Final Operational Plan for Greater Manchester West Mental Health NHS Foundation Trust. For External Publication

Transcription

1 Final Operational Plan for Greater Manchester West Mental Health NHS Foundation Trust For External Publication 1

2 1. Introduction This document sets out Greater Manchester West Mental Health NHS Foundation Trust s Operational Plan for in line with Delivering the View: NHS planning guidance 2016/17 to 2020/21 and outlines our approach to activity, quality, workforce and financial planning for 2016/17. We have a strong track record of delivering all required financial, operational and quality targets and standards and this Draft Operational Plan demonstrates how we will sustain this performance under the current pressures, whilst delivering our strategic priorities. 2. Approach to activity planning The following investments and associated activity levels have been agreed with Commissioners for implementation in 2016/17. These are an outcome of successful tenders either as a single provider or in partnership with other organisations. Expectations around activity are clearly set out in each individual service specification with processes for activity reporting and monitoring also agreed. Investments in 2016/17 include: HMYOI Risley and Thorncross ( 543k) provision of mental health and substance misuse services within an integrated healthcare system. Primary Care Psychology Services in Bolton ( 803k) undertaking the role of Lead Provider for the psychological therapies pathway including Steps 2, 3 and 4. HMP Styal ( 457k) provision of primary and secondary mental health services and personality disorder services. Early Intervention (Salford 674k, Bolton 509k, Trafford 80k) delivery of new access and waiting time targets and NICE compliant requirements in Early Intervention services. Bolton Single Point of Access ( 125k) embedding the Single Point of Access Service with clear, effective links to IAPT. Working Well Talking Therapies Service for Greater Manchester ( 720k) provision a range of IAPT compliant Talking Therapies to be delivered across Greater Manchester in parallel with the expansion of the Personalised Support element of the existing Working Well Pilot Programme. Braeburn House ( 3m) Development of a Rehabilitation and Recovery Service for Manchester Commissioners. In terms of our existing services, there are no major disinvestments planned by commissioners in 2016/17 and no associated impact on activity. Where formal notification of contractual changes has been received from commissioners, activity levels and inputs have been adjusted. Work is in progress to enable us to implement service line reporting and devolved financial management in 2016/17, which will strengthen our activity and capacity modelling in future years. Delivering the Forward View 2016/ /21 confirms the mental health must dos for 2016/17 to 2

3 be: Achieving the following access targets: o Improving Access to Psychological Therapies (IAPT) 75% of people with common mental health conditions referred to IAPT treatment programme will be treated within 6 weeks of referral and 95% treated within 18 weeks. o Early Intervention (EI) More than 50% of people will commence treatment with a NICE approved care package within 2 weeks of referral. Continuing to meet a dementia diagnosis rate of at least two thirds of the estimated number of people with dementia i.e. 67%. The Trust has worked collaboratively with commissioners over the last two years and has negotiated additional investment into IAPT and EI services. In line with the new planning guidance and to meet the required RTT targets, services have submitted business cases to support developments based on national capacity planning guidance and local health economy performance intelligence. The position against the new RTT targets for 2016/2017 is summarised below. 2.1 Improving Access to Psychological Therapies GMW provides IAPT services in Bolton (step 3), Salford (step 3) and Trafford (steps 2 and 3). Key developments in 2016/17 include: Bolton: GMW has been awarded Lead Provider status for the Bolton Psychological Therapies Health Economy from 1 st April As such the Trust will, in addition to step 3, now directly provide step 2 services and will hold responsibility for the provision of the full primary care mild to moderate Psychological Therapies pathway. This will involve sub contract arrangements to manage the voluntary sector provision in the Borough. Salford: GMW has been actively engaged with commissioners in 2015/16 in reviewing the overall Health Economy IAPT pathway and has subsequently agreed additional investment to support the implementation of a Borough wide single point of access model (SPOA). As the revised local IAPT pathway across steps 2 and 3 embeds this will ensure there is sufficient capacity at the GMW step 3 service to provide services which meet the access and waiting time requirements in 2016/17. Trafford: In conjunction with commissioners, GMW IAPT Services have continued to improve access and treatment options during 2015/16. Commissioners have recently supported additional investment at step 2 which will ensure there is sufficient capacity to meet the access and waiting time requirements during 2016/17. Through strong performance management and close collaboration with commissioners across the GMW footprint, IAPT development plans are in place to meet the required RTT Access Targets. However, redesign and recruitment plans will be on going in Q4 2015/16 and Q1 2016/17 and as such the changes need to firmly embed before full capacity within the services is reached. GMW is unlikely to meet the RTT Target at 6 weeks for Q1 2016/17. It is anticipated there will be an increasing improvement and the Trust will achieve the target by the end of Q2. 3

