked to fill in the matrix using a RAG rating system.

• Red = no/ very limited experience. • Amber = some experience. • Green = extensive experience.

This is with exception of the section on ‘Diversity’ for which the Board is required to complete in writing.

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Skill/ Expertise

Executive Director Non Executive Director

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SECTOR; Sectors worked in prior to or alongside the position held at CPFT.

NHS Social Care Public Services Voluntary/ Charitable Sector Political/ Local Government Private Sector Financial Accountancy Law Media Creative Industry Academia

POSITIONS HELD; Positions held prior to or alongside the current role of Executive Director or Non Executive Director at CPFT.

Partner/ President Vice President Chairman Vice Chairman Governor/ Trustee Executive Director Non Executive Directorship Senior Management Clinical Services Governance

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Skill/ Expertise


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indm

arch

Sim

on

Bur

row

s

Jo

Luca

s

Sar

ah

Ham

ilton

TECHNICAL SKILLS/ EXPERIENCE; Areas of strength, knowledge and expertise.

Senior Management; evaluating the performance of senior management and strategic human capital planning. Experience in organisational change management programmes.

Financial & Audit; ability to analyse statements and financial viability as well as contribution to financial planning, budgets and funding arrangements.

Senior Operational Management; overseeing the production of goods and/or provision of services ensuring a smooth, efficient service that meets the expectations and needs of customers and clients.

Commercial Leadership; leadership of an organisation through the commercial landscape. For example product development, identifying new market opportunities, determining the optimal pricing to balance profit with customer/client satisfaction, and directing marketing operations.

Marketing; maximisation of profits and services through developing sales strategies that match customer requirements. Promotion of products, services or ideas.

Market Research and Development; ability to assess and act upon market research data in line with organisations strategy.

Communications; the development and implementation of communication plans.

4

Skill/ Expertise


Aid

an

Tho

mas

Sco

tt H

alda

ne

Ste

phen

Le

good

Mel

anie

C

oom

bes

Che

ss

Den

man

Sar

ah

War

ner

Deb

orah

C

ohen

Julie

S

penc

e

Julia

n B

aust

Mik

e H

indm

arch

Sim

on

Bur

row

s

Jo

Luca

s

Sar

ah

Ham

ilton

Public Relations/ Engagement; successful reputation management. Proficient in influencing and expectation management.

Political Engagement; successful reputation management. Proficient in influencing and expectation management.

Stakeholder Engagement; successful engagement of stakeholders and consideration of their opinions in order to enhance company performance, improve decision-making and accountability.

Customer Care; the provision of excellent service through the fundamental understanding of their needs.

Patient Care; the provision of excellent care as well as a comprehensive understanding of individual needs.

Clinical Research; please provide details.

Other Research; please provide details.

Technology; knowledge of IT governance including privacy, data management and security.

5

Skill/ Expertise


Aid

an

Tho

mas

Sco

tt H

alda

ne

Ste

phen

Le

good

Mel

anie

C

oom

bes

Che

ss

Den

man

Sar

ah

War

ner

Deb

orah

C

ohen

Julie

S

penc

e

Julia

n B

aust

Mik

e H

indm

arch

Sim

on

Bur

row

s

Jo

Luca

s

Sar

ah

Ham

ilton

GOVERNANCE COMPETENCIES; Governance specific areas of knowledge and expertise

Performance management; the planning, monitoring and review of individuals work objectives and overall contribution to the organisation.

Risk Assessment/ Management; ability to identify and monitor risk and risk compliance. Including knowledge of legal and regulatory requirements.

Strategic thinking/ planning; the identification and critical assessment of any opportunities and threats to the organisation. Development of strategy in line with policies and business objectives.

Profile/ Reputation Enhancement; the understanding of behavioural consequences and upholding of organisations values.

Compliance focus and Policy Development; the identification of key issues and development of appropriate parameters within which the organisation should operate.

INTERPERSONAL SKILLS; Please answer with Yes or No with example if necessary.

Leadership; the ability to make decisions and take actions in the best interest of the organisation. Represent the organisation favourably and analyse issues to contribute to Board level solutions.

6

Skill/ Expertise


Aid

an

Tho

mas

Sco

tt H

alda

ne

Ste

phen

Le

good

Mel

anie

C

oom

bes

Che

ss

Den

man

Sar

ah

War

ner

Deb

orah

C

ohen

Julie

S

penc

e

Julia

n B

aust

Mik

e H

indm

arc

h Sim

on

Bur

row

s

Jo

Luca

s

Sar

ah

Ham

ilton

Ethics and Integrity; a full understanding of legal responsibility, maintain confidentiality and full declaration of any conflicts of interest.

Contribution; constructive and informed contribution to Board discussions, with Directors and other colleagues.

Negotiation; this could include the ability to drive stakeholder and Governor support for Board decisions.

Crisis Management; including the constructive management, leadership around solutions and contribution to strategy communication.

Courage; the ability to provide a constructive and informed challenge to the Board in all circumstances.

Job Description

Non Executive Director &

Trust Chair

August 2016

1

1. Professionalism - We will maintain the highest standards and develop ourselves and others...by demonstrating compassion and showing care, honesty and flexibility

2. Respect - We will create positive relationships...by being kind, open and collaborative 3. Innovation - We are forward thinking, research focused and effective...by using evidence

to shape the way we work 4. Dignity - We will treat you as an individual... by taking the time to hear, listen and

understand 5. Empowerment - We will support you...by enabling you to make effective, informed

decisions and to build your resilience and independence 6. The Trust Board has endorsed the concept of recovery as central working of the Trust.

Recovery is embedded in the vision and values of the Trust.

JOB DESCRIPTION

1. CPFT’s Mission:

2. NHS Values: 3. Our Values:

4. Post Details:

5. Key Relationships and Organisation Chart:

i. Chief Executive ii. Executive Directors iii. Trust Secretary iv. Non Executive Directors v. Council of Governors


↓

Trust Chair

Job Title: Trust Chair; Non Executive Director

Band: N/A

Accountable to: Council of Governors

Base: Trust Headquarters, Elizabeth House, Fulbourn Hospital

Our mission is to put people in control of their care. We will maximise opportunities for individuals and their families by enabling them to look beyond their limitations to achieve their goals and aspirations.

We are committed to the core NHS values, which we underpin in all that we do -

1. Working Together for Patients 2. Compassion 3. Respect & Dignity 4. Everyone Counts 5. Improving Lives 6. Commitment to Quality of Care

2

6. Non Executive Director Job Summary:

7. General Responsibilities & Duties:

1. To set the strategic direction of the organisation considering the views of the Council of Governors and agreeing appropriate plans to achieve them.

2. To exercise appropriate oversight over the execution of the agreed strategic objectives by the Executive Team.

3. To provide constructive, considered and appropriate challenge to the Board of Directors, monitoring performance reporting.

i. Non Executive Directors should satisfy themselves in regards to the integrity of operational, financial and clinical information provided.

ii. Non Executive Directors should satisfy themselves that all quality controls, systems of risk management as well as the governance of the Trust are robust and defensible.

4. To ensure that the Trust places patient safety at the heart of its work including the

reinforcement of a positive corporate culture by adopting exemplary behaviours within the Boardroom and across the Trust.

5. To support the Chief Executive and Executive Directors in promoting and upholding CPFT’s

mission, vision and values.

6. Where appropriate, and in order to ensure the provision and understanding of decisions, Non Executive Directors have a duty to elicit and consider external advice.

1. It is stated within the National Health Service Act 2006 that the duty of the Board and each

individual Director is to act with a view of promoting the success of the organisation as to maximise the benefits for both its members and the public.

2. As set out in the Code of Governance every NHS FT should be headed by an effective Board of Directors. The Board is collectively responsible for the performance of the NHS FT’

3. Non Executive Directors play a crucial role within the Board as, in addition to any specific

knowledge and skills that they may have they provide an independent perspective to the operational Executive Directors.

4. Furthermore it is the duty of a Non Executive Director to uphold the highest standards of

probity and integrity as per the Trust’s core values as well as encouraging good relations within the Boardroom.

5. Non Executive Directors are expected to participate fully as members of their assigned Sub

Committees as well as assuming the role of Committee Chair when appointed. As a representative of Cambridgeshire and Peterborough NHS Foundation Trust it is their responsibility to ensure their own awareness of the views of the Council of Governors in order to give good consideration to these views when advising senior management on all Trust related issues.

3

8. Constitutional Responsibility of all Committee members:

1. The Committee is constituted as a standing committee of the Trust Board in accordance

with its Constitution.

2. The Committee is authorised to act within the powers delegated to it as set out in the Trust’s Scheme of Delegation.

3. The Committee is authorised to act within the agreed Terms of Reference. All members of

staff are required to cooperate with any request made by the Committee.

4. The Committee is authorised by the Board of Directors to obtain such internal and external information as is necessary and expedient to the fulfilment of its functions.

4

1. The Trust Chair is expected to provide support and advice to the Chief Executive, where

necessary whilst respecting the Chief Executive’s responsibilities for executive matters.

2. The Trust Chair must hold to account the Chief Executive to ensure effective management and delivery the Trust’s strategic aims, objectives and direction.

Responsibilities of the Trust Chair 9. The Trust Chair Job Summary:

10. The relationship with the Chief Executive:

11. Representation and environment of CPFT:

12. Responsibility to the Board of Directors:

1. The Trust Chair must maintain an independent perspective.

2. Alongside the duties and responsibilities outlined in sections one to eight the Trust Chair

plays a vital role in promoting and upholding strong relationships between all members of the Board of Directors in order to ensure that it is effective in its tasks of setting and implementing the Trust’s direction and Strategy.

3. The Trust Chair must provide leadership to the Board of Directors and Council of

Governors so that a culture supportive of both the NHS and CPFT values is maintained and promoted throughout the organisation.

4. The Trust Chair must promote an ethos of transparency within CPFT.

1. The Trust Chair is expected to act as the Trust’s leading representative; working to build a

strong partnership with local authorities, national regulators, the local health economy and other stakeholders.

2. It is the duty of the Trust Chair to ensure balanced and effective communication with stakeholders, the public and MPs.

i. This includes maintaining a good knowledge of local issues and awareness of the

Trust’s role as a major local employer.

3. The Trust Chair should be aware of all relevant policies, both governmental and regulatory.

1. It is the duty of the Trust Chair to take a leading role in the determination of the composition

and structure of the Board of Directors including assisting in the appointment of Directors.

i. The Board of Directors should maintain good balance between Executive and Non Executive Directors experience and expertise.

ii. The Trust Chair should lead Director development, including assuring that a

comprehensive induction programme is in place.

2. The Trust Chair must engage the Board in assessing and improving its own performance, by reviewing its effectiveness on an annual basis.

3. The Trust Chair should identify gaps within the Board and ensure that an appropriate Board Development programme is produced.

5

13. Duties when leading the Board of Directors meetings:

14. Responsibility to the Council of Governors:

15. Duties when leading the Remuneration Committee and Nominations Committee:

1. The Trust Chair will chair the Council of Governors meetings, held quarterly.

2. The Trust Chair must use their connections with the Council of Governors and Board of

Directors to promote and uphold a harmonious and effective relationship between both.

3. The Trust Chair must ensure that the views and opinions of the Council of Governors are considered by the Board of Directors.

4. It is the Duty of the Trust Chair to ensure that the Trust’s Strategy and Objectives is

communicated successfully with Governors.

5. The Trust Chair will lead the Nominations Committee, held twice yearly.

i. The Trust Chair must ensure that the committee adheres to its Terms of Reference.

1. The Trust Chair will lead The Remuneration Committee and Nominations Committee

meetings. Ensuring that the following is fulfilled:

i. The Cycle of Business is accurate and current.

ii. Each Committee Agenda is a true reflection of the Cycle of Business.

1. The Trust Chair will lead the Board of Directors, meetings. Ensuring that the following is

fulfilled:


ii. Each Board agenda is a true reflection of the Cycle of Business and items are allocated sufficient time.

iii. Accurate and relevant information is communicated to the Board of Directors.

iv. The Trust Chair will encourage all board members to fully participate in considered

discussion and challenge; drawing on their skills and experience. Discussion is directed towards the emergence of a consensus.

v. Once a consensus has been reached regarding any matter the Committee Chair

must summarise the discussion to ensure clarity.

5. In the event of any equality of votes, the Trust Chair shall have a second or casting vote. The Trust Chair will Chair the bi monthly Board of Directors meetings.

4. The Trust Chair will conduct the annual appraisals for each Non Executive Director.

i. As discussed within each appraisal, it is the duty of the Trust Chair to set the

objectives for each Non Executive Director.

6

16. Personal Development:

17. Time Commitment:

18. Quality and Patient Safety:

1. It is the responsibility of the Trust Chair to ensure that they make sufficient time in order to

discharge their responsibilities effectively. This is contracted as 13 days per month.

2. The Trust Chair must inform the Trust Secretary of any on going time commitments prior to their employment.

3. If anything should occur that would impact on the ability to fulfil the time requirement then

the Trust Secretary should be notified as soon as is reasonably possible.

1. The Trust Chair is required to participate in the CPFT induction programme that will include

reading induction material, attending workshops, partnering Executive Directors and attending meetings.

2. It is a legal requirement for all of the Trust’s senior management team to be approved as a

Fit and Proper Person as part of the Terms of Employment, requirements for this are as follows:

i. The completion of an Enhanced Disclosure & Barring Service check (DBS)

ii. The Trust Chair must declare any standing interests to the Trust, including pecuniary interests. Completing a ‘Declaration of Interests’ form does this.

iii. The completion of a Fit and Proper Persons declaration.

3. As part of the on-going development of each Non Executive Director they are required to

visit services across the Trust and provide a report of their findings to the Board of Directors. 4. Completion of an annual appraisal with the Senior Independent Director and Lead Governor

is a mandatory requirement, conclusions from which will include any future objectives. As part of this, completion of the annual Board Self Assessment form is also a mandatory requirement.

iii. Accurate and relevant information is communicated to the Council of Governors.

v. The provision of time is allocated to each participating Director and Governor to

ensure full and considered discussion and challenge is achieved.

vi. Once a consensus has been reached regarding any matter the Trust Chair must summarise the discussion to ensure clarity.

2. In the event of any equality of votes, the Trust Chair shall have a second or casting vote

1. Protection of Children & Vulnerable Adults – To promote and safeguard the welfare of

children, young people and vulnerable adults. 7

To be noted:

• This is not an exhaustive list of duties and responsibilities, and the post holder may be required to undertake other duties, which fall within the grade of the job, in discussion with the manager.

• This job description will be reviewed regularly in the light of changing service requirements and any such changes will be discussed with the post holder.

• This post is subject to the Rehabilitation of Offenders Act 1974 (Exemption Order 1975)

and as such it will be necessary for a submission for disclosure to be made to the Criminal Records Bureau to check for previous criminal convictions. The Trust is committed to the fair treatment of its staff, potential staff or users in line with its Equal Opportunities Policy and policy statement on the recruitment of ex-offenders.

2. Implementation of NICE guidance and other statutory / best practice guidelines. (if

appropriate)

3. Infection Control - To be responsible for the prevention and control of infection.

4. Incident reporting - To report any incidents of harm or near miss in line with the Trust’s incident reporting policy ensuring appropriate actions are taken to reduce the risk of reoccurrence.

5. To be aware of the responsibility of all employees to maintain a safe and healthy

environment for patients/ clients, visitors and staff.

6. To contribute to the identification, management and reduction of risk in the area of responsibility.

7. To ensure day to day practice reflects the highest standards of governance, clinical

effectiveness, safety and patient experience.

8. To ensure monitoring of quality and compliance with standards is demonstrable within the service on an ongoing basis.

8

Job Description

Non Executive Director, Deputy Trust Chair &

Chair of the Business & Performance Committee

August 2016

1


2. Respect - We will create positive relationships...by being kind, open and collaborative 3. Innovation - We are forward thinking, research focused and effective...by using evidence to

shape the way we work 4. Dignity - We will treat you as an individual... by taking the time to hear, listen and




JOB DESCRIPTION



4. Post Details:


Job Title: Non Executive Director, Deputy Trust Chair and Chair of the Business & Performance Committee

Band: N/A

Accountable to: Trust Chair, Council of Governors


i. Trust Chair ii. Executive Directors iii. The Trust Secretary iv. Non Executive Directors v. Council of Governors vi. The Director of Finance vii. The Director of People

and Business Development


↓

Trust Chair,

↓

Non Executive Director, Deputy Trust Chair and Chair of the Business & Performance

Committee




2




individual Director is to act with a view of promoting the success of the corporation so as to maximise the benefits for both its members and the public.



knowledge and skills that they may have they provide an independent perspective to the operational Executive Directors .




