IBP Chapter 3 Strategy - DWMH NHS · detained under the Mental Health Act. Core services are provided predominately to Dudley and Walsall, but also to neighbouring Trusts in Worcestershire,

DWMH Annual Plan 2015/16 2

CONTENTS

1 FOREWORD ......................................................................................................................................... 3

2 ABOUT THE TRUST .............................................................................................................................. 4

3 STRATEGIC CONTEXT AND DIRECTION .................................................................................................. 8 3.1 OVERVIEW OF 2014/15 ................................................................................................................................8 3.2 PRIORITIES FOR 2015/16 ..............................................................................................................................9 3.3 IMPACT OF COMMISSIONING INTENTIONS ...................................................................................................... 11 3.4 LOCAL HEALTH ECONOMY FACTORS .............................................................................................................. 12 3.5 PLANNED SERVICE CHANGES ....................................................................................................................... 17 3.6 STRATEGIC DEVELOPMENTS ......................................................................................................................... 17 3.7 ORGANISATIONAL SUSTAINABILITY ................................................................................................................ 20

4 APPROACH TO IMPROVING QUALITY AND SAFETY ............................................................................. 23 4.1 PROGRESS AGAINST QUALITY PRIORITIES 2014/15 ......................................................................................... 23 4.2 QUALITY IMPROVEMENT PLANS 2015/16 ..................................................................................................... 25 4.3 QUALITY AND SAFETY AT THE HEART OF SERVICE TRANSFORMATION .................................................................. 26

5 DELIVERY OF OPERATIONAL PERFORMANCE STANDARDS .................................................................. 27 5.1 KEY TARGETS ............................................................................................................................................ 27

6 WORKFORCE PLANS .......................................................................................................................... 30 6.1 SAFE STAFFING .......................................................................................................................................... 30 6.2 PROPOSED WORKFORCE CHANGES ................................................................................................................ 30 6.3 QUALITY IMPACT ASSESSMENTS ................................................................................................................... 30 6.4 STAFF DEVELOPMENT, ENGAGEMENT AND SUPPORT ........................................................................................ 30 6.5 VALUES .................................................................................................................................................... 32 6.6 STAFF HEALTH AND WELLBEING ................................................................................................................... 32

7 FINANCIAL AND INVESTMENT STRATEGY ........................................................................................... 33 7.1 ONE YEAR FINANCIAL PLAN ......................................................................................................................... 33 7.2 FINANCIAL SUSTAINABILITY .......................................................................................................................... 34 7.3 KEY RISKS AND MITIGATIONS ....................................................................................................................... 35


1 FOREWORD

The NHS is in one of the most challenging periods in its recent history. The tight financial setting, coupled with rising patient expectations, set against significant structural change in how the NHS is run and regulated, creates a challenging environment for everyone who works in the NHS.

Regardless of these complexities, we remain clear about our overall purpose and vision. We will continue to provide high quality services to the communities of Dudley and Walsall, and beyond. We will achieve this by:

Focussing on service development and growth – remaining a stand-alone organisation which actively pursues partnerships where they support our clear purpose

Developing our staff and encouraging innovative practice

Working in partnership with service users and carers, ensuring that we use feedback to improve services

Sustaining effective and positive relationships with our partners and stakeholders

Despite the challenging environment, the Trust continues to demonstrate high quality delivery and performance, excellent governance and financial robustness. In addition, we are fortunate to have the support of our commissioners and the active engagement of our service users and communities.

It goes without saying that we will strive to continue to deliver the best in mental health care for the people of Dudley and Walsall and to create a sustainable and forward thinking Trust fit for the future challenges that parity of esteem and the five year forward view will bring.

Our plans for 2015/16 will focus in particular on the following:

Launch of our 2nd

Clinical and Social Care Strategic Vision

Moving forward with our Older Adults Pathway development and Therapeutic Hubs implementation

Building on our growth strategy with a number of innovative new service developments

Supporting our workforce to meet the rising challenges of professional development and continuous quality improvement

Using technology, creativity and inclusion to enhance our stakeholder engagement

Taking forward PbR and activity based contracting to support the development of mental health tariffs

We are pleased to present our full annual plan for 2015/16 that describes our priorities for the forthcoming year. This should be read in conjunction with our 2014/15 Annual Report.

Gary Graham Danielle Oum Chief Executive Officer Chair


2 ABOUT THE TRUST

The Trust is a multi-site provider (29 sites) serving the Black Country boroughs of Dudley and Walsall (within the West Midlands).

The Trust’s headquarters are situated in Dudley, approximately 10 miles north-west of Birmingham.

The Black Country region demonstrates cultural, economic and educational diversity. Walsall, along with Sandwell and Wolverhampton, is a “Spearhead” region based on a high level of multiple deprivation.

Since formation, the Trust has made significant progress in the development of the organisation, engaging with its communities and taking stock of service quality and performance.

We pride ourselves on being:

• A high-performing mental health and social care Trust

• Successful integration of two culturally and operationally different services

• Reputation for consistently good service quality

• Consistent high performance

• Good engagement with service users, carers, agencies and community groups

• Strong relationships with commissioners and excellent local health economy knowledge

• A small and flexible organisation, responsive to change and challenges

• Open and transparent

Figure 1 Key Statistics

Statistics 2013/14 (March 31st

)* 2014/15

Population Served Dudley – 306,600; Walsall – 255,900

Dudley – 306,600; Walsall – 255,900

Total Employees Health Staff: 1,074; Social Care Staff: 109

Health Staff: 1,016; Social Care Staff: 99

Number of Sites Total 29 Total 29

Total Inpatient Beds 191 191

Number of Main Commissioners 2 2

Total Income £65.4m £64.8m

CCG Income from activities £57.5m (88%) £57.8m (89%)

Income from non-healthcare sources 4.6% 5.0%

Service User activities c 350,656 c344,487

Total Outpatient Attendances 17,651 17,482

Total Inpatients Treated 1,035 1,215

No. of patients referred to services by their GP

30,694 29,263


2.1.1 Our Service Portfolio

Mental health conditions are very common with 1 in 4 people experiencing some kind of mental health problem in the course of a year. These are split into two categories; “common mental health problems”, which include conditions such as depression and anxiety, and “severe and enduring mental health problems” such as schizophrenia and bipolar disorder.

The Trust provides a full range of mental health treatment and rehabilitation services that manage both categories of mental health conditions. The Trust’s range of services spans GP based primary care counselling and psychological therapies for common mental health problems through to the treatment and care of people detained under the Mental Health Act.

Core services are provided predominately to Dudley and Walsall, but also to neighbouring Trusts in Worcestershire, Staffordshire, Birmingham and Warwickshire:

We provide:

• Community mental health services for children, adults & older people

• Inpatient services for adults and older people

• Primary Care Mental Health services (including IAPT)

• Mental Health Social Care Services (via local authority partnerships)

• Psychological Therapies

• Substance Misuse Services

• Employment, education and training support for people with mental health problems

• Specialist Deaf CAMHS (national hub)

In 2009, the Trust was selected by the National Commissioning Group to be one of four centres in England to deliver a national Deaf Service for children up to the age of 18 and their families.

2.1.2 Service Line Structure

The Trust operates within five service lines, with service line management being led by a Head of Servcie and Clinical Director. The current structure is shown below:

Figure 2 Trust's Service Line Structure

Service Lines

Community Services Acute and Older Adult Services

Early Intervention Services

Community Services

Recovery Services

Older Adult Services

Acute & Access Services

Primary Care Mental Health

Improving Access to Psychological Therapies (Dudley)

Children & Adolescent Mental Health

Eating Disorders

Early Intervention in Psychosis

Deaf Child and Family Mental Health

Community Recovery Service Teams (CRS) inc. Assertive Outreach and Psychology

Criminel Justice/Offender Liaison

Day Services

Rehabilitation Inpatients (Walsall)

Vocational services

Carers service

Crisis beds

Substance Misuse

Wards

Day Services

Community Mental Health Teams

Memory Service

Outpatients

Wards

Crisis Resolution Home Treatment

Psychiatric Liaison

Electro Convulsive Therapy

Medical Records

Mental Health Act Administration

Outpatients

Early Access service (EAS)

NOTE: In 2015/16, we will merge the Community and Recovery Service Lines.


2.1.1 Management of the Trust

Since being established, the Trust has developed a strong culture of leadership, responsibility, excellence and service user focus.

The Trust is organised into four directorates, each of which has a Board-level director lead. The directorates are described below, along with a brief overview of areas of responsibility.

