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Good and Beyond
Operational
Plan
2019 - 2020
Improving Lives In Our Communities
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Introduction Patients, families and carers are at the heart of everything we plan and do. We must ensure we continue to provide the best services for our local population now and in the future. Our Operational Plan for 2019/20 sets out the work we will do in the year ahead to maintain and improve our services, taking into account what we know patients and their families want and need, the resources we have, and the legislative and regulatory requirements we work within. Patients come first, and continuing to improve quality is a priority that shapes our service change. Our Quality Strategy reflects our ambition to achieve a Care Quality Commission (CQC) rating of at least ‘Good’ for all of our clinical services. Our Vision, which is underpinned by our Clinical Strategy, describes how we want our services to develop. It shapes our transformation programme and the ways in which we will improve services for our patients, families and carers. We have identified key areas that we will focus to build on and improve our existing services. We know that the needs of our patients are changing and that the services that we provide, as part of the wider health system, need to change. We want our patients to be able to access as many services as possible either in their home or close to their home.
We recognise the importance of developing clinical models and services that are based in people’s neighbourhoods where this is clinically appropriate. We are working closely with our partners to build clinical teams that will work alongside GPs and other care providers in community settings. Community services are a critical part of a wider health and care system and are dependent on working in partnership with others. Our plan describes how we will work closely with our health and social care partners to give patients more control over their own care and find necessary treatments more readily available. Our workforce is our greatest asset, their compassion ensures that patients feel valued and receive high quality care. Ensuring that we look after our staff will ensure that they are able to deliver the high quality services that we aspire to. We will ensure that our staff feel valued and that our Trust is seen as a great place to work.
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Our Services
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About Us Shropshire Community Health NHS Trust (SCHT) specialises in the provision of community-based services, supporting people to live independently at home. Our focus is on supporting people to optimise their opportunities for good health and help them to remain at home when they are unwell, avoiding the need for a stay in hospital.
Last year, we carried out over 717,000 community contacts, the vast majority of which were with people in their homes, in community centres and clinics. We also provided over 60,000 outpatient attendances. There were over 30,000 attendances at our minor injury departments. We have an income of approximately £84m and employ 1,601 staff.
Our Vision “We will work closely with our health and social care partners to give patients more control over their own care and make necessary treatments more readily available. We will support people with multiple health conditions, not just single diseases, and deliver care as locally and conveniently as possible for our patients. We will develop our current and future workforce and introduce innovative ways to use technology.”
Our Vision supports the ambitions of the wider health and care community in Shropshire and Telford and Wrekin.
Our Values Our Values have been developed with our staff and other key stakeholders. They are a statement of how we strive to deliver services on a day to day basis.
Improving Lives: We make things happen to improve people's lives in our communities. Everyone Counts: We make sure no-one feels excluded or left behind - patients, carers, staff and the whole community. Commitment to Quality: We all strive for excellence and getting it right for patients, carers and staff every time. Working Together for Patients: Patients come first. We work and communicate closely with other teams, services and organisations to make that a reality. Compassionate Care: We put compassionate care at the heart of everything we do. Respect and Dignity: We see the person every time - respecting their values, aspirations and commitments in life – for patients, carers and staff. Living these Values underpins everything that we do for both our staff and the patients that we support.
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Direction of Travel and
Strategic Priorities
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Strategic Goals and Priorities 2019/20 Our commitment to continuously improving quality and to work with our partners is reflected in our Strategic Goals, which describe the outcomes we are trying to achieve. These are:
To deliver high quality care
To support people to live independently at
home
To deliver integrated care
To develop sustainable community
services
In order to achieve our goals we have identified three Strategic Priorities:
1. Good and Beyond
2. Transformation Plan and
3. Optimising the Use of Technology.
To deliver our Strategic Priorities we have identified a suite of Strategic Initiatives. Our Strategic Priorities and the supporting Strategic Initiatives for 2019/20 are described below.
Good and Beyond Review our approach to quality and service improvement. Respond to what we learn from our CQC assessment. Refresh our Clinical and Quality Strategies.
Transformation Plan Further develop pathways and processes to support transition of young people into adult services. Redesign services with commissioners, providers and our patients, and implement pathways to support the delivery of care closer to home.
Implement the new Stoke Heath Integrated Care prison service. Develop the opportunities
that arise through the partnership with Shropshire Doctors Co-operative (Shropdoc).
Deliver the People Strategy priorities to improve health and wellbeing. Introduce systematic processes for talent management. Embed impactive staff networks. Strengthen workforce planning and optimise our available workforce. Deliver a sustainable cost improvement programme and embed robust processes to support project management processes and quality impact assessment. Implement our Estates Strategy: improve the environments we provide care from and ensure that we optimise the utilisation of our estate. Develop strategic relationships and work closely with our system partners to develop sustainable community services as part of a wider integrated care system.
Optimising the Use of technology Complete the roll out of the RiO (Electronic Patient Record - EPR) system and realise the benefits to support quality, safety and efficiency of the services we provide.
Optimise opportunities associated with technology and digital platforms, ensure that we have the right skills and we use data to support decision making. These Strategic Priorities, alongside our Vision, Values and Goals are brought together in our Strategy on a Page which is shown in Appendix 1.
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Good and beyond
Safe, Caring, Effective, Responsive, Well-Led
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Strategic Priority: Good and Beyond Quality remains a top priority within our Trust. We continue to invest in quality initiatives and take time to review the portfolios of our Quality Team. This enables us to effectively and continuously drive forward improvements identified in our Quality Strategy and our key priorities within our annual quality account. Our Quality Strategy sets out our drivers and enablers to achieving our vision to be the best at what we do and deliver the highest quality interventions for the people we serve. It is complemented within the People Strategy and is underpinned and driven by Care Quality Commission (CQC) fundamental standards. We reviewed our Quality Strategy in 2018 and will be refreshing it again in 2019/20. This will take place alongside a refresh of our Clinical Strategy. Our refreshed strategy for 2019 onwards will build on what we have achieved and where we want to be in the future. It will be strengthened further through greater alignment to the CQC domains.
Quality Improvement Our quality improvement work continues to be shaped by national and local priorities. Our Director of Nursing and Operations is our Executive Lead and also our Quality Improvement Lead. The Director of Nursing and Operations leads our Trust Quality team. This team work closely together and in partnership with our operational teams, and support services to continuously drive quality improvements.
The Quality Strategy sets out our vision and, our direction of travel for improvement over time. It builds on what has already been achieved.
The Quality Strategy has been developed with our staff and represents a shared focus approach to realise the strategic vision. Throughout the year, the Quality team reports progress on the implementation of the Strategy; this proves to be valuable in monitoring progress. Our Trust Quality and Safety Committee enables supportive assurance and challenge dialogue to take place. This ensures an understanding of information provided and the proactive approach of how we respond to areas that require focused attention for improvement. Whilst our Strategy sets out our vision over time, we also develop a number of key quality improvement priorities we focus on throughout the year. These are aligned to our Quality Strategy and Trust values. They are developed through working with patients, members of the public, staff and other NHS and local authority partners, to make sure that our priorities address their thoughts, concerns and aspirations for Community Health care. Quality remains at the heart of everything we do. Our Quality and Equality Impact Assessment (QEIA) process ensures any service changes that may impact on quality or equality of care delivered to our patients and carers, or staff experience, are considered and mitigated appropriately.