Committees as well as assuming the role of Committee Chair when appointed. Also, as a representative of the Cambridgeshire and Peterborough Foundation Trust it is their responsibility to ensure their own awareness of the views of the Council of Governors in order to give good consideration to these views when advising the Senior Management on all Trust related issues.

1. To set the strategic direction of the organisation considering the views of the Council of

Governors and agreeing appropriate plans to achieve them.




ii. Non Executive Directors should satisfy themselves that all quality controls, systems

of risk management as well as the governance of the Trust are robust and defensible.






7. All Non Executive Directors are invited to become the ‘champion’ of specific areas; such as

Research & Development, Children’s Services, the Mental Health Act, the Recovery College or other areas of interest and expertise.

3

8. Council of Governors:


10. Responsibilities of the Chair of the Business & Performance Committee:

1. All Non Executive Directors should ensure that they attend The Council of Governors

meetings, held quarterly.

i. In doing so they should consider the views and interests of the Council of Governors, bearing in mind that this viewpoint is representative of the Trust’s Membership, Service Users, Carers and Staff.

2. All Non Executive Directors regarding all Performance, Strategy and Governance related issues should maintain an ongoing dialogue with the Council of Governors.

i. Non Executive Directors should ensure that any feedback provided by the Council of

Governors regarding the Trust’s performance is communicated to the Board of Directors and other members of Senior Management effectively.

1. The Committee Chair and the Lead Executive Director of the Committee are jointly

responsible to ensure that the Committee adheres to its Terms of Reference.

2. The Committee Chair should ensure that the Committee provides assurance to the Board of Directors in relation to all aspects of Business as outlined in the Terms of Reference.

3. As Committee Chair it is your responsibility to ensure the overall effectiveness of the

Committee; findings and concerns should be raised with the Board of Directors when appropriate.

i. The Committee Chair is to present a report stating the activities of the Committee, to

the Board of Directors after each meeting.

ii. In particular, the Committee Chair must draw to the attention of the Board any issues that require disclosure to the full Board of Directors.

4. The Committee Chair must ensure that the long term business and financial strategy is

delivered and updated accordingly. 5. The Committee Chair will lead the bi monthly Business & Performance Committee








4

11. The Responsibilities of the Deputy Trust Chair:



ii. Each committee agenda is a true reflection of the Cycle of Business and items are allocated sufficient time.


iv. The Committee Chair will encourage all committee members to fully participate in

considered discussion and challenge; drawing on their skills and experience. Discussion is directed towards the emergence of a consensus.



6. In the event of any equality of votes, the Committee Chair shall have a second or casting vote.

1. It is the responsibility of the Deputy Trust Chair to deputise for the Trust Chair whenever

necessary. This includes chairing the Board of Directors, Council of Governors, Remuneration Committee or Nominations Committee Meetings.

2. The Deputy Trust Chair will preside at Board of Directors meetings in the following circumstances:

i. In the absence of the Trust Chair.

ii. In the event that the Trust Chair declares a pecuniary interest that would prevent

their participation in the consideration and discussion of a particular subject.

3. The Deputy Trust Chair would preside at Council of Governors meetings in the following circumstances:

i. In the Absence of the Trust Chair.

ii. In the event that the Council of governors are asked to discuss the remuneration, conduct or terms of office of the Trust Chair.

iii. In the event that the Council discuss the reappointment of the current Trust Chair.

iv. In the event that the Trust Chair declares a pecuniary interest that would prevent


1. All Non Executive Directors are required to participate in the CPFT induction programme

that will include reading induction material, attending workshops, partnering Executive Directors and attending meetings.

2. It is a legal requirement for all of the Trust’s senior management team to be approved as a Fit and Proper Person as part of the Terms of Employment, requirements for this are as follows:

5




ii. All Non Executive Directors must declare any standing interests to the Trust,

including pecuniary interests. Completing a ‘Declaration of Interests’ form does this.


3. As part of the on-going development of each Non Executive Director they are required to visit services across the Trust and provide a report of their findings to the Board of Directors.

4. Completion of an annual appraisal with the Trust Chair is mandatory, conclusions from which will include any future objectives. As part of this, completion of the annual Board Self Assessment form is also a mandatory requirement.

1. It is the responsibility of the Non Executive Director, Deputy Trust Chair and Chair of the

Business & Performance Committee to ensure that they make sufficient time in order to discharge their responsibilities effectively. This is contracted as 3 days per month.

2. Non Executive Director, Deputy Trust Chair and Chair of the Business & Performance Committee must inform the Trust Secretary of any on going time commitments prior to their employment.



1. Protection of Children & Vulnerable Adults – To promote and safeguard the welfare of children, young people and vulnerable adults.

2. Implementation of NICE guidance and other statutory / best practice guidelines. (if appropriate)


4. Incident reporting - To report any incidents of harm or near miss in line with the Trust’s

incident reporting policy ensuring appropriate actions are taken to reduce the risk of reoccurrence.

5. To be aware of the responsibility of all employees to maintain a safe and healthy environment for patients/ clients, visitors and staff.

6. To contribute to the identification, management and reduction of risk in the area of

responsibility.

7. To ensure day to day practice reflects the highest standards of governance, clinical effectiveness, safety and patient experience.

8. To ensure monitoring of quality and compliance with standards is demonstrable within the

service on an ongoing basis.

6

To be noted:





7

Job Description & Person Specification

Non Executive Director

& Senior Independent Director

August 2016

1







JOB DESCRIPTION



4. Post Details:


Job Title: Non Executive Director & Senior Independent Director

Band: N/A



i. Trust Chair ii. Executive Directors iii. The Trust Secretary iv. Non Executive Directors v. Council of Governors


↓

Trust Chair

↓

Non Executive Director & Senior Independent Director




2
























3









1. Each Committee is constituted as a standing committee of the Trust Board in accordance


2. Each Committee is authorised to act within the powers delegated to it as set out in the Trust’s Scheme of Delegation.

3. Each Committee is authorised to act within its agreed Terms of Reference. All members of


4. Each Committee is authorised by the Board of Directors to obtain such internal and external information as is necessary and expedient to the fulfilment of its functions.

7. All Non Executive Directors are invited to become the ‘champion’ of specific areas; such as Research & Development, Children’s Services, the Mental Health Act, the Recovery College or other areas of interest and expertise.

4

Responsibilities of the Senior Independent Director (SID)

10. Responsibilities to the Trust Chair

11. Responsibilities to the Board of Directors:

1. The Senior Independent Director has a key role in supporting the Trust Chair in leading the

Board of Directors.

2. It falls to the Senior Independent Director to act as a sounding board for the Trust Chair.

3. The Senior Independent Director must act as an intermediary between the Trust Chair and Directors wherever necessary.

4. Whilst the Council of Governors determines the process of the Trust Chairs’ Annual

Appraisal the Senior Independent Director is responsible for carrying it out.

i. This includes holding an annual meeting with the Non Executive Directors.

ii. Setting the Trust Chairs’ Objectives.

5. The Senior Independent Director is responsible for holding any meeting in absence of the Trust Chair with the Non Executive Directors. Reasons for this would include the following:

i. During a reappointment process of the Trust Chair.

ii. Should the Governors express concern regarding the Trust Chair.

6. It is the responsibility of the Senior Independent Director to liaise with the Chief Executive and Trust Chair and at times of stress, intervene if appropriate to resolve a problem. This includes:

i. If the relationship between the Chief Executive and Trust Chair is regarded as

particularly close the SID must step forward to provide a link.

ii. If there is ever a disagreement or rift between the Chief Executive and Trust Chair the Senior Independent Director must step forward to mediate.

7. The Senior Independent Director must ensure that the Trust Chair allocates sufficient time

for succession planning.

1. The Senior Independent Director role is particularly important if and when the Board

undergoes a period of stress. In such periods the SID may be called upon to do the following:

i. Work as an intermediary between the Chief Executive, Trust Chair, Non Executive

Directors, Stakeholders and Governors.

ii. Address any concerns or issues that may not have been properly addressed through the usual channels of communication.

5

12. Responsibilities to the Council of Governors: 13. Personal Development:


15. Quality and Patient Safety





ii. All Non Executive Directors must declare any standing interests to the Trust, including pecuniary interests. Completing a ‘Declaration of Interests’ form does this.



visit services across the Trust and provide a report of their findings to the Board of Directors.


1. It is the responsibility of the Senior Independent Director to ensure that they make sufficient

time in order to discharge their responsibilities effectively. This is contracted as 3 days per month.

2. The Senior Independent Director must inform the Trust Secretary of any on going time commitments prior to their employment.




children, young people and vulnerable adults.

1. The Senior Independent Director must maintain sufficient contact with the Council of

Governors, including attendance of meetings to obtain a clear understanding of governor’s views on the key strategic and performance issues surrounding the Trust.

2. Where it is not appropriate to involve the Trust Chair, for example the setting of the Chairs’ objectives, any problems with the Trust Chair. The Senior Independent Director must be available to governors as a source or guidance and advice.

6

To be noted:











responsibility.


7

Job Description

Non Executive Director & Chair of the Quality, Safety and Governance Committee

August 2016

1







JOB DESCRIPTION



4. Post Details:


Job Title: Non Executive Director & Chair of the Quality, Safety and Governance

Committee

Band: N/A



i. Trust Chair ii. Executive Directors iii. The Trust Secretary iv. Non Executive Directors v. Council of Governors vi. The Director of Nursing and Quality vii. The Director of People



↓

Trust Chair

↓

Non Executive Director & Chair of the Quality,

Safety and Governance Committee


We are committed to the core NHS values, which we underpin in all that we do - 1. Working Together for Patients 2. Compassion 3. Respect & Dignity 4. Everyone Counts 5. Improving Lives 6. Commitment to Quality of Care

2
























3



10. Responsibilities of the Chair of the Quality, Safety and Governance Committee:







1. The Chair and the Lead Executive Director of the Committee are jointly responsible to

ensure that the Committee adheres to its Terms of Reference. 2. The Committee Chair must ensure that the Committee provide assurance to the Board of

Directors that high standards of care are provided by the Foundation Trust and, in particular, that adequate and appropriate governance structures, processes and controls are in place throughout the Trust as outlined in the Terms of Reference.

3. It is the responsibility of the Committee Chair to ensure the overall effectiveness of the












4



1. All Non Executive Directors are required to participate in the CPFT induction programme that

will include reading induction material, attending workshops, partnering Executive Directors and attending meetings.





3. As part of the on-going development of each Non Executive Director they are required to visit

services across the Trust and provide a report of their findings to the Board of Directors.


1. It is the responsibility of the Non Executive Director & Chair of the Quality, Safety and

Governance Committee to ensure that sufficient time is allocated to discharge their responsibilities effectively. This is contracted as 3 days per month.

2. The Non Executive Director & Chair of the Quality, Safety and Governance Committee must inform the Trust Secretary of any on going time commitments prior to their employment.

3. If anything should occur that would impact on the ability to fulfil the time requirement then the

Trust Secretary should be notified as soon as is reasonably possible.

4. The Committee Chair will lead the bi monthly Quality, Safety and Governance Committee meetings. Ensuring that the following is fulfilled:









5


To be noted:













responsibility.




6

Job Description

Non Executive Director & Chair of the Audit & Assurance Committee

August 2016

1







JOB DESCRIPTION



4. Post Details:


Job Title: Non Executive Director & Chair of the Audit & Assurance Committee

Band: N/A



i. Trust Chair ii. Executive Directors iii. The Trust Secretary iv. Non Executive Directors v. Council of Governors vi. The Director of Finance


↓

Trust Chair,

↓





2
























3



10. Responsibilities of the Chair of the Audit and Assurance Committee:








ensure that the Committee adheres to its Terms of Reference.

2. The Committee Chair must ensure that the following is delivered in line within its Terms of Reference:

i. Governance, Risk Management and Internal Control. ii. Internal Audit iii. External Audit iv. Financial Reporting including the Annual Report, Annual Governance Statement,

Statutory Accounts and Quality Accounts. v. Counter Fraud & Security Management Service vi. Compliance with relevant regulatory, legal and code of conduct requirements vii. Review of Tender Waivers, Losses and Compensations, Registers of Gifts and

Hospitality and approve appropriate write offs.









4








3. As part of the on-going development of each Non Executive Director it is a requirement to



3. The Committee Chair must ensure the overall effectiveness of the Committee; findings and concerns should be raised with the Board of Directors when appropriate.

4. The Committee Chair must present a report stating the activities of the Committee, to the

Board of Directors after each meeting in support of the Annual Governance Statement.

i. In particular, the Committee Chair must draw to the attention of the Board any issues that require disclosure to the full Board of Directors.

5. The Committee meets quarterly with an additional meeting to approve the annual report.

Ensuring that the following is fulfilled: i. The Cycle of Business is accurate and current.








5



To be noted:





1. It is the responsibility of the Non Executive Director & Chair of the Charitable Funds

Committee to ensure that they make sufficient time in order to discharge their responsibilities effectively. This is contracted as 3 days per month.

2. The Non Executive Director & Chair of the Audit & Assurance Committee must inform the Trust Secretary of any on going time commitments prior to their employment.











responsibility.




6

Job Description

Non Executive Director & Chair of the Charitable Funds Committee

August 2016

1







JOB DESCRIPTION



4. Post Details:


Job Title: Non Executive Director & Chair of the Charitable Funds Committee

Band: N/A





↓

Trust Chair,

↓





2
























3


9. Constitutional Responsibility of all Committee members: 10. Responsibilities of the Chair of the Charitable Funds Committee:









2. The Committee Chair should ensure that the Committee provides assurance to the Board of Directors in relation to the protection and investment of charitable funds as outlined in the Terms of Reference.

3. The Committee Chair must ensure the overall effectiveness of the Committee; findings and

concerns should be raised with the Board of Directors when appropriate.

i. The Committee Chair is to present a report stating the activities of the Committee, to the Board of Directors after each meeting.









4











ii. In particular, the Committee Chair must draw to the attention of the Board any issues

that require disclosure to the full Board of Directors.

4. The Committee Chair must ensure that the investment and reserves policies, as set out by the Board of Directors are considered by the Committee all times.

5. The Committee Chair will lead the quarterly Charitable Funds Committee meetings. Ensuring

that the following is fulfilled:









5



To be noted:







2. The Non executive Director & Chair of the Charitable Funds Committee must inform the Trust Secretary of any on going time commitments prior to their employment.











responsibility.




6

Job Description


August 2016

1







JOB DESCRIPTION



4. Post Details:


Job Title: Non Executive Director

Band: N/A




Trust Chair, Council of Governors

↓





2
























3












4. Complete an annual appraisal with the Trust Chair, conclusions from which will include any future objectives. As part of this, completion of the annual Board Self Assessment form is also a mandatory requirement.



i. In doing so they should consider the views and interests of the Council of Governors, bearing in mind that this viewpoint is representative of the Trusts Membership, Service Users, Carers and Staff.








staff are required to cooperate with any request made by each Committee.


4



To be noted:





1. It is the responsibility of the Non Executive Director to ensure that they make sufficient time in

order to discharge their responsibilities effectively.

2. The Non Executive Director must inform the Trust Secretary of any on going time commitments prior to their employment.











responsibility.




5

1

Agenda Item: 3.2


REPORT

Subject: Fit and Proper Person Annual Declaration Date: 7 September 2016


Lead Director: Julie Spence, Trust Chair Executive Summary: In line with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 5; all Directors and equivalents, on appointment to the Trust must be fit and proper persons.

Recommendations:

The Council of Governors’ is asked to note the content of this report.

2




Links to BAF / Corporate Risk Register

Without ensuring that each member of the Board of Directors is a Fit and Proper person they are not eligible to carry out their duties which would impact upon the Trusts integrity.


Health and Social Care Act 2008 (Regulated Activities)


Without ensuring that each member of the Board of Directors is a Fit and Proper person they are not eligible to carry out their duties which, in turn would impact upon the Trusts Finances.