Figure 3 Directorate Responsibilities

Directorate Trust Board Executive lead

Overview

Operations, Nursing & Estates

Ms Wendy Pugh All aspects of clinical service delivery

Quality and Innovation

Professional Leadership (Occupational Therapy, Nursing & Social Care)

Mental Health Act Management, including deprivation of liberty (DoLS) and detained patients

Records Management

Clinical and Information Governance

Risk Management and Health & Safety

Estates & Facilities Management

Medical Dr Kate Gingell and Dr Mark Weaver

Medical Leadership

Medical Education

Research and Development

Quality

Pharmacy Services & Medicines Management

Finance, Performance & IT

Mr Mark Axcell Financial Reporting & Budget Management

Technical Accounting

Information Management & Technology

Performance Management & Reporting

Contract Management and Monitoring

Procurement

People and Corporate Development

Ms Marsha Ingram

Human Resources Management

Workforce Planning & Development

Learning & Development

Employment Services (including payroll)

Communications and Engagement

Service Experience including Complaints and PALs

Corporate Governance

Equality and Diversity

Business Strategy and Development

The Chief Executive Officer oversees Clinical Services Development, Growth and Business Continuity.


2.1.2 Estates

In 2014/15, the Trust had 29 sites across its two boroughs; owning, renting and occupying premises. Of these, 14 are owned by the Trust and the remainder are leased and/or shared with other agencies for example, services provided from within GP clinics or health centres. This is a significant asset and opportunity for the Trust. The chart below shows the locations of the Trust’s main sites.

Figure 4 Trust Locations

Inpatient services are delivered at three sites – Dorothy Pattison Hospital (for working age adults) and Bloxwich Hospital (for older people) in the Walsall locality, and Bushey Fields Hospital in Dudley.

Over the last four years the Trust has invested over £5m in refurbishment projects to improve its estate. Investment has mainly been focussed on properties within the Walsall locality and some examples of works completed are:

Extensive refurbishment of Dorothy Pattison Hospital including patient areas and office accommodation

Creation of a new facility in Walsall that houses a range of mental health services for children and young people

Refurbishment of the Kings Hill facility

Refurbishment of New Hill House

Replacement of windows at Bushey Fields Hospital

In 2015/16, we expect our estates to reduce to 23 sites.


3 STRATEGIC CONTEXT AND DIRECTION

3.1 Overview of 2014/15

2014/15 was a positive and rewarding year. We noted some significant organisational achievements whilst at the same time gaining public recognition for the Trust and the work we do.

Some examples of the highlights of 2014/15 are described here but will be detailed in full in our 2014/15 Annual Report.

3.1.1 Highlights/Achievements 2014/15

Some of the highlights and achievements of 2014/15 are discussed briefly here but will be described in more detail in our annual report in due course.

Appointment of new Chair and Director of Finance

New Older Adult Head of Service recruited

Trust voted “Top 100 places to work in the NHS” by HSJ

Encouragingly positive results from our Community and Inpatient National Surveys

Triangle of Care Gold Star award – the first in the region

Income growth from host commissioners c£1.6m

Focus on investment/improvement in urgent care – Street Triage, Psychiatric Liaison, Mental Health Urgent Care Centre

Awards from HEWM – Patient Champion and Inclusivity Champion – both shortlisted for National Awards

Integration of TRS/Day Services and TTT into our CRSs – Recovery Intervention Service

Apprentice scheme launched with 1st cohort in place

Psychological Therapies Showcase event – a resounding success

Launch of new App and self-help library – over 3000 downloads and 4.5 score on the iTunes App store

Grant secured to support commercial research

Launch of new Staff engagement bulletin - “In the Loop”; Engagement Champions and Workplace Advisors

Introduced our CEO Blog

3.1.2 Annual Plan Review

The Trust reports progress against its annual plan objectives quarterly at Trust Board. The current review of progress against our annual plan objectives shows that the majority of our objectives for 2014/15 are on track to be completed within the year.

One of our objectives was of course to become licensed as a Foundation Trust during this year, but due to changes to the format of CQC inspections and assessments, local health economy reviews and capacity within Monitor, our application was delayed, therefore this, and related objectives, will remain on hold until 2015/16.


3.2 Priorities for 2015/16

The Trust has reviewed its priorities for 2015/16.These are shown below. These priority activities represent what is over and above everyday business for the Trust. In particular we will focus on the following:

Launch of our 2nd

Clinical and Social Care Strategic Vision

Moving forward with our Older Adults Pathway development and Therapeutic Hubs implementation

Building on our growth strategy with a number of innovative new service developments

Supporting our workforce to meet the rising challenges of professional development and continuous quality improvement

Using technology, creativity and inclusion to enhance our stakeholder engagement

Taking forward PbR and activity based contracting to support the development of mental health tariffs

Figure 5

Strategic Theme Strategic Objectives Priorities for 2015/16

High Quality Services

Implement 2015/16 service development plans, including workforce, finance and activity plans and develop the framework for future plans

Utilise national, regional and, most importantly, local priorities, to drive continuous improvement in service quality and safety

Support a culture of innovation and new ways of working to enable staff to contribute to all aspects of the QIPP agenda

Enhance the Trust's embedding lessons processes

Launch of our new Clinical & Social Care Vision - working with staff and commissioners to address identified service gaps and opportunities

Older Adult Services pathway review and redesign

Urgent care pathway review following pilot implementation and the Crisis Care Concordat

Improve access to psychological therapies through the implementation of a therapeutic hub

Focus on waiting times and reducing DNAs

Embed the relevant principles of the new Care Act

Modernising Administration Services

Embed the Triangulation Group, maximising and sharing lessons learned across the Trust

Further enhance our investigation and reporting skills

Inclusive Partnerships

Take a lead on mental health across the local health economy, raising awareness, knowledge and skills of our partners

Work within the local health economy to explore partnership working that improves patient pathways and service experience

Stakeholder Communications and Engagement Strategy and Plan Launch

Using technology, including social media, to enhance our stakeholder engagement

Develop Recovery Stories to reduce stigma and promote services

Youth Forum / Youth Council development

Work with commissioners on their implementation of the NHS 5 Year Forward View, service developments and local priorities

Leadership Culture

Empower leaders to develop a culture that will enable us to achieve the high standards of quality and innovation that we aspire to

Implement 360 appraisals across the Trust to include Doctors, Operational leaders and executive team

Create a step change in the culture and quality of Appraisal processes

Improve the quality of clinical supervision to support care delivery and practice

Identify Talent and develop appropriate succession plans

Responsible Workforce

Motivating, developing and empowering staff to meet the challenges we face

Investment and focus on Nurse Development and Revalidation

Refresh of our Learning and Development portfolio

Enhance Nurse prescribing

Embed our new staff engagement roles


Introduce “Hello, my name is….” Campaign

Supporting Strategies

Become authorised as a Foundation Trust

Increased focus on growth and service portfolio development

Effective marketing of the Trust and its services

Council of Governors engagement programme

Clearly define our 5 year business development plans and prioritise opportunities for progression towards our growth ambition

Service Line Business Planning and Marketing to support retaining and winning new business

Increase awareness of the potential to attract, engage and be part of research programmes, commercial studies and portfolio research

Effective and Efficient Resources

Meet and where possible exceed national, regional and local performance targets

Utilise technology to improve productivity and efficiency

Build strong contract management and commissioner liaison framework

Delivery of 2015/16 Cost Improvement Plans and development of 2016/17 plans

Roll-out of our Agile Working strategy

Refresh of our IT Strategy

Support the shift in focus to cost and volume and cluster day contracting

Finalise PbR clustering/mental health currencies and launch of our Quality Outcome Measures

Implement Phase 1 of the Business Intelligence Hub

Closer integration between Growth PMO, Contract Management and Clinical Services Development


3.3 Impact of Commissioning Intentions

The Trust has excellent relationships with its commissioners and we engage at a variety of levels including performance and contract review meetings, service change plans, mental health awareness events, community engagement, training and of course strategic direction, service and commissioning gaps.

We have received commissioning intentions and Service Development Implementation Plans from our two main commissioners, Dudley CCG and Walsall CCG. We have responded to these, sharing our views on commissioning gaps and inconsistencies that we would welcome discussion on.

Two of the biggest changes we expect over the plan period is the Older Adults Services Pathway redesign and the delivery of Primary Care mental health Services.

3.3.1 Local Mental Health Plans – Walsall

Consistent with ‘Everyone counts: Planning for Patients 2014/15 to 2018/19’ and the NHS Outcomes Framework locally, Walsall CCG has agreed its 5 years strategy with our vision to “Improve the Health and Well-being of the people in Walsall”. They will do this by working in partnership with the public, people who use their services, carers, clinicians, staff and health and social care providers, to design services which:

Improve health and quality of life outcomes (measured against national and local targets)

Reduce health inequalities across Walsall

Target areas where there is greatest need

Support people to take greater responsibility for living well, staying healthy and living independently

Walsall CCG will focus on achieving the best health outcomes, regardless of organizational form of providers across the system. This means that they will be advocates ‘for the people’, working in partnership with providers, but using market shaping and every contractual lever available to them to achieve sustainable and high quality services.