Measuring Improvement Our operational teams use a range of tools and methodologies to ensure that we provide safe, effective and equitable care closer to home. This contributes to a structured approach in the flow of quantitative and softer qualitative intelligence throughout our Trust as a measure of how well we are delivering safe and effective healthcare. Our Trust Quality and Safety Committee reports to and is accountable to our Trust Board. This provides assurance and reassurance as to the delivery of safe healthcare within our services.
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This Committee receives quality assurance reports providing oversight of any risks and controls, compliance, challenges and achievements against our quality metrics. Our commissioners and our regulator also monitor our performance through regular Clinical Quality Review Meetings. These meetings consider both improvements identified in our Quality Strategy and specific quality improvements known as CQUINs (Commissioning for Quality and Innovation).
Continuous Learning Our staff are committed to providing safe, high-quality care to our patients. However, there are rare occasions when something may go wrong. We make sure that we learn from these errors and avoid the same thing happening again.
We investigate when things go wrong. In order to improve or maintain patient safety, we do not just focus on the error. We also bring many other human factors into the process. We consider how we work together, talk to each other, develop relationships with other services, and make decisions, as well as how we cope with our daily dilemmas, how we adjust and adapt every day and, most importantly, how we behave. We continue to create a balanced approach to safety, ensuring we have a responsible culture and not a culture of blame.
Investigating and learning from all incidents ensures that we always deliver the best possible care to patients. We will continue to strengthen our processes by which learning is shared across teams and services, not only when things go wrong but when we can share excellence in practice to help services
develop further. We will utilise out Quality Leads to provide support to teams. Recognising and preventing things from going wrong is an important part of learning. We will focus this year on ‘always events’. These are the aspects of the patient and family experience that should always occur when patients interact with healthcare professionals.
Embedding National Early Warning (NEWS) and Sepsis tools are good examples of early recognition and prevention. We have convened a NEWS group led by one of our
Associate Medical Directors. Patients within all healthcare provider settings may be at risk of physiological deterioration, including one of the key causes of deterioration in a patient’s condition - sepsis. The work of the NEWS group will gain momentum during 2019/20 through strengthening the available clinical tools to assist our clinical staff in recognising and undertaking the appropriate response where a patient may require urgent treatment, including transfer to an acute trust setting. We will continue to contribute to national audits that are relevant to our services in order to ensure that the care we provide is measured against national standards, and to identify where we can improve.
Assessment of our Services The Care Quality Commission (CQC) set out regulatory standards for all health care providers. The CQC independently inspects all health care provider services to make sure they meet fundamental standards of quality and safety; standards that we as a health care provider should maintain. In March 2016, our inspectors gave us a rating of ‘Requires Improvement’. We have worked hard and taken action to put this improvement in place since this inspection and between January and March 2019, our Trust has undergone a re-inspection. We are currently waiting for the outcome of that process.
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As a healthcare provider we want to achieve at least ‘Good’ in how we deliver healthcare to our patients and service users so that care is Safe, Caring, Effective and Responsive, and that services are Well Led. Our ambition is to exceed this and achieve ‘Outstanding’.
All of our staff are committed to this ambition of achieving Good and Beyond by focusing on the things that they can change, always keeping our patients and their families and carers as their priority. We will continue to review our services and improve them. We ensure that the CQC inspection is not just a one-off inspection; it is a helpful part of our continuous review process.
End of Life Care
Every adult, child, young person and their families deserve high quality, person-centred end of life care. Meeting the individual wishes and preferences of those in the last year(s) of life is very important to those involved in receiving the care and those people who deliver that care. Our End of Life Strategy sets out our vision for both adults and children’ services, describing how we will further develop our services to improve the care and experiences of both patients and their families. We are well under way in implementing our vision and have involved other local healthcare providers to support sharing and working together for the good of our patients and their families and carers. We need to ensure that we provide support and training for our staff so that they feel confident and informed to provide the highest quality of care. We provide training and supervision through a designated Clinical Practice Educator.
Ensuring that Children and Young People and their families are supported is also a priority for our End of Life Care service. In 2019/20 we will ensure that patients receive appropriate advice and information, delivered sensitively, and is reflective of the level of information that they wish to be given. Supporting children with life-limiting illnesses as they move into adult services remains a challenge. In 2019/20 we will continue to focus on working with young people and their families to begin planning for this transition. We will work closely with clinicians providing adult services to ensure a seamless transfer for all young people as they move from one service to the other. Ensuring that we are improving End of Life Care can only be assessed by the impact we are having on patients and their families. Regular audits will enable us to monitor progress locally to demonstrate that patients last wishes and preferences are met.
Supporting Patients with Dementia
We recognise the need for longer term solutions to care for patients living with dementia and have set our vision for this through development of our Dementia Strategy. Involving patients and carers in the development of this strategy will ensure that we meet the specific needs of these patients. We will hold consultation events and attend relevant interest groups.
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We will also identify and report key performance indicators and milestones in improving and providing high quality care for every patient with dementia. These will be developed with the Dementia Strategy Group and our Advanced Practitioner in Mental Health.
We will identify the benefits from our investment in Memory and wellbeing workers by doing a thematic review of their impact at Quality and Safety committee.
Looked After Children Many of these children have had difficult life circumstances which result in them being placed in foster care, kinship care, or some form of residential care. We will continue to work closely in partnership with Social Care and Education to help Looked After Children remain healthy both physically and emotionally. We will continue to support these children to reach their full potential. We will ensure the child’s health assessment and care plan is of high quality and they are able to participate in decisions about their health care. We will ensure that all healthcare practitioners who come into contact with Looked After Children will have the skills, knowledge, values and attitudes that are required for safe and effective practice. We will support a smooth transition to adulthood so that young people continue to obtain the health advice and services they need.
Patient Feedback and Involvement Ensuring that patient feedback received informs service improvement and service development is very important to us. We will continue to build on the work to-date to strengthen and increase the use of our existing electronic patient feedback system.
We will continue to utilise a variety of patient experience feedback methods that look at both quantitative and qualitative information and data such as Friends and Family Test (FFT), Observe & Act, Patient Stories, surveys and focus groups.
Patient stories are used in a number of forums and meetings such as Board meetings, Staff Away Days, Service Delivery Group, Quality and Safety Committee and staff meetings. We have designed a tool that provides immediate feedback; both good feedback and areas where we could make improvements. NHS Improvement and NHS England have supported the development of this tool which has been rolled out into parts of the West Midlands.