Without ensuring that each member of the Board of Directors is a Fit and Proper person The Trust would breech the Health and Social Care Act 2012


Without ensuring that each member of the Board of Directors is a Fit and Proper person Trust with the Public and Stakeholders



3

Fit and Proper Person

In line with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 5; all Directors and equivalents, on appointment to the Trust must be fit and proper persons. This means that they must meet the below criteria:

a. the individual is of good character,

b. the individual has the qualifications, competence, skills and experience which are necessary for the relevant office or position or the work for which they are employed,

c. the individual is able by reason of their health, after reasonable adjustments are made, of properly performing tasks which are intrinsic to the office or position for which they are appointed or to the work for which they are employed,

d. the individual has not been responsible for, been privy to, contributed to or facilitated any serious misconduct or mismanagement (whether unlawful or not) in the course of carrying on a regulated activity or providing a service elsewhere which, if provided in England, would be a regulated activity, and

e. none of the grounds of unfitness specified below apply to the individual:

1. The person is an undischarged bankrupt or a person whose estate has had sequestration awarded in respect of it and who has not been discharged.

2. The person is the subject of a bankruptcy restrictions order or an interim bankruptcy restrictions order or an order to like effect made in Scotland or Northern Ireland.

3. The person is a person to whom a moratorium period under a debt relief order applies under Part VIIA (debt relief orders) of the Insolvency Act 1986.

4. The person has made a composition or arrangement with, or granted a trust deed for, creditors and not been discharged in respect of it.

5. The person is included in the children's barred list or the adults' barred list maintained under section 2 of the Safeguarding Vulnerable Groups Act 2006, or in any corresponding list maintained under an equivalent enactment in force in Scotland or Northern Ireland.

6. The person is prohibited from holding the relevant office or position, or in the case of an individual from carrying on the regulated activity, by or under any enactment.

As Trust Chair, I retain responsibility to discharge the requirement placed on the Trust to ensure that all directors meet the fitness test. I am reassured that the recent appointment of Sarah Hamilton has followed a robust process and that she meets Fit and Proper Person requirements.

As Trust Chair I am also reassured that the Board of Directors continues to meet the fitness test. Each member of the Board of Directors has followed a robust process and all members meet the Fit and Proper Person requirements.

As per Trust policy, DBS checks should be renewed every three years. Therefore the Trust Secretariat will begin this process.

In line with best practice, all governors and committees should be Fit and Proper Persons. Therefore the Trust Secretariat will continue to work with governors to ensure that this requirement is met.

1

Agenda Item: 4.1


REPORT

Subject: Integrated Performance Report – Summary

Date: 7 September 2016 Author: Jonathon Artingstall – Head of Information and Performance Lead Director: Scott Haldane – Director of Finance Executive Summary: The existing operational performance framework within the Trust utilises an integrated report, showing high level summary data across a range of measures.

The attached report is a brief summary of the key issues on the latest Trust wide version of this Integrated Performance Report, reporting data for the first quarter of FY 1516. This report includes brief problem analysis for indicators and also a summary of the plans in place to rectify issues.

Additionally, the focus of this report has been enhanced, to provide insight into areas that demonstrate good practice and performance, to give a more rounded view of progress within the Trust.

Recommendations:

The Council of Governors is asked to note the content of this report.

2





The information supports the mitigation of risks on the Corporate Risk Register and BAF.


N/A



Partnership working and public engagement implications / impact No


Business and Performance Committee Quality, Safety and Governance Committee


1

Agenda Item: 4.1.i Current Issues

Indicator Lead Director This

Period YTD Target Root Cause Remedial Actions and Trajectory for Improvement

Recovery Date

Patient Food Melanie Coombes (DoN)

62.4% (end Jun)

61.6% =>75% • Dissatisfaction with cooked

chill meals • Ambivalence from patients on

some Specialists units

• Discussion taking place with contracted meal providers

• Locally prepared food trialled within inpatient units

• Menu patterns reviewed and refreshed.

• Reestablish CPFT Food group in Q2

Q4 1617

Diagnosis recording

Chess Denman (MD)

72.2% 72.2% =>95%

• Diagnosis not being recorded as part of standard RiO process.

• Not all staff accept need for diagnosis as central to their work.

• Clinical Dashboard usage not universal across all staff

• ICD10 coding guidance for RiO reissued to all staff

• Individual Clinical Dashboards now availble for all staff, outlining missing KPIs including diagnosis

• 8 months continual performance growth

Q4 1617

% Spend Temporary Staffing Agency

Stephen Legood (DoBD&P)

7.0% (end Q1)

7.0% <4%

• ICD transitioning staff agency rate much higher than original CPFT rate.

• New target specified by Monitor for agency nursing spend.

• Newly launched services requiring immediate staffing

• Proactive communication around use of bank verses agency staff

• Enhanced monitoring at monthly PREs of agency spending

• Successful contract negotiation with agency providers to reduce rate.

Dec -16

2



Recovery Date

% Patients with a HoNOS with Cluster Review Period

Chess Denman (MD)

71.7% (end Q1)

71.7% >95%

• Cluster reviews not occuring within guidance timelines

• Lack of transparency within legacy reporting around review date requirements

• Clusters within review needed for implementatoin of MH PbR

• Clinical Dashboard usage becoming more established

• Improvements seen month on month for 5 months.

Sep 16

% Vacancy rate Stephen Legood

(DoBD&P) 5.0% 5.0% <4.35%

• CPFT affected by national difficulty recruiting

• Internal movement of staff to newly created services

• Continue focussed recruitment days

• No patterns in leaver interviews forming

Mar 17

A selection of areas of postive performance

Indicator Lead Director This Period YTD Target Comments

CRHT Gate Keeping

Sarah Warner (COO)

100% 100% >95%

• Measures crisis team assessment and involvement in the decision to admit a person into an inpatient bed.

• Robust gatekeeping processes and methods in place • Three months of 100% compliance

Service User CPA review 12 months

Chess Denman (MD)

97.1% (end Q1)

97.1% >95%

• Monitor target, measuring formal review of service users in the Care Program Approach

• Continued consistent postive performance, through robust routine reporting and monitoring methods

Safe Staffing Levels (Registered and Unregistered)

Melanie Coombes (DoN)

107% 107% >80% • Trust wide monitoring and reporting of data demonstrates good practice against this patient safety measure

3


• Reporting includes the physical health wards of the Integrated Care Directorate.

CAMHS Choice Waiting List Over 18 Weeks

Sarah Warner (COO)

0% (end Q1)

0% (end Q1)

0%

• Plans and outcomes materialising as expected. • Sustained performance on maintaing CAMHS Choice Waiting List below 18 weeks • Continued reduction in CAMHS Choice waiting times, now around 40 days for non

urgent cases

% Inpatient Physical Health checks within 24 hours

Chess Denman (MD)

97.4% (end Q1)

97.4% >95%

• Effective and timely reporting through CPFT data warehouse • Proactive Business Support, working closely with ward managers • Legacy issue of out of hours admissions resolved

EIP Access Target - % waiting > 2 weeks (from April 2016)

Sarah Warner (COO)

73.7% 73.7% 50% > 2 weeks

• New Access and Wait times target, implemented April 2016, measuring timelienss of early intervention in psychosis services.

1

Agenda Item: 4.2.i


REPORT

Subject: Finance Report Q1 Date: 7 September 2016

Author: Derek McNally, Deputy Director of Finance

Lead Director: Scott Haldane, Director of Finance Executive Summary: The attached report is a Summary Finance Report for Month 3. This highlights the following:-

• Month 3 deficit is £0.030m against a planned deficit of £0.044m. • The Year to Date performance is now £6k ahead of plan, with a £0.190m deficit against a

planned deficit of £0.197m. • CIP performance in the month is £0.637m against the plan of £0.530m. The over

performance in month improves the Year to Date delivery to £1.481m against a plan of £1.589m. However there is a higher than desired reliance on non-recurrent savings, for which work is ongoing to replace these with recurrent savings.

• Financial Sustainability Risk Rating for the month is a 3, against a planned 3. • Cash balance above plan at the end of the month.

Recommendations:


2






N/A


Report on progress against financial plan for FY17



N/A

Committees / groups where this item has been presented before Trust Board

Has a QIA been completed? If yes provide brief details

N/A

Finance Report to 30 June (Month 3)

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Agenda Item: 4.2.ii

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Corporate services Finance Report M3

Finance Report to 30 June 2016

2

Contents:

Executive Summary

Appendix 1 – Directorate Report

Appendix 2 – Cost Improvement Programme

Scott Haldane

Director of Finance


3

Executive Summary

Summary of PerformanceAt the end of period 3, the Trust is reporting a net deficit of £0.190m, which is £0.007m better than plan. This financial performance generates a Financial Sustainability Risk Rating of 3 for the month.

Key I&E issues:• Income – shortfall in month 3 of £0.243m against plan,

£0.271m relating to Cost Dependent services, partially mitigated by small over-recovery in various other services.

• Pay Expenditure – pay costs are £0.280m higher than plan in the period. After an improvement in month 2, Agency costs have returned to levels greater than the Agency ‘cap’ set by NHSI. The cause of this is being investigated.

• Non Pay Expenditure – spend on OATs is £0.075m above plan in month 3, due to higher number of packages than budgeted, partly as a result of the fire remedial works at the Cavell Centre. The Trust continues to investigate contractual terms within the PFI contract that will allow these additional costs to be offset by reduced PFI costs.

Key Balance Sheet issues:• Capex – in-month capital expenditure is £0.236m below plan,

due to slippage on schemes including Agile working. As the next phase of the business case has now been approved, increased spend will occur in Quarter 2.

• Cash – actual cash held at the end of month 3 is £3m above plan due to favourable working capital variances.

Key Risks and Actions:• Income – number of smaller contracts yet to be finalised. Action to improve

recovery against Variable Income targets.• Expenditure – continue to focus on TSS services project to reduce Agency

expenditure to at least ceiling levels.• CIP – further work to finalise plans and address unidentified gap.

Key Directorate issues:• Clinical – underspend in month 3 of £0.023m. Made up of

small over and under spends in each Directorate, see Appendix 1 for detailed analysis.

• Corporate – overspend of £0.105m in month 3, predominantly due to non delivery of CIP.

Key FSRR issues:• FSRR actual is a 3 for the period against a planned 3.

CIP:• Over delivery of £107k against plan in month 3 bringing YTD performance to

£108k under plan – however see Appendix 2 for how this underperformance can be mitigated.

• Higher than desired reliance on non-recurrent mitigating savings. Work is ongoing to address this and identify further recurrent schemes.

Summary Key Financial Performance Indicators

Month 3 & Year to date Plan Actual Plan to

DateActual to

Date£m £m £m £m £m £m

Income 16.285 16.041 (0.243) 48.896 48.058 (0.838)Operating Expenditure (15.628) (15.380) 0.248 (46.991) (46.171) 0.820EBITDA 0.656 0.661 0.005 1.905 1.887 (0.018)Financing (0.700) (0.691) 0.009 (2.102) (2.077) 0.025Net Surplus/(deficit) (0.044) (0.030) 0.013 (0.197) (0.190) 0.007EBITDA % 4.03% 4.12% 0.09% 3.90% 3.93% 0.03%I&E Surplus Margin % -0.27% -0.19% 0.08% -0.40% -0.39% 0.01%

Agency Spend (0.617) (0.907) (0.290) (1.851) (2.077) (0.226)Agency Spend % 5.5% 8.0% -2.5% 5.4% 7.0% -1.6%Capex 0.422 0.186 (0.236) 1.262 0.506 (0.756)Cash and Cash Equivalents 10.000 13.000 3.000 10.000 13.000 3.000Cost Improvement Programme 0.530 0.637 0.107 1.589 1.481 (0.108)FSRR 3 3 3 3

Month 3 Year to Date

Variance Favourable / (Adverse)



Appendix 1 - Directorate Report

In-Month Variations

The Clinical Directorates are reporting a £23k in-month positive variance against plan, with a YTD £148k positive variance:

- Adult Directorate is showing an underspend of £10k in-month. This is delivered by vacancies within the Community teams, and increased income for Springbank. This underspend is reduced by an overspend in OATs packages (£59k), as discussed in Appendix 1.2.

- Children’s Directorate has a £12k underspend in Month 3, generated by vacancies in a number of services which are being actively recruited to.

- Specialist Directorate has a £11k underspend in the month. This is due to savings from vacancies across a range of services (£43k), and over-recovery of income by the Phoenix Centre (£35k), reduced by the inclusion of a provision to reflect the likely reduction in contract value as discussed in Appendix 1.1.

- Integrated Care Directorate is reporting an overspend of £10k in month. Continuing savings from Specialist pathway teams, NT’s and DIST have offset ongoing cost pressures from agency spend on inpatient units. They have also non-recurrently mitigated the M3 CIP target.

The Executive Portfolios are reporting an overspend of £105k in the month. The overspend in the Chief Exec portfolio relates to the M3 staff costs for the new Associate Director of Corporate Affairs post and a higher than expected System Transformation Fund charge, which is currently being challenged. The overspend within the Finance Director portfolio relates to non-delivery of CIP, predominantly in respect of the SERCO contract as this saving can not be realised until contract negotiations are concluded, which is expected by the end of July. The overspend in the Medical Director portfolio is due to Agency costs within the Pharmacy department which is covering maternity leave. The overspend in the Director of People Services directorate relates to non-delivery of CIP.


Appendix 2 -Cost Improvement Programme

5

Month 3 target has been over delivered, bringing the YTD delivery to only £108k behind plan. If the recurrent SERCO savings were reflected in this position this would increase delivery by £125k YTD which would give a YTD performance slightly above plan. See Appendix 1.2 for why this saving is currently not included.

Delivery is still heavily reliant on non recurrent delivery, however only £420k of the full year target of £6.355m has not been identified for recurrent delivery, therefore some of this variance is due to the timing slippage of some of the recurrent schemes, which is being mitigated by non recurrent delivery

The table below shows the analysis of performance by Directorate and also type of Scheme. The ‘target’ columns relate to the overall CIP target required to be delivered, and the planned columns show the value of recurrent schemes currently identified to deliver this, therefore the difference between these is the unidentified balance, for which work continues to identify plans to deliver.

1

Agenda Item: 4.2.iii


REPORT

Subject: Review Quarterly compliance returns to NHS Improvement

Date: 7 September 2016


Lead Director: Scott Haldane, Director of Finance Executive Summary: The Quarter 1 Governance Return to NHS Improvement was self-certified by the Trust Board and submitted to NHS Improvement on 29th July 2016. The full report is attached which demonstrates the Trusts position against each of the indicators.

Recommendations:

The Council of Governors is asked to:

• To note the Board statements submitted to NHS Improvement on 29th July.

2



Maximising the contribution of IT and the Trust estate: We will develop highly innovative and effective ways to use technology and the Trust estate in support of person-centred care and maximising the financial benefit for CPFT. A commercial and financial sustainability strategy: We will ensure sustainable services through delivery of a financial strategy based on increased cost effectiveness, value for money, growth and investment by 2019.



Compliance with NHSI Requirements


Legal implications / impact Compliance with Licence Conditions

Partnership working and public engagement implications / impact N/A


Board of Directors


NHS ImprovementQuarterly Performance Report and Board Statements

Agenda Item: 4.2.iv

Corporate services

NHS Improvement Quarterly Performance Report and BoardStatements

2

Quarter 1 2016/17

July 2016

ContentsIntroduction , overview and recommendations. page 2-3Deriving the governance risk rating page 4-7Other governance exception items page 8Board statement submission page 9 -10

Scott Haldane Director of Finance

Corporate services

Introduction

3

Purpose of this document

The purpose of the paper is to present the quarter 1 of 2016/17 compliance position and the Board Statement that the Trust will submit to NHS Improvement, subject to its approval, on 29th April 2016.

Overview and commentary

As part of the in year quarterly monitoring, NHS Foundation Trusts are required to confirm Board statements in respect of Finance and Governance, these are as set out below for information.

• For Finance that:

The Board anticipates that the trust will continue to maintain a continuity of service risk rating (COSSR) of at least 3 over the next 12 months

The Board anticipates that the trust’s capital expenditure for the remainder of the financial year will not materially differ from the amended forecast in this financial return

• For Governance that:

The board is satisfied that plans in place are sufficient to ensure: ongoing compliance with all existing targets (after the application of thresholds) as set out in Appendix A of the Risk Assessment Framework; and a commitment to comply with all known targets going forwards.

Otherwise:

The Board confirms that there are no matters arising in the quarter requiring an exception report to Monitor (per the Risk Assessment Framework, Table 3) which have not already been reported.

Consolidated Subsidiaries:

Number of subsidiaries included in the finances of this return. (Exclude NHS Charitable Funds)

Board Statements which the Trust are asked to consider for this period are outlined on page 9.