Their four strategic objectives to drive our change over the coming five years are:

1. Improve health outcomes and reduce health inequalities

2. Provide the right care, in the right place, at the right time

3. Commission consistent, high quality, safe services across Walsall

4. Secure best value for the Walsall pound and deliver public value

Their local priorities for mental health are:

Improve Mental Health Well Being and Parity of Esteem

Urgent Care

Referral to Treatment

Demand/capacity planning

Hospital Standardised Mortality Ratio (HSMR) and Long term conditions (LTCs)

3.3.2 Local Mental Health Plans – Dudley

In September 2013, the CCG published its first set of commissioning intentions since its establishment as a statutory organisation. These intentions described a set of principles that the Trust wished to adhere to in approaching the contracting process for 2014/15.

In February 2014, in the context of the national planning guidance, the CCG agreed its operational plan for 2014/15 and agreed its service contracts, some of which were also for a two year period.

In September 2014, Dudley CCG announced that they would be holding a review of the state of the local health economy in partnership with providers and stakeholders. This review was based upon uncertainty of the financial stability and sustainability of some providers. The Trust has committed to work in partnership with the CCG as a priority and as such agreed a short delay to its FT application reactivation.

As stated in their 2015/16 commissioning intentions, Dudley CCG aims to take integration to a deeper level, whereby services and professions are not only integrated to serve patients, but patients and professionals share ownership and responsibility, and the benefits of working together in the NHS. We call this ‘Mutual Care’ because mutually sharing ownership, responsibility and benefits.


They therefore expect existing providers to demonstrate how they are contributing to this mutualist approach – particularly in the delivery of the population-based health and wellbeing services which are part of their new integrated care model.

There are some specific intentions based on Service development and Improvements:

Service integration – the continued implementation of an integrated model of care which starts with the patient, supported by practice-based integrated teams

Rapid response team and associated services

Systematic management of patients with long term conditions

Urgent care – effective management of urgent care will be facilitated with the opening of a new Urgent Care Centre

Planned care – effective pathway management, where all services are delivered to a consistent level of efficiency and outcome

Services for children with additional needs – the commissioning of a single team to manage this client group

Stroke care – implementing the outcome of the stroke review project;

Mental health services o commissioning a service model based upon a 0-25 service o an older adults service o a specialist dementia care service o ensuring an appropriate response for CAMHS tier 3 plus clients

Frail elderly care – commissioning a pathway which reflects national best practice and includes the appropriate care of people with dementia entering secondary care

commissioning for outcomes – the CCG will develop outcome based measures on a local population basis and reflect these in contracts

3.4 Local Health Economy Factors

Many factors are contributing to this overall increase in demand, nationally and indeed locally. The main ones cited are the ageing population and the change in ethnic diversity, two areas where mental health co-morbidity is high. Add to this multiple deprivation, again higher across the region than the England average and it is not difficult to see that demand locally may be higher still.

The continuing challenging economic environment is expected to put increased pressure on the public as a whole, and on the health service itself. There is already evidence that the 2008-9 recession and ongoing economic fragility have pushed up demand for mental health services, while in-patient numbers have risen for the first time in five years. With rising unemployment and financial pressure, there is an expectation that mental ill-health will continue to rise despite health budgets being cut.

3.4.1 Local Demand Drivers

Drivers of demand for mental health services are complex and inter-related but are influenced by four key factors:

1 High level of multiple deprivation 2 Ageing population 3 Increasing ethnic diversity and young BME 4 Growing trend of increased mental health issues in the young 5 Substance misuse and mental health co-morbidity

The Trust considers this to be an excellent opportunity to work in partnership to ensure that mental health retains both its focus and commitment across the local health economy.

Across Dudley and Walsall commissioners, there are active strategies to:

Focus on prevention

Reduce health inequalities especially in children

Reduce premature deaths

Focus on physical health of those with mental health needs

Improve the lives of those living with Dementia

Reduce alcohol related harm and subsequent hospital admissions


Add to this, national drivers such as improving access to psychological therapies, promoting recovery and social inclusion and reducing those on long term benefits, and the agenda for mental health service commissioners and providers starts to open up to the possibility of much more locally tailored strategies.

The Trust has a clear, focused strategy that underpins the delivery of core mental health services for the populations of Dudley and Walsall. In implementing its strategy, the Trust will have the flexibility and skills to be able to address emerging and unmet need that will arise from the drivers discussed earlier.

The Trust has embraced commissioner’s visions for the local health economy and has been working with them and other local health economy stakeholders to develop strategies and plans to deliver it.

The following section defines the Trust’s main commissioners’ strategic needs assessments and plans and how the Trust’s own strategy supports these and the Local Health Economy (LHE).

3.4.2 Relationships with Commissioners

The Trust is working closely with the commissioners to maintain existing strong relationships and raise awareness of mental health services through the following engagement:

Board to Board meetings with both CCGs

Monthly meetings with local GP mental health leads

Monthly Mental Health Programme Board (GPs, Clinical Commissioning Groups, Local Authority commissioners)

Modular GP Packs distributed – clear information about access, referrals and contact information

As a result of these regular meetings, a number of workshops have been held, with more planned, to focus on specific areas of interest. These are led by the Trust.

3.4.3 Competitive Position

Market Share

The Trust’s strategy is to develop and/or introduce services to meet existing, unmet or emerging demand in Dudley, Walsall and the Black Country and potentially further afield, building on the core skills of the Trust.

It is believed that the Trust currently provides around 80% of mental health services across the localities. In addition, the Trust provides services for people outside the region such as the national deaf CAHMS contract and referrals from GPs in neighbouring counties.

The table below shows the Trust’s share of NHS Dudley and NHS Walsall commissioners’ mental health spend.

Figure 6 Spend on Mental Health in Dudley and Walsall

2013/14 Spend on Mental Health £000’s NHS Dudley NHS Walsall

Dudley and Walsall Mental Health Partnership NHS Trust 26,285 27,112

Other NHS Trusts 3,600 950

Other Sectors - Independent, Charitable, and Public Sectors 2,051 4,300

TOTAL 31,970 32,300

Trust Market Share 82% 84%

Dudley and Walsall Mental Health Partnership NHS Trust 26,285 27,112

Other NHS Trusts 3,600 950


Core Competencies

In working with its commissioners and other key stakeholders, the Trust has identified its core competencies as follows.

Figure 7 Core Competencies

Core Competency Some of the Main Sources of Evidence

High quality, accredited and commended services

CQC registration and reports

West Midlands Quality Review

Appreciative Enquiries

Quality Account Priorities

PLACE (PEAT); AIMS; ECTAS; MSNAP

Patient feedback and surveys

Friends and Family test

A high performing, well managed and governed Trust

Contractual KPIs

Fully met CQUIN schemes

GRR score of 0

Effective risk management - NHSLA Level 1

Financial robustness - CoSR score of 4

Excellent relationships with local commissioners and stakeholders

Consistently good feedback and support expressed by Commissioners directly and externally

Endorsement of the Trust’s Clinical and Social Care Strategic Vision

Good partnership working across the LHE

High attendance levels at ST engagement, FT consultation and formal meetings such as the Trust’s AGM

Agreed long term system plans

Acquired local knowledge and cultural awareness

Community Development Workers and Primary Care Mental Health Workers working closely with the community

Retention of health and social care staff on formation

Culture awareness training for staff

Over 7500 members recruited with excellent representation across all population groups especially BME

Local presence 29 Trust facilities across the boroughs

Ownership of a high proportion of facilities

Services sited on large number of communal community venues including GP clinics, Day Centres and Social Care facilities

3.4.4 National Drivers - Summary PESTEL Analysis

The table below captures the main national and regional drivers that are affecting mental health trusts specifically. This has been developed through horizon scanning and local intelligence gathering. A summary is presented here and a full analysis, including the potential impact on finance and resources.

Figure 8 PESTEL Analysis

Political/Policy Economic Sociological

The Care Act

The new Health & Social Care Bill

NHS Five Year Forward View

The Foundation Trust agenda and timeline

Increase in Quality Governance

CQC Regularity Framework

GP Commissioning (CCGs)

Urgent Care Concordat

Significant and challenging CIP targets

Increased commissioning portfolios of LA’s

Rising expectations of required cost savings from LA’s

Better Care Fund

Changes in the social care market and personalisation agenda

Lack of clarity around the

High levels of multiple deprivation

Increased expectation of service quality and the patient experience

Steadily ageing population

Growing ethnic diversity and the proportion of young BME

Rise in substance misuse, related harm and co-morbidity

Consumerism, choice and direct payments


Patient choice

Mid Staffs issue and close proximity

New Mental Health Strategy

Triangle of Care approach

Transparency in NHS (implementing duty of candour)

Improving access to psychological therapies

Increased competition from other providers

Meeting local public health challenges

Proposed changes to the Quality and Outcomes Framework (QOF) element of the GP contract for England

Service Line Reporting

implementation of Payment by Results

Private Patient Income Cap

CQUIN – increased income

Continued economic recession

Clinical ownership of cost improvement programme

Approach to costing patient care

Implementation of tariffs for education and training from 01 April 2013

Using social media to increase the profile and awareness activity of mental health

Technological Environmental Legal

Social networking as a health tool

Telehealth and telecare

Popularity of computerised cCBT

More funding for research and improvement in dementia

Implementation of Innovation, health and wealth (IHW)

Growing environmental agenda

Ageing condition of NHS estate

Growing importance of legally binding contracts

Equality and Diversity Act

Cost of legal compliance

NHS Constitution and patient rights

Increased legislation around FT application

Competition regulations: Fair Playing Field

Safeguarding in terms of mental health

Treating patients and service users with respect, dignity and compassion

3.4.5 SWOT Analysis

In considering the external environment and the Trusts’ competencies, a SWOT analysis has been devised that defines the Trusts market position:

Some of these factors have been built into the Trust’s risk registers and sensitivity analysis, where the impact is assessed from a financial perspective.

