Theme Question Answer IM&T 1. When will one clinical system be in place that all staff can use?

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1 Theme Question Answer IM&T 1. When will one clinical system be in place that all staff can use? It depends on a number of things: 1. the number of existing systems that are in use across the SSSFT/SSOTP estate (currently there are at least 48 different systems in use all the time) 2. the contractual basis for their use (ie the Sexual Health teams are contractually obliged to use a particular system to manage their work) 3. the levels of engagement we get from the system suppliers (we need them to be available to work with us to merge systems and to create a single index of patients that is used across all systems, and in the case of RiO we need to get both organisations onto the same version before we can merge the two instances) 4. the capability of RiO to replicate the functionality of other systems 5. the duration of the contracts we currently hold with suppliers 6. the specification of work created by the clinical 7. the complexity of creating the new functionality in RiO, 8. the resources, capacity and skills we have to do this BUT, there is a real commitment to work toward this. IM&T 2. How will we practically get to the point of having one clinical system and will this be Rio? IM&T 3. What will happen to the clinical systems which become redundant? In practical terms it's about working with the clinical teams, providers and internal and external developers, and planning what we're doing so that it's transparent and measurable. The intention is to reduce the number of clinical systems currently operating to as few as possible, and to replicate functionality and integrate with RiO as much possible. There are a lot of systems in use, and we need to make sure that we can deliver the best patient/service user experience we can. Where systems can't talk to each other, its not in the interests of the patient to keep them that way (unless there's a legal requirement to do so) so a shift to RiO, wherever possible, will be key to that. Data will be extracted from them, contracts relating to their support will be curtailed and they'll be shut down securely. The data will be wiped from them and if they are still running on locally owned hardware (and not in the Cloud) that is useable, it'll be recycled.

2 IM&T 4. How will IT systems be sufficiently embedded so that all staff can use them? IM&T 5. Will we move to integrated systems, processes and policies? IM&T 6. Is there sufficient resource within the IM&T department to support the significant changes required to get all staff onto one system? HR 7. When will decisions be made on a management structure? HR 8. Once the senior management structure is in place how quickly will structures for staff beneath these be developed and shared? HR 9. What is being done to ensure that the new organisation has the right skill mix of staff? HR 10. What will happen to SSOTP staff who work under SCC and NHS contracts once the merge happens? HR 11. What will the executive structure look like? The role of the training function is to be expanded, with on-site support given to teams as they move onto RiO. This will require clinical leadership and support, as this is a key cultural change that will need addressing at a non technical level That is the intention, yes, because if we deliver services, we need to be doing so consistently in terms of the patient/service user experience. Having common systems, processes and policies that govern their use and provide guidance to staff is key to this. Not at the moment within the challenging timeframes being articulated. There are also skillsets needed that we don't have and a great deal of pre-work needed before we can start to bring systems together. We are now actively working on a plan to put the needed resources in place as soon as possible. The management structure is being informed by our ongoing engagement with stakeholders. Exercises such as 'Mavis' at our engagement events will help to inform our service model and this in turn will help determine the management structure needed to support front line services. More information on management structures will be made available as we progress toward merger. Once the senior management structure is in place the expectation is that structural change, where needed, will follow as soon as possible. It is anticipated that structural change in corporate functions and management will be needed soonest to ensure front line services continue to receive the support they require. Both organisations already have a broad range of highly skilled and experienced staff. As a new Trust we would be required to continue workforce planning across all areas of our current and future services as part of our overall strategy. Colleagues from SSOTP will join the new Trust on their existing terms and conditions. There may be some technical changes (such as pay date) which may need to happen to help the running of the new Trust. If any changes of this kind are expected we will engage with both SSOTP and SSSFT colleagues and trade union representatives. We are expecting to announce more about the executive structure as we move closer to merger.

3 HR 12. Will all members of staff from both organisations go through a Management on Change when the merger takes place? HR 13. Will there be compulsory redundancies? HR 14. If jobs are going to be affected will this be from the top to front line? 15. How will staff get their voices heard in such a large organisation? OD 16. Building relationships - how can teams and services start working together? When can we start to meet each other? OD 17. There has been so much change. How will this change be embedded? Formal Management of Change processes will be kept to minimum and will only be used where absolutely necessary. Some change is inevitable in our journey towards being better together, but every effort will be made to achieve a different kind of change. Every effort will be made to avoid redundancies. However we cannot rule out redundancies in some areas such as corporate and senior management positions. We will work to retain employees' skills within the NHS by using mechanisms such as the new Regional Redeployment Team. Our aim is to reduce the impact on front line services as much as possible. Where changes are made they will be to support and enhance front line delivery as commissioned. SSSFT already has an established Listening in Action programme the principles of which will be continued in the new organisation to ensure that all staff are listened to. In addition the organisation will utilise the Staff Opinion Survey. Feedback from the survey will initially be from separate organisations but will be taken forward in a joint action plan. Finally there will continue to be a series of staff engagement events during formation of the new organisation, which will provide opportunities for staff from both organisations to ask questions and share their thoughts and opinions. Staff from SSSFT and SSOTP are encouraged to start working together at the earliest opportunity. Some of the clinical, corporate and operational leads have already started to meet and work out which people and groups would also benefit from meeting. Professional forums are already in place and professional leads are looking at how these group could come together. Both SSSFT and SSSOPT are aware that we will need to work differently in the future. Moving forward teams will be working in a locality model. Organisational development colleagues from both trusts have been involved in the process of supporting staff to understand these changes from the very beginning of this process. A series of staff engagement events will take place to support embedding new ways of working and the new organisation will have shared values and vision which will be co-developed with our staff.

4 OD 18. How will staff be supported to develop their skills, remain resilient and keep motivated during this change? OD 19. The new organisation may expect staff to be multi skilled what training will be provided? OD 20. Have lessons been learnt from pervious and other merges? Comms 21. What is the communications strategy for our commissioners? (including public health and local authorities) Comms 22. How will effective communications be achieved in such a large organisation with vast geographical boundaries? Comms 23. How will stakeholders, public, patients, services users and carers be involved in developing what the future will look like? The trusts have coaching, mentoring and a staff support service as well as occupational health and a comprehensive health and wellbeing offer to support all staff. In addition staff will be able to access Leadership programmes which are designed to help build resilience for teams. A training needs analysis/personal development review will be conducted to examine skills gaps and provide appropriate training/development for staff. Yes lessons have been learnt particularly from the SSOTP process when three healthcare Trusts and Social Care merged. Particular issues were: - IT infrastructure (we have one IT lead across both organisations) - Bringing different cultures together and not making assumptions - Valuing and acknowledging the history and stories behind staff - Retaining organisational knowledge We have developed a strategic communications plan to ensure all our stakeholders are engaged and informed. We aim to ensure that our external stakeholders, including our commissioners; Understand that enhanced partnership between two trusts is appropriate, for healthcare sustainability; Understand that quality healthcare is our collective priority; We will engage and involve key stakeholders in change. Both our organisations have experience in working across a large geography and with an extensive range of different services. There will continue to be centralised communication and some tools and approaches we use in common such as our intranet and website, but we will also support local team/directorate/service communications. The way our communication is organised will be dependent on the agreed structure of our new organisation which has still to be determined. We are all committed to ensuring our stakeholders are engaged in developing and improving services. As we look at the different services we provide to see how they can be better together we will engage those who use, commission and work in those services to determine how they can best meet local need. This won t all happen by 1 April, but will be an ongoing process.

5 Comms 24. What will the Trust be called? We haven t decided on a new name for our organisation as yet. We are bound by NHS guidelines which ensure health organisations reflect the services they provide and where they provide them. When we have some suggestions we will ask internally for feedback. Comms 25. How is the merger of the two organisations being communicated to services outside of Staffordshire and Stoke-on-Trent? Comms 26. Will Standard Operating Procedures be communicated before the 'go live' date? Strategic 27. How will services be mapped out so that both organisations are aware of what each Trust provides? Strategic 28. How are we anticipating working with other local partners, ie. North Staffordshire Combined Health Care, GPs, Virgin Healthcare A number of the services provided by our two organisations are based outside of Staffordshire and Stoke on Trent and we will include stakeholders in these different areas in our communications plans. This will include regionally and specialist commissioned services. Local services will also continue to communicate with their local stakeholders to ensure we continue to improve and develop services which best meet local needs. There will be a piece of work to ensure any Standard Operating Procedures and Policies which are business critical to the new organisation are updated ready to go live on 1 April These will be communicated to all staff via the usual routes and made available online. Other procedures and policies will continue to be operated in their current form and updated according to an agreed timetable. Colleagues from both our organisations are already working together on this. As a starting point a high level brochure outlining the services which both trusts provide was present at the Better Together staff engagement sessions in October. This has since been followed up with Issue 1 of the Better Together newsletter, which will be issued to all staff on a regular basis. Future staff engagement events will enable more networking opportunities where staff will be able to get to know each other and the services that each organisation provides. A comprehensive exercise has recently taken place to map out the services across both organisations; this exercise is currently being validated and information from this exercise will be central to how services are developed and integrated moving forward. Extensive information about each organisation, including Directory of Services, is available on both trust websites. At each level of the organisation staff will be encouraged to continue to build partnerships with each other and continue the local service development work, which involves other partners. We want to empower teams to work together for the benefit of the patients and services users, and within the concept of being 'good neighbours'.

6 Strategic 29. Will we bid for new services separately or collaboratively during the transaction period? Strategic 30. How will the new organisation ensure all services have access to business support? Strategic 31. How will we work to meet the needs of different stakeholders in different geographical areas and still provide a consistent service? Strategic 32. In North Staffordshire the main relationship regarding mental health is with North Staffordshire Combined Health Care. How will we get it right for these patients when we merge with SSSFT? Where it makes sense to do so we may bid collaboratively for a tender e.g. the tender may be a service that we both currently provide and it would not make sense to compete but instead we could enhance the service model for the benefit of the patient/service user. Some tenders will not benefit from a collaborative bid and where this is the case we would not submit a joint bid. In some cases we would choose to collaborate with a different partner depending upon the nature and requirements of the tender. There will be a review of the Corporate services and their functions to assess where they best fit and how they should align with operational services. This work has not yet been completed. We will ensure that representatives of those corporate functions are included in the review. The Sustainability & Transformation Partnership (STP) identifies priority focus conditions or cohorts such as long term conditions, frailty and end of life. The local work will be from a holistic perspective to address some of these conditions. So whilst some of the local work may vary slightly, the objectives and outcome aims will be standardised where possible. This is a journey and will take time to achieve. This approach is also dependent upon the type of contract that is in place. Clinical Commissioning Groups (CCGs) are already progressing steps towards developing and supporting new models of care. We encourage you continue to work with GPs and stakeholders to develop local solutions, to learn from each other, and to share your wins and best practice. We will continue to deliver our contract for services and the people of North Staffordshire. There is already a lot of local work and partnership working to find local solutions, and this will continue. An example of this is in Newcastle where SSOTP are working with NSCHT, voluntary sector and GPs to develop a frailty model. This is being coordinated by the North Staffs and Stoke-on-Trent Alliance Board.

7 Governance 33. Are we going to have to assimilate all policies again and if so will there be additional resource to assist? A pragmatic approach to the alignment of policies will be taken. There will be an initial focus on "business critical" policies, which will need to be prioritised and a schedule agreed through the relevant committees to identify the priorities and a timeframe for review of those not considered business critical. This will include a view on whether or not to adopt one set of policies followed by a process of qualitative review to ensure that they are evidence based and fit for purpose. A different approach will be required, however, for HR policies where there may be implications for the terms and conditions of staff from the two organisations which will require consultation and engagement with Staff Side colleagues. Finance 34. What will happen to SSOTP's debts? The Trust will need to negotiate with NHSI as to what will happen in relation to the loans SSOTP has had to take out. The current SSOTP financial plans return the Trust to balance by the end of 2018/19 and these plans will need to be implemented by the merged organisation. Finance 35. Will the new organisation continue to outsource some of its finance functions (i.e. Payroll and procurement)? Finance 36. Will the organisation need to save money due to the merger? Finance 37. Will we have standardised commissioning across services? Finance 38. Who will manage the money and make decisions regarding our clients and they support they need? Both finance teams are working together to determine what the best solution for the merged organisation will be. We will be considering both the costs of the alternative options but also the quality of the services being provided. The STP assumes that savings will be made once the merged organisation can dispense with some management costs e.g. the cost of one board With the creation of one Accountable Officer across Staffordshire it is hoped that we will be able to standardise services to improve the quality of services provided. We will of course still have different commissioning arrangements outside of Staffordshire, but wherever possible we will try to standardise services and commissioning arrangements. The newly merged organisation will manage all income that relates to contracts that it holds, but the S75 in SSOTP relinquished control of all client income from 1 April 2017 and these funds are now manged by SCC.

8 Estates 39. How will the two organisations come together if bases are all in different locations? Estates 40. Will there be one base for corporate staff? Estates 41. Will there be more expected moves for staff? This will need to be a thoughtful process co-aligning estate from both SSOTP and SSSFT to support