Recommendation

The Board is asked to:

• Review and consider the performance of the Trust against the governance measures including the performance against national measures and assessment against the quality governance framework.

• To review and agree the Board statements to be submitted to NHS Improvement.

Corporate services

Section 1: Deriving the governance risk rating

4

Q1 2016/17

5

Target Actual

• Referral to treatment time, 18 weeks in aggregate, non-admitted patients 92% 100%

• A&E Clinical Quality - Total Time in A&E under 4 hours 95% 99.8%

• Care Programme Approach (CPA) follow up within 7 days of discharge 95% 95.5%

• Care Programme Approach (CPA) formal review within 12 months 95% 96.6%

• Admissions had access to crisis resolution / home treatment teams 95% 100%

• Meeting commitment to serve new psychosis cases by early intervention teams OLD measure - use until Q1 2016/17 95% 100%

• Minimising MH delayed transfers of care <=7.5% 4.3%

• Access and Waiting Times for new psychosis cases by early intervention teams NEW measure (from Q1 2016/17) 50% 75.6%

• Improving Access to Psychological Therapies - Patients referred within 6 weeks NEW measure (from Q1 2016/17) 75% 97.56%

• Improving Access to Psychological Therapies - Patients referred within 18 weeks NEW measure (from Q1 2016/17) 95% 100%

• Data completeness, MH: Identifiers 97% 99.1%

• Data completeness, MH: outcomes 50% 89.8%

• Compliance with requirements regarding access to healthcare for people with a learning disability Met Met

• Community care – referral to treatment information completeness 50% 100%

• Community care – referral information completeness 50% 98.33%

• Community care – activity information completeness 50% 97.93%

Section 1 – Performance against National Measures

6

Risk of, or actual, failure to deliver Commissioner Requested Services

Date of last CQC inspection • 18-22 May 2015

CQC Compliance action outstanding (as at time of submission) • None

CQC enforcement action within last 12 months (as at time of submission) • None

CQC enforcement action (including notices) currently in effect (as at time of submission) • None

Moderate CQC concerns or impacts regarding the safety of healthcare provision (as at time of submission)

• The Trust has an amber rating

(requires improvement) under

safety, with an overall rating of

Good (green).

Major CQC concerns or impacts regarding the safety of healthcare provision (as at time of submission) • None

Overall rating from CQC inspection (as at time of submission) • Good

CQC recommendation to place trust into Special Measures (as at time of submission) • None

Trust unable to declare ongoing compliance with minimum standards of CQC registration) • n/a

Trust has not complied with the high secure services Directorate (High Secure MH trusts only) • n/a

Section 1. Third Parties

Corporate services

Section 1 Cont. Mandatory Services, Other board statements

7

NHS Litigation Authority:

• Failure to maintain, or certify a published CNST level 1; 1.0 or have in place alternative arrangements 2.0

Met

Mandatory services:

• Declared risk of, or actual failure to deliver mandatory services 4.0Met

Other board statement failures:

• If not covered above, failure to either provide or subsequently comply with annual or quarterly board statements

Met

Other factors:

• Failure to comply with material obligations in areas not directly monitored by Monitor• Includes exception third party reports, represents a material risk to compliance

Met

Corporate services

Other Governance Exception Items

8

List of Governors’ elections for Cambridgeshire and Peterborough NHS Foundation Trust

Elections in the following constituencies: • Public Cambridgeshire• Public Peterborough• Staff• Service Users Cambridgeshire• Service Users Rest of England

Executive Team Turnover

Total number of Executive posts on the Board (voting) • Six

Number of posts currently vacant • None

Number of posts currently filled by interim appointments • None

Number of resignations in quarter • None

Number of appointments in quarter • None

Corporate services

Section 2: Board Statement Submission

9

Q1 2016/17

Corporate services

Appendix 1 Board Statements

10

The Board is recommended to self certify that:

For finance that:The Board anticipates that the trust will continue to maintain a financial sustainability risk rating of at least 3 over the next 12 months. (CONFIRMED)

The Board anticipates that the trust’s capital expen diture for the remainder of the financial year will not materially differ from the amended forecast in this financial return. (CONFIRMED)

For governance that:The Board is satisfied that plans in place are sufficient to ensure: ongoing compliance with all existing targets (after the application of thresholds) as set out in Appendix A of the Risk Assessment Framework; and a commitment to comply with all known targets going forwards.(CONFIRMED)

Otherwise:The Board confirms that there are no matters arising in the quarter requiring an exception report to Monitor (per the Risk Assessment Framework, Table 3) which have not already been reported. (CONFIRMED)

Consolidated Subsidiaries:Number of subsidiaries included in the finances of this return. (Exclude NHS Charitable Funds) (ZERO )

1

Agenda Item: 4.4


REPORT

Subject: Audit of Accounts and Quality report FY16 Date: 7 September 2016

Author: Chris Long, Grant Thornton

Lead Director: Paul Hughes, Grant Thornton Executive Summary: This report contains the following items:

• Report to the Council of Governors on the Audit of the Accounts 2015/16 • Report to the Council of Governors on the Quality Report 2015/16

Recommendations:

The Council of Governors is asked to note the contents of these reports.

2




Links to BAF / Corporate Risk Register As above – this links to all strategic goals and objectives.


The assurance on the Quality Accounts ensures that the Trust meets CQC standards and NICE guidelines.


The auditor’s review ensures that the Trust has given a true and fair view of its financial position and that there are proper arrangements in place to secure economy, efficiency and effectiveness in its use of resources.

Legal implications / impact This report is a requirement of NHS Improvement and ensures the Trust does not breach its license.


This assures the public that the Trust is being true and fair in its reflections and transparent with the public.


This was discussed at the Audit and Assurance Committee.


© 2016 Grant Thornton UK LLP | Report to Governors on the Audit of the Accounts for Cambridgeshire and Peterborough NHS Foundation Trust | September 2016

Report to Governors on the Audit of the

Accounts for Cambridgeshire and

Peterborough NHS Foundation Trust

Year ended 31 March 2016

September 2016

Cover page

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Agenda Item: 4.4.i

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© 2016 Grant Thornton UK LLP | Report to Governors on the Audit of the Accounts for Cambridgeshire and Peterborough NHS Foundation Trust | September 2016 2

Executive Summary

Overall review of financial statements

Purpose of this report

This Report to Governors summarises the key findings arising from the following

work that we have carried out at Cambridgeshire and Peterborough NHS

Foundation Trust (the Trust) for the year ended 31 March 2016:

• auditing the accounts;

• satisfying ourselves that the Trust has made proper arrangements for securing

economy, efficiency and effectiveness in its use of resources (the 'Value for

Money' conclusion);

• reviewing the Trust's Quality Report.

We issued a Report to Governors on the Quality Report in May 2016.

Audit conclusions The audit conclusions which we have provided in relation to the 2015/16 financial

year are as follows:

• an unqualified opinion on the accounts which give a true and fair view of the

Trust's financial position as at 31 March 2016 and the Trust's income and

expenditure for the year ended 31 March 2016;

• based on our review, we are satisfied that, in all significant respects, the Trust

had proper arrangements in place to secure economy, efficiency and

effectiveness in its use of resources.;

• a group assurance return, issued to the National Audit Office, in respect of

Whole of Government Accounts which did not identify any significant

accounts issues for the group auditor to consider.

• we issued an unqualified limited assurance report in respect of the Foundation

Trust's Quality Report, the findings of which are presented in our "Report to

Governors on the Quality Report 2015/16".

Key messages for governors

Financial statements audit

The key messages arising from our audit of the Trust's financial statements were:

• the accounts were prepared to a high standard;

• one minor unadjusted misstatement was identified; and

• a small number of disclosure amendments to the financial statements and

annual report were identified during the audit which management agreed to

correct.

Value for money conclusion

The key messages arising from our value for money conclusion were;

• through our risk assessment process, we identified one significant risk in

relation to UnitingCare, the findings of which are set out later in this report;

• we issued an unqualified value for money conclusion.

We issued an unqualified opinion on the Trust's accounts and an unqualified value

for money conclusion on 25 May 2016, meeting the deadline set by Monitor/NHS

Improvement. A copy of the opinion is included in the Appendix. We also issued

our unqualified limited assurance opinion on the Trust's quality report on the 25

May 2016.

Acknowledgements

We would like to record our appreciation for the assistance and co-operation

provided to us during our audit by the Trust's staff.

Grant Thornton UK LLP

September 2016


Value for Money


Value for Money

We identified one significant risks in relation to the Trust's arrangements, which

related to UnitingCare, details of which are set out on the next page. In arriving at

our conclusion, our main considerations, across the set value for money criteria,

were:

Informed decision making and working with partners and third parties

• the Trust has strong governance arrangement in place, through the board, committees and council of governors. We identified a significant risk in relation to the appropriateness of the Trust's governance arrangements and working with partners in relation to the UnitingCare contract. This was with regard to the criteria over acting in the public interest through demonstrating and applying the principles of good governance and working effectively with third parties to deliver strategic priorities;

• as part of the UnitingCare contract, the Trust has absorbed a number of new community service staff. This has assisted in creating improved local integration between mental health and community services. Alongside this, the 2016/17 NHS planning guidance requires place based transformation and financial sustainable plans, and the Trust is actively involved in this process.

• based on our overall assessment, we have not identified any other significant risks or findings in relation to informed decision making and working with partners and third parties.

Sustainable resource deployment

• the Trust has historically delivered in line with budget and substantially

delivered CIP savings. For 2015/16, the Trust achieved a £3,750k deficit, but

when excluding the exceptional payment to UnitingCare, would have

delivered a small surplus. The Trust has a Strategic Plan in place covering to

2019, forecasting breakeven positions over the period. This plan does not

reflect the additional community services now provided following the

UnitingCare contract, but the Trust will refresh its long term planning as part

of the local sustainability and transformation plans. The Trust holds a

Monitor/NHS Improvement Financial Sustainability Risk Rating of 3, the

second highest possible;

• based on our overall assessment, we have not identified any significant risks

or findings in relation to sustainable resource deployment.

We have set out more detail on the risks we identified, the results of the work

we performed and the conclusions we drew later in this section.

Value for Money conclusion

Based on the work we performed, we concluded that the Trust had proper

arrangements in all significant respects to ensure it delivered value for money in

its use of resources.


Value for money

Key findings

We set out below our key findings against the significant risks we identified through our initial risk assessment and further risks identified through our on-going review of

documents.

Significant risk Work to address Findings and conclusions

UnitingCare

UnitingCare Partnership LLP, a joint venture set up by the Trust and Cambridge University Hospitals NHS Foundation Trust (CUHFT), entered into a contract with Cambridgeshire and Peterborough CCG to provide integrated adults and older peoples services in the region from 1 April 2015. The arrangement collapsed in December 2015, and the Trust is currently winding up the company and re-evaluating the contract position with the CCG for 2016/17 onwards. There has been extensive media scrutiny around the arrangements, and various reviews have been carried out to consider the contract, procurement arrangements and the failing which led to the demise of UnitingCare. While it is clear that issues in relation to procurement process rest primarily with the CCG, there is a risk that the Trust, as owner of UnitingCare did not have appropriate governance arrangements in place to ensure it entered a financially viable contract.

We will consider the outcomes of the reviews into the UnitingCare contract and procurement arrangements, with particular focus on the role of the Trust in developing appropriate governance arrangements for entering into what proved to be a non–viable contract. We will consider the financial and operational impact of the demise of UnitingCare for the Trust.

A number of external reviews have been carried out in relation to the UnitingCare contract and procurement arrangements. In particular, we have considered the review by Cambridgeshire and Peterborough CCG's internal auditors and NHS England. These reviews have highlighted that the contract was terminated on the grounds that it was no longer financially viable. The reports do note that late changes were made to the structure of UnitingCare, resulting in the limited liability partnership (LLP) model and without parent company guarantees (from the Trusts), and that the contract values were not fully determined at the time of entering into the agreement. These issues relate specifically to the procurement by the CCGs and are not reflective of a failure of governance at the Trust. From our review, there are no evident concerns raised over the adequacy of the Trust's governance arrangements. In addition to the external reviews, as a 'significant transaction', the Trust was subject to review by Monitor over the arrangement. Monitor authorised the transaction prior to the Trust entering into the contract. Following conclusion of their review, no evident concerns have been raised by Monitor, and the Trust now hold a 'Green' with 'No evident concerns' rating. From our discussions with the Trust, we note that the Trust had three member representation (50%) on the board of UnitingCare, plus involvement from other senior board members, in accordance with the partnership agreement between CPFT and CUHFT. The Trust undertook reasonable procedures at the time of signing of the contract, which included a special meeting of governors and the Board and appropriate review and evaluation through the Trust's internal committees prior to entering into the contract. The Trust established clear risk management processes around the implementation of the service, including regular reporting to both the Trust and UnitingCare's Boards and through the committees. While the project ultimately proved non-viable, we are satisfied that the Trust acted reasonably in its arrangements over UnitingCare and its attempt to deliver an innovative new model of care, and those arrangements are designed effectively. As part of the closure of UnitingCare, the Trust has made payments totalling £4.15m to settle its share of outstanding debts. Discussions with the Trust have confirmed that while the Trust had no legal obligation to settle the debts under the LLP model, it has made the payments (treated as an increase in its investment) so as not to destabilise the wider local health and wellbeing economy. We are satisfied that the payment is for the unexpected additional cost in delivering the model of care, and does not present a risk or finding in relation to the Trust's delivery of value for money. On that basis we concluded that the risk was sufficiently mitigated and the Trust has proper arrangements

over acting in the public interest through demonstrating and applying the principles of good governance

and arrangements for working effectively with third parties to deliver strategic priorities.

Value for Money (continued)


Fees for audit and non-audit services

Fees for audit services

Per Audit plan

£

Actual fees

£

Foundation Trust 40,100 54,100 Charitable Fund 2,200 2,200 (expected) Total fees 42,300 56,300 (expected)

Reports issued and fees

We confirm below our final fees charged for the audit and non-audit services.

An additional fee of £14,000 was agreed with management in relation to the additional

audit and value for money work required relating to UnitingCare. Fees for non audit

services involved the limited assurance opinion on the quality report (£5,000) and a

review of the Qatar mental health venture (£25,000). All fees exclude VAT.

Reports issued

Report Date issued

Audit Plan (to Audit and Assurance Committee) January 2016

Audit Findings Report (to Audit and Assurance Committee) May 2016

Report to Governors on the Quality Report May 2016

Report to Governors on the Audit of the Accounts September 2016


Appendix – Audit opinion


© 2016 Grant Thornton UK LLP. All rights reserved.

'Grant Thornton' means Grant Thornton UK LLP, a limited liability partnership.

Grant Thornton is a member firm of Grant Thornton International Ltd (Grant Thornton International). References to 'Grant Thornton' are to the brand under which the Grant Thornton member firms operate and refer to one or more member firms, as the context requires. Grant Thornton International and the member firms are not a worldwide partnership. Services are delivered independently by member firms, which are not responsible for the services or activities of one another. Grant Thornton International does not provide services to clients.

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© 2016 Grant Thornton UK LLP | Governors' Report on the Quality Report | Cambridgeshire and Peterborough NHS Foundation Trust

Report to Governors on the Quality

Report 2015/16

Cambridgeshire and Peterborough NHS Foundation Trust


May 2016 UPDATED TO 25 MAY 2016

Paul Hughes

Engagement Lead T 020 7728 2256 E [email protected]

Chris Long

Engagement Manager T 020 7728 3295 E [email protected]

Andy Conlan

In Charge Accountant E [email protected]

Aperry

Typewritten Text

Agenda Item 4.4.ii

Aperry

Typewritten Text


Contents

Section

Executive summary 2

Compliance with regulations 4

Data quality of reported performance indicators 5

Fees 9

Appendix

Appendix A - Action plan 10

Appendix B – Form of limited assurance report 11

1

The contents of this report relate only to the matters which have come to our attention,

which we believe need to be reported to you as part of our audit process. It is not a

comprehensive record of all the relevant matters, which may be subject to change, and in

particular we cannot be held responsible to you for reporting all of the risks which may affect

the Council or any weaknesses in your internal controls. This report has been prepared solely

for your benefit and should not be quoted in whole or in part without our prior written

consent. We do not accept any responsibility for any loss occasioned to any third party acting,

or refraining from acting on the basis of the content of this report, as this report was not

prepared for, nor intended for, any other purpose.