The Trust utilises its strengths and exploits its opportunities to support change and to win new business. This is evidenced both through the level of engagement with stakeholders and the broad support for Trust plans. The Trust developed an Ansoff Matrix, using this as a tool to set the strategy for growth. This focuses on expansion within the Trust’s existing markets, only looking to break into new markets in areas where key strengths can clearly be exploited and are linked to the SWOT analysis.


Figure 9 Summary SWOT Analysis

ST

RE

NG

TH

S

Reputation for high quality, accredited and commended services

Excellent engagement and relationships with local commissioners and stakeholders

Clear, focused strategy

Strong financial position and high cash reserves

Clinical leadership and engagement

Well-developed and stable Trust Board

Asset rich and control of capital expenditure

Continued investment in development of the Trust and its staff

Size of the Trust - flexibility and responsiveness

Proactive approach to Equality and Diversity

Size of the Trust - potential for financial vulnerability

Embeddedness of new service model and awareness across the local health economy

Some areas of high levels of long term sickness absence

Inconsistencies in the provision of admin support across teams

Inherited Estate requiring further rationalisation

CAMHS Out of Hours provision

Older Adults future planning

WE

AK

NE

SS

ES

O

PP

OR

TU

NIT

IES

Set and own the quality agenda alongside service users

Take ownership of mental health as experts within the Black Country

Developing the commercial focus required of Foundation Trusts

Efficiency and productivity gains through new ways of working/technology

New business opportunities - income generation

Introduction of Payment by Results

The formation of a single Black Country Mental Health Service provider

Significant system reform at a time of financial and economic instability

Currency and tariff in mental health

Increased contestability and competition

Levels of awareness of mental health issues within the GP community

Consumerism, choice and personalisation

Availability of some specialist skills

The formation of a single Black Country Mental Health Service provider

TH

RE

AT

S


3.5 Planned Service Changes

Derived from the Trust’s SWOT, the changing environment and the emerging needs of the local population, a number of clinical service change plans have been identified. These plans are led by the Trust’s Medical Directors as executive leads for service development.

These changes will be implemented over a 3 year period with the on-going development and implementation of care clusters being integral. This will provide clarity for all teams in terms of which clusters they deliver, the interventions for each cluster, skills and competencies required to deliver those interventions, and the outcome measures to be used. This will play a significant part in moving services away from a target-focused approach to an outcomes focus.

A review of all other services the Trust provides has been undertaken during the first year to enable all services to be coherent with, and support, the new service model.

Service Development Plan Timeline

2014/15 2015/16 2016/17

Community Services

Early Intervention Rehabilitation Service

Community Services (CRS/AOT/TTT)

Therapeutic Hub Admin Review Phase 2

Liaison and Diversion

Agile Working Phase I Agile Working Phase II Agile Working Phase III

Inpatient Services

Establishment and skill mix review Hospital site rationalisation review

Older Adult Older Adult Services review

Older Adults Services Implementation Memory Services

Pan Trust

Corporate Services

Estates feasibility studies

Estates rationalisation & utilisation

Estates & Facilities efficiency gains

Sustainability efficiency gains

Corporate Management Structures

Business Intelligence Unit

Pharmacy re-tender

Procurement efficiency gains

IT contract review

OMS contract review

Corporate Clinical Leadership Structures

Back office function review

Catering contract review

Back office implementation

Note: Bold denotes major change plan

3.6 Strategic Developments

The Trust has a clear, focused strategy that underpins the delivery of mental health services for the populations of Dudley and Walsall.

In protecting its long term viability, the Trust will explore opportunities that support the delivery of mental health services across the wider health economy, building on the skills of the Trust and meeting unmet or emerging needs.

In developing its strategy, the Board stated its commitment to becoming a “top quality, highly regarded provider of core mental health services”. The Board has an undertaking to be flexible in its on-going consideration of the scope of services it provides in order to reflect the genuine needs of service users and carers.

In the short term this required a cautious strategy for growth, and BOT (the Business Opportunities Team) was set up to manage this process. BOT has been active for some time, in understanding the tendering process and pursuing some small, local bids as well a large SMS bid in partnership with the 3

rd sector.


As an ambitious aspirant Foundation Trust, the Trust aims to develop our services to:

Utilise our core skills and expertise to deliver mental health services as close to home as possible for people in Dudley and Walsall and to fill gaps in current service provision

Build on these core skills to extend our portfolio in selected areas of expertise in order to sustain our viability as a standalone mental health Trust

Invest and innovate to tailor services that are responsive and sensitive to the needs of our communities

Effectively market our services, expertise, skills and knowledge to proactively attract new commissioners

Use the freedoms of FT to work collaboratively with partners to deliver seamless, integrated care

A longer term growth strategy and approach has now been agreed and will provide the Trust with a strong platform from which to capture and manage new opportunities more consistently and effectively. To support this, the Trust has established a Service/Business Development (SBD) PMO.

3.6.1 Developing Strategic Partnerships

The Trust has been successful in embedding a robust reputation across the local health economy and beyond. As a result of this we have developed a diverse range of partnerships, such as:

Formal partnership agreements with Dudley and Walsall Borough Councils under the terms of Section 75 of the NHS Act 2006

University of Wolverhampton:

o Joint development and delivery of a modular MSc/MA in Mental Health

o Partner in the development of a University Technical College (Healthcare) in the Black Country

As an integral component of Infection Prevention and Control (IPC) work programme, the Trust works in close partnership with NHS Dudley and NHS Walsall IPC teams

Locality Stakeholder Board – Board member with a track record of 7 successful bids bringing resource into the Dudley and Walsall health economy to support areas such as safeguarding vulnerable adult/children training and coaching e.g. working closely with a local hospice to provide expert training for end of life care

Business Development partnerships with a number of 3rd

sector organisations

We are fortunate to also have high levels of engagement from our service users, carers and the community as a whole. This is evidenced in a variety of ways:

Some of the highest national survey response rates years on year

High attendance levels at our Annual General Meetings since we formed in 2008

High level of interest when we held a partnership meeting to discuss Walsall Substance Misuse Service delivery

Participation of GPs, commissioners and a range of support agencies in workshops to develop of our Clinical and Social Care Strategic Vision

Recruitment of over 7,000 public members

Overwhelming number of applicants for our Experts by Experience programme and volunteering in general

Growing popularity in our Mental Health Forum held quarterly for the public, service users, carers and support agencies

Recognition as a “HSJ Top 100” places to work in the NHS

3.6.2 Business Development (Growth) PMO

The Trust already has an established PMO for the management of CIP schemes; this is closely linked with Service Transformation. This process is embedded and is effective in managing both straight-forward and complex schemes.

The Trust has now established a PMO approach to oversee and manage all new service / business opportunities. This mirrors the CIP PMO with regard to process and approvals but uses tools adapted specifically for new business opportunities.


All opportunities that could potentially create new income for the Trust will be managed and supported by the PMO. corporate and operational services

The PMO will manage projects from concept through to implementation and will also play a pivotal role in partnership and market development.

The PMO reports to MExT every six weeks and to Trust Board quarterly. The PMO is championed by the CEO and the Chairman. There are strong links with Operations, Finance and HR through attendance of the PMO Lead at Executive Comms weekly meetings.

Opportunity Development

The opportunity development process follows four simple steps and is designed to be “light-footed”:

Daily tender alerts, horizon scanning and regular networking to identify opportunities (tenders and funding) as they arise

Quick screening tool to decide whether to pursue opportunities or not

Centralised project management aligned to the business case process, to ensure consistency of approach and good governance

“Virtual team” to maximise use of resources, to ensure clinical and corporate input across the required disciplines and to develop bid responses

Building on successes

The Trust has block contracts in place for its two host CCGs, i.e. Dudley and Walsall. At month nine in 2013/14, a number of teams were noted to be over-performing against contract levels, particularly the primary care teams. As part of final contract negotiations, the total sum of £775k additional income was agreed to reflect this increased activity. This includes the following:

Investment in nurses within Older Adult services


Criminal Justice

EAS and CRS

Psychiatric Liaison

In addition to this, we have also gained £1.6m to enhance a number of services. These are:

CAMHS Learning Disability Service in Walsall

Mental Health Urgent Care Centre

Home Treatment - Dementia


Psychiatric Liaison

Memory Services

Street Triage

Liaison and Diversion

More recently, the Trust has been involved in some very significant competitive tender processes and in each case, has been successful in reaching the final presentation / interview stage:

Substance Misuse Services in Partnership with 3rd sector provider, Swanswell, approx. £1m pa for the Trust (lost)

Dudley Substance Misuse, approx. £900k pa (lost)

Bristol Employment Services, approx. £500k pa (lost)

Walsall SMS, approx. £1.7m (lost)

Stoke-on-Trent SMS approx.. £700k (pending)

This has proved to be very valuable insight and learning and has resulted in a number of debrief/lessons learned sessions and some key action points to aid future success.


