Correspondence

NHS foundation trust bulletin: February 2015

Published 25 February 2015

Applies to England

1. For action

1.1 Tariff arrangements for 2015/16 activity: 4 March 2015 deadline

David Bennett and Simon Stevens wrote to all providers of NHS services outlining interim arrangements for operating the NHS payment system, pending a final decision on the way forward on the national tariff for 2015-16.

We have been working closely with NHS England to finalise a voluntary interim arrangement for 2015-16, and the letter sets out the details of the scheme. All providers are asked to respond to the offer on the form enclosed with the letter by 4 March 2015.

1.2 Specialised commissioning baseline clarification for ‘Enhanced Tariff Option’

Monitor and NHS England will shortly be publishing an FAQ on the tariff arrangements for 2015/16 following our letter on 18 February. However there is one query that has been raised a number of times that we are able to clarify now in relation to the basis upon which the 2014/15 position will be included in the acute prescribed specialised services baseline and whether this is to be based upon month 10 outturn. The tariff arrangement letter confirms that under option A (Enhanced Tariff Option) ‘all contract variations agreed as at the end of January will be incorporated into the baseline’. We can confirm that this means the baseline will be the 2014/15 plan position adjusted for all agreed contract variations as at the end of January 2015, which may or may not include actual over or under performance.

1.3 Extension to the annual planning timetable

In response to our announcement on the interim proposals for the 2015/16 National Tariff, we have also issued a separate letter to the sector outlining an extension to the existing planning timetable. This is because we recognise that providers and commissioners will need additional time to respond to the relevant changes in their planning and contracting processes.

Most immediately, the deadline for full ‘draft’ submissions has been extended from 27 February to early April.

Acute and specialist foundation trusts are still required to submit the activity element of the draft plan by midday on 27 February, as planned activity levels should be unaffected by the tariff discussions. This is designed to help trusts focus on meeting NHS constitutional standards and other known demand pressures. A separate template covering the activity element only should now be in your MARS portal (not applicable to mental health, ambulance and community trusts).

NHS foundation trusts requiring interim or planned support in 2015/16 must still submit draft plans (comprising both activity and finance data) on 27 February.

We will shortly be in a position to confirm a final revised timetable. Please look out for further communications.

1.4 Technical guidance on applying Monitor’s 2015/16 financial assumptions

We have also now published guidance explaining how to interpret and apply Monitor’s financial assumptions (with reference to the new tariff proposals) to individual foundation trust 2015/16 plans.

This guidance serves as an appendix to Monitor’s core planning guidance document ‘Guidance on the 2015/16 annual planning review for NHS foundation trusts’.

1.5 Reminder to prepare your annual governance statement

NHS foundation trusts are required to prepare an annual governance statement (AGS) for inclusion in their annual report (see chapter 7 of the NHS foundation trust annual reporting manual (FT ARM)). Foundation trusts should be at an advanced stage in their year-end planning by now, but please note the following points:

• you must now include disclosures of serious incidents relating to information governance, including data loss or confidentiality breach, in your AGS
• the AGS template includes a new requirement to disclose how foundation trusts assure the quality and accuracy of elective waiting time data, and the risks to the quality and accuracy of this data

Please follow the format of the model AGS in annex 6 to chapter 7 of the FT ARM.

In particular, it is important that your AGS has a clear conclusion. This must either state that no significant control issues have been identified, or provide clear details of any significant internal control issues which have been identified in the body of the AGS. In a number of 2013/14 statements it was difficult to identify which, if any, issues had been considered significant internal control issues.

1.6 Freedom to speak up review: what it means for you

Sir Robert Francis’ report, following his review into creating an open and honest reporting culture in the NHS, has now been published.

Monitor’s Chief Executive David Bennett has written to all foundation trust chief executives about the report. His letter emphasises both the overall importance of the review and the importance of managers ensuring that all of their staff are made fully aware of the expectation that they will come forward, speak up and raise any concerns, and that they know how to do this outside their line manager relationship if necessary.