Executive summary

The Quality Report The Quality Report is Report is a mandatory part of a foundation trust’s

Annual Report. Its specific aim is to encourage and improve the foundation

trust’s public accountability for the quality of the care it provides. It allows

leaders, clinicians, governors and staff to show their commitment to

continuous, evidence-based quality improvement, and to explain progress to

the public.


This report to governors summarises the results of our independent

assurance engagement on your Quality Report. It is issued in conjunction

with our signed limited assurance report, which is published within the

Quality Report section of the Trust's Annual Report for the year ended 31

March 2016.

In addition, this report provides the findings of our work on the indicator

you selected for us to perform substantive testing on, to provide assurance to

support your governance responsibilities.

In performing this work, we followed Monitor's Detailed guidance for

external assurance on quality reports 2015/16' ('Guidance').

The output from our work is a limited assurance opinion on whether

anything has come to our attention which leads us to believe that:

• the Quality Report is not prepared in all material respects in line with the

criteria set out in the NHS FT annual reporting manual (ARM) and

supporting guidance;

• the Quality Report is not consistent in all material respects with the

sources specified in Monitor's Guidance;

• the indicators in the Quality Report subject to limited assurance are not

reasonably stated in all material respects in accordance with the ARM and

supporting guidance and the six dimensions of data quality set out in the

Guidance.

Conclusion

Our work on your Quality Report is complete. We are proposing to issue an

unqualified conclusion on your Quality Report.

The text of our proposed limited assurance report can be found at Appendix

B.

2


Executive summary (continued)

3

Key messages

• we confirmed that the Quality Report had been prepared in all material

respects in line with the requirements of the ARM and supporting

guidance;

• we confirmed that the Quality Report was not materially inconsistent with

the sources specified in Monitor's Guidance;

• our testing of two indicators included in the Quality Report found no

evidence that these were not reasonably stated in all material respects in

accordance with the ARM and supporting guidance;

• our testing of the indicator selected by governors found no evidence that

this was not reasonably stated in all material respects in accordance with

relevant guidelines on calculation, and have raised one minor

recommendation.

Acknowledgements

We would like to thank the Trust staff for their co-operation in completing

this review.


Compliance with regulations

Requirement

Work performed

Conclusion

Compliance with regulations We reviewed the content of the Quality Report against the requirements of Monitor’s published guidance which are specified in Annex 2 to Chapter 7 of the NHS Foundation Trust Annual Reporting

Manual 2015/16 and the additional detailed guidance for Quality Reports 2015/16.

Based on the results of our procedures, nothing has come to our attention that causes us to believe that, for the year ended 31 March 2016, the Quality Report is not prepared in all material respects in line with the criteria set out in the NHS Foundation Trust Annual Reporting Manual.

We checked that the Quality Report had been prepared in line with the requirements set out in Monitor’s Annual Reporting Manual.

4


Consistency of information

Requirement

Work performed

Conclusion

Consistency with other sources of

information

We reviewed the content of the Quality Report for consistency with specified documentation, set out in the auditor's guidance provided by Monitor. This includes the board minutes for the year, feedback from commissioners, and survey results from staff and patients.

Based on the results of our procedures, nothing has come to our attention that causes us to believe that, for the year ended 31 March 2016, the Quality Report is not consistent in all material respects with the sources specified in the Detailed

Guidance for External Assurance on Quality Reports.

Other checks We also checked the Quality Report to ensure that the Trust's process for identifying and engaging stakeholders in the preparation of the Quality Report has resulted in appropriate consultation with patients, governors, commissioners, regulators and any other key stakeholders.

Overall, we concluded that the process conducted so far has resulted in appropriate consultation.

We checked that the Quality Report is consistent in all material respects with the sources specified in Monitor's Detailed Guidance for External Assurance on Quality Reports 2015/16.

5


Data quality of reported performance indicators

Selecting performance indicators for review

The Trust is required to obtain assurance from its auditors over three indicators.

For trusts providing community services, Monitor requires that we select two indicators in a prescribed order of preference from the list of four mandated indicators that are relevant to this Trust.

These two indicators are subject to a limited assurance opinion: we have to report on whether there is evidence to suggest that they have not been reasonably stated in all material respects in accordance with the NHS Foundation Trust Annual Reporting Manual and the six dimensions of data quality set out in the Detailed Guidance for External Assurance on Quality Reports.

In line with the auditor guidance, we have reviewed the following indicators: • 100% enhanced Care Programme Approach patients receiving follow-up contact within seven days of discharge from hospital: selected from the subset

of mandated indicators. • admissions to inpatient services had access to crisis resolution home treatment teams: selected from the subset of mandated indicators.

In 2015/16, NHS foundation trusts also need to obtain assurance through substantive sample testing over one additional local indicator included in the quality report, as selected by the governors of the trust. Although the foundation trust’s external auditors are required to undertake the work, this is not subject to a formal limited assurance opinion in 2015/16.

In line with the auditor guidance, we have reviewed the following local indicator: • percentage of patients with a Health of the Nation Outcome Scales (HoNOS) score.

We undertook substantive testing on certain indicators in the Quality Report.

6


Data quality of reported performance indicators (continued)

Indicators subject to limited assurance opinion

Indicator & Definition Indicator outcome Work performed Conclusion

100% enhanced Care Programme Approach

patients receiving follow-up contact within

seven days of discharge from hospital

The percentage of patients on Care Programme Approach (CPA) who were followed up within seven days after discharge from psychiatric inpatient care during the reporting period.

96.2% We reviewed the process used to collect data for the indicator. We checked that the indicator presented in the Quality Report reconciled to the underlying data. We then tested a sample of 25 items in order to ascertain the accuracy, completeness, timeliness, validity, relevance and reliability of the data, and whether the calculation is in accordance with the definition.

Based on the results of our procedures, nothing has come to our attention that causes us to believe that, for the year ended 31 March 2016, the indicator has not been reasonably stated in all material respects.

Admissions to inpatient services had access

to crisis resolution home treatment teams

The percentage of admissions to acute wards for which the Crisis Resolution Home Treatment Team (CRHT) acted as a gatekeeper during the reporting period.



7



Local indicator not subject to limited assurance opinion


Percentage of patients with a Health of

the Nation Outcome Scales (HoNOS)

score

The local indicator records the percentage of patients receiving a HoNOS score in 2015/16.

95.3% We reviewed the process used to collect data for the indicator. We checked that the indicator presented in the Quality Report reconciled to the underlying data. We identified that HoNOS scores are recorded on the live Rio system. The data as reported in the Quality Report is not retained for audit purposes. We therefore are unable to provide specific assurance over the indicator as reported. However, we did carry out detailed testing of the data available in May 2016, which covered only those patients on the system at that date. We tested a sample of 25 items in order to ascertain the accuracy, completeness, timeliness, validity, relevance and reliability of the data, and whether the calculation is in accordance with the definition.

The results of our testing were; • due to the lack of audit trail or retained audit data,

we are unable to provide assurance over the indicator percentages reported in the quality report;

• for the testing we did carry out over available information at the audit date, we did not identify any issues over the validity or accuracy of the data on the system;

• we identified that four out of 25 HoNOS reports were not entered onto the patient notes system in a timely manner. This could lead to inaccuracies in the HoNOS indicator percentage;

• we observed that the HoNOS indicator report (used to generate the indicator) was not being run at the month end date, meaning the indicator reported does not reflect the exact month end position.

8


Fees

Fees for the audit of the Quality Report

Service Fees £

For the audit of the Quality Report 2015/16 5,000

9


Appendix A - Action plan

10

Assessment Issue and risk Recommendations

1.

Testing in relation to the HoNOS indicator identified that an audit trail was not retained for data included in the Quality Report. We observed that the HoNOS indicator report (used to generate the indicator) was not being run at the month end date, meaning the indicator reported does not reflect the exact month end position.

To ensure the HoNOS score presents an auditable indicator, the Trust should ensure data is retained for all patients throughout the year, and is recorded at the correct point in time for the presentation of the indicator.

2.

We identified that four HoNOS reports were not entered onto the patient notes system in a timely manner. This could lead to inaccuracies of the HoNOS indicator percentage.

Ensure appropriate policies and procedures are in place for HoNOS assessments to be included on the Rio system in a timely manner.

Assessment Significant deficiency – risk of significant misstatement Deficiency – risk of inconsequential misstatement


Appendix B – Form of limited assurance report

Independent Auditor's Limited Assurance Report to the Council of Governors and Board of Directors of Cambridgeshire

and Peterborough NHS Foundation Trust on the Quality Report

We have been engaged by the Board of Directors and Council of Governors of Cambridgeshire and Peterborough NHS Foundation Trust to perform an independent

limited assurance engagement in respect of Cambridgeshire and Peterborough NHS Foundation Trust’s Quality Report for the year ended 31 March 2016 (the ‘Quality

Report’) and certain performance indicators contained therein.

Scope and subject matter

The indicators for the year ended 31 March 2016 subject to limited assurance consist of the national priority indicators as mandated by Monitor:

• 100% enhanced Care Programme Approach patients receiving follow-up contact within seven days of discharge from hospital

• admissions to inpatient services had access to crisis resolution home treatment teams

We refer to these national priority indicators collectively as the ‘indicators’.

Respective responsibilities of the directors and auditor

The directors are responsible for the content and the preparation of the Quality Report in accordance with the criteria set out in the ‘NHS Foundation Trust Annual

Reporting Manual’ issued by Monitor.

Our responsibility is to form a conclusion, based on limited assurance procedures, on whether anything has come to our attention that causes us to believe that:

• the Quality Report is not prepared in all material respects in line with the criteria set out in the ‘NHS Foundation Trust Annual Reporting Manual’ and supporting

guidance

• the Quality Report is not consistent in all material respects with the sources specified in Monitor's 'Detailed guidance for external assurance on quality reports 2015/16’,

and

11


Appendix B – Form of limited assurance report (continued)

• the indicators in the Quality Report identified as having been the subject of limited assurance in the Quality Report are not reasonably stated in all material respects in

accordance with the ‘NHS Foundation Trust Annual Reporting Manual’ and the six dimensions of data quality set out in the ‘Detailed guidance for external assurance on

quality reports 2015/16’.

We read the Quality Report and consider whether it addresses the content requirements of the ‘NHS Foundation Trust Annual Reporting Manual’, and consider the

implications for our report if we become aware of any material omissions.

We read the other information contained in the Quality Report and consider whether it is materially inconsistent with:

•Board minutes for the period 1 April 2015 to 25 May 2016;

•papers relating to quality reported to the Board over the period 1 April 2015 to 25 May 2016;

•feedback from Commissioners, dated 23 May 2016;

•feedback from Governors, dated 17 May 2016;

•feedback from local Healthwatch organisations, dated 15 May 2016 and 18 May 2016;

•feedback from Overview and Scrutiny Committee, dated 12 May 2016;

•the Trust’s complaints report published under regulation 18 of the Local Authority Social Services and NHS Complaints Regulations 2009, dated 18 April 2016;

•The national patient survey '2015 National NHS Community Mental Health Service User Survey Management Report for Cambridgeshire and Peterborough NHS

Foundation Trust’;

•the 2015 national staff survey;

•the CQC Intelligent Monitoring Report dated February 2016;

•the Head of Internal Audit’s annual opinion over the Trust’s control environment, dated May 2016.

We consider the implications for our report if we become aware of any apparent misstatements or material inconsistencies with those documents (collectively, the

‘documents’). Our responsibilities do not extend to any other information.

We are in compliance with the applicable independence and competency requirements of the Institute of Chartered Accountants in England and Wales (ICAEW) Code of

Ethics. Our team comprised assurance practitioners and relevant subject matter experts.

12



This report, including the conclusion, has been prepared solely for the Council of Governors of Cambridgeshire and Peterborough NHS Foundation Trust as a body and

the Board of Directors of the Trust as a body, to assist the Board of Directors and Council of Governors in reporting Cambridgeshire and Peterborough NHS Foundation

Trust’s quality agenda, performance and activities. We permit the disclosure of this report within the Annual Report for the year ended 31 March 2016, to enable the Board

of Directors and Council of Governors to demonstrate they have discharged their governance responsibilities by commissioning an independent assurance report in

connection with the indicators. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the Board of Directors as a body, the

Council of Governors as a body and Cambridgeshire and Peterborough NHS Foundation Trust for our work or this report, except where terms are expressly agreed and

with our prior consent in writing.

Assurance work performed

We conducted this limited assurance engagement in accordance with International Standard on Assurance Engagements 3000 (Revised) – ‘Assurance Engagements other

than Audits or Reviews of Historical Financial Information’, issued by the International Auditing and Assurance Standards Board (‘ISAE 3000’). Our limited assurance

procedures included:

• evaluating the design and implementation of the key processes and controls for managing and reporting the indicators

• making enquiries of management

• limited testing, on a selective basis, of the data used to calculate the indicator back to supporting documentation

• comparing the content requirements of the ‘NHS Foundation Trust Annual Reporting Manual’ to the categories reported in the Quality Report and

• reading the documents.

A limited assurance engagement is smaller in scope than a reasonable assurance engagement. The nature, timing and extent of procedures for gathering sufficient

appropriate evidence are deliberately limited relative to a reasonable assurance engagement.

Limitations

Non-financial performance information is subject to more inherent limitations than financial information, given the characteristics of the subject matter and the methods

used for determining such information.

13



The absence of a significant body of established practice on which to draw allows for the selection of different, but acceptable measurement techniques which can result in

materially different measurements and can affect comparability. The precision of different measurement techniques may also vary. Furthermore, the nature and methods

used to determine such information, as well as the measurement criteria and the precision of these criteria, may change over time. It is important to read the Quality Report

in the context of the criteria set out in the ‘NHS Foundation Trust Annual Reporting Manual’.

The scope of our assurance work has not included governance over quality or non-mandated indicators, which have been determined locally by Cambridgeshire and

Peterborough NHS Foundation Trust.

Conclusion

Based on the results of our procedures, nothing has come to our attention that causes us to believe that, for the year ended 31 March 2016:


guidance;

• the Quality Report is not consistent in all material respects with the sources specified above; and

• the indicators in the Quality Report subject to limited assurance have not been reasonably stated in all material respects in accordance with the ‘NHS Foundation Trust

Annual Reporting Manual’ and supporting guidance.