Partnerships

The Trust has and continues to explore creative partnerships to in response to competitive tenders and proactive services marketing.

3.7 Organisational Sustainability

In order to demonstrate Organisational Sustainability, a number of attributes need to be in place. These are described here and the Trust’s position against them is discussed in the following section.

It is clear that the information summarised here and documented throughout our Annual Plan and the Trust’s five year Integrated Business Plan, demonstrates sound organisational sustainability.

3.7.1 The Attributes of Organisational Sustainability

The diagram below illustrates the main attributes that underpin long term organisational sustainability.

Figure 10 Attributes of Organsational Stability

3.7.2 Demonstrating the Trust’s Organisational Sustainability

The Trust’s annual and integrated business plans articulate in full how we demonstrate robust organisational sustainability. This is reinforced here:

Figure 11 Assurance Statements

Dimension Trust statement of assurance

History of strong performance

The Trust was formed in 2008 and now has six years of strong financial performance, meeting or exceeding its planned surplus year on year.

Robust financial management and

Since the Trust’s inception the organisation has steadily improved and embedded processes with regard to financial planning, governance and probity. This has been

History of past performance across all areas

Robust financial management and planning processes

Strong stakeholder engagement and support

Focus on quality and outcomes

Effective contract management processes

Robust efficiency plans and cost improvement programmes


planning demonstrated through unqualified audit opinions in respect of the Trust’s accounts for the first half year and the subsequent five full financial years. Auditors consistently comment on the high quality of the accounts produced. Internal Audit reports also confirm that robust financial controls and strong financial management are in operation within the Trust, with the Trust achieving, “full assurance” from Internal Audit in relation to Financial Management (2011/12, 2012/13 and 2013/14), Cost Improvement Programme management (2011/12, 2012/13 and 2013/14), and Contract and Commissioning Arrangements (2011/12).

Strong stakeholder engagement and support

The Trust benefits from consistently high levels of interest and engagement evidenced by:

Recruited over 7,000 members and filled all of our Governor seats

Gained continued support for our service transformation plans and new clinical & social care vision

Endorsement by the CQC on our service quality and service user engagement

Local health economy support for FT application

Achieved some of the highest national survey response rates in the country

Been recognised by the TDA for our contribution to the local health economy

Gained good feedback from recruitment activities including apprenticeships and in particular to our EBE programme

Grown attendance at our Quarterly Mental Health Forum to require a “waiting list” for spaces

Award winning “Patient Champion” in HEWM Leadership Awards

Focus of Quality and Outcomes

Our focus on quality and Outcomes can be evidenced by the following:

Delivery of operational performance KPIs and standards

AIMS, ECTAS, MSNAP and other relevant accreditations

Lead on PbR for the region and development of the innovative DWROM tool

Award winning “Equality and Diversity - Inclusivity” and “Patient Champion” in HEWM Leadership Awards Rated “good” by CQC pilot inspection

Triangle of Care Gold Star

Rigorous application of Quality Impact Assessments for all major change projects

Effective Contract Management

We have excellent relationships and engagement with our lead commissioners and can demonstrate this through:

Sharing of commissioner intentions aligned to our Clinical and Social Care Strategic Vision

Clinical Quality Review meetings monthly

Contract Performance Reviews monthly

Performance against CQUIN targets year on year

In year enhancements to contract income based on over-activity

New investment in pilot schemes in urgent care, primary care and older adult services

Board to Board meetings with both CCGs

Monthly meetings with local GP mental health leads

Monthly Mental Health Programme Board (GPs, Clinical Commissioning Groups, Local Authority commissioners)

Modular GP Packs distributed – clear information about access, referrals and contact information

Robust efficiency plans and CIPs

The Trust has achieved its cost improvement target on a recurring basis in each year since it was established in 2008.

The Trust Board has agreed CIP schemes for 2015/16 and 2016/17. These will help the Trust maintain a strong financial surplus, while keeping CIP at a level which does not put excessive pressure on frontline services.


3.7.3 Risk to Organisational Sustainability

The Trust can clearly articulate the known risks to our long term sustainability. In our Integrated Business Plan and LTFM, we mitigate the potential downsides caused by these risks.


4 APPROACH TO IMPROVING QUALITY AND SAFETY

The Trust’s Governance and Quality Committee has overarching responsibility for quality and for the monitoring and assurance of quality performance. Underpinning this committee’s function are the Service Line Quality Groups that meets monthly and the monthly Quality Review Meetings with commissioners.

The Trust has established an annual process for identifying quality priorities based on intelligent data and risk profiles, from which targeted quality improvement plans are developed. The quality improvement plans set out the measures of success and SMART (Specific, Measurable, Accurate, Realistic and Timescaled) objectives and are delivered through a project management approach. Monitoring of the implementation and impact of projects is via quarterly reports to the Governance and Quality Committee.

Additional inputs to the committee’s deliberations come from trend analysis and external assessments that can trigger the development of further specific quality initiatives.

The Trust has a good culture of learning lessons and has established a governance process, linked to risk management and incident reporting policies, to facilitate the learning, sharing and implementation of key lessons following serious incidents. This is delivered through fortnightly „embedding lessons‟ sessions held with senior managers and service user experience representatives.

An annual Quality Account is produced by the Trust that sets out the quality priorities and then reports on outcomes in delivering those priorities. Most importantly this Account is subject to scrutiny by commissioners, Health, Overview and Scrutiny Committee, Health Watch, Experts by Experience and service users. In terms of embedding quality outcomes and being assured by third parties that the Trust is delivering quality this forms a crucial piece of assurance.

In preparation for becoming an authorised NHS Foundation Trust, the Trust completed a Board Quality Statement signed on behalf of the whole Trust Board and supported by a Memorandum summarising the governance arrangements for monitoring and continually improving the quality of healthcare provided to its patients. The Memorandum outlines 10 key quality governance questions that test the robustness of quality governance, referencing good practice, and how the Trust evidences compliance with the following:

Boards accurately understand the quality of the care of their organisation

Boards are able to assess and mitigate risks to quality

Quality is seen as the responsibility of the entire board, not just the medical and nursing directors

Trusts are committed to continuous quality improvement and have put in place the tools to address poor performance

4.1 Progress against Quality Priorities 2014/15

The Trust continues to implement the Quality Improvement Strategy that was launched in 2014/15, and promote a culture of on-going quality improvement throughout the services delivered.

Seven quality improvement priorities have been set for 2014/15 within the Quality Account. These priorities were published in June 2014 in the Trust’s Quality Account and widely disseminated across the Trust and shared with key partners.

To ensure the priorities are mapped into the Trust Quality Governance Framework, a full quarterly update is provided to the Committee, detailing progress and an overview of outcomes and exceptions.

In addition, all staff were provided with a credit card size card to refer to.


The following provides a review of progress against the seven quality priorities for 2014/15:

Quality Priority

Quality improvement initiative

Progress

Providing meaningful and effective inpatient activities

Undertake a full review of inpatient activities

To develop and implement Trust wide standards based on national and locally defined best practice

There has been a continued focus on the provision of activities during Q3 to move the Trust forward into developing a therapeutic hub. The hub will improve access to psychological therapies across community services, but in particular will have a hub that focuses on inpatients.

Immediate improvements have also been made to inpatient activities which include.

A revised programme for therapeutic/diversional activities

An activity recording tool

Education for inpatient nursing regarding therapeutic activities is being developed

Supervision for staff delivering inpatient activities has been strengthened

Environmental review to increase space to deliver activities and interventions

Embedding the ‘Think Family model across Child and Adolescence Services and Adult Mental health services.

Development of joint protocols and pathways to support ‘think family approach’

Further development of electronic clinical processes to ensure families are identified

Incorporate parental mental health in safeguarding training

This improvement has progressed well in Q3 which has included the development of

Joint working protocol between AMhs and CAMhs

Roles and responsibilities training delivered to clinical managers/leads

OASIS training incorporates searching for family members that live at the same address

Management of Disruptive and Aggressive behaviour

Undertake review of trust Guidance against best practice and review policies

Incorporate the principles of restraint reduction planning

Enhance training in de-escalation technique

Considerable progress has been made in Q3 which includes.

MAPA policy ratified in Q3

A new model to assist in developing behaviour support plans for patients is being piloted on two acute wards. Evaluation involves working with Experts by Experience with view to rolling it our across all wards.