1.7 Quality reports: content and assurance requirements for 2014/15

We have published our requirements for foundation trusts’ 2014/15 quality reports. The changes from the 2013/14 arrangements are minor and can be found in the section ‘Statement of Directors’ Responsibilities’. We have also clarified that the disclosure of referral to treatment performance indicators in the quality report should be based on the average for the year.

We have also published guidance for NHS foundation trusts and their auditors on how external assurance should be provided on the quality reports. Section 1.3 of the guidance explains the key changes compared to 2013/14.

1.8 Update on private finance initiative (PFI) termination transactions for foundation trust accounting officers

Foundation trust accounting officers should be aware that HM Treasury has recently confirmed that all PFI termination or buy-out transactions are ‘novel and contentious’ as defined by Managing Public Money (MPM). Foundation trusts undertaking such transactions will therefore require HM Treasury and Department of Health (DH) approval. This review and approval process will run alongside a Monitor review where Monitor is otherwise reviewing such a transaction because it has been judged to be significant under the ‘Risk assessment framework’.

This applies regardless of whether the transaction is financed by loans from the DH, elsewhere in the public sector or private finance.

Foundation trusts should be aware that approval for such transactions will only be made available if the termination proposal offers clear value for money and is affordable for the DH. Foundation trusts should discuss PFI termination proposals with their Monitor relationship team at the earliest stage of developing of such proposals. This is to avoid incurring expenditure on developing proposals that are ultimately not approved and where those costs may be deemed a fruitless payment that would require disclosure in foundation trust accounts.

1.9 Managing referral to treatment using independent sector capacity

Thank you to all trusts involved in this programme for their continued effort in updating the patient level trackers and sending them to the Project Management Office (PMO) each week. This is a reminder to please ensure that your information is updated as soon as it is available, as it will only be patients who have been discharged by the 31 March 2015 and recorded as discharged on the patient level trackers that will be eligible for funding as part of this programme.

Please continue to work with your local independent healthcare providers to manage To Come In dates and discharge dates to ensure this occurs.

If you are having issues obtaining timely information or have any other queries please contact Lizzie Scragg at the PMO on 07785 440 481or email lizzie.scragg@kpmg.co.uk.

1.10 Data validation

Maintaining good quality data is critical for ensuring continuity of care for service users, managing risk and performance, and supporting service planning and design. It is also important for reporting against key national standards such as Referral to Treatment (RTT) times.

As a result, we would encourage all trusts to ensure they have robust processes in place to complete routine and robust data validation across all specialties, for admitted, non-admitted and incomplete pathways. This should include making sure that the processes of applying and recording RTT rules are clear and well understood.

We would also encourage you to speak with your regional Monitor representative as soon as possible if you are currently undertaking data validation and could benefit from additional resource that is available through the national data validation programme until the end of the financial year.

Separately, the RTT indicator for patients on an incomplete pathway will be subject to external assurance for foundation trusts providing the relevant acute services in 2014/15. More details can be found in Monitor’s detailed guidance for external assurance on quality reports.

1.11 Rescheduling cancelled operations

Please remember that if you cancel an operation on the day a patient is due to arrive, after they have arrived, or on the day that their operation is due to take place, you should offer new dates for treatment which are within 28 days of their original appointment.

This standard is a pledge in the NHS Constitution. This covers all planned and booked hospital operations, including day surgery. It doesn’t, however, cover minor procedures carried out in outpatient clinics or as ward attenders.

2. For information

2.1 Approved costing guidance - updated February 2015

We have updated our approved costing guidance, which sets out the costing approach that Monitor encourages providers of NHS services to adopt.

We recommend that costing practitioners review and update their costing processes and costing systems in line with the updated guidance, and HFMA’s 2015/16 clinical costing standards for acute and mental health services.

This guidance is for the following types of providers: acute, mental health, community and ambulance.

2.2 Foundation trust performance in quarter 3 2014/15

For a summary of the sector’s performance, read this report and infographic.

2.3 Special measures guidance updates

Monitor, Care Quality Commission, and the NHS Trust Development Authority have updated the special measures guidance for NHS foundation trusts and NHS trusts.