4 2.2 Early Intervention (EI) Services GMW provides EI Services in Bolton, Salford and Trafford. Salford has, since 2004, had an At Risk Mental Health State (ARMS) Service. In response to the RTT, to ensure that 50% of people experiencing a first episode of Psychosis will commence on a NICE recommended care pack of care within 2 weeks, the Trust, in collaboration with the three CCGs, have developed business cases to meet the new standards. The Business Case for each locality seeks to: Provide an EI Service to all over 14 years of age Provide a full range of NICE compliant care packages Address the additional demand that EI services had absorbed compared to the original commissioned number of patients in treatment. Establish a service in Bolton and Trafford for those patients who are assessed as having an At Risk Mental State (ARMS) but not deemed to be experiencing a first episode of psychosis. The Business Cases were considered by each of the locality CCGs during 2015/16. Salford CCG confirmed full funding in November 2015 investing an additional 674k. Bolton and Trafford proposed partial funding citing competing financial pressures. Recruitment has taken place against the agreed resource envelopes. Bolton CCG have subsequently confirmed full recurrent funding of 509k in late January 2016 and recruitment to these additional posts is currently underway with plans to achieve full capacity in Bolton by Q2 2016/2017. The Trafford service will be unable to provide a fully NICE compliant service during 2016/2017. Trafford CCG have funded 200k recurrently, leaving a 100K recurrent gap against the agreed business case. As a result of the Trafford position and Bolton late funding, the overall trajectory for GMW for 2016/17 is non compliance with the target until the end of Q2 2016/17. Negotiations continue with Trafford CCG and the Trust position has been strengthened by Delivering the Forward View which has identified this as one of the nine must dos. 2.3 Dementia Diagnosis We provide Memory Assessment Services in Bolton, Salford and Trafford and we are already achieving the required target for dementia diagnosis across all services. We are confident we will continue to meet this target for 2016/17. GMW has a robust performance management framework which is part of the overall contract governance system with all commissioners. Through this framework routine surveillance and monitoring of demand takes place. This intelligence is used to inform early discussions with commissioners around any major fluctuations in demand. 4

5 3. Approach to quality planning 3.1 Quality Priorities National and Local Commissioning Priorities In developing our Operational Plan for 2016/17, we have reviewed our five year Strategic Plan for 2014 to 2019 and our Operational Plan for 2015 to We have also analysed both the national and local commissioning priorities and our key strategic priorities for 2016/17 are summarised below in Figure 1. 5

6 OPERATIONAL PLAN KEY PRIORITIES FOR 2016/17 VISION Improved Lives and Optimistic Futures for People Affected by Mental Health and Substance Misuse Problems STRATEGIC CONTEXT Independent Commission Acute MH: Old Problems New Solutions Mental Health Taskforce Report DevoManc Strategic Plan Winterbourne, Berwick, Francis and Keogh Inquiries and Reports National and local commissioning intentions Delivering the Forward View 2016/ /21 Closing the Gap Choice and competition Crisis care Concordat GM Mental Health Strategy CQC Inspection Regime Monitor s Risk Assessment Framework Financial Climate: Efficiencies & PBR for Mental Health STRATEGIC OBJECTIVES Promote recovery by providing high quality care and delivering excellent outcomes Work with service users and carers to achieve their goals Engage in effective partnership working Invest in our environments Enable staff to reach their potential and innovate Achieve sustainable financial strength and be well governed TRUST WIDE PRIORITIES Competition Responding to tender opportunities (new and existing business) Promoting and delivering quality and performance agendas Developing and strengthening partnerships Achieve Quality Account Priorities Reviewing and improving existing clinical services Promoting recovery through education Recovery College Continuous improvement acting on patient experience feedback Proactive workforce planning, development and management Engage in Devo Manc agenda Embed Paris System Respond to tender of mental health services in Manchester Delivering the financial plan, including efficiencies 6

7 CLINICAL SERVICE DEVELOPMENT PRIORITIES Introducing new expanded teams to achieve the new Early Intervention targets more than 50% of people seen within two weeks and offered NICE approved packages Improving the psychological therapies offer by taking the lead provider role for Bolton and developing the Working Well Talking Therapies service across Greater Manchester Improving access to psychological therapies achieving 75% 6 week and 95% 18 week maximum wait targets Open Braeburn House, a new 28 bedded male recovery service, and work with commissioners across Bolton, Salford, Trafford and Manchester to develop Rehab and Recovery Services to return out of area placements and further improve pathways Support the implementation of the Salford Integrated Care Organisation Capital project to improve in patient and community properties in Bolton Implement the lead provider RAID model at South Manchester A&E Continue to develop better pathways and closer working relationships with GP s, Substance Misuse Services, Housing and CAMHS Further Development of Woodlands as a centre of excellence for MATs and Older Adults Implement capital projects including a new bedroom suite at Gardener Unit and expansion of Junction 17 To respond to tenders for Lancashire prisons, Bolton SMS, CAMHS and adult secure services (may also be some tenders to retain other contracts in SMS) Implement the new mental health service at HMP Risley and HMP Thorn Cross Opening of 4 th Ward at Recovery First Use expertise to reduce restrictive practice across services Continue to develop pathways and closer working relationships with district and specialist services across Greater Manchester Extended the provision of Tier 4 inpatient detoxification services to meet the contracting requirements for St Helens and Knowsley Central Lancashire Substance Misuse Service service re design 7