A further pilot is underway on the same two wards which provides a revised model for debriefing both staff and patients.

Focusing on dementia care

Undertake a review of staff competency and training and introduce revised skills based training programme

Ensure the inpatient environment is conducive to best practice guidance and standards

Revisit local standards based on best practice for behaviours which challenge

In Q3 work has continued to provide training for staff to up skill them in dementia care. This has included

Review of competency and training needs analysis completed.

Basic skilled based training has now been delivered to all inpatient nursing staff.

Dementia Care Awareness E-Learning package rolled out 2014 - all staff now completed.

Dementia care workbook developed. Pilot group identified from both inpatient and community and due to start Feb 2015.

Work has progressed regarding the environment on Holyrood

Review of Holyrood ward environment completed by specialist architect and actioned.ie work to commence March 2015.

Health Care Assistant development programme

Implementation of Health Care Development programme

Progress continues to be made in Q3, however it should be noted that not all cohorts have been filled to capacity since cohort 1 this is being proactively promoted to enable full use of allocated places.

From late January post course line manager & delegate evaluations will commence to measure the impact of course.

My Care Plan Revision of the Care Programme Approach (CPA)/Non-CPA training on outcome focussed and service user lead care planning

Revision of the Trust wide clinical standards for care planning

Progress continues to be made in Q3, however there has been a delay in revising the CPA policy, this will be completed in Q4

The Care Programme Association has published National best practice standards for care planning, which the Trust has adopted and is provided clinicians with a CPA best practice handbook to support practice and supervision.

My Care Plan now forms part of the nurse development programme in delivering Recovery focused Care Planning.

Family and Continued Implementation In Q3 the Trust achieved accreditation from the Carers Trust for its commitment and


carer involvement

of Triangle of Care Model across Adult Services

Policies, protocols and procedures

Carers support/ information

Training

Documentation and record keeping

progress made in relation to the implementation of TOC. It is the first Trust regionally to receive this recognition.

Q3 has focused on rolling the programme into community services to include

Unannounced EBE visits to community teams

TOC awareness sessions for community teams

Pan Trust Carer awareness training commencing in January 2015

4.2 Quality Improvement Plans 2015/16

Each year the Trust develops a set of annual quality improvement priorities. This process supports the delivers of the Trust Quality Improvement Strategy and also adheres to the guidance set out in the NHS toolkit for the development of annual Quality Accounts

The Trust is currently developing its Quality Improvement Priorities for 2015/16 aligned to the CQC CREWS model. The draft priorities have been developed following the triangulation of national, local drivers and themes.

A short list of priorities has been developed for discussion by the Trust’s Governance and Quality Committee. The final short list was presented to the Committee in March for agreement and referral to trust Board. The priorities will be published within the Trusts’ Quality Account by June 30

th 2015.

Draft Quality Priority Shortlist CQC CREWS Domain

1. Enhance care and compassion through the introduction of ‘My name is’ initiative Trust wide.

Caring

2. Improve Trust processes for managing Did Not Attends (DNAs) Responsive; Safety

3. Improve the quality of dementia care through dementia mapping Caring; Responsive;

Effective

4. To improve the quality of clinical supervision to support care delivery and practice

Safety; Well led

5. To demystify our care pathways to ensure transparency and ease of understanding for service users/carers/stakeholders

6. To improve the management and monitoring of long terms physical conditions e.g. diabetes, heart disease in partnership with primary care

Responsive; Effective; Safe

7. To improve patient and staff experience relating to the impact of incidents and their management on their perceptions and feelings of safety

Effectiveness; Well led;

Safe

8. To improve access to psychological therapies through the implementation of therapeutic hub

Responsive; Effective

In 2015/16 we will build on our quality improvement programme by:

Continuing to embed the CREWS model into our quality improvement programme

Revisiting our Quality Improvement Strategy for 2015/20, in line with our Clinical and Social Care Strategic Vision

Seeking external assurances of our Service Development programme – through peer reviews

Further development of our Embedding Lessons process through the “Your Experience Matters” campaign – a way of communicating what we have done as a result of feedback

Developing and rolling out standard service experience surveys (PREMS) in order to enable us to benchmark and monitor service experience


Taking part in a research study developed by the University of Sheffield, titled ‘Recovering Quality of Life’ (ReQoL). The ReQoL study aims to test a new Patient Reported Outcome Measure (PROM) for people with different mental health conditions who have an allocated care cluster ranging between 1 and 17. The study will be taking place across the Trust from March to November 2015, and will include both inpatients and outpatients.

4.3 Quality and Safety at the Heart of Service Transformation

The Trust’s Service Transformation Programme is a key driver for change across the Trust, supporting areas and departments to review and redesign pathways and procedures through support, advice and expert knowledge. The Service Transformation Programme is committed to improving the services for local people and delivering improved efficiency.

In order to ensure that quality and safety are upheld at all times, we launched Quality Impact Assessments to be carried out prior to service change or redesign and Hear and Now reviews for post change evaluation. New Perspectives was also launched to enable senior managers, executive Directors and Board members to get out and about on the “front line” to see for themselves how things were.

The new service model has identified areas of quality improvements, efficiency savings and productivity gains. These are fundamental to delivering the QIPP agenda but some are also pivotal in delivering the Trusts Cost Improvement Programme (CIP) target.

The Role of Service Transformation in delivering QIPP

With this in mind, a key part of the service transformation implementation plan is anchored around the Quality Impact Assessment (QIA) process, a tool designed as part of the Trust’s Quality Improvement and Risk Strategy.

QIAs are designed to ensure that service transformation plans place quality and safety improvement as the highest priority. They are applied to all service transformation plans and especially those that involve cost improvements.

QIA’s form part of the Trust’s CIP Governance Framework that is overseen by the Trust’s CIP project management Office (PMO).


5 DELIVERY OF OPERATIONAL PERFORMANCE STANDARDS

The Trust has made steady progress to become a high performing, well led and well governed provider. This is evidenced by:

CQC pilot inspection outcome of “good”

Staff surveys and Friends and Family Test

National Patient surveys and Patient Friends and Family Test

Meeting our national, local and regional performance targets including CQUINs

The Trust delivers a GRR of 0 under Monitor’s risk assessment framework. This is made up of:

Selected national access and outcomes standards

CQC judgments on Quality of Care

Relevant information from 3rd parties

Quality Governance

Risk to continuity of services

5.1 Key Targets

Prior to the Trust’s formation, there was already a strong belief that bringing the mental health services of Dudley and Walsall together would mean a better service for the communities of both boroughs. The results and feedback from the last financial year, from a range of reviews, assessments and performance targets, clearly show the progress that this Trust has made and demonstrates that the Trust is truly “Better Together”.

In this section the Trust’s performance is described against a range of national and local key performance indicators, standards and measures including staff and service user experience. A summary of the Trust’s historical performance can be seen in the summary table below.

Figure 12 Key Targets

Key Indicators 2012/13 2013/14 2014/15

National Measures Fully Met = 8 Fully Met = 8 Fully Met = 8

CQUIN Targets Fully Met = 7 Fully Met = 6 96% met

Contractual KPIs Fully Met = 15

Fully Met = 15

Not Met = 1

Fully Met = 15

CQC standards Fully Compliant Fully Compliant Fully Compliant

Staff Survey Best 20% = 10

▲Average = 9

Average = 5

▼Average = 4

Best 20% = 10

▲Average = 9

Average = 5

▼Average = 4

Best 20% = 9

▲Average = 12

Average = 4

▼Average = 4

National Patient Surveys

Community 2012

Overall experience rated

very good = 25%

Community 2013

Overall experience rated very

good (rating 8-10) = 55%

Inpatient 2013


good = 39%

Community 2014

Overall experience rate very

good (rating 8-10) = 56%

Inpatient 2014


good = 40%

PEAT / PLACE Inspections

Excellent = 8

Good = 1

Acceptable = 0

Poor = 0

Cleanliness = 99%

Food = 89%

Privacy, dignity, wellbeing = 91%

Environment = 88%

Cleanliness = 99.67%

Food = 87.97%

Privacy, dignity, wellbeing = 85.95%

Environment = 92.26%

Quality Indicators SUIs = 88

Complaints = 74

Patient Net Promoter = 75%

SUIs = 79

Complaints = 105


SUIs = 67

Complaints 127


NHSLA compliance Level 1 Level 1 Level 1


5.1.1 Performance against National Measures

A summary of the Trust’s previous and current performance against the National Measures from the NHS Operating Framework is provided in the table below. Full details of our 2014/15 performance can be found in our 2014/15 Annual Report.