London

25 May 2016

14





15


Open to the public and press

Date: Wednesday 7 September 2016 Time: 15.00 - 17.30 Venue: The Lounge, C3 Centre, Coldhams Lane, Cambridge CB1 3HR Chair of the meeting: Julie Spence


AGENDA

Time Enclosures



1.1 15.00 Introduction , apologies for a bsence and declarations of interest

5 Mins Verbal

1.2 15.05 Minutes • To approve the minutes of the meeting held on

11 May 2016

5 Mins Enclosed

1.3 15.10 Action Log / Matters Arising 5 Mins Enclosed 2.0 Representing the i ntere sts of, and communicating

with the Trust’s membership

2.1 15.15 Chair’s Report (Julie Spence, Chair)

10 Mins

Enclosed

2.2 15.25 Chief Executive’s Report (Aidan Thomas, Chief Executive)

10 Mins Enclosed

2.3 15.35 Judge Business School UnitingCare Report

20 Mins Enclosed

2.4 15.55 Non Executive Director Updat e (Simon Burrows, Non Executive Director)

10 Mins Verbal

2.5 16.05 Lead Governor Update (Elizabeth Mitchell, Lead Governor)

10 Mins Enclosed

2.6 16.15 Appointed Governor U pdate

10 Mins Verbal

2.7 16.25 Governor Leads / Com mittee Leads review (Lauren MacIntyre, Trust Secretary)

5 Mins Enclosed

3.0 Governance

3.1 16.30 Nominations Committee Update (Julie Spence, Chair)

• Board Skills Mix • Non Executive Job Description

10 Mins Enclosed Enclosed Enclosed

3.2 16.40 Fit and Proper Person Declaration (Julie Spence, Chair)

5 Mins Enclosed


4.1 16.45 Governor Questions on the Integrated Performance 10 Mins Enclosed

Report (Scott Haldane, Director of Finance; Julian Baust, Business and Performance Committee Chair)

4.2 16.55 Governor Questions on the Financial Update (Scott Haldane, Director of Finance; Julian Baust, Business and Performance Committee Chair)

• Finance report • NHS Improvement Q1 report

10 Mins

Enclosed Enclosed

4.3 17.05 Annual Report and Accounts ( To note) (Lauren MacIntyre, Trust Secretary)

5 Mins Tabled

4.4 17.10 Audit of Accounts and Quality report FY15 (Grant Thornton)

15 Mins Enclosed


5.1 17.25 Any Other Business 5 Mins Verbal

5.2 17.30 Questions from members of the public 5 Mins Verbal

Date of Next Meeting (Julie Spence, Chair) To note the next meeting will be held on Wednesday 14 December 2016

Julie Spence OBE Chair Role of Governors

• Governors have an important role in making an NHS foundation trust publicly accountable for the services it provides

• Governors represent the interests of Trust Members and public • Governors should be answerable and responsive to the constituency from which they were

elected (public, service user/carer or staff) • Governors hold the Non Executives collectively and individually to account for the

performance of the Board of Directors • Governors should always act in the best interests of the Trust and adhere to its values and

code of conduct Statutory Duties of Governors

• Appointing and removing the Chair and deciding their remuneration and conditions of office • Approving the appointment of the Chief Executive • Appointing and removing Non Executive Directors and deciding their remuneration and

conditions of office • Representing the interests of members and the public • Receiving the Trust’s annual accounts and annual report • Appointing and removing the external auditor • Approving significant transactions • Approving changes to the Constitution

1

Minutes of the Council of Governors Meeting held on 11 May 2016 from 17.30 until 20.30

at Conference Hall, Block 20, Ida Darwin, Fulbourn, Cambridge CB21 5EF

Members Present Julie Spence Chair Eric Revell Public Governor, Cambridgeshire Mike Collier Public Governor, Cambridgeshire Chris York Public Governor, Peterborough Jane Powell Staff Governor Lesley Crosby Appointed Governor, Peterborough and Stamford Hospitals NHS FT Lawrence Ashelford Appointed Governor, Cambridgeshire University Hospitals NHS FT Kirsty Trigg Service User Governor, Cambridgeshire Bernie Gold Public Governor, Cambridgeshire Elizabeth Mitchell Lead Governor, Carer Governor Ian Arnott Public Governor, Peterborough Margaret Johnson Public Governor, Cambridgeshire In attendance Jo Lucas Non-Executive Director Simon Burrows Non-Executive Director Stephen Legood Director of People and Business Development Julian Baust Non-Executive Director Scott Haldane Director of Finance Lauren MacIntyre Interim Trust Secretary Louisa Bullivant Assistant Trust Secretary (minute taker) Patrick Sissons Non-Executive Director Mike Hindmarch Non-Executive Director Mel Coombes Director of Quality and Nursing Sarah Hamilton Non-Executive Director Sara Sampson Awaiting Governor ratification Charlotte Paddison Awaiting Governor ratification Ruth Cloherty Awaiting Governor ratification Apologies Aidan Thomas Chief Executive Sarah Warner Chief Operating Officer Deborah Cohen Director of Service Integration Chess Denman Medical Director Diana Wood Appointed Governor, University of Cambridge Emily Gray Appointed Governor, Voluntary Sector Wendy Ogle-Welbourn Appointed Governor, Peterborough City Council

2

Lucy Nethsingha Appointed Governor, Cambridgeshire County Council John Cranston Public Governor, Cambridgeshire Melica Martin Public Governor, Rest Of England Keith Grimwade Patient Carer Governor Mark Batey Service User Governor, Peterborough Drury Thomson Public Governor, Peterborough

ITEM DESCRIPTION ACTION BY

Judge Business School – UnitingCare Partnership Review Update Judge Business School was invited to the Council of Governors to provide opportunity for them to engage with Governors. The review process did not, at this stage, have any firm material to bring forward to the meeting. As part of their engagement with Governors, their intention was to get an idea of the Governors perception before, during and through to the end of the contract. Governors were encouraged to contact the Chief Executives’ Executive Assistant, Helen Thomson to arrange an interview with Judge Business School.



There was one question asked by a Mr Lawrence, public member, who requested to ask a question not related to the agenda, the Chair accepted this.

Mr Lawrence asked the Chair if he was able to use the Cambridgeshire and Peterborough NHS Foundation Trust’s library in Fulbourn, Cambridge; based on the fact that he used to be a Governor and was currently a member of the Trust. He thought that this would be adequate enough for him to be able to use the facility. The Chair responded advising that due to the size of the library the Trust could not possibly allow for 14,000 members to use the facility and therefore the library could only to be used by staff and Governors of the Trust.

1.1

Introduction, apologies for absence and Declarations of Interest The Chair welcomed those present to the Council of Governors meeting and noted apologies. Aside from the standing interests held by the Trust Secretary, no other conflicts of interests were declared.

1.2 Minutes The minutes from the Council of Governors on 16 March 2016 were

3

presented. They were agreed as an accurate record, with the following amendments: Item 2.2, Governor Questions on the Financial Update Page five, first paragraph, line four should read “was higher mainly because Lord Byron B ward was staffed by agency staff.”

1.3 Action Log/ Matters Arising Action 1 The Governors confirmed that they had not received the letter to commissioners in relation to shortcomings. Action 2 The Governors confirmed that they had not yet received confirmation of the percentage of self-referrals to the Psychological Wellbeing Service. It was agreed that both action 1 and 2 would be picked up by the Chief Executive. All other actions were noted as complete or not yet due.

Chief Executive 20 May 2016 Chief Executive 20 May 2016

2.0 Representing the interests of, and communicating with the Trust’s membership

2.1 Chair’s Report The Chair referred to her report and updated the Council of Governors on the following:

Governor Elections:

She informed the Council of the following successful candidates:

Public; Cambridgeshire: • Mike Collier • Bernie Gold • Charlotte Paddison

Public; Peterborough :

• Helen Blythe Patient; Service users living within the electoral areas of Cambridgeshire County Council:

• Elizabeth Bannister Staff:

• Ruth Cloherty • Sara Sampson

The Council of Governors collectively agreed to ratify all new Governors.

4

The Chair highlighted the date of the Governor induction day as Thursday 16 June 2016 and encouraged all Executive and Non Executive Directors to come along to meet the Governors during the lunch break. The Chair directed Governors to the timeline of the Well-Led Governance review. The Council were informed that Tricia Amos had returned to the Trust on a temporary basis to help to support the process and that the Director of Nursing was the Executive Lead.

The Chair informed the Council that all Non Executive Directors had been appraised for 2015/16. The Council was asked to decide whether it was content to extend two of the Non Executive Directors terms of office for a further three years based on their performance. The Chair explained that the Trust had advertised Non Executive Director positions externally for the last three years and that the current Board skills mix showed a strong variety of skills and experience. The Council of Governors agreed to extend the terms of office for both Patrick Sissons and Julian Baust.

As per recommendations, the Council of Governors noted and discussed the Chair’s Report, ratifying new Governors and the extension of the two Non Executive Directors.

2.2 Chief Executive’s Report In the Chief Executive Aidan Thomas’s absence, Director of Finance, Scott Haldane, presented the Chief Executive’s Report. He informed the Council of Governors of the significant progress the Trust had made in underpinning the Older People’s Model (formally UnitingCare). The Trust had jointly drafted a letter with the CCG in order to advise GP’s, Integrated Care Staff, Acute Hospitals and Local Authorities of the joint work that was taking place to develop community services within Cambridgeshire and Peterborough CCG, and what it means for services delivered by the Trust in 2016/17. This letter would be circulated to the Council of Governors. In regards to the contracting round, the Mental Health Contract was noted as the only contract which required mediation. The consequence of mediation had meant that the Trust was able to agree part year funding for: capacity to cope with demand in Crisis Teams, Personality Disorder Services, and Community Teams, additional psychology input into acute services, age extension for Early Intervention services and full year funding for safer staffing. He also advised that the Trust would be reviewing the totality of the £50m normally spent by CCG on Adult Mental Health, and if there was any other way in which this could be spent on services which were aligned to the formally known UnitingCare model. Initially, this would be picked by the Board and followed up with Governors as part of planning for the Five Year Strategy. The Director of Finance also updated the Council on the possibility of the National Audit Office arranging interviews to look specifically at NHS

Chief Executive 20 May 2016

5

England’s review of UnitingCare. He updated the Council on the current position of the Children’s service, advising that the Trust were preparing for the likely forthcoming tendering exercise across Cambridgeshire and Peterborough. He noted that as part of this process there had been discussions relating to the joint working between Cambridgeshire Community Services Trust who provided universal children’s services and paediatrics services in Cambridgeshire and CPFT who provided both these services in Peterborough, and the Children’s Mental Health Services across Cambridgeshire. Public Governor, Bernie Gold asked if there had been any other agency applying for the Children’s Services tender. The Director of Finance advised that he was unable to confirm this. Lead Governor, Elizabeth Mitchell asked if the Trust was involving the education services, voluntary sector and Cambridgeshire Community Services. It was confirmed by the Director of Finance that all of the services had been involved to ensure a holistic approach. Public Governor, Bernie Gold asked if there was any update relating to the Learning Disabilities services since the Chief Executive had written his report. The Director of Nursing and Quality, Mel Coombes, advised that NHS England had produced a national framework. She described the framework as a good plan led by the CCG. She explained that the Trust’s Learning Disabilities Acute Care - Intensive Assessment and Support Service (IASS) ward was currently closed and there were limited beds available for admission on the Hollies at the Cavell Centre. Public Governor, Bernie Gold queried whether there were any day centres available for Learning Disability services. The Director of Nursing and Quality advised that there were no longer any day centres within the Trust. It was noted by the Council that there was a requirement to eradicate the use of acronyms unless accompanied by their full explanation. The Council of Governors were content with the information provided in the report which they noted and discussed.

2.3 Patient engagement strategy update This item was deferred to 7 September 2016 Council of Governors meeting due to the absence of the Head of Patient of Experience.

2.4 Non-Executive Director update Non Executive Director, Jo Lucas, updated the Council of Governors on her experience, interests and why she decided to join the Trusts Board of Directors.

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Reasons included 40 years experience of Mental Health and its systems, her passion and interest in the NHS, strategic thinking, her interest in patient and carer involvement and being active in the community. Having sat on many Boards within the voluntary sector she acknowledged that the Trust’s Board was one of the most effective that she had seen. She explained that she was the Interim Chair of the Quality, Safety and Governance Committee as well as the Non Executive Director Recovery Champion and Chair of Recovery and Inclusion Board. She informed the Council that all Non Executive Directors were involved in Chairing appeals and that she had been invited to deep dive into Serious Incident reviews. This looked at the learning process of Serious Incidents, how learning was implemented, if learning was taken seriously and what happened as a consequence. She said she had been on many service visits and that she admired and respected the determination of staff to deliver safe, high-quality care even in the face of change. She spoke of her thoughts for the future; highlighting her desire to remain an active member of the Board, contribute further to the development of the Recovery College as well as the Charitable funds activities, open a coffee shop in Fulbourn and to be involved in international opportunities. Lastly she acknowledged the importance of the role of the Governors within a foundation trust and commended the Chair for ensuring the inclusion of Governors in processes, including governance.

2.5 Lead Governor update Lead Governor, Elizabeth Mitchell, presented her report. There had been feedback from 170 people from the Patient & Public Involvement in Research for the Collaborations for Leadership in Applied Health Research and Care (CLAHRC). Governor’s involvement in the Triangle of Care had continued. The Council were updated on the Triangle of Care self-assessment process used across directorates and the challenges that this had faced. It had been decided to organise meetings at the Croft, Darwin and Phoenix Centres to try to resolve these challenges. Lead Governor, Elizabeth Mitchell said that she would feedback to the Council of Governors at the meeting in September 2016. She updated the Council that Public Governor, Bernie Gold, had presented to Hunts Congress on the 10 May 2016 at the Patient Participation Group on behalf of the Medical Director. It was noted that this had gone very well on the day and Public Governor, Bernie Gold was thanked for his efforts.

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The ‘Sharing the Caring’ event on 7 June 2016 was noted as progressing well; there were opportunities for Governors and other members of the public to attend. The day would include the Carers Trust presenting their Pride in Carer’s award, market stalls, guest speakers including Jane Hawking and live singing. The Chair’s appraisal was completed by Elizabeth Mitchell and Sir Patrick Sissons, Senior Independent Director (SID) and Non Executive Director. The appraisal evaluated the following areas; Strategic Direction, Holding to Account, Influencing and Communication, Team Working, Intellectual Flexibility, Patient and Community Focus and Self Belief. Input was incorporated from the Chief Executive and other Non Executive Directors. Following the final appraisal meeting, objectives for the Chair were developed. There would be a large connection with the Chair’s, Chief Executives and the Trust’s objectives. Finally, Elizabeth Mitchell commended the Chair for her successes, in particular the open and transparent process that she had created for Governors and staff. More recently, an example of this was the change to the Board meetings where there was one Public session which would start at 10.00am and a small Private session prior to the meeting. The Private Board meeting would be for commercial and personnel issues, but would not include CCG contracts which would remain with the Public Board meetings. The Council of Governors noted the content of the Lead Governor Update.

2.6 Appointed Governor update The Chair had received 3 updates, from Lucy Nethsingha Appointed Governor, Cambridgeshire County Council, Emily Gray Appointed Governor, Voluntary Sector and Wendy Ogle-Welbourn Appointed Governor, Peterborough City Council. It was noted that these would be circulated to the Council following the meeting. Appointed Governor, Peterborough and Stamford Hospitals NHS FT Lesley Crosby, highlighted how busy the hospital remained especially in respect of the Emergency Department. The hospital had capacity and flow challenges although this was recognised as system wide issue. Early in May the Trust declared an ‘internal critical incident’ due to the amount of admissions outweighing the number of beds available. She informed the Council that the Junior Dr’s strike had not presented the services with any issues; in fact attendance to emergency department had reduced. She advised that there was no definitive decision in respect of the work being undertaken with Hinchingbrooke. Public Board Meetings for both Trusts would be held on 23 and 24 May 2016. Appointed Governor, Cambridgeshire University Hospitals NHS FT,

Trust Secretariat

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Lawrence Ashelford, reported that there continued to be high levels of activity in A&E; and that some of this activity could more appropriately be dealt with by other parts of the NHS such as community pharmacy or primary care. It was noted that the Chief Executive was to attend a series of meetings to look at strategy with the recently appointed Chief Executive from Cambridgeshire University Hospitals NHS FT. This raised a question from the Lead Governor, Elizabeth Mitchell, who asked if it would be appropriate for the Governors of the Trust and Cambridgeshire University Hospitals NHS FT to meet to discuss a way forward. Lead Governor for Cambridgeshire University Hospitals NHS FT, Julia Louden, would be contacted to organise the two way Governor sessions. The Council were reminded that the Director of People and Business Development, Stephen Legood was an appointed Governor for Cambridgeshire University Hospitals NHS FT. The Chair advised the Council that Appointed Governor, Cambridgeshire Police, Kevin Vanterpool would soon be retiring. She advised that the replacement arrangements would be put in place for his successor. Updated following the meeting - it was agreed with the Chair that Superintendent, Laura Hunt, would be the new Police representative.