8 3.1.2 Local Context and links to STP The devolution of health and social care responsibilities to CCG s and Local Authorities in Greater Manchester from April 16 will shape the local context during 16/17 and beyond. The final draft of the Greater Manchester Health and Social Care Devolution Strategic Plan ( Taking Charge of our Health and Social Care in Greater Manchester ) was endorsed by the Health and Social Care Strategic Partnership Board on 18 th December It is informed by Locality Plans (see below) and an integrated financial plan, outlining how the region will deliver clinical and financial sustainability over the next five years and the actions to be taken to address the estimated 2billion deficit by 2020/21. GMW has also linked to local health economies outside of Greater Manchester, where the Trust is a provider of services including Cumbria and Lancashire. Work to develop a Greater Manchester Mental Health and Wellbeing Strategy has continued in parallel with the drafting of the Strategic Plan. The final version of this strategy is expected to be agreed in February 2016 with implementation from April The Mental Health and Wellbeing Strategy is focused on achieving a self sufficient mental health system for Greater Manchester residents through better prevention, access, integration and sustainability Locality Plans Mental Health Priorities Locality Plans have been prepared by Bolton, Salford and Trafford CCGs and respective LAs, with input from providers sought via the respective Health and Wellbeing Boards. The Locality Plans are currently in draft form with final versions expected in February/March The Bolton Health and Care 5 Year Locality Plan is focused on improving mental well being, reducing inequalities and delivering improved health outcomes for the whole population through collaborative working and focus on the following local priorities: Early intervention and prevention; Improved access; Strengthening community services to reduce the need for admission to hospital; Strengthening crisis response and urgent care services; Improving access to psychological therapies; Improving the physical health of people with mental health problems (parity of esteem); Improving the care of older people with mental health problems with a specific focus on dementia care; and Integrating care across health and social care settings to enable individual care plans and seamless transition between services. Bolton s plan also outlines interventions to address outcome areas where the region is furthest away from the national average. These include reducing suicide and self harm and reducing avoidable harm and mortality due to alcohol. 8

9 Salford s Local Sustainability Plan is built around a life course model (start well, live well and age well) with activity and outcomes defined as short, medium and longer term impacts. The transformation initiatives and outcomes agreed for the existing Integrated Care Programme for older people, and the planned Integrated Care Organisation (ICO) for adults (see below), are identified as critical enablers. The Locality Plan for Trafford to 2020 seeks to reduce waiting times and increase the range of mental health support provision, enabling more people to be cared for and treated at home and the number of hospital admissions to reduce by a proposed 15%. Specific priority areas include: Improved access to Psychological therapies and early interventions for individuals experiencing psychosis linking to the national access targets; Improved access to diagnosis and post diagnosis support for those with, or caring for people with, dementia; Enhanced 24/7 psychiatric liaison/diversion and RAID services, police custody/criminal justice system diversion and primary care support; Shared care protocols for prescribing and physical health checks; and Enhanced support for children and adolescents with mental health difficulties. The Trafford Care Coordination Centre (TCCC) is highlighted as a key driver for the Locality Plan Manchester Mental Health Key to the local context of mental health service provision will be the future of Manchester Mental Health and the potential impact of this on other service providers during 2016/17. A decision on the preferred procurement process has now been confirmed by the TDA and is likely to commence early March 2016 with a decision expected in July The clinical and financial challenges should GMW acquire this organisation are evident. Whilst the tender has yet to be published, the Board has considered a number of papers and commenced the development of a Strategic Options Case to examine the potential benefits. These can be summarised as: Ability to offer more integrated pathways Transfer of our Acute Care Pathway Programme to Manchester Added value through access to specialist clinical expertise including RAID, RADAR, psychological therapies and early intervention Leadership for example clinical leadership and psychological therapies Access to capital GMW s active research and development positive examples of putting research into practice Economies of scale and associated savings clinical and corporate Salford Integrated Care Organisation The Trust is working collaboratively to support the development of Integrated Care Plans across Bolton, Salford and Trafford which are at various stages of development within each district. 9