Our approach to patient and carer involvement in our services is to encourage those that use our services to contribute to them in a really meaningful way. We have a vibrant Patient and Carer Panel that attend groups and committees. Volunteers also work on co-production issues and deliver training for staff on some feedback methods.
Healthy Engaged Staff How staff feel when they are at work is key to the successful delivery of high quality patient care. Evidence shows us that having engaged, healthy staff leads to increased productivity and an overall happier workforce.
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In 2019/20 we will build on our work to-date and continue to promote a working environment that supports wellbeing and provides a great working experience. We will ensure there are opportunities for discussion between staff and managers, identifying ‘what matters to me’ conversations. Appraisals provide one of these discussion opportunities. We have reviewed our appraisal process to ensure appraisals are meaningful and relevant for our staff. As part of our commitment to quality and our staff, we will monitor appraisal rates and ask staff if they found their appraisal relevant and useful.
Skills and Competencies During 2018/19 we implemented a Clinical Education Group to strengthen governance of clinical skills development for our staff. We have developed a standardised competency approach for clinical skills and are building a suite of competencies for staff to achieve or measure their performance against this year. We will also ensure that the training we offer
to our staff is relevant and accessible, with access to role specific training identified during appraisal or as a service need. This is an important component to our workforce strategy as we embark on new workforce models with different ways of working and different roles to deliver healthcare. The trainee Assistant Practitioners and Nurse Associates are a good example of new ways of delivering healthcare.
Staffing Levels Ensuring that we have the right number of staff with the right skills across our clinical services will ensure that we deliver high quality care and that staff feel supported. In 2019/20 we will ensure the comprehensive guidance on Workforce Safeguards described by NHS Improvement (NHSI) is embedded into our workforce plans.
Our Plan
Initiative Timeframe Milestones
Review Quality Assessment and
Accreditation System (QAAS) to
ensure fir for purpose for each
service area and implement
changes identified through the
review
Q2 Fully rolled out across all core services
Strengthen our assurance
processes to ensure that we learn
from when things don’t go well
Q1 2019/20
Q2 2019/20
onwards
Review and strengthen the existing tracking and monitoring system.
Reporting process in place to monitor delivery of actions and provide assurances that improvements are in place
Embed learning from CQC
Q2 2019/20
Q3 2019/20
onwards
Development of CQC improvement action plan for core services
Regular performance reporting to Quality and Safety Committee
Q2 2019/20
onwards
Q3 2019/20
onwards
Development of CQC improvement action plan for the CQC Well-Led assessments actions
Regular performance reporting Trust Board
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Initiative Timeframe Milestones
Develop an action plan to
implement NHSI workforce
safeguards and ensure robust
processes for future application of
the safeguard requirements
Q1 2019/20
Q1 2019/20
Undertake a Trust self-assessment against NHSI recommendations.
Develop an Action Plan to implement changes to address the gaps identified
Review and refresh the End of Life
Strategies
Q2 2019/20
Q3 2019/20
Refreshed End of Life Strategy approved by Trust Board
Roll out and embed the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) form for all patients in the last 12 months of life
Review and refresh our Quality
Strategy (aligns to Clinical
Strategy)
Q2 2019/20
Q2 2019/20
Q4 2019/20
Updated Quality Strategy for 2020 and beyond approved by Trust Board
Strengthened process and reporting schedules in place to monitor implementation against agreed timescale at Service Delivery Group Quality, Safety and Delivery Meeting
Report on progress against our strategy to Quality and Safety Committee
Refresh and develop our Clinical
Strategy for 2019/20 onwards
(aligns to Quality Strategy)
Q1 2019/20
Q3 2019/20
Q1 2020/21
Working Group established to undertake a refresh and progress the development of our Clinical Strategy
Clinical Strategy approved by Trust Board
Report on progress against our Strategy to Trust Board
Strengthen governance
arrangements for skills
development to support new and
existing workforce models
Q2 2019/20
Q3 2019/20
Q4 2019/20
Develop a clinical skills competency matrix
Identify a training portfolio and programme to deliver clinical skills (internal and external)
Implement governance processes to support the future development and approval of competencies
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Transformation
Plan
Sustainability and Transformation Partnerships (STP)
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Sustainable Community Services
Our vision for services and our Strategic Priorities recognise that high quality sustainable community services are critical to meet the changing needs of our population. Health and care needs are complex, and patients receive services from many different organisations. The Shropshire and Telford and Wrekin Sustainability and Transformation Partnership (STP) Plan brings together plans across these organisations. This joint plan describes how we are working together to coordinate and improve services for patients and their families. We will continue to work closely with partners as local services develop.
Strategic Priority: Transformation Plan The future direction of travel both locally and nationally focuses on delivering services in a community setting where patients are currently being seen and treated in an acute setting. The recently published NHS Long Term Plan supports our long term strategy and guarantees investment in community services. The Plan describes the intent to ensure that care is patient centred. The focus being to improve out of hospital care and “dissolve the historic divide between primary and community care”, reduce pressure on hospital services - including admission avoidance and reduced delays to discharge. Given the wide range of services we provide and the clinical pathways we contribute to, The NHS Long Term Plan is central to our vision and strategy development. Our Operational Plan for 2019/20 describes how we will contribute to the longer term system plan. The emerging Integrated Care System, which we anticipate will be developed over the next two years, provides an opportunity to realise our vision to work closely with our health and social care partners to give patients more control over their own care and find necessary treatments more readily available. Our operational priorities reflect the steps required to achieving more joined up services
across organisations as we support the transition into Integrated Care Systems. We recognise that the sustainability of community services is intrinsically linked to the development of new models of care and our ability to support the health economy to develop credible alternatives to hospital services in the community. Our ambition and operational priorities remain committed to developing integrated models that will provide care closer to home for our patients. These new models are being developed and in 2019/20 we will continue to work closely with the STP partners to quantify the impact of the shift of activity from the acute sector to the community. Our community nursing and therapy teams will support future admission avoidance initiatives whilst at the same time contribute to early supported discharge schemes. The underlying principle driving the development of our services is to either avoid an admission to hospital or, where an admission is unavoidable, reduce the time that our patients spend in the acute hospital. In 2019/20, we will continue to develop working relationships with our partners to deliver the care our populations need, and in consultation with them.
Our new clinical models will focus on holistic services that ‘wrap around’ the patients and the communities in which they operate. We will support the newly formed Primary Care Networks across Shropshire and Telford and Wrekin.
Our Clinical Strategy Our Clinical Strategy reflects our ambitions and our commitment to providing the highest standards of care. It demonstrates how we are listening to our patients, staff and partners, and
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how we will work with them to deliver coordinated and integrated services that are designed around the needs of our local communities. We have identified a set of key operational priorities. These include the development of:
New models of care to support patient
needs in the community as alternatives
to hospital based care
New roles and skills to deliver the new
models of care
Expansion of admission avoidance and
care coordination services
More efficient ways of working
optimising effectiveness and efficiency
New technologies for health records
and mobile working
The current pressure on our local GPs is widely recognised. Our integrated workforce will support local GPs and primary care resilience with timely access to out of hospital multidisciplinary healthcare teams that are responsive to local need and priorities. The reconfiguration of acute services within our local health system signifies a significant transformation programme with a large capital commitment. The expansion of community services is critical to support this reconfiguration. We must, and will, ensure that our patients are able to receive the care that they need as close to home as possible and at the same time reduce the demand on acute services. The health and the needs of our population are very different across the county. We will utilise public health data to identify future demand for services and to prioritise health needs within these communities.