Elizabeth Mitchell, Lead Governor

2.7 Annual Plan The Director of People and Business Development presented the Annual Plan. He informed the Council that the final plan was submitted on 18 April 2016 and confirmed that feedback received from the Council of Governors meeting on 16 March 2016 had been incorporated into the plan. He advised that the Trust was waiting for formal commentary from NHS Improvement, formally known as Monitor. Public Governor, Peterborough, Ian Arnott referred to Seven Day Services, Safe Place regarding The Sanctuary which is being provided by the voluntary sector (MIND). He asked if the operation of this seven day service could be explained. Non Executive Director, Jo Lucas confirmed that The Sanctuary had been opened in Cambridge on 4 April 2016 to allow people to get practical and emotional support. If The Sanctuary proved successful, the Trust would look to have other similar safe places elsewhere in Cambridgeshire and Peterborough. Public Governor, Peterborough, Ian Arnott referred to Workforce Strategy Key Performance Indicators (KPI’s) regarding the percentage of staff who recommend the Trust to either their family and friends as a place to care for; he thought that the projection for improvement was over optimistic. The Director of People and Business Development confirmed the projection was being stretched using a 5% trajectory over the next five years and he

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supported this outcome as being achievable. Public Governor, Peterborough, Ian Arnott referred to Agency Rules. He asked if the reduction was over optimistic. The Director of Finance felt this was a realistic target on the basis that it related to the cap which had been enforced by NHS Improvement. As part of the number of different initiatives; the Trust would make sure that there was a sensible balance of temporary staffing vs substantive workforce. An example of this was moving away from the high premium agency rates opting for over time for substantive staff instead. The Chair also added that there was a wider project that the Chief Operating Officer was working on and confirmed that agency rates would be appearing on the agenda of every Board meeting. She also applauded the stretched target. A query was raised regarding the cap and what the Trust would do if it reached the cut off point. The Director of Finance referred to the minutes from Council of Governors meeting held on 16 March 2016 where it detailed a higher use of agency due to Lord Byron B ward. He explained that, as part of the contracting mediation for the older people’s mental health service, agency spend for Lord Byron B was included as part of a continued commitment for CCG to fund. Sarah Hamilton referred to ‘Financial Sustainability Risk Rating’ (FSSRR); she asked if the Trust had received a rating of two or three. It was confirmed by Director of Finance that the plan predated the FY15/16 and the rating was confirmed at a three. It was noted that Governors had little time to read through all of the papers when long items such as the Constitution were included. The Interim Trust Secretary, Lauren MacIntyre confirmed that all papers for the Council of Governors meeting had been sent out on time, as outlined in the Constitution, and as paper copies had to go to the printers and in the post, they were received by the Governors later than the electronic papers. It was agreed that if any long documents were ready prior to the paper submission date, they would be sent out electronically. Public Governor, Cambridgeshire, Eric Revell asked for clarity on ‘Risk and Mitigation’ and referred to failure to deliver Cost Improvement Plan (CIP) savings. He asked if this meant that there would be a closure of a service in order to sell properties. The Director of Finance confirmed that as part of the Capital Plan the Trust were looking at optimising estate and were not looking to sell, but to utilise existing property. Public Governor, Cambridgeshire, Mike Collier asked why he could not see any reference to the Triangle of Care within the plan. The Director of People and Business Development agreed that the Triangle of Care should have been more prominent in the public version. The Council of Governors noted the Operational / Annual plan submission and received assurance that a suitable process had been followed to

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ensure the required plan was submitted before the deadline and in line with guidance. The plan was also driven by the strategic direction set by the Board and the healthcare system.

2.8 Volunteering strategy The Director of Nursing and Quality presented the report on the Volunteering strategy and briefly outlined the background of the strategy as the development of a new framework for volunteering. The strategy had already been through the Quality, Safety and Governance Committee as well as Board. As a result recommendations to provide additional resources had been agreed and work was ongoing regarding governance; in particular supervision of voluntary staff. Non Executive Director, Julian Baust, commented that the strategy had been really well thought through and was a commendable piece of work. The Chair asked for the Volunteering strategy to be presented at the meeting on 7 September 2016, in order for Governors to bring forward ideas that they believe would support the strategy. The Council of Governors noted the content of the volunteering strategy report.

3.0 Governance

3.1 Constitution The Interim Trust Secretary presented the Constitution and a report noting the amendments that had been made. Public Governor, Cambridgeshire, Eric Revell asked for the Interim Trust Secretary to refer to Page 6 of the Constitution. He spoke in relation to section 15.2.4 ‘May hold office for a maximum of nine consecutive years. This may be extended at the Chairs discretion on a strictly case by case basis and without setting any precedents for any further or future decisions.’ He expressed that he thought it should not be at the Chair’s discretion and he also believed that the maximum term as Governor should service was nine years. Interim Trust Secretary responded that best practice guidance did suggest nine years as a maximum. However, the Constitution Steering Group had felt that it would be a shame to lose a Governor whose contributions remained valuable because they had served nine years. She suggested that it was at the Council’s discretion rather than the Chairs. Non Executive Director, Julian Baust, referred to;

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10.1 An individual who has attended any of the trusts hospitals as either a patient or as a carer of a patient may become a member of the trust. He noted that this should read trust’s services. The Council of Governors approved the Constitution subject to any amendments requested.

3.2 Council of Governors self -evaluation The Interim Trust Secretary presented the report on Governor Self-Evaluation. She acknowledged the one week turn around and recognised that this may have impacted on the low number of returns but emphasised the importance of the exercise. Public Governor, Cambridgeshire, Mike Collier noted that it was hard to assess whether the Council of Governors had the right mix of skills without understanding what mix it should have. Kirsty Trigg, Public Governor, Cambridgeshire, queried how the topics for development sessions were decided. Interim Trust Secretary advised that as part of Louisa Bullivant’s role she had written to Governors requesting their feedback in terms of what areas they would like covered in their development days. She explained that the Trust Secretariat also looked at current relevant matters in the Trust and if Governors would benefit from a development session on them, they were added to the programme e.g. CQC, UnitingCare Bid, Well-led Governance review. Non Executive, Sarah Hamilton asked if Governors had individual appraisals. She was advised that they did not but the Chair had an open door policy allowing for informal discussion. The Chair thanked those who had responded and the Council of Governors noted the contents of the report.

3.3 Governors involvement in strategy development The Director of People and Business Development outlined the opportunity for Governor involvement in the development of the Five Year Strategy. In its third year, the Trust was looking to refresh the strategy and involve Governors in this process, by inviting them to a series of meetings. The following timeline was shared with the Council: 13 June 2016 Pre reading Information issued; Market Analysis and System/ National Info 22 June 2016 Board Development Day; Lead Governor attending 20 July 2016 Draft revised Strategy Issued for comment 27 July 2016 Update on revised Strategy to be issued at Governor meeting 28 September 16 Sign off Public Board

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December 16 NHS Improvement planning Guidance issued 7 December 16 Timetable on Trust Business Planning / Commissioning 8 March 17 Review Draft 17/18 Operational Plan 29 March 17 Operational Plan – Board approval April 17 Submission of Operational plan Public Governor, Cambridgeshire, asked if it was known when a decision would be made by the CCG in terms of the commissioner’s strategic direction, and whether this would affect the timeline which had been presented to the Council. The Director of People and Business Development responded that the CCG’s timetable for System One was six months from the 1 April 2016, and he did not think that the timeline would be affected.


4.1 Governor Questions on the I ntegrated Performance Report The report was presented by the Director of Finance who updated the Council as follows: Service User Governor, Cambridgeshire, Kirsty Trigg asked why the percentage of patients with (HoNOS), Health of the Nation Outcome Score, with Cluster Review Period was outlined as a current issue and the percentage of patients with HoNOS score was outlined as an area with a positive performance. Director of Finance confirmed that HoNOS scoring was currently being reviewed by Head of Performance, Jonathon Artingstall and Clinical Director, Dr Manaan Kar-Ray, who would be looking at the current dashboard in order to improve the process of HoNOS score. Service User Governor, Cambridgeshire, Kirsty Trigg referred to the Early Intervention in Psychosis (EIP) access targets; new monitor measure for EIP and NICE and asked if there was a plan for this work stream to help achieve the target. It was confirmed that there was a two year plan for EIP and the Trust was working in collaboration to develop a three year plan. The Council of Governors noted the report.

4.2 Governor Questions on the Financial update The update was presented by the Director of Finance. He informed the Council that he had an Audit Clearance Meeting with the external auditors on 11 May 2016. He reported that the external auditors were very happy with the Trust’s process of the financial accounts and they were content that change was not necessary. He informed the Council that the Trust had been working closely with auditors, legal advisors and NHS Improvement. As a result the Trust had been able to reach a FSSR score of three as opposed to the predicted two.

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He thanked everyone involved for working to achieve this rating. Serco performance The Director of Finance explained that the Trust was working with Serco to refine the second four years of the contract. He advised that there was a four year break point which could only be exercised if Serco had not fulfilled their obligations in the performance metrics. The Trust did not believe that Serco had met those metrics but was prepared to work with them over the second half of the four years subject to getting an agreement of improvement required. The Council of Governors noted the report.


5.1 Any Other Business There was no other business brought forward for discussion.

5.2 Questions from members of the public There were no questions raised by the public.

Date of next meeting Date: 7 September 2016 Location: To be confirmed Time: 15.00 – 17.30

Signed………………………………………………….Dated…………………………..

Julie Spence Chair


ACTION LOG

Action log

number Date of Meeting Agenda

Item Action Due Date Lead Status

1. 1.6 The Governors confirmed that they had not received the letter to commissioners in relation to

shortcomings so this was carried forward to be picked up

by Chief Executive, Aidan Thomas


COMPLETE:

Joint letter between CCS and CPFT has been sent to all Governors.

2. 16 March 2016 2.1 Governor Questions on the Integrated Performance Report

To confirm percentage of self-referrals to the Psychological

Wellbeing Service


COMPLETE: Information has been sent out to all Governors.

3. 11 May 2016 2.6 Appointed Governor Update

Lead Governor, Elizabeth Mitchell to liaise with Lead

Governor for Cambridgeshire University Hospitals NHS FT,

Julia Louden, in order to organise a two way Governor

session

12 September

2016

Lead Governor, Elizabeth Mitchell

ONGOING: Confirmation received that Elizabeth Mitchell has the contact details for Julia Louden. Elizabeth has been contacted via email for the date of the meeting.

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Agenda Item: 2.1


REPORT

Subject: Chair’s Report Date: 7 September 2016


Lead Director: Julie Spence, Trust Chair Executive Summary: This report contains the following items:

• Trust secretariat team update • System Transformation Plan. • Joint Board and Governor Development Event / Wider Leadership Strategy Development -

22 June 2016. • Health and Care Conference, London – 30 June 2016. • Governance Review • Governor update • Non-Executive Director Activity logs

Recommendations:

The Council is asked to note the contents of this report.

•••• Note the contents of this report

2


The development, commissionin g and implementation of a new integrated service strategy from April 2016: We will work with patients, carers and key stakeholders to change our services to deliver innovative, integrated person centred care and support that represents the highest possible standards in safety, effectiveness and personal experience of our services. The design, development and implementation of the future CPFT workforce: Our staff will be a highly engaged, well trained, flexible and productive workforce who are able to deliver more at better value


Links to BAF / Corporate Risk Register Items 2, 4 and 5 discuss topics that are linked to identified risks.


None


The report discusses the negotiations of contracts and the Well Led Governance Review, each which has a financial implication on the Trust.


This report discusses the Well Led Governance review and System Transformation Plan, each of which have legal implications on the Trust.


Governor and Board working partnerships are discussed throughout.



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Chair’s Report

1. Trust secretariat team update Trust Secretary. On the 1 July 2016 a panel including representatives from the Executive, Non Executive

Directors and Governors interviewed shortlisted candidates for the role of Trust Secretary.

We had a strong field of 14 applicants who were shortlisted to 4 individuals. We unanimously agreed to offer the role to Lauren MacIntyre who has accepted the post with immediate effect.

Deputy Trust Secretary On 12th August 2016 a panel, including a service user, interviewed five candidates for the role of Deputy Trust Secretary. It was unanimously agreed to offer the role to Alex Perry who has accepted with immediate effect.

2. System Transformation Plan. The CEO and I agreed, with the other health economy CEOs and chairs, to sign off the System Transformation Plan. This has now been a subject of national level scrutiny and been given a green light; it is now subject to public consultation which is being led by the CCG. (Appendices 2.1.i, 2.1.ii and 2.1.iii)

3. Joint Board and Governor Development Event / Wider Leadership Strategy Development - 22 June 2016.

We had a very positive discussion in the morning which enabled governors to explore

how they could feel comfortable with their role 'to hold the Non Executive Directors and Board to account'.

In the afternoon we explored refreshing the 2014-19 strategy. The workshop enabled us

to reflect on organisational changes, external priority and landscape changes and new challenges that needed to be incorporated into the strategy. Governors considerations and priorities, elicited in the morning, where fed into the discussions alongside those of clinicians, operational and corporate leaders. The feedback has now being pulled together and a next steps developed by the executive lead Stephen Legood. At the July Board we agreed the following strategy development timetable.

DATE ACTION June 2016 Board Development Day – Initial review of the 4 Strategic Work

Streams 18th July 2016 NHSI & NHSE review and challenge Meeting (STP)

September 2016 SWOT/Market/Environmental Analysis Completed

September 2016

Strategy review with CPFT staff supported through existing structures facilitated by Alumni - TBC

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4. Health and Care Conference, London – 30 June 2016. On the 30 June I gave a candid Chairs perspective on the collapse of the Uniting Care contract. On reflection this was the first public utterance from the Provider or Contractor side and

was well received. Afterwards an organisation that runs courses at Churchill College approached me and

asked if I would talk on one of their programmes - from their perspective it filled the gaps of an incomplete picture and unanswered questions currently in the public domain.

5. Governance Review

The Trust has begun its process for a Well-Led Governance Review in line with NHS Improvement’s Well-Led Framework. This is a process that each Trust must complete at least every three years. The review will examine the governance from the boardroom to the frontline - looking at the policies, practices and processes the Trust has in place to ensure services can be delivered safely and to the highest possible standard. The review will look at four areas:

1. Strategy & planning: Does the board have a credible strategy to provide high quality services?

2. Capability & culture: Does the board demonstrate leadership of the Trust? 3. Process & structures: Are there clear lines of accountability? 4. Measurement: Is the information about Trust’s analysed and challenged?

An independent review team will be visiting the Trust this month and in October. They will complete desk top document reviews, service visits and interviews and focus groups with staff, stakeholders and governors.

September 2016 Stakeholder engagement including commissioners, LA, patients,

carers, police, NHS providers and third sector organisations – the scope of this engagement to be agreed by CEO/Chair

7th September 2016

Board of Governors – Outline timeframe and update on Board Development Day

27th September 2016

Executive Team Away Day – Initial Review of first draft

28th September 2016

3 Year Strategy - Initial high level draft plan presented to Board

5th October 2016 Wider Leadership Team – Detailed review with CPFT staff

16th November 2016

3 Year Strategy - Review of draft strategy Board of Governors

30th November 2016

3 Year Strategy – CPFT Board review & sign off

5

We can now confirm that after an extensive procurement exercise, Deloitte were chosen as the Trust’s preferred bidder. We were grateful to John Cranston, Public Governor Cambridgeshire, who joined us on the interview panel. Before the review, the Board of Directors were required to carry out an initial Trust self- assessment, and this was approved at the July Board of Directors meeting and will be used by consultants as the basis for their review.

6. Governor update

Ian Arnott will also be stepping down in September after nine years as Governor I would like to thank him for his valuable and insightful contribution to CPFT. The new appointed Police Governor will be Superintendent Laura Hunt who replaces Kevin Vanterpool who recently retired on 20 July 2016.

We are looking to encourage a new broad range of governors to fill our vacant posts.

This autumn Louisa Bullivant will start a piece of canvassing in order to recruit suitable individuals for the current governor vacancies. If suitable people are identified we will co opt them until the next elections in May 2017 so they can understand what the role entails.