10 Salford s plans are the most advanced having established an Alliance Agreement in September 2014 to deliver Salford s Integrated Care Programme for Older People. The Alliance Agreement formalised the partnership, known as Salford Together between four statutory strategic partners: Salford Clinical Commissioning Group (CCG) Salford City Council (SCC) Salford Royal NHS Foundation Trust (SRFT) and Greater Manchester West Mental Health NHS Foundation Trust (GMW) Salford Together now seeks to extend this programme to the adult population thereby transforming the health and social care system in Salford promoting greater independence for people and delivering more integrated care. It is recognised that these changes will be enabled and supported through the creation of an Integrated Care Organisation (ICO) bringing together responsibility for adult health and social care provision through a prime provider model. It has agreed that SRFT would be the prime provider with the responsibility for provision Adult Social Care Services transferring from Salford City Council to SRFT. The contractual model proposed for the mental health services provided by GMW is via a sub contract arrangement whereby Salford Directorates Mental Health Services, currently included within the Multilateral Contract, will be commissioned and provided via a sub contract arrangement with the lead provider, SRFT. The Outline Business Case for this transaction was approved by all parties in December 2014 and the Full Business Case is schedule to be considered in April 2016 proposing establishment of the Integrated Care Organisation from July Quality Goals We view ourselves as a learning organisation that is committed to continually improving the quality of care we provide. Our quality improvement priorities reflect national and local commissioning intentions and regulations and include: Quality Account There was a comprehensive consultation process with regards to the Quality Account priorities for 16/17. This completed on 30 th March Feedback was received from a wide range of stakeholders including staff, service users, carers and public representatives. This has resulted in the identification of two new priorities for 16/17 in the following areas: o Staffing Improve Individual and Organisational Well Being to enhance patient care o CAMHS Review care pathways, models of care and skill mix of the CAMHS units to ensure care and treatment is safe and effective. Three priorities from 15/16 were removed following significant success and assurance that these are now embedded in practice and can be led via existing networks. The priorities removed were Carers Involvement, Psychological Therapies and Dual Diagnosis. Five priorities were retained from 15/16 with new improvement measures identified. This means that there are seven Quality Account Improvement Priorities for 16/17 as follows: o Service User Experience Listening to and Learning from Service User Feedback. o Recovery Improving Outcomes through the delivery of Recovery focused services. o Enhancing the Quality of Life of People with Dementia and Older People with Functional Illness 10

11 o Physical Health includes a focus on weight management o Positive and Safe Promoting positive and safe practice o Staffing Improve Individual and Organisational Well Being to enhance patient care o CAMHS Review care pathways, models of care and skill mix of the CAMHS units to ensure care and treatment is safe and effective. Each priority has a senior named lead to ensure effectively progressed to meet identified targets. Clear quarterly milestones will be identified as in 15/16. Leads provide quarterly reports on progress to the Trust Quality Governance Committee. These are also reflected in reports to Trust Board. CQUIN (Commissioning for Quality and Innovation) We have achieved all of our CCG and Specialist Commissioner CQUIN targets up to Quarter 3 in 2015/16 and are planning to continue to drive forward quality improvements in 2016/17. We are developing CQUIN schemes with the District CCGs for inclusion in our 2016/17 contracts and have received confirmation of the NHS England CQUIN requirements. 2.5% of our income will be dependent on the achievement of our CQUIN targets in 2016/17. Clear agreed quarterly milestones are in place for each indicator and progress is reported within the Trust wide performance report to Board. Care Quality Commission (CQC) Monitoring compliance with the CQC s new Registration Regulations and associated standards of quality and safety and actively preparing for the new inspection regime. We are focused on strengthening our assurance process in 2016/17 and will be continuing a regular programme of internal inspections against the CQC standards to ensure compliance. The formal CQC inspection took place in February We were well prepared and aware of our key risks. Feedback received has informed the development of our Quality priorities. Delivering Contractual Key Performance Indicators (KPIs) Existing Quality Concerns and key risks The Trust Board s Board Assurance Framework sets out the key strategic risks, which could affect delivery of our key strategic and quality priorities. The risks identified in the Board Assurance Framework are based on a collective assessment by the Trust Board of the operating environment. They are also informed by risks identified at Directorate/service level, which are managed via local Risk Registers and reviewed at the Trust wide Risk Management Committee. Directorate risks are escalated to the Board Assurance Framework in the event that they could significantly impact upon the delivery of our strategic objectives. As quality is at the heart of all of our objectives, risks identified in the Board Assurance Framework have the potential to impact on service quality. Our current key strategic risks, and associated controls, are as follows. Where gaps in controls have been identified by the Trust Board, actions are being progressed to mitigate these. This work will report to the Nursing Leadership Board, though to the Quality Governance Committee up to the Board. 3.2 Quality Improvement The Trust s leadership, management and governance arrangements are key to delivering this operational 11

12 plan and addressing the challenges faced. To ensure that our governance arrangements are fit for purpose, both now and in future, the Trust has taken steps during 2015/16 to identify and address development needs. This work has been undertaken in the context of Monitor s Well led Framework and the Care Quality Commission s characteristics of a well led organisation. The Trust has developed a more coherent governance structure, which has been communicated, and is in operation, across the organisation. The risk and performance management arrangements described elsewhere in this Operational Plan align with this structure. Individual members of the Board of Directors have been tested to ensure that they meet the requirements of the Fit and Proper Persons Regulations being of good character, physically and mentally fit, and offering the necessary skills, qualifications and experience. Trust Board members continue to be visible within clinical services and pursue a programme of development. This provides members with opportunities to triangulate evidence, speak to service users and staff about their experience and to ensure that there is an open and transparent culture within the Trust. All staff engagement activity is framed by the Trust s vision, values and strategic objectives. Our Quality Governance Framework outlines our commitment to deliver equitable, high quality customer centred care to all our service users. The Framework provides information on the structures and processes at and below board level to lead Trust wide quality performance to ensure that; required standards are achieved, any evidence of poor standards are addressed, and that best practice and the management of risks are a priority in order to plan and drive continuous improvement. Our Trust Board hold ultimate responsibility for quality and they have established the Quality Governance Committee (QGC) which leads the Quality Governance Agenda. The named executive lead is Gill Green, Director of Operations and Nursing. The monthly Trust Performance report to Board includes detailed updates on all quality objectives, performance targets, financial position and workforce data to facilitate triangulation and identification of any risk. These structures and processes are depicted in our Governance Map shown below: 12