Figure 13 Operating Framework Targets

Key Targets 2012/13 2013/14 2014/15

Follow up contact within 7 days of discharge >95% 97% 98% 95%

CPA review within 12 months >95% 97% 96.2% 95.8%

Minimising Delayed Transfers of care ≤7.5% (All) 5.4% 3.2% 1.4%

Admissions to inpatient had access to crisis resolution home treatment teams >90%

100% 100% 100%

Meeting commitment to serve new psychosis cases by Early Intervention >95%*

107% 118% 110%

Data Completeness: identifiers >99% 99% 99% 99.8%

Data Completeness: Outcomes for patients on CPA 50%

75% 95% 96.2%

Clostridium Difficile breaches 0 0 0 0

MRSA breaches 0 0 0 0

18 week waiting time

(95th

percentile in 11/12)

(% target in 12/13)

98% (completed)

95%

(incomplete)

99% (completed)

99%

(incomplete)

100% (complete)

98% (incomplete)

Over the course of 2014/15, we have continued with the use of OASIS, PCMIS, HALO and the data warehouse which has enabled high quality Business Intelligence to be used to inform strategic and operational decisions at all levels of the organisation.

Key achievements include:

A strengthened performance culture throughout the organisation with clear structures and processes that have enabled performance to be understood and actively managed at all levels.

Establishing data feeds from ESR and Safeguarding recording systems into the data warehouse solution and commenced development of required reporting based on these feeds

Establishing a Business Intelligence function, providing a central point for the Heads of service and team managers, enabling Performance, HR and Governance information to be presented in a single integrated dashboard.

Continuing the delivery of extensive data quality project actions to enable accurate reporting across a wide range of metrics including national, local and service transformation quality indicators.

Improving data quality in caseload, KPI, ethnicity, IAPT, CAMHS and clustering to align with the strategic direction of travel and the move to cost and Volume/ PbR based contracts

Implementing actions to enable full compliance with the Information Governance toolkit as at March 2015.

Supporting the development of PbR through the development of required reporting to enable monitoring of required standards

Centralising the various Data Quality actions into a single Data Quality Improvement Plan to be monitored throughout the year

Extending the use of OASIS to cover Employment Services

Rollout of eDatasets

FACE risk assessment electronically delivered


The key aims for Performance and Information for 2015/16 include:

Rolling out Business Intelligence to all Heads of service and team managers and including Finance and estates information to be presented in a single integrated dashboard.

Including Inpatient services within the OASIS application

Extending the use of electronic training for Clinical applications

Improving the support for clinical applications with the trial of centralised service desk

Promoting the use of texting to patients for appointment reminders and as a way of communicating

Examining the use of the eReferral service within Dudley and Walsall

Implementing electronic discharges to all GPs

Implementing the Save As You Go feature within OASIS in line with audit requirements


6 WORKFORCE PLANS

6.1 Safe staffing

The Trust commissioned an independent review of staffing establishment in June 2014 that informed the Board of our compliance with the recommendations from the Cummings report. This initial report and a subsequent review in December 2014 has provided assurance to the Board of our compliance and has led to a change in the way we report staffing. The Trust also participated in a regional project co-ordinated by the LETB to benchmark staffing levels as part of the development of a safer staffing tool in mental health services.

Staffing levels are currently based on agreed caseloads, bed occupancy and observation levels. Our workforce plan takes into account staffing factors such as observation levels, sickness absence, training, annual leave. All services have a business continuity plan to cater for unexpected incidents such as widespread illness, extreme weather conditions or loss of access to premises for example.

Managers are enabled and supported to manage their rosters accordingly to provide safe staffing levels at all time. The Trust is investing in e-rostering software, which will help compliance and provide assurance. Managers have access to bank staff , many of whom have worked with the Trust for many years and agency staff if necessary.

6.2 Proposed workforce changes

A Recruitment Plan for 2015/16 has been developed with Heads of Services and Workforce, which has been signed off by Finance for implementation. The Recruitment Plan will then form the basis of a three year recruitment and retention strategy.

Workforce Plans for each service are to be developed and fed into the Trust’s overarching Workforce Plan developed.

6.3 Quality Impact Assessments

The Trust carries out Quality Impact Assessments on all of its major CIP schemes.

Where CIP schemes involve a reduction or change to the staffing or skill mix within a service, this is covered in detail within the QIA and informs the scheme risk log.

Schemes risk logs are reviewed alongside the QIA and these are also presented to Governance and Quality Committee.

Major schemes involve engagement with staff, service users and carers and our Experts by Experience to both develop the change plan and the QIA.

QIAs are developed and reviewed by a multi -disciplinary team as part of the Trust’s Management Executive Team Meetings.

“Hear and Now” reviews take place to triangulate any findings or feedback and allow staff to raise any concerns they may have.

6.4 Staff development, engagement and support

We support a culture that is based upon working closely and better together to provide high quality services which put the experience of our service users at the heart of all we do.

Around 1200 staff work for the Trust, the majority of whom are clinicians and “front-line‟ staff. They are our most important resource and without their dedication we would not be able to provide the services that we do.

We continue to support the development of our staff to ensure they are equipped to deliver the high quality services described in this plan and are supported to achieve their full potential. Learning and development is threaded throughout the organisation and takes many different forms.

Priorities for 2015/16 include

A focus on ensuring all of our staff receive regular, high quality appraisal that has a positive impact on how they deliver their role

Refining approaches to delivering and monitoring mandatory and essential training to improve overall performance in this area


Delivering Talent for Care initiatives to include: o Embedding delivery of the Care Certificate through our existing Fundamentals of Care Programme o Building on current business and admin apprenticeship success by extending the breadth and

volume of apprenticeship opportunities o Extending work experience opportunities and delivering mental health focused career events o Developing volunteering opportunities o Introducing Assistant Practitioner roles across acute in patient areas through foundation degree

pathways o Continuing to support access to registered professional routes through LEaP and secondment into

HEI programmes

Ensuring readiness for nurse revalidation across the nursing workforce and continuing to deliver nurse development programmes at each level of the career framework

o To include growth in the number of non-medical prescribers active within the trust and a shift towards development of clinical nurse specialist roles

Proactively supporting CPD opportunities through the trusts study leave process and developing a wider range of clinical development opportunities in house

Further developing our library service to ensure the evidence needs of the trust are met

Sustaining our positive role in developing future health and social care professionals across all disciplines through delivery of practice placements and trainee programmes

Further developing leadership across the trust through use of 360 feedback process, coaching, mentoring and through accessing regional programmes that support developing leaders at all levels of the organisation

Continuing to deliver organisational development solutions in response to evolving needs and the trusts transformational agenda

We recognise that building a culture of two-way communication, is crucial in helping to ensure that staff feel recognised and valued and we have developed a number of ways which we engage and communicate with our staff, including:

Ask Gary - A dedicated mailbox set up to encourage staff to email the Chief Executive any questions they may have

Monthly “Team Brief‟ which is delivered and presented by the Chief Executive and Chairman. A copy of the bulletin is emailed to every member of staff as well as being posted on the Intranet

Active Desktop – focussed messages which appear on the desktop of all Trust computers and are seen by all users every time they login

Wednesday Wire – a weekly news and information bulletin for all staff

The Exchange – staff intranet

Newsround – a bi-monthly bulletin featuring mental health in the news – local, regional and national

A formal Staff Partnership Forum comprising recognised trade unions and other professional groups.

New Perspectives - quarterly sessions which enable all members of the Management Executive Team and the Board to get out and about across all of our sites and encourage staff to put forward ideas or ask any questions they may have

Bright Ideas – an Intranet tool that allows staff to share and progress their ideas for improving services or developing new ones

“Hear Me‟ – to support the Trust’s Whistle blowing policy and in response to feedback from our annual Staff Survey, a dedicated confidential concerns hotline

Membership magazine “One in Four‟ – Quarterly magazine for all public and staff members of the Trust, providing information, news and updates on important mental health topics

The Trust has a Twitter account where the public and staff can keep up to date with news

6.4.1 New Initiatives for 2015/16

We strive to improve our methods of communication so that a culture of two-way communication is fully embedded and maintained at all times.

The new CEO Blog – a regular internal update for staff

The new “In the Loop” staff engagement bulletin

Workplace Advisors

Engagement Champions


“On Board” senior managers visibility programme

“Moment of Truth” to encourage staff at all levels to give feedback “in the moment” rather than wait for reviews or appraisals

6.5 Values

It is an exciting time for our Trust. As we seek Foundation Trust status it is a perfect time to refresh our values and reflect staff views.

Our values are the essence of our identity. They describe what we are, and what we stand for. They support our vision, shape the culture and more importantly represent what staff value as employees.

We are reviewing our values and involving staff with the refresh of these as we ask staff what they feel should be represented by the Trust.. We shall then seek further input from staff as to whether they are believed to be the right values. Then we shall look at launching them and making them part of our very fibre – visible, appropriate and more importantly lived and breathed by all.

6.6 Staff Health and Wellbeing

The wellbeing of our staff continues to be of paramount importance to us as we recognise that this has a direct impact on clinical outcomes and the experience of patients. It is therefore important that our staff are energised, motivated and healthy.