Neighbourhood Working and New Models of Care
During 2018/19 we have been working closely with Shropshire Clinical Commissioning Group on the Shropshire Care Closer to Home Programme. This is a three-phase model, with Phase 1 being completed with a Frailty Intervention Team successfully established.
Phase 2 of the programme proposes a Case Management approach to managing patients in the community. This will be delivered through an integrated multi-disciplinary team bringing together primary care, community services, mental health, local authority and voluntary sector services. During 2019/20, our expectation is that our teams will continue to be involved with the development of Phase 3 of this important programme. At the same time we have been working closely with Telford and Wrekin CCG in the development of the Telford Integrated Neighbourhood Teams Programme. This model is similar in so much as it brings together our community staff, GPs, mental health and the local authority. This integrated team will support the local communities within each of these Neighbourhoods. In 2019/20, we will continue with the development of locality and neighbourhood working. The focus of this will be to identify where we can support patients at an earlier stage of illness and optimise their opportunity to remain well at home. Our future service offer is being designed around a ‘one team’ approach that builds on the existing services within communities. We have worked closely with commissioners to align our community teams to the Primary Care networks which our GP colleagues are currently developing. Community Teams will be the first point of contact for patients who do not require emergency treatment. They will help to prevent admission to acute services and to support patients once they have been discharged from acute or rehabilitation facilities.
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We have been working closely with commissioners to develop alternative models of care which will release pressure on primary care.
In 2018/19 a new Wound Healing service commenced, which is now available throughout Telford and Wrekin. Patients who have complex wounds and previously attended their GP practice are treated within this service. This has freed time in the practices and is demonstrating positive patient outcomes. In 2019/20 we will explore opportunities to deliver a Wound Healing service across the whole of Shropshire. This service is currently delivered by our community nurses. New Assistant Nurse Practitioner roles could provide this service freeing up district nursing teams to support admission avoidance schemes. We know that for some patients their place of residence is either a care home or a nursing home. Providing advice and guidance to the staff and supporting care assessments within the home provide an opportunity to prevent some of those patients having to attend an acute hospital. In 2019/20 we will continue the work commenced by our Telford Care Home service, supporting nursing and residential homes to optimise the health and well-being of residents. This service provides care planning, advice and guidance to avoid the need for a hospital stay. Urgent care and emergency care services are under growing pressure. Many patients are admitted to a hospital bed or taken to emergency departments. We know that in many non-emergency situations this is not the best place for these patients and increases the pressures in the acute hospitals. During 2018/19 we have developed a partnership with Shropshire Doctors Co-operative (Shropdoc) for the provision of a GP-Led Out of Hours Services as part of the wider Integrated Urgent Care service in Shropshire. The new service works alongside the national NHS111 service providing urgent care and advice to provide timely interventions and reduce the demand on Emergency Departments.
We will work with our partners across the health system further to develop and improve urgent care services within the county. The development of the Integrated Urgent Care service is the first step in a developing partnership and we will work closely with Shropdoc over the next 12 months to identify and explore further opportunities to develop community services. We will continue to progress opportunities for community staff to have input to the discharge planning for patients who are in hospital, to maintain continuity of care for patients and support earlier recovery. Our teams will work closely with the hospital teams to support patients who are ready to leave hospital. Our community Matrons will ensure that patients are identified as soon as possible and that the required healthcare support measures are in place to enable them to go on to the most appropriate destination. Some patients attend hospital sites or are admitted into a bed for care that can be provided outside of the hospital. Expanding community based treatments and alternatives to bed based service delivery will reduce the need for admission to hospital and free up beds for patients who are acutely ill. In 2019/20 we will continue to expand our ability to provide Intravenous (IV) antibiotic therapy in the community, both at home and in some of our centres, to avoid the need for patients to have long hospital stays.
Children and Young Peoples Services Over the past twelve months, Children’s services have continued to transform. In 2018/19 Shropshire Local Authority commissioned a new model of care aligned to
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the national 0-19 Healthy Child Programme introducing a new model of care for Children and Young People. We have recently been awarded a contract to provide a 0-19 Healthy Child Programme Service in Telford and Wrekin. The model is an innovative new model that has inspired the service and continues our ethos of putting the child at the centre of everything we do. We hope to mobilise this exciting new model in 2019/20. A specific quality focus for the Service Delivery Group moving into 2019/20 is to evaluate and improve service provision for Children and Young People who have Special Educational Needs and Disability (SEND). The focus will be on improving the journey for the child/young person but also the family. It is acknowledged the complexity not only of health, but also local authority provision can be daunting for families who often feel they have to repeat their story to access services to meet their needs. We are looking to ensure the services we provide are seamless for the families. The roll out and embedding of RiO will enable this with
improved access to care records from all disciplines.
Demand for our services is increasing, so ensuring that we deliver value for money and are as efficient as we can be is really important. To support us to do this, we will undertake a review of all services using a ’12-Stage Productivity and Financial Plan’ tool. Children’s Services will focus on access to services, in particular with relation to meeting the needs of speech and language whose referrals continue to grow; this will include innovative approaches to delivery such as bespoke group sessions.
Our Plan
Initiative Timeframe Milestones
Children and Families Service Delivery Group (SDG)
Develop pathways and processes to support transition of young people into adult services
Q1 –Q2 2019/20
Q3 2019/20 Q4 2019/20
Draft transition policy to be piloted in Children Community Nursing team for children with ongoing complex medical conditions
Amendments to policy following pilot outcomes
Roll out new policy to therapy services
Undertake a review of SEND services and implement changes identified within the Improvement Plan
Q1 2019/20 Q2 2019/20
Establish working group to develop overarching strategy
Strategy approved by Trust Board
Embed the 0-19 new model of care for the 0-19 Healthy Child Programme
Q1 2019/20
Q1 2019/20
Q2 2019/20
Q3 2019/20
Review of lessons learned from Shropshire 0-19 model currently being used
Results of Telford and Wrekin tender announced - If successful beginning staff engagement events
Review of KPIs for Shropshire contract and action planning via staff engagement events to redesign service as required to deliver Healthy Child Programme
Mobilisation of Telford and Wrekin model
*all of the above are subject to CCG timescales for approval
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Initiative Timeframe Milestones
Scope opportunities to deliver Children’s Development Reviews via Skype
Q1 2019/20 Q2 2019/20 Q4 2019/20 Q4 2019/20
Scope out opportunity to use, and roll out Skype
Pilot the process in Telford and Wrekin – subject to CCG
Evaluation
Launch of Skype / mobile services identified in quarter 3 as per mobilisation plan
*all of the above are subject to CCG timescales for approval
Expand social media to reach families – children’s specific (Chat Health, Facebook)
Q1 2019/20 Q2 2019/20
Q3 2019/20
Review existing website and identify changes
Audit training needs of staff to enable website updating and delivery of accessibility options identified
Undertake lessons learned review
Undertake a Service review of Children’s services community equipment and implement changes identified to ensure equity of access
Q1 2019/20
Q1 2019/20 Q1 2019/20
Review of service specification with commissioners, and external processes and procedure
Sign off of specification pending CCG approvals
Project plan to implement new service.