13 Accountability Framework for Quality Governance Committee In 2016/17, the Board of Directors will again review its governance system, taking into account in particular the feedback received from its CQC inspection. In accordance with the requirements of Monitor s Risk Assessment Framework, the Trust will commission an external well led review of its governance arrangements towards the end of 2016/ Top Three Quality Priorities Through our Business Planning Framework for 2016/17 we have identified our key quality improvement priorities for 2016/17 and our top three quality priorities are: Strengthened staffing to facilitate increased continuity of care for service users and their carers Improving accessibility to services by further development of the interface with primary care 13

14 Continuing to learn lessons and share best practice Taking Responsibility Taking Responsibility was an initiative launched in 2014 by the Academy of Medical Royal Colleges to ensure continuity of care for all inpatients through having a clearly identified responsible consultant (or clinician) and named nurse. The guidance also included other initiatives which were primarily aimed at the acute sector and do not easily translate to the mental health inpatient setting. GMW has been fully compliant with this guidance from the outset. All inpatients have an identified consultant who over sees their clinical care. Additionally all patients with enduring disorders are managed under the policy of the Care Programme Approach, with each patient having a named Care Coordinator who ensures continuity of care across inpatient and community settings. 3.3 Seven day services During 2015/16 there has been a redesign of the Acute Care Pathway offer in the district services across GMW which has provided the opportunity to further invest in community services. This has allowed community services to offer a seven day a week service supported by a 24 hour helpline. In 2016/17 this offer will be consolidated and further extended across district services to ensure equitable access. We will continue to implement the strengthened Community Service pathways and improve access for adults and older people. In addition, we will continue to develop and embed the urgent care service offer with comprehensive liaison services (Rapid Assessment Interface Discharge, RAID) and out of hours support in partnership with the CCGs and acute Trusts. 24 hour liaison services were commissioned and established during late 2014/ early 2015 in Bolton and Salford. An extended hours 7 day per week service was commissioned and established in Trafford. The service covers peak times but not the full 24 hour period. All services have continued to perform well during 2015/16 with the response time to A&E departments varying between 90% and 98% within 1 hour of referral. GMW has recently been awarded Lead Provider status for the provision of liaison services at University Hospital South Manchester (UHSM) and Trafford General Hospital (TGH) subject to final agreement of the service specification and funding. This development will see the expansion of services in these hospitals during 2016/17 and support a more comprehensive 24 hour provision. 3.4 Quality Impact Assessment Process The cost improvement schemes/targets have been formulated as part of the Annual Business Planning, budget setting and financial planning processes. The Cost Improvement Programmes (CIP) have been developed through discussion with individual Directorates and, where required, with Commissioners and other key stakeholders. Directorate Senior Management Teams (SMT), which includes clinicians, and our Trust wide Clinical Leadership Group have also contributed to the CIP development process. CIP schemes have been subject to the Trust Quality Impact assessment Framework, whereby CIPs are risk rated taking into account the impact on patients, staff, carers and the environment. The CIP Quality Impact 14

15 Assessments are then reviewed by the Director of Nursing and Operations and the Medical Director to evaluate any potential impacts on service delivery and quality. Only schemes that have been RAG rated as green have been put forward to deliver the CIP for 2016/17. CIPs are devolved to Directorates as part of their annual budget and CIP plans will be monitored on a monthly basis, with progress routinely reported to the Executive Management Team and the Board of Directors. The Director of Finance Capital and IM&T will oversee the delivery of CIPs via financial performance management of Directorate budgets and this will form part of the monthly finance report to the Trust board. In addition to the above efficiency requirements, Local Authority partners continue to levy significant CIPs on the Trust s district services. The Trust is working with the Local Authorities to agree how these pressures can be managed without adversely impacting significantly on service provision and our ability to deliver our agreed strategic priorities. 4 Approach to workforce planning 4.1 Workforce Planning Developing Excellent People to Deliver Excellent Care is the vision that guides our workforce development. This vision recognises the established link between the quality of Human Resource practices and quality of care; it also provides a commitment to investing in the workforce. Our workforce is critical to the ongoing and successful delivery of our plans and our commitment to our workforce is encompassed in the Trust strategic objectives, in particular `To enable staff to reach their potential and innovate. Our values articulate what we stand for as an organisation and how we will work together to achieve the best for staff, service users and carers. We are welcoming and friendly We are caring and kind We value and respect We work together We go the extra mile We have a robust Workforce Planning process in place which is fully aligned to the Annual Operational Planning process taking account of national priorities and local commissioning strategies. Our Workforce Planning model follows the 6 Step workforce planning methodology and is integrated within the Trust s annual business planning process. Local Business Plans are developed through engagement with key stakeholders in the service areas including managers, clinicians and staff groups. The workforce implications of delivery against the objectives are then set out in the local service workforce plans.local workforce plans are used to develop a Trust wide Workforce Plan which is used to 15