We have refreshed our Health and Wellbeing Programme by introducing a senior - led committee to include champions from across the Trust, which also presents another opportunity to engage with staff over an issue which is important to them. This Committee will lead the refreshment of the Health and Wellbeing Strategy due this year. Health and wellbeing programmes include activities linked to our health priorities such as resilience, eye sight tests for headaches and physiotherapy for musculo-skeletal issues but more importantly they are supposed to be fun so we have included activities such as Pilates, laughing yoga and Mindful meditation. All of the activities in the programme are linked in some way to our sickness reasons and also national priorities such as smoking and obesity.

This year one of the key areas of focus has been assisting staff and managers to get staff back into the workplace, particularly in the instance of long term sickness, by providing extra help and support of a Health and Wellbeing co-ordinator supported by the health and wellbeing programme.

Staff health and wellbeing is also a wonderful mechanism for staff engagement as it is easily accessible and understanding and most of all, fun.


7 FINANCIAL AND INVESTMENT STRATEGY

The Trust was formed in 2008 and now has six years of strong financial performance.

Since the Trust’s inception the organisation has steadily improved and embedded processes with regard to financial governance and probity. This has been demonstrated through unqualified audit opinions in respect of the Trust’s accounts for the first half year and the subsequent six full financial years. Auditors consistently comment on the high quality of the accounts produced. Internal Audit reports have also confirmed that robust financial controls and strong financial management are in operation within the Trust, with the Trust achieving “full assurance” from Internal Audit in relation to Financial Management (2011/12, 2012/13, 2013/14 and 2014/15), Cost Improvement Programme management (2011/12, 2012/13 and 2013/14), and Contract and Commissioning Arrangements (2011/12).

7.1 One Year Financial Plan

7.1.1 Financial Outturn 2014/15

The Trust is forecasting to achieve its planned £808k surplus in 2014/15.

The Cost Improvement Programme schemes in place for 2014/15 should deliver £2.107m full year effect against a target of £2.087m. The Trust aligns cash savings with planned CIP. The timing slippage on CIP schemes has been covered by the non-recurring use of recurrent reserves. This means that there is circa £200k of recurrent schemes were covered by the use of central reserves.

7.1.2 2015/16

The Trust is forecasting a surplus of £950k in 2015/16.

Figure 14 Statement of Comprehensive Income

Statement of Comprehensive Income Total

2015/16 £

Contract Income (60,625,109)

Corporate Services 10,900,258

Acute and Older Adults 18,420,212

Community Services 14,699,788

Medical Services 11,661,773

PDC 1,301,108

Interest Receivable (40,000)

CIP (2,143,000)

General Reserves 810,000

Incremental Drift Reserve 439,970

Inflation 975,000

-CQUIN 1,400,000

-Growth 750,000

-Inflation 500,000

Planned Surplus (950,000)

In 2015/16, Cost Improvement Programme schemes should deliver savings of £2.143m.


7.2 Financial Sustainability

7.2.1 Cost Improvement Programme

The Trust has achieved its cost improvement target on a recurring basis in each year since it was established in 2008. The Trust Board has agreed CIP schemes for 2015/16 and 2016/17. These will help the Trust maintain a strong financial surplus, while keeping CIP at a level which does not put excessive pressure on frontline services.

The table below shows the total recurring CIP achieved by the Trust to date:

Figure 15 CIP Target

Year 2009/10 2010/11 2011/12 2012/13 2103/14 2014/15 2015/16 TOTAL

CIP Target ‘000s 2,000 1,991 2,726 2,781 2,565 2,087 2,143 16,293

The 2015/16 CIP has been programme has been agreed by the Trust Board.

7.2.2 Capital

The Trust held a special planning meeting of its Estates and Capital Planning Group in January 2015 in order to establish the priorities for its capital programme in 2015/16 and beyond. This has enabled detailed plans to be developed and tenders to be initiated for the major projects prior to the start of the 2015/16 financial year.

The planned capital expenditure is £3,201k, which is £1,462k in excess of the Trust depreciation. The excess expenditure will be funded via a combination of 2015/16 I&E Surplus, utilisation of unspent capital cash from previous years and NBV of planned disposals. The level of planned Capital Expenditures reflects the Trust’s commitment to improve the facilities for its patients and staff.

A high-level summary of the plan is detailed below.

Figure 16 Capital Plan

Capital Plan 2015/16

£’000

Funding Depreciation and Amortisation 1,739 I&E Surplus 2015/16 950 NBV of Assets Expected to be Sold 390 Unspent Capital Cash Carried Forward 122 Total 3,201

Capital Expenditure BFH Holyrood 216 DPH Langdale 35 Purchase of Community based property 490 Service Transformation and Estates Rationalisation Schemes 360 DPH Research Facility 37

Estates Maintenance Schemes 344 Quality Improvement Schemes 70 Green and Environmental Schemes 100 Anti-Ligature Schemes 185 Wifi 71

Agile Working Schemes 578

Enterprise Wide Agreement for Windows 31

Business Intelligence Hub 239

Clinical Systems Development 332

Other Information Technology Schemes 113 Total 3,201


7.2.3 QIPP

The Trust has not historically been involved in QIPP initiatives with commissioners; and has approached its internal Cost Improvement and Efficiency Programmes as local “QIPP”. This is acknowledged by our commissioners, who consider that the Trust has delivered QIPP by managing increasing demand with reducing resources. The Trust’s Service Development Programme continues, closely linked to the Trust’s established CIP PMO. CCG’s have intimated that they would be looking at developing QIPP proposals for the Trust, although to date the Trust has not received any detailed QIPP proposals

Walsall CCG have established a framework for QIPP via “Service Transformation and Redesign” (STaR) groups, overseen by the long-established Mental Health Programme Board, of which the Trust is a key member.

Dudley CCG are introducing a new locality model to manage health economy system issues. The Trust’s community teams are already aligned to the new locality model, and have strong links with commissioners. The Trust is in the process of agreeing organisational development initiatives to further develop services in line with the locality model.

7.2.4 Growth

In 2014/15 the Trust secured £775k of growth funding on the basis of over-performance against the 2013/14 indicative contact activity. In 2015/16 contract negotiations the Trust successfully secured a further £750k additional income, which is net of some cross boundary issues. Growth is covered in more detail in section 3.6.2.

Growth is covered in more detail in section 3.6.2.

7.2.5 Better Care Fund

In June 2013 The Better Care Fund was announced by the Government which stated that the government would introduce £3.8 billion pooled budget for health and social care services, shared between the NHS and local authorities, to deliver better outcomes and greater efficiencies through more integrated services.

As part of this the Trust has sought assurances from commissioner’s regarding the extent and scope of the better care fund in relation to mental health services. The Trust has reviewed the detailed plans shared by commissioners and h representation on the steering groups that will implement the plans.

7.3 Key Risks and Mitigations

The Trust has reviewed its financial risks and the table below details those risks and the mitigations.

Figure 17 Financial Risks

Key Risks Mitigations

Inability to effectively support the requirements of Service Development

Deputy Dof Supports the Trust’s CIP PMO

Finance and Business Manager partnering approach

CIP is closely monitored and ledger CIP reconciled with CIP PMO information on a monthly basis

Detailed and timely feedback from MExT regarding developments

Inability to sustain / provide a high quality financial management service

Robust monthly results confirm and challenge meetings

Management accounts to continue to work closely with Business Managers in order to understand services, Service Transformation and development

Attendance at Estates and Capital Planning Meetings and input into Capital Business Cases

Finance Governance meetings held regularly to ensure strong governance continues

Regular team away days held to enable and encourage team discussion and debate

Inability to effectively continue to support the development of MH PbR

Regular attendance at the Trusts MH PbR Steering Group

Regular review of the capacity of Income and Costing Accountant

Close working with the Trust’s PbR Lead

Continued regular discussions with Managers and Commissioners

Procurement and implementation of a new costing system has been


completed

Monthly finance and clustering activity update reports to CARM and F&P Committee

Insufficient personal development and training provided to Finance staff

Importance of personal development reinforced through regular team meetings

Regular appraisals for all staff with personal development needs identified

Membership of the HFMA for all staff where possible

Attendance at HFMA regional and national events where possible

Regular review of roles and responsibilities, particularly following periods of change, to ensure training needs identified

Inability to continue effectively with the implementation of Service Line Reporting (SLR) within the Trust

Continue with SLR as a regular agenda item on the Contract Activity Review Meeting (CARM) agenda

Increase sharing of SLR information across the Trust

Work with Information team to ascertain the capabilities of the Data Warehouse to perform the function going forwards

Procurement and implementation of a new costing system has been completed

Inability to meet Cost Improvement Program (CIP) targets and the impact on the viability of the Trust

Detailed development of CIP targets

PMO established

Level of CIP communicated to operational teams

Management arrangements in place for delivery of corporate cost savings

Quality Impact Assessments carried out for all schemes

Active partner of the Mental Health Program Board

Sensitivity analysis built into plans

Reporting arrangements to Board enhanced


Documents

IBP Chapter 3 Strategy - DWMH NHS · detained under the Mental Health Act. Core services are provided predominately to Dudley and Walsall, but also to neighbouring Trusts in Worcestershire,