*all of the above are subject to CCG timescales for approval
Embed RIO and realise the benefits associated with the new system
Q1 2019/20
Q1 2019/20
Q1 2019/20
Continue roll out to services not yet live with system – immunisation and vaccination service, wheelchair service etc.
Review with services who have been live to ensure system meets service needs
Meetings scheduled with information team for teams to discuss any changes required to meet Key Performance Indicators (KPIs)
Scope opportunities to roll out Skype technology for consultations across the whole of Children and Families services across a range of settings
Q1 2019/20 Q2 2019/20 Q2 2019/20
Implementation plan agreed
Implementation of proof of concept
First stage roll out to wider service
Adults SDG
Implement and evaluate the new integrated model of care in Stoke Heath Prison and ensure robust contracts are in place to support delivery of the whole service
Q1 2019/20 Q1 2019/20 Q1 2019/20 Q3 2019/20
Implement new integrated model 1 April 2019
Feedback to all staff involved with regard to the new model
Formal report and Lessons Learned completed
6 month review of new model
Implement new models of care emerging from the Shropshire Care Closer to Home and Telford and Wrekin Neighbourhood Schemes
Q2 2019/20
Q3 2019/20
Q3 2019/20 Q3 2019/20
Shropshire Care Closer to Home Pilot Phase 2 June 2019
(P.I.G.)
Evaluation of Shropshire Care Closer to Home Phase 2 roll out
Impact Assessment of Shropshire Care Closer to Home
Assess impact of Telford and Wrekin Neighbourhood Scheme
*all of the above are subject to CCG timescales for approval
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Initiative Timeframe Milestones
Redesign and implement the community nursing and therapy service delivery model aligned to the Shropshire Care Closer to Home and Telford and Wrekin Neighbourhood Schemes
Q1 2019/20 Q4 2019/20
Governance process and project plan agreed
New service operational across all localities
Develop a sustainable alternative model to our GP led units (Whitchurch Community Hospital)
Q1 2019/20
Q2 2019/20 Q4 2019/20
Develop local model based on evidence gained from other areas (May 2019)
Recruitment to new roles in the alternative model
Undertake an impact assessment and lessons Learned review to inform roll out
Scope opportunities to roll out Skype technology for consultations across a range of settings
Q1 2019/20 Q2 2019/20 Q2 2019/20
Implementation plan agreed
Implementation of proof of concept
First stage roll out to wider service
Implement e-rostering (subject to a successful evaluation)
Q1 2019/20 Feedback regarding benefits evaluation
Embed RIO and realise the benefits associated with the new system
Q1 2019/20 Q2 2019/20
Complete phase 4b
Rollout of full Electronic Patient Record system (EPR)
TeMS and Outpatients
Move Musculoskeletal (MSK) service (Shropshire) to Alternative Partnership model
Q4 2019/20
Q4 2019/20
Q4 2019/20
Q4 2019/20
Take up role within MSK programme Q1, ensure high profile contributor
Prepare current model for transfer to alternative, work with Shrewsbury and Telford NHS Trust (SaTH) subcontract to be able to provide appropriate service data for STP
Support STP from outside MSK programme contribution on behalf of STP
Scope alternatives to inform STP process
Implement First Contact Physio (FCP) Shropshire - Pilot
Q2 2019/20 Q3 2019/20 Q4 2019/20
6 months pilot undertaken
Evaluation undertaken of pilot for wider roll out
Offer prepared for upscale of current FCP
Support development of Integrated Falls pathway
Q2 2019/20 Q3 2019/20 Q4 2019/20
New model for service developed
Specification agreed with CCG
New model implemented
Refine current Community Neurological Rehabilitation Team (CNRT) model of care to support stroke pathway work
Q1 2019/20 Q2 2019/20
Q3 2019/20 Q4 2019/20
New model developed
Workforce finalised
Tariff unbundled
Service specification agreed with CCG
Implementation of new model
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Initiative Timeframe Milestones
Implement evidenced based Podiatry service aligned to NICE recommendations
Q1 2019/20
Q1 2019/20
Q4 2019/20
Review and contribute to the developing CCG service specification for the future service
Agree Podiatry specification for Shropshire Community Health NHS Trust (SCHT) draft as above
Implement new model
Implement a new system to provide a Single Point of Access for each locality
Q1 2019/20
Q1 2019/20 Q2 2019/20 Q4 2019/20
Prepare QEIA for SPR disaggregation and commence Project Management Office (PMO)
Project Plan developed o Phase 1 disaggregation of the capacity hub o Phase 2 - relocate hub staff to clinical teams
implemented
Scope opportunities to roll out Skype technology for consultations across a range of settings
Q1 2019/20 Q2 2019/20 Q2 2019/20
Implementation plan agreed
Implementation of proof of concept
First stage roll out to wider service
Local service plan to optimise use of social media, apps and voice to text solutions
Q2 2019/20 Q4 2019/20
Clinical identification of potential service area
Implement by priority
Embed RIO and realise the benefits associated with the new system
Q1 2019/20 Q2 2019/20
Complete phase 4b
Rollout of full EPR
Strategy Team
Contribute to the development of community based models of care sharing intelligence within our Trust and influencing design outside of our Trust
Q1 2019/20
onwards Q2 2019/20
onwards
Q3 2019/20 onwards
Lead the developing pilot for the case management model in Shropshire (subject to CCG timelines)
Develop Project Initiation Documents (PID) and robust project plans to support the implementation of our Trust’s transformation programme
Identify and evaluate partnership opportunities for service improvement and development, and ensure they are established to align system developments with Trust developments
Develop robust planning tools and processes to support integrated strategic planning and ensuring that operational plans are live
Q1 2019/20 Q2 2019/20 Q4 2019/20
Refresh PID and process
Review existing projects to identify Lessons Learned
Undertake Lessons Learned for all completed PMO supported projects, with a report to Benefits Realisation Group (BRG)
Strengthen the PMO function to enhance project support provide training to develop improved business skills across our Trust
Q1 2019/22 Q2 2019/20 Q3 2019/20
PMO Tracker developed and Dashboard refreshed
Business training programme developed
Training events scheduled
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Estates Strategy Our Estates Strategy is a dynamic strategy and is reviewed and revised if required on an annual basis to inform our Capital Programme. Our strategy considers the developing and changing nature of our Trust and sets out to address:
Operational effectiveness
Operational efficiency
Flexibility
Working with partners
Taking opportunities
The Estates Strategy incorporates the NHS 10-Year Plan, Carter Metrics and the Model Hospital agendas on using space more efficiently and effectively. It also considers the changing models of care associated with the development of integrated care teams. This is in line with the Right Place and Right Agenda workshops, which identify the best location for services. A significant element of our asset base is our estate. As such, a large element of ongoing capital investment is required to address estate maintenance and statutory and mandatory obligations. In 2019/20 we are committed to investing in buildings work to address compliance issues such as improvements relevant to infection prevention and control. The development of local Neighbourhood models of care (Integrated Care) is also driving our estates strategy. During the past year our Transformation Programme and new models of care have developed in dialogue with commissioners, and our estates plans remain closely aligned with that. During the past twelve months we have progressed a range of initiatives including the development of Wound Clinics in Telford and Wrekin. In 2019/20 we will continue to respond to evolving clinical models. Our property management strategy is shaped by the need for inherent flexibility to accommodate
change. Going forwards we will look to operate a range of property holdings that can either:
be altered easily to meet changed
circumstances;
be able to be flexed up or down in size;
be disposed of where necessary; or
are centrally and/or accessibly located.