16 identify areas for redesign and informs the commissioning process for education. The Trust Workforce Plan is ratified through the Trust Workforce Development Committee and final approval for the Plan is through the Executive Director of HR and Corporate services. The actions set out in the workforce plan are monitored through the Workforce Development Committee. 4.2 Workforce Transformation Programmes Our Workforce plans have identified a number of key workforce transformation areas that will be driven forward in the next 12 months. These include: Early Intervention Services In line with new access targets and NICE compliance, there will be an increase in the workforce within the Early Intervention services which will see the ongoing development of Mental Health Practitioners, additional psychology, nursing and administrative roles within the services alongside additional medical support. Enhanced Community Provision There will be continued consolidation of the new roles invested within the Community services in 2014/15. The investment enabled the development of 7 day services across CMHT s and enhancement of Home Based Treatment. There will be a relocation of a number of clinics into the community in Bolton which will improve access for the local community. Primary Care Psychology Additional investment in primary care psychology brings opportunity to introduce a range of Psychological therapists into the Trust to enhance our psychological therapy offer. Dual Diagnosis Innovation Fund The dual diagnosis innovation fund has been extended for a further 12 months within Salford CCG which involves the directorate working closely with Substance Misuse to meet the needs of service users. This demonstrates effective partnership working to meet service users with mental health and substance misuse needs in a fully coordinated way. Salford Integrated Care We continue to work in partnership across the Salford Integrated Care agenda to deliver: o Better health and social care outcomes o Improved experience for service users and carers o Reduced health and social care costs We have been involved in the development of an Integrated Workforce Strategy for integrated care to ensure the long term future sustainability of a highly competent, flexible workforce to meet community needs. Substance Misuse Services Redesign There will be continued service redesign within substance 16

17 misuse services to ensure the services remain competitive and fit for purpose. The increased partnership work and development of community assets within substance misuse ensures that high quality services can be delivered by GMW within a competitive market. Workforce Development Overarching all the workforce transformation programmes is the ongoing development of the Trust workforce in order to work in the most effective way for our service users. A key development within our in patient services is the ongoing development of positive and safe strategies and reducing restrictive practices. These areas of work will have a significant positive impact on the experience of our patients and also our staff members. 4.3 The Use of E Rostering and Temporary Resourcing We are currently implementing e rostering across our 7 day services. We anticipate the benefits of e rostering will be similar to those experienced in pilot sites which demonstrate efficiency savings and improved use of nursing resources with more time to deliver higher quality services. In addition, Trusts who have implemented e rostering have seen benefits through the reduction in spend on bank and agency usage through better utilisation of their existing workforce. We recognise the importance of having a flexible and responsive temporary staffing solution to support both peaks in workload relating to clinical activities such as special observations and additional escorting of patients, and also to cover unplanned shortages such as sickness absence or cover for vacancies. As a result, we have developed an in house bank to support temporary staffing needs. The in house bank demonstrates better value for money and also enables us to support, train and develop bank staff in order to provide high quality care for the people who use our services. The in house bank fill rate is currently approx. 83% cover which means agency nursing staff are sometimes called upon to provide temporary cover. We have worked within the Monitor Agency Framework since its introduction and it is not anticipated that we will need to work outside of the framework in the future. We have a robust process for accessing agency cover and continually monitor activity and reports in line with Monitor requirements. The Trust has been set a cap on nursing agency usage at 3%. The monitoring of agency usage shows the Trust has operated under this cap since the introduction in November In order to further improve the in house bank coverage for nursing and healthcare support cover, we have been running a recruitment campaign to increase the number of bank staff on the temporary resourcing bank. One important area for the non registered workforce which adds to the attraction of joining the GMW bank is the introduction of the Living Wage which we signed up to in November This has resulted in an increase in the basic wage setting the minimum hourly rate at 8.25 for all staff, including bank staff. This is beneficial both in terms of attracting bank staff in order to reduce the reliance on agency staff, but 17

18 also to improve staff retention within the healthcare support workforce. Our spend on medical locum cover has increased as a result of both gaps in training doctors on rotation but also due to senior medical vacancy cover. These areas are being addressed through an increased recruitment campaign to fill consultant posts substantively and also plans to cover gaps in the rotation. 4.4 Workforce indicators Trust Board receive a monthly report of all performance metrics through the Board Performance Report. This brings together all key information relating to the Trust which enables the Trust Board to identify any potential hot spot areas. More detailed information is provided for service and line managers through a range of reports (including HR and Risk and Safety performance reports) which set out workforce and risk and safety metrics. Analysis takes place at a local level and informed discussions, including identification of workforce risks take place in Risk Management and Workforce Development Committees. Local Risk Registers are also reviewed and any Trust wide workforce risks identified. A number of workforce risks are identified on the Board Assurance Framework, including Safe Staffing Levels, Sickness Absence and Mandatory Training. Information, such as data on turnover, sickness absence, agency usage, is correlated with incident data to identify any particular risk areas, or drill down to team/ward level to identify any particular hot spot areas or potential risks that may impact on the quality of care delivered to patients. The ward managers also have access to a Ward Dashboard which brings together all the key indicators for consideration at a local level. Our key workforce priorities focus on improving effectiveness and safety through improvements in staff health, safety and wellbeing, improving attendance in work, vacancy management and recruitment and promotion of learning and development. 4.5 Workforce Cost Improvement Programmes Within our business planning and financial cost improvement programme we have a comprehensive process for conducting Quality Impact Assessments against all proposed Cost Improvement plans. This is explained further in section 3.4. Given the pace of change across Greater Manchester the overarching theme within the workforce plans is the need to develop a workforce that is equipped to work in a flexible and responsive way to deliver the services required for the population and to work across boundaries. We will continue to involve and engage our workforce and work in partnership with trade unions to ensure that we can respond flexibly to change in a positive way. 5 Approach to financial planning 18

19 5.1 Financial Planning The Trust s financial strategy for 2016/17 aligns with the national planning guidance and commissioners strategic intentions. It is focused on achieving long term financial sustainability and resilience whilst continuing to deliver all key financial targets and effectively managing financial risks. The Trust will do this by: Utilising a dynamic financial model and periodically modelling financial scenarios as they change/arise Undertaking regular reviews of the Trust s financial performance, including any variations against plan Holding a contingency and a risk reserve Maintaining robust forecasting mechanisms The key financial drivers are to meet the requirements set out by the NHS Improvement Authority (Monitor and the Trust Development Authority) planning guidance. The key financial requirements for 2016/17 are: a) Returning the NHS provider sector to financial balance b) Efficiency assumptions and business rules a) Returning the NHS provider sector to financial balance During 2016/17 the sector will be required to return to financial balance using funds from the 'Sustainability and Transformation Fund' (STF). Work will include: (i) Deficit reduction trusts will be expected to agree with NHS Improvement how they will break even in a reasonable timeframe. This will include agreeing a control total for their 2016/17 budget. The deficit reduction plan will be expected to include a reporting and delivery plan for how the trust will meet the savings outlined by Lord Carter as part of his review into NHS productivity, and delivering of reductions in agency spending. (ii) Delivery of constitutional access standards (iii) Progress on transformation, as demonstrated through the collaborative STP process noted above. For GMW, the forecast outturn position for 2015/16, at Quarter 3 is 9.5m surplus. This includes two nonrecurrent items, namely the release of deferred income and revaluation inflation. The underlying recurrent position of the Trust is a surplus of 3/ 4m. b) Efficiency assumptions and business rules A headline net adjustment to prices of +1.1 % for 2016/17 is proposed (with CNST adjustments in addition to this) based on: 2% efficiency factor for 2016/17. The planning guidance states that this efficiency factor is predicated on the providers meeting a deficit position of 1.8bn at the end of 2015/16. Any further deterioration of this position would require new efficiency requirements to meet the control totals set by NHS Improvement 3.1% cost uplift (including a one off adjustment for the effect of changes to pensions). 19

20 5.1.2 Financial Objectives 2016/17 The Trust is planning to generate a surplus to remain sustainable and to continue to maintain and improve its estate by funding capital expenditure over and above the cash generated via the depreciation charge. The Trust s overall financial objectives for 2016/17 are: To deliver an operational surplus to sustainable and provide funds for potential investment in services To generate earnings before interest, tax, depreciation and amortisation To maintain a Financial Sustainability Risk Rating (FSRR) of 3 / 4 To ensure cash balances are maintained to meet current commitments and whenever possible, interest generated for investment in services and non recurrent expenditure to manage risks Financial Forecasts We have delivered, subject to audit, a retained income and expenditure surplus of m, 27k above plan, which will enable improvements in service quality through capital investment in our buildings and estate. The outturn position is subject to audit during April and May The Trust financial plan is to deliver a retained income and expenditure surplus of 3.007m at 2016/17 year end shown in Table 1 below: Table 1 Income and Expenditure INCOME & EXPENDITURE (I&E) plan Forecast turn 000s Out Plan Income 166, , ,697 Employee Expenses (117,608) (119,392) (126,783) Drugs (3,210) (3,442) (3,279) Clinical Supplies (3,022) (4,457) (3,710) Other Costs (23,925) (24,710) (24,604) EBITDA 18,759 18,155 10,321 Depreciation (3,379) (3,730) (3,730) Interest (87) 21 (14) PDC (2,394) (2,780) (3,040) Gain/(Loss) on Sale of asset (503) (562) 0 Net Surplus 12,396 11,104 3,537 Impairments (2,294) (975) (530) Retained Surplus 10,102 10,129 3,007 Impact of revaluation Revaluation Reserve/ Other Reserves 3,985 (15) (15) Total Comprehensive Income 14,087 10,114 2,992 20