2.4 Review of 2013/14 audits of NHS foundation trusts

We have published an independent report following the review of a sample of 2013/14 foundation trust audits. The aim of the review is to provide assurance that the audits were carried out correctly.

2.5 Guidance to support the introduction of access and waiting time standards for mental health services in 2015 to 2016

This document from NHS England sets out details on how new mental health access and waiting standard times will be measured. As detailed in our recent consultation on the ‘Risk assessment framework’ (RAF) we are considering how we might include measures on ‘early intervention in psychosis’ and ‘improving access to psychological therapies’ in the RAF in future.

3. Events and webinars

Keep up to date with all of our events and webinars.

3.1 Local price determination workshops for innovative payment approaches; various locations: 5 March 2015 to 21 May 2015

For: the following roles within foundation trusts, NHS trusts and independent providers:

• heads of contracts, income and costing
• contracting, income and costing accountants
• clinicians and nurses involved in setting payment approaches
• others involved in local price determination and contracting with clinical commissioning groups

Why attend? To shape and form a payment system that works for patients by providing input into the local price determination rules and principles.

The interactive workshops will help explain:

• what the Health and Social Care Act 2012 (the 2012 Act) says about local price determination and what the statutory responsibilities are
• the consequences of non-compliance with the National Tariff or the 2012 Act for the sector as a whole
• how to comply with all the rules and principles around local price determination
• why we collect local price information and how it affects price determination in the Tariff

Read more and register.

(Some dates for these workshops have sold out but if you are interested in being put on a waiting list, please email Ushma.Mistry@monitor.gov.uk.)

3.2 CEO and chair induction day – 19 March 2015, London

For: Newly appointed chairs and chief executives of NHS foundation trusts without previous experience of our foundation trust authorisation process.

Why attend? To learn about:

• Monitor’s role, including an overview of pricing and competition
• the NHS foundation trust legal framework
• the regulatory regime, including how we assess risk and our enforcement processes
• current issues in the NHS
• quality and quality governance
• foundation trust governance, including working effectively with governors

If you’d like to attend this event or be kept informed of future dates, please contact mel.baldwin@monitor.gov.uk. Places are limited.

3.3 Webinar: aligning strategies across local care economies, watch again online

This webinar looks at how you can use our strategy development toolkit both within foundation trusts and across partners in local health and care economies.

Care planning and delivery, particularly in light of the Five Year Forward View, should be viewed within the context of the whole local care economy where providers (across health settings and social care) play their part alongside relevant bodies.

We would welcome any further suggestions about how we can develop this work. If you’d like to get involved please email either strategydevelopment@monitor.gov.uk or integration@monitor.gov.uk.

3.4 Mental Health Network annual conference and exhibition, 18 March 2015, London

For: All providers of mental health services including NHS foundation trusts, NHS trusts and independent providers.

Why attend? To talk to Monitor staff throughout the conference and exhibition on stand 6.

This is an opportunity for you to hear leaders across the mental health community share practical ideas, tools and solutions that can help respond to increasing pressures facing the sector today.

We will be on stand 6 all day and Adrian Masters, Managing Director of Sector Development at Monitor, will also be part of a panel discussing mental health payment systems.

The full programme is available online.

4. External updates

4.1 Update from the Secretary of State for Health

Read the latest update.

4.2 NHS Change Day 11 March 2015

NHS Change Day is dedicated to looking at ways that people working in the health sector can make changes to benefit everyone, from patients and service users, to local communities. This year’s event is on 11 March. You can read examples of positive change and how to get involved. You can also follow events on the day on Twitter: @NHSchangeday.

4.3 Updates on the NHS procurement and efficiency programme

The latest updates for NHS procurement staff were added to the Centre for Procurement Efficiency portal on 5 February 2015.

5. Get in touch

5.1 Our latest job opportunities

For more information or to apply, please visit our recruitment website joinmonitor.com.

5.2 Queries or feedback

If you have any queries about the information in this bulletin, please contact your relationship manager at Monitor.

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5.4 Publications

All of our publications are available to download from our publications section.