In 2019/20 we will continue to work with Midlands Partnership NHS Foundation Trust on a number of joint initiatives. We both deliver out of hospital care through community-based teams for the people of Shropshire and Telford and Wrekin. It is logical that supporting services are reviewed and co-located where possible to support integrated working and deliver efficiencies.
Centralising services, reception staff and estates optimisation will reduce costs and support a single point of service for healthcare in the community. In 2019/20 we will work alongside system partners as service reviews are undertaken in line with the Sustainability and Transformation Plan. The impact on estates will then be considered as part of future planning. Our Capital Investment Policy recognises the need for re-investment to replace existing assets, and to assist in the reduction of backlog maintenance. The ongoing monitoring and management of resources will help support improvements already made with the sustainability of the estate.
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Our Plan
Initiative Timeframe Milestones
Improving physical access to services for families
Q2 2019/20 Q2 2019/20 Q4 2019/20 Q4 2019/20
Disability Access survey
Diversity survey
STP Estates Strategy agreed and adopted
Capital plans for 2020/21
Introduce a robust Room Booking Information System
Q3 2019/20
Completion of business case and approval to complete the electronic drawings of our buildings required to develop the system
Implement the 3 year improvement programme with a clear delivery plan, with short and medium term actions
Q4 2019/20 See note *
STP Estates Strategy agreed and adopted
Defined capital bids for STP funding
* 3 year programme with March 2020 STP bids. 3 year dynamic capital programme for smaller works based on annual plans as funding becomes available.
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Optimising the use of
technology
Implementing Electronic Patient Record
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Strategic Priority: Optimising the Use of Technology We recognise the growing digital agenda and how technology can support transformational change. Mobile working, telehealth and shared care records are key areas for development.
Information Management and Technology Strategy Our Information Management and Technology (IM&T) Strategy considers the emergence of both Telecare and Telehealth and how our Trust needs to deploy Information Technology (IT) appropriate solutions. It describes our vision over the next five years and our priorities, which are:
Conclude the implementation of our RiO
Electronic Patient Record (EPR) (described
in the following chapter)
Implement our new data connectivity
infrastructure – the Health and Social Care
Network (HSCN)
Continue the use of mobile working
solutions for our workforce and work with
our Sustainability Transformation
Partnerships (STP) to provide wireless
services across the wider public sector
estate
Complete the investment in wireless
technology for patients
Invest in appropriate telehealth and telecare
technologies with our partners, including the
use of video conferencing facilities
Through the digital roadmap process, work
with our partners to create an integrated
care record at the point of care delivery
Maintain General Data Protection
Regulation (GDPR) Compliance
Explore the implementation of electronic
prescribing and medicines management
systems
Optimise the use of our existing data to
enable effective demand and capacity
modelling for efficient service planning
Maintain our investment in the IM&T
infrastructure, keeping pace with wider NHS
developments to ensure safe and effective
services
Many of our services are delivered in rural locations across the County. Being able to access to information, both clinical and non-clinical ensures that our staff have up to date and timely information. We have invested in equipment and infrastructure to improve connectivity which will provide access to appropriate information in a timely manner. During 2019/20, we will continue to invest and explore options to improve this further.
In addition to the single clinical record at point of care, technologies such as mobile working and implementation of telecare and telehealth care also form part of the key enablers to support increasingly localised service delivery. In 2019/20 we will further explore options to enable the expansion of treatments in the community. In 2018/19 we successfully worked with NHS Digital in the implementation of patient Wi-Fi services across our Trust. This has enabled patients to use their smart phones or other devices to be online and to keep in touch with friends and family whilst away from home. We recognise the potential information governance challenges associated with new ways of working and the introduction of the GDPR requirements. The information governance agenda also includes the management and mitigation of risks associated with cyber-security issues; nationally these are addressed by the Care Computer Emergency Response Team (CareCERT) process; and locally by rigorous application of threat mitigation practices.
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Our Plan
Initiative Timeframe Milestones
Implement the NHS Digital HSCN programme (replacing N3)
Q3 2019/20 Improved connectivity across the main estate
Develop skills and expertise to support robust data capture and data analysis
Q4 2019/20 Initialisation of digital skills facilitators / trainers programme;
ideally requires external support potentially from Health Education England (HEE)
STP – Gov.Roam - assist in the provision of economy wide Wi-Fi services for staff across the STP estate
Q3 2019/20 GOV.Roam (Wi-Fi) is operational across the STP public
estate
STP – Summary Care Records with Additional Information (SCR+Add Info) - encourage staff in our services to promote this to our patients; it will form the foundation of the Local Health Care Record (LHCR)
Q4 2022/23 SCR+Add Info has 90% coverage across the population
Implement IT strategic priorities including enhancements to cyber-security, upgrades to operating systems and applications, review of mobile data requirements and Microsoft365 and Cloud First; together with review and potential provision of NHSmail Skype
Q4 2019/20 Implementation and delivery plans are in place as part of
robust project plans
Implementing Electronic Patient Record The continuing deployment and development of our RiO Electronic Patient Record (EPR) system represents a significant investment both in financial and other resources. The system is a key enabler to support revised delivery models including Care Closer to Home and Neighbourhoods service delivery model. Identifiable benefits include:
Improved patient experience
Easier access to records for clinicians
Reduced clinical risks and management
overheads arising from fragmented paper
and electronic systems
A framework for standardisation and service
re-design of clinical and administrative
processes across our Trust
The need to align the local systems with
national Information Management and
Technology (IM&T) strategies, particularly
with regard to moving to ‘paper-light’ and
providing patients with electronic access to
their records
The need to provide a technical solution that
can work with other clinical systems both
within our Trust and across the Local Health
economy including other NHS Trusts, GP
Practices and Social Care
Enables mobile working with the ability to
share the patient record across the large
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geographical area that our Trust spans both
within and across operational services
All of these benefits play an important part in supporting us to deliver safer, modern and high quality health services for the communities we serve. This will enable us to fulfil our obligations as part of the STP Digital Roadmap in delivering a single clinical record at the point of care. The RiO EPR system in conjunction with the deployment of mobile devices, facilitate the necessary service and workforce transformation that is envisaged by the STP vision. RiO has the potential to drive significant efficiencies in the future and will simplify how we communicate and importantly share information with our partners and patients.