21 5.1.4 Planning Assumptions Delivery of 2% efficiency in 2016/17 and future years, to ensure increases in costs associated with inflation are met No major changes to contract income, other than the tariff inflator of 1.1%. This takes into account the minimum efficiency requirement of 2% and assumes a 3.1% uplift to cover inflationary pressures and increases in CNST contributions Additional CQUIN income of 2.5% of contract value ( 2.9million, non recurrent) linked to quality and innovation an income contingency has been set aside to offset any slippage against these schemes No significant impact on income arising from introduction of pay and prices for mental health No major changes in commissioners intention with regard to mental health services No major service investments or disinvestments in year The Trust s plan does not include any assumptions regarding the potential acquisition of Manchester Mental Health and Social Care Trust. Other income planned for 0% uplift for the next five years. Where any specific agreements have been reached with commissioners regarding additional funding, the uplifts have been included as part of the year s contract income. Deferred income currently held on our balance sheet will be released to fund transitional costs arising from any service changes Costs: o Pay costs reflect the nationally agreed uplift for 2016/17 of around 3.3%. Incremental drift has been included as a cost pressure of around 1%, and increased employer pension contributions have been factored in. o Drug costs have been reduced in line with market forces for mental health drugs, but uplifted by 1.6% for inflation and an additional 1% for NICE drugs and local advice o 2.6% uplift assumed for clinical supplies based on planning guidance o Impairments A desk top valuation exercise undertaken in February 2016 has indicated a significant increase in the value of the Trust s asset base. Early indications suggest an increase of 17.7m following revaluation. The impact of the revaluation would result in an increase of 13.2m, which would reverse previous impairments and impact on the Trust s I & E position. The revaluation would also result in a 4.5m increase revaluation reserves on the Balance sheet. Given the complexities of the GMW estate, on multiple sites over a large geographical area and the limitations of a desk top review, a full revaluation of the Trust Estates will be undertaken in 2016/17. Surplus The Trust plans to generate a surplus to maintain and improve its estate stock and fund capital expenditure over and above the cash generated via depreciation Impact of Drivers on Financial Forecasts The Trust s finance plan for 2016/17 does not identify a requirement for loans or working capital finance due to the levels of cash held by the Trust. However, the Trust is aware of the need to ensure that satisfactory cash balances are maintained. 21

22 There are no major disinvestments planned by commissioners in 2016/17. Where formal notification of contractual changes has been received from commissioners, the anticipated income at risk has been excluded from our total income forecast. Where services are subject to competitive tender, and notification has been received from commissioners, we have provided a contingency reserve to mitigate the risks of an unfavourable commissioner decision. Contracts currently under review include CAMHS Tier 4 and Adolescent Low and Medium Secure Services Sensitivity Analysis Table 1, above, summarises the Trust s forecast I & E surplus for 2015/16 and the planned position for 2016/17 based on the assumptions set out in Section It is recognised that the planning scenario for 2016/17 may not be sustainable in the longer term, as the financial environment will likely result in levels of NHS funding unable to support the a continued increase in demand and quality requirements. The Trust has modelled a number of down side scenarios to test its financial resilience and ability to survive material commissioner disinvestment and/or reduction in costs in line with the annual 2% efficiency requirement. The following scenarios have been considered in detail, both exclusively and also as a combined model: Loss of major alcohol and drugs contracts Centralisation of district services i.e. reduction in the current number of sites to a single site option Impact of Pay and Prices for mental health and/or movement from block contracts Size of organisation and possible mergers Future of specialist mental health trusts if integrated care organisations are mandated The results of the financial modelling confirm that one or more of the above scenarios would present significant risks in terms of the Trust s income, cost base, surplus and capital spending plans. Risks would have to be mitigated by reducing costs to ensure that our recurrent expenditure matches the Trust s recurrent income. In some instances, it may be necessary to review the level of our service offer to ensure that it is deliverable within the resources available Risks The Trust has identified a number of financial risks, which have been factored into our financial plan alongside the assumptions and capital investment plans described above. Taking these risks and associated mitigation into account, the Trust s financial risk rating or FSRR for 2016/17 is planned to at Level Efficiency Savings for 2016/ Cost Improvement Programme (CIP) The Trust has strong record of delivering all of its financial duties since our inception as an NHS Foundation Trust. The Trust set a cost improvement target of 4.4m in 2015/16 (4%), which was fully achieved in year. For 2016/17, the Trust is planning to deliver further efficiencies of 2.2m (2.0%), which is 22