The current, five vacancies are as follows:

It should be noted that unfortunately Elizabeth Bannister decided to step down shortly after she was ratified at our last Council of Governors meeting in May 2016. Constituency Number of Vacancies

Service user living within the rest of England One Service users living within the electoral areas of Cambridgeshire County Council

One

Public Cambridgeshire Three

7. Non-Executive Director Activity logs

Julie Spence June 2016

AM PM EVENING

6th Emails and correspondence

7th Carers Event Telecon: Aidan Thomas 8th Lisa Thomlinson:

Health Conf 30/6

9th Telecon: Scott Haldane 13th CPFT Art @ Hot

Numbers Spirituality Forum

14th Appeals at Anglia Ruskin

Appeals at Anglia Ruskin

15th Meeting Andrea Grosbois

Meeting Chess Denman Citizenship Ceremony

6

16th Governor Induction Visit CPNs @ Police HQ 17th Mtg: Alison Manton Mtg Kathy

Bonney(CCG) Mtg Board/Gov & Strategy Days

21st Strategy day preparation

22nd Board / Governor Development

Strategy Development Call Stephen Moir ( NHSE)

23rd Quality Heros Awards Meeting Chair CCS 24th Meeting Trust

Secretary Presentation Preparation

25th Reading CVs re Trust Sec post

27th Mtg Lead Gov: Rachel Wakefield

Shortlisting Trust Secretary

Meeting re STP sign off

28th Well Led Review - Tricia/ Peter

29th Talk to Leadership programme

B&P & QSG mtg: Venkat Reddy

NED dinner with CEO

30th Speaking Health & Care event

re: collapse of Uniting Care

- Provider Perspective


1st Mtg Trust Secretary Meeting CEO Telecon: Chair of CUHP 2nd Finalising Report for

Board

4th E of England Chairs BAF workshop Mtg: COO: Trust Secretary

7th Finalising Board Agenda 11th Email with Exec re

Board

12th Correspondence re Gov Review

13th Approve Board Gov Review paper

20th Emails re CUHP Board clash

25th Emails re Board Agenda 26th Preparation for Peer

Graduation 27th Communication with

CEO Preparation for Board Preparation for Board

28th Board meeting Board Meeting 29th Meeting Lead

Governor Peer Worker Graduation Nominations Committee

August 2016 AM PM EVENING

7

1st Visit MH services - Ormiston

2nd Meeting Trust Secretary

Visit PWS, Cambridge

3rd Meeting re Governance Review

Prep for charitable funds

4th Charitable Funds Committee

Follow up PSW visit: FD&Estates

5th Meeting Lead Governor

Meeting Patrick Sissons

7th Visit report to PSW Report for Council of Governors

8th Call with Trust Secretary

Emails and reports Governance Review meetings

9th Minutes for Nomination Committee

15th Governance Review

29th Review and reply to emails

30th Call with CEO Updating on issues. Board Minutes

31st Meeting Aidan Thomas Mock interview re: Governance Review

Mtg: new CEO of CUHP

Julian Baust

April 2016 AM PM EVENING

6th S2 Visit 8th Meet with S Legood 11th Appeal Prep Appeal Prep 12th Admin Board to CCG 13th Appeal Prep 14th 15th emails/admin

18th UCP telephone interview (no show)

19th A&A Prep A&A Prep 20th A&A Prep 24th QS&G Prep QS&G Prep 25th B&P Prep B&P Prep 26th UCP interview 27th QS&G B&P 28th Admin/emails 11th A&A Prep A&A Prep

May 2016 AM PM EVENING

8

3rd Workforce Strategy review

4th Quality Report review 10th Gov. Meeting prep Gov. Meeting prep 11th Gov Meeting 13th NAO Prep/Meeting

15th B&P Board report/A&A Prep

16th Meet with S Legood STP Meeting 17th Rem. Comm prep

18th Rem Comm./ A&A

prep

19th A&A Prep 20th A&A A&A 23rd Board Prep Board Prep 24th Board Prep 25th Board Board

June 2016

AM PM EVENING

1st Board self evaluation / emails

3rd Appeal Prep 7th Good Gov. Interview

14th Chinese delegation Chinese delegation/emails

15th EM Case read 16th Governors Lunch 21st Dev Day papers 22nd Dev Day Dev Day 26th NAO UCP Report QS&G Prep 27th QS&G/B&P Prep 28th B&P Prep 29th QS&G B&P CEO Dinner


12th Well lead Gov. review meeting

13th A&A 17th B&P Report for Board 26th Board Prep 27th Board Prep 28th Board meeting Board meeting

Jo Lucas

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June 2016

AM PM

EVENING

21st Reading for development day

22nd Board development day

Board development day

24th responding to mails and follow up from meetings

27th QS&G papers 29th QS&G Inquest discussion

July 2016

AM PM

EVENING

1st reviewing RCE legal structures and work plan

Reviewing RCE work plan and recs for structure

4th BAF workshop 24th board papers Board papers 26th RC Board meeting

preparation

27th Recovery Board preparation

Recovery Board meeting and follow up

28th Board meeting Board meeting 29th Recovery College

graduation

Mike Hindmarch


4th Audit Committee minutes

7th Well led Governance review

21st Board development prep

22nd Board development Board development 24th Appeal Hearing prep 27th Appeal Hearing Appeal Hearing 28th Appeal Hearing letter B&P prep 29th B&P committee Dinner NED & Aiden

July 2016

AM PM EVENING

4th BAF workshop 5th RSM- Financial RSM-Financial

10

Governance Governance

7th Audit Committee agenda & papers

12th Audit Committee prep Well led Governance review Audit Committee prep

13th Audit Committee

15th Stakeholder panel AD Children’s

Stakeholder panel AD Children’s

20th Service visit CMHT Peterborough

22nd Annual leave 23rd Annual Leave 24th Annual leave 25th Annual leave 26th Annual leave 27th Annual leave 28th Annual leave 29th Annual leave

Sarah Hamilton

June 2016

AM PM EVENING

6th Sharing the Caring conference

Sharing the Caring conference

9th

Well Led Governance meeting with Tricia and Peter

16th Governors induction lunch

21st Meeting Carol Cole RHFT

22nd Board development day 28th Read QSG papers Read BP papers 29th QSG meeting BP meeting Dinner Aidan and NEDs

July 2016

AM PM EVENING

4th Well Led Governance Review Workshop

19th Amend QSG notes Draft QSG Summary 27th Read Board papers Read Board papers 28th Public Board meeting Private Board meeting 31st Emails and Skills matrix

August 2016

AM PM EVENING

1st NED visit PWS March NED visit PWS March

11

10th Prepare NED visit report

Read tenders from Deloittes and PWC

16th Meet Trish Davies CCS 23rd Breakaway training Meeting Deborah

Cohen

30th Read QSG papers Read B&P papers

Simon Burrows


12th Admin/reading/emails

21st Pre read/prep for Board Dev. Day

22nd Board Development Day Board Development Day

28th Prep for B&P Prep for B&P 29th B&P Committee NED Dinner with CEO

July 2016

AM PM EVENING

12th Prep for Audit & Assurance

Prep for Audit & Assurance

13th Audit & Assurance

Committee

21st Service visit to Fenland Adult Locality

27th Prep for Board meeting

Prep for board meeting/service visit

report 28th Board Meeting Board Meeting

@fitforfuturenhs

fitforfuturenhs

fitforfuture.org.uk

How health and care services in Cambridgeshire and Peterborough are changing

Why do we need to change?Our health and care services face challenges

The population of Cambridgeshire and Peterborough is growing rapidly. People are generally living longer, so we have an aging population, and more people have long term conditions or higher levels of obesity.

In addition, we are facing practical challenges:

• healthcare is not as good in some places as in others, and does not always meet the standards that it should

• recruiting and retaining staff is a challenge for all health and care services

• our health, local authority and other care services are not always joined-up, not always designed to meet people’s individual needs, and do not always balance physical health with mental health and wellbeing

• overall, we spend too much of our time and resources treating illnesses which can be prevented or kept under control in better ways.

In Cambridgeshire and Peterborough we have a total budget of more than £1.7billion for NHS services, but we spend about £150million each year more than that. By 2021, this overspend is set to grow to about £250million if nothing changes.

What you’ve told us so far

During 2015, we held listening events across Cambridgeshire and Peterborough to seek your views on the health and care system. We heard that:

• you want to be empowered to stay healthy

• you want easy access to information about health (you use Google and pharmacies)

• you want to understand how to use the right health and care service at the right time

• when you need care urgently, you would rather use a local service than be sent to A&E

• you want consistent access (e.g. opening hours for services) across Cambridgeshire and Peterborough

• you want care as close to home as possible

• children’s services need to be co-ordinated better (they are currently too fragmented)

• you would be happy to be sent home from hospital sooner if you had visits from a nurse to support you

• you do not want to be sent home too early with no support – you are concerned about needing to be readmitted

• you need better communication and planning before you leave hospital

• you want the people who provide health and care services to collaborate and work more closely together.

This document tells you about our plan, both to meet your ambitions for health and care and to make services financially sustainable.

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The NHS and local government officers have come together to develop a major new plan to keep Cambridgeshire and Peterborough Fit for the Future. Our plan aims to:



• ensure that our health and care services are financially sustainable and that we make best use of the money allocated to us.


It has been developed by our health and care organisations. We are working together and taking joint responsibility for improving our population’s health and wellbeing, with effective treatments and consistently good experiences of care.

Local doctors and other clinicians are leading this work, supported by NHS England and NHS Improvement, the organisations that oversee our local NHS - ensuring that the views of patients and local people shape key decisions.

Fit for the Future sets out a single overall vision for health and care, including:

• supporting people to keep themselves healthy

• primary care (GP services)

• urgent and emergency care

• planned care for adults and children, including maternity services

• care and support for people with long term conditions or specialised needs, including mental ill health.

We know that we need to develop improved communication and stronger working relationships across our organisations. We also need a shared culture that means we can learn and make improvements together. We are committed to delivering the healthcare you need - working together as one system with one budget.

We are well placed to make the changes we need and have a lot to be proud of. Cambridgeshire and Peterborough has a committed and expert health and care workforce. We provide some excellent services to which people travel from other parts of the country. We host groundbreaking research and deliver excellent medical education and training. We have a resourceful voluntary sector, strong organisations, active local communities, and we work alongside research and technology industries which are world leaders in improving healthcare.

2 Our five-year plan to make Cambridgeshire and Peterborough Fit for the Future

What are the priorities?Through discussion with our staff, patients, carers, and partners we have identified four priorities for change and developed a 10-point plan to deliver these priorities.

Fit for the Future programme

At home is best1. People powered health and wellbeing2. Neighbourhood care hubs


3. Responsive urgent and expert emergency care4. Systematic and standardised care5. Continued world-famous research and services


Supported delivery

7. A culture of learning as a system8. Workforce: growing our own9. Using our land and buildings better10. Using technology to modernise health

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Priority one – At home is best


We will help people to make healthy choices, keep their independence, and shape decisions about their health and care. We will work with community groups and businesses so people of all ages have good health, social, and mental wellbeing support.

Our first aim is to prevent illness and support people to take control of their own health and wellbeing. We will develop health services which work alongside patients and carers, social care, and housing providers, and help to build strong communities.

We want patients to become equal partners with those caring for them, make more decisions about their own treatment and, with advice and support, become increasingly confident to manage their own conditions, supported by technology.



We aim to coordinate care better so it is tailored to the needs of the individual, paying close attention to the health and care services necessary to keep people living at home successfully - because we know this is the best way to keep people healthy and to maintain their independence.

When people become unwell, we will take every opportunity to spot warning signs, for example during regular health checks and visits to urgent care services, and focus local support to help people live with long-term health conditions.

We would like to see more joint working between local health and social care, with GPs playing a central role, supported by hospital clinical teams.

Patient story - future scenario Better safe than sorryWhen, on a Sunday morning outing, eight year old Olivia fell off her bike and banged her head, her mother Gemma didn’t know what to do. She thought about driving to A&E or dialling 999 but remembered seeing posters saying that 111 was a better option for injuries that were not serious or life threatening.

She called 111 and they arranged for Olivia to see a GP later that morning. The GP, Martin, examined Olivia and advised Gemma about what to look out for following a head injury, and what to do if Olivia’s condition changed. Martin directed Gemma to the NHS Choices website for further information.

In the afternoon, and using the information that she had been given, Gemma became concerned that Olivia was getting worse, not better. Following the advice that GP Martin had given her earlier she took Olivia to the hospital. The specialist children’s team could access Olivia’s notes and details of what had happened so Gemma didn’t need to repeat her story. Olivia was observed for six hours and discharged fit, well, and keen to get back to playing with her friends.

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Priority two – Safe and effective hospital care, when neededResponsive urgent and expert emergency care


This will be supported by better coordination, for example referral through NHS 111, close working with the ambulance service, and clear information provided to patients about which services are available – and how to reach them - when they have an urgent health need.

We have made a commitment that all urgent and emergency care services must meet the recently revised national standards.

We expect that 24/7 urgent care services will remain on our main three sites: Addenbrooke’s Hospital, Hinchingbrooke Hospital, and Peterborough City Hospital.



We aim to make better use of research evidence – drawn from Cambridgeshire and Peterborough and beyond – to help us to use care and treatments systematically which are proven to be the most effective.

Where it is important to provide services from several sites across the area, we believe we can use our skills and expertise collectively to achieve better results through doctors and nurses working across more than one hospital site and sharing their expertise.

We expect that maternity services will also remain at The Rosie Hospital, Hinchingbrooke Hospital, and Peterborough City Hospital.



We believe we can achieve consistently better results for people with more serious needs, such as for heart and lung services, or complex surgery, in fewer, specialist units which make best use of the world-class expertise of our specialist consultants.

Patient story - future scenarioLooking forward – keeping active Mark gave up playing rugby after a broken wrist and had become an armchair fan at the age of 39. He still enjoyed regular evenings out, and was ashamed to admit that his smoking had increased since he gave up sport. But Mark remained convinced he was still fit and healthy – with nothing to worry about.

Aisha, Mark’s GP, was not so sure. Responding to an invitation for a regular check-up, Mark was told that he was significantly overweight, with warning signs suggesting he was at risk of developing diabetes. Aisha knew that persuading Mark to make the lifestyle changes he needed would require both a plan and support.

First, she connected him to the local smoking cessation service, which organised drop-in sessions Mark could easily get to, and put him in touch with a fitness coach who could recommend an exercise programme to suit him. She also realised that Mark’s smartphone was his window on the world, and suggested some websites and a wellbeing app to help him plan and stick to his diet and fitness regime.

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Priority three – We’re only sustainable together

Partnership working Everyone who provides health, social, and mental health care across Cambridgeshire and Peterborough will plan together and work together.

We believe we must work across boundaries: between NHS and local authority social care; GPs and hospital care; and physical health and mental health.

In addition, we aim to support our GPs to collaborate more, and work with them to develop sustainable services. We believe this will enable better access to resources through sharing and specialisation and closer working between GPs and their colleagues in hospitals. Development of the primary care workforce is an important part of this.

We also recognise that people are supported by a network of formal and informal care, and aim to work in partnership with local organisations such as faith groups and the voluntary sector.

Living beyond psychosisJack was becoming increasingly isolated; he had stopped attending school and seeing his friends, and had complained of hearing voices. Following a comprehensive assessment at which he was considered to have developed an early onset psychosis, he was referred to the early intervention service. He began a three-year programme tailored to his needs. The service worked with Jack to deliver a holistic care plan.

Family therapy enabled Jack and his family to understand more about his experiences and to begin to resolve them.

Jack is now aware that he can choose to access a wealth of insight and to share experiences through social media. He is actively involved in monitoring his state of mind, has discussed in advance what he would like to happen in a crisis, and understands what to do if he becomes unwell again. His GP and the practice team are very involved with the care plan and can call on a range of support for Jack. Perhaps the most important connection was with an employment project which supported Jack through his college application. Now, in the second year of his course, Jack can see a much brighter future.

Patient stories – future scenariosCare shaped around the patient After she turned 80, Doreen found her health deteriorating. Doreen has diagnoses of diabetes and emphysema (COPD), as well as early stage dementia. She lives with her husband, Roy, who is 82, who also has diabetes but is otherwise fit and cares for her.

Paul, her GP, invited Doreen for her annual assessment. Based on her increasing frailty, he accepted her onto the caseload for complex, case-managed patients who are supported by a multidisciplinary team in the community. Angela, a member of the community team, is her care coordinator.

Paul and Angela worked with Doreen and Roy to create two plans. The first was a care plan which summarised Doreen’s health needs according to her preferences and priorities, and what she and Roy would want in the event of a crisis or deterioration in health. The second, a self-care plan, allowed Doreen to describe her goals and needs for caring for herself safely at home, and identified how she could be supported in doing so by Roy and the health system.

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Priority four – Supported delivery



We want to develop a culture of learning. This means our staff developing a shared understanding of our services, priorities and challenges, a common approach to analysing opportunities and problems, and finding solutions together.

We believe we can share knowledge and expertise from the specialist services in Cambridgeshire and Peterborough, making the most of our world-class medical and healthcare education and training, and using research to drive improvement.



We want staff to choose to work here and to see themselves as part of the whole health and care service in Cambridgeshire and Peterborough – not just the organisation which employs them, or their own clinical or professional groups. This will help us where we have services that have staffing shortages.



We want to explore how we can work together to get more value from our land and buildings, and bring all our sites up to modern standards.

There is a great deal of building development in Cambridgeshire and Peterborough, so we see opportunities for new strategic partnerships, such as the planned Hinchingbrooke Health Campus.



Shared information will help hospital clinicians, GP practices, community teams, and social care to work together more effectively.

Technology will help us to provide more rapid and reliable information for patients, and our clinicians will make sure technology is built in to new services.

Staff story – future scenarioMaking the right call Joanne supports several people with long term health conditions, enabling them to continue to live independently at home. She has built up a lot of knowledge about signs to look out for and urgent care options, and has always felt that she has valuable insight into how the emergency admission process works and whether it could provide a better experience for patients and carers.

Now working within a larger, multi-disciplinary team she can play a greater role. For example, she has received coaching from a local hospital consultant from whom she can also access immediate support and advice. This includes examples of symptoms which should raise concerns, so Joanne has the reassurance that she knows when it is right to call an ambulance and how she can help to prevent emergencies.

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