We have completed the implementation across a number of service areas in 3 Major Phases:
Phase 1: Podiatry and Minor Injury Units
(MIUs)
Phase 2: Children’s Services
Phase 3: Adult Community Services
We have also made significant progress in the final phase, which will be completed during 2019/2020 - Phase 4: Community Hospitals. A robust clinically-led benefits realisation process is in place to ensure that we monitor and evaluate the impact of the RiO deployment. The individual benefits realisation plans for the programme are being finalised on a team-by-team basis.
Electronic Prescribing and Medicines Management (ePMA) is a dedicated work stream within our EPR programme. In 2019/20 we will identify, scope and explore opportunities to identify a clinically viable solution to enable us to access robust medicines information in the same way as we access other clinical information.
Our Plan
Initiative Time-frame Milestones
Embed RiO and realise the benefits associated with the new system
Q1 2019/20 Q2 2019/20
Complete phase 4b
Rollout of full EPR
Develop an Implementation Plan to enable the introduction of the new Electronic Prescribing and Medicines Administration (ePMA) system across our Trust in 2020/21
Q2 2020/21 Implementation plan approved.
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People
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People Strategy Our people are at the heart of our Trust and are very important to us. They form the core of service delivery. We have a number of initiatives, processes and strategies in place to support our people to deliver the work they do. Our People Strategy sets out the strategic vision for our workforce for the period 2018 – 2021. We are now in its second year of implementation. Our Strategy has been shaped by two key strategies:
The Health Education England (2017) Facing the Facts, Shaping the Future Strategy
Shropshire, Telford and Wrekin Sustainability and Transformation Plan (STP) Strategic Workforce Transformation Group (2018) People Strategy
Our clear aim is to develop skilled and motivated people who are confident to deliver high quality services in new local models of care. Our ambitions include:
Ensuring that all our people have critical
clinical and leadership skills
Expanding the scope of registered
professionals’ roles, strengthening the
unregistered workforce by creating
different routes into employment
Attracting new staff offering innovative
new models of employment and exciting
career development
Creating a healthy environment which
brings out the best in staff
Focusing on providing crucial
management skills for those new to
leadership roles, and supporting people to
adapt to the changing demands
Ensuring that we can create a great
employment experience for all people from
all backgrounds and experiences
Workforce Sustainability Ensuring that we recruit and retain the right people who share our Values is really important to us. Our recruitment assessments ensure that we attract and employ the best people who in turn will ensure that their colleagues and our patients are treated and supported in a caring way. We face particular recruitment challenges in some roles including dental practitioners, registered nurses and allied health professionals. The clinical sustainability of our inpatient services and minor injury units continues to be challenged. Some of our more rural areas with long travel times to the next urban area struggle to recruit, despite efforts to improve the attractiveness of our employment. These are all challenges we are working to overcome. The health and wellbeing of our staff is important to us to help retain skilled, healthy and valued people. We will provide access to services to support our staff, ensuring that they feel valued. This includes mental and emotional wellbeing support showing our commitment to a person centred approach in absence management.
We are committed to refreshing our organisational approach to recognition and reward, and are reviewing our approach to flexible working to support both the needs of the service and our people.
The diversity of our workforce and our inclusive approach are important to us and we are working to further expand and develop our staff networks to enhance our practice.
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In order to ensure safe staffing and optimise the development and progression of our people we are developing a structured approach to workforce, succession and talent planning. We have a successful apprenticeship offer and will continue working to widen and develop this.
We have aligned the People Strategy to support delivery of the Clinical Strategy and Quality Improvement Priorities. This enables us to support work across inpatient and community services, and the implementation of Care Closer to Home and Neighbourhood models. We will continue to equip our staff with the knowledge and skills to deal with changes required to deliver these services - including the use of technology.
Staff Experience
We are committed to ensuring that our staff feel valued and are able to give and receive feedback through a number of mechanisms.
The annual Staff Survey provides an opportunity to ask how staff feel. Our most recent survey showed:
Our staff are proud of the care they deliver
They feel safe to speak up when things
are not right
Staff feel that we act fairly on career
progression and nearly all who responded
said that they had an up to date appraisal
Detailed discussions about our results have resulted in three areas of focus for the coming year:
Creating time to look after ourselves, each
other and our teams
Working together and living our values to
get to zero bullying and harassment
Continue to develop our leaders to have
conversations that count around staff
wellbeing and appraisals
Our Plan
Initiative Time-frame Milestones
Equipping our staff to stay as well as they can be in work
Q2 2019/20
Q2 2019/20
Q3 2019/20
Broadening our offer of physical, mental and
emotional health and wellbeing support for our staff
Develop our portfolio of corporate wellbeing
campaigns
Develop a financial wellbeing offer for our staff
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Initiative Time-frame Milestones
Working as a Health and Social Care Economy – working together for STP Workforce Priority
Q3 2019/20
Q3 2019/20
Q4 2019/20
Q4 2019/20
Optimise opportunities for rotation of staff and other development opportunities between employers, including the implementation of shared rotational apprentice roles
Develop a joint approach to recruitment across partner employers
Work collectively to develop an STP approach to a shared staff bank
Work collectively with education providers to optimise our use of resources – including research projects and publicising community services as career development
Introduce systematic process for Talent Management
Q2 2019/20
Q2 2019/20 Q3 2019/20
Q3 2019/20
Q3 2019/20
Q4 2019/20
Q4 2019/20
Q4 2019/20
Expand our Apprenticeship offer and develop our apprentice employment model– optimising use our Apprenticeship Levy
Implement a structure for Talent Management.
Develop support for leaders to better manage the performance and development of the workforce
Provide enhanced training and development programmes to further develop leadership, clinical and digital skills
Develop a more structured approach to succession
planning Develop a competency framework for all roles
starting with the core skills for the non-registered and junior registered frontline staff and clinical and non-clinical leadership roles
Develop and promote available clinical skills training, encouraging the sharing of knowledge and skills
Further develop rotational roles within our Trust and
across the system
Embed impactive staff networks
Q2 2019/20
Q3 2019/20
Work with our BME, Diversity and Disability staff networks to enhance the employment experience
Deliver our action plans for Workforce Race Equality
Scheme (WRES) and develop an action plan for
Workforce Disability Equality Standard (WDES)
Strengthen workforce planning and optimise our available workforce
Q2 2019/20
Q2 2019/20
Q2 2019/20
Q3 2019/20
Q3 2019/20
Q3 2019/20
Work with Operational leaders to apply strategic workforce planning principles in support of our business, contracts and services, developing the profile of our workforce to ensure it is fit for purpose
Create a targeted approach to recruitment where relevant
Develop our recruitment processes and practices to ensure they are of the highest quality, flexible and responsive to the needs of the business
Introduce an integrated workforce planning process to complement and improve the annual business planning process
Offer appropriate and flexible employment models for different stages of life, to help people remain in employment with us
Support the design and implementation of new and integrated workforce models
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Initiative Time-frame Milestones
Q4 2019/20
Q4 2019/20
Q4 2019/20
Further develop our approach to bank and flexible working solutions
Helping staff adjust to changed culture and working practices as a result of technology
Adopt new and innovative approaches to safeguard workforce supply for new and developing roles
Develop an action plan to implement NHS Improvement (NHSI) workforce safeguards and ensure robust processes for future application of the safeguard requirements
Q1 2019/20
Q1 2019/20
Undertake a Trust self-assessment against NHSI recommendations
Develop an Action Plan to implement changes to address the gaps identified
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Finance
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Finance Plan
As a provider of community NHS services we receive the majority of our income from NHS commissioners (e.g. Clinical Commissioning Groups in England and Local Health Boards in Wales). We also receive a significant proportion from Local Authorities.
We recognise that the clinical and financial sustainability of our organisation is intrinsically linked to the development of new models of care and our ability to deliver these models and work in partnership with our health and social care partners. This will continue to be the focus of our planning. In 2019/20 we will work closely with other health and care providers, such as the acute hospitals where our staff will expand and develop services to avoid admission and will also support discharge and ongoing care. We will also work closely with local authorities through our integrated health and social care teams. Like the rest of the NHS, we have to meet the needs of our patients whilst at the same time finding ways to be more efficient. We need to ensure that we continue to deliver best value for money.
Each year we are set some challenging financial targets to meet, especially given the scarcity of resources in the current economic climate. All healthcare providers are set a ‘target’ each year. For 2019/20 our regulators NHSI have set a control total of £0.844m surplus. NHS England has established a Provider Sustainability Fund (PSF). This pot of money is intended to support providers to reach financial balance and to support the transformation of
health services. The PSF is linked to the achievement of financial controls and the delivery of agreed performance targets. Our 2019/20 plan assumes receipt of £0.844m from the PSF. Assumptions included within the financial plan are consistent with the 2019/20 financial framework for providers and have been adjusted to ensure they are appropriate for our organisation. We have taken into account known changes in activity, service developments, decommissioned services and internal and external cost pressures as necessary. Particular attention has been paid to ensure workforce implications are consistent with the financial model. Notable assumptions within our plan include:
Tariff: net 2.5% in line with national assumptions
Pay: 3.3% overall uplift, consistent with national guidance
Non-pay: 1.5% targeting specific areas where costs are likely to rise
Sustainability and Transformation Fund: £844k
Cost Improvement Programme We are targeting a Cost Improvement Programme (CIP) of £3.5m for 2019/20, which includes the carry forward of CIP met non-recurrently in 2018/19 as well as the impact of investments and other local cost pressures. Delivery of this required level of efficiency savings remains a significant challenge and is very high risk both in terms of the development status of schemes and the delivery risk. Our Trust remains focused on ensuring we fully develop schemes to meet the efficiency target for 2019/20, and that we realise the benefits and cost savings associated with those schemes implemented. We use a Quality and Equality Impact Assessment (EQIA) process to ensure these schemes have no adverse impact.
Procurement
Our Procurement Group plays an integral part in evaluating all non-pay products and assists with clinical rationalisation as part of the review process.
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Reporting is currently in place to identify our Trust’s top 100 non pay spend items by value and usage and particular attention is made in assessing alternative products which can produce a step change in cost.
Capital and Cash
The Capital Programme is regularly reviewed to ensure that it meets current and future Trust and System needs. Capital schemes will continue to be evaluated through the Capital and Estates
Group in direct contact with service areas to test their appropriateness and alignment to Trust and STP ambitions. The proposed Capital Plan for 2019/20 totals £1.9m which is entirely financed through internally generated.
Our Plan
Initiative Timeframe Milestones
Finance team to ensure Trustwide focus is maintained on identifying, quantifying and delivering CIP in the short and long term.
Q1 2019/20
Q2 2019/20
Q2 2019/20 Q2 2019/20
Deliver Productivity and Financial Performance Improvement training
Implement a plan for the Finance team to provide ‘Outstanding Business Support’ incorporating Future Focus Finance (FFF) accreditation
Finalise Investment Policy
Update process for 3 year rolling Cost Improvement Programme (CIP) identification / quantification / delivery (aligning with PMO)
Finance team to identify opportunities for continuous improvement in internal and external reporting, use of financial systems, information supporting decision making, controls and processes to deliver efficiencies
Q2 2019/20 Q3 2019/20
Develop Long Term Financial Model (LTFM)
Implement feedback from users of financial information to improve decision making
Build relationships and work closely with the finance teams across the STP to support integrated planning
Q3 2019/20
Finalise SCHT contribution to the system wide 5 year financial plan
Implement a ’12 stage financial and productivity plan’ across all operational services
Q1 2019/20
Q1 2019/20
Q1 2019/20 Q2 2019/20 Q2 2019/20 Q2 2019/20
Q2 2019/20
Q3 2019/20
Q4 2019/20
Process and support agreed. Commence within service areas
Meetings booked with service leads to discuss and plan 12 stages
Completion of action plan for each individual service
Develop PID for any actions requiring project support
Complete QEIAs as required for any actions identified
Monitor progress of plans via 1:1s with service leads and as a whole at the Service Delivery Group (SDG) Quality and Performance monthly meetings
Remedial planning to be put in place for any deviations from the action plan
On-going monitoring of PIDs/actions plans for delivery of milestones Post project reviews as completed in all areas
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Summary Sustainable community services are key components of future health and care services and our Operational Plan reflects the transformational change required to support the strategic plans of the local health and care system. We will continue to work with our partners and build on the work that has been completed to ensure that our services meet the needs of our population. Our Values will continue to underpin how we work: Improving Lives in the Community with a strong Commitment to Quality, recognising that Everyone Counts and Working Together for Patients, providing Compassionate Care and treating every person with Respect and Dignity.
High quality services that focus on continuous improvement are the expected outcomes of any future service redesign. These principles will underpin our new clinical models of care ensuring that services are centred around our patients. The NHS is facing significant challenges as the demand for services grow within a challenging financial environment. Recruitment is a challenge nationally and can have a significant impact in rural areas. Through partnership working we will develop integrated services that utilises the skills of our workforce to improve outcomes for our patients and deliver value for money in this challenging financial environment.
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Appendix 1 - Strategy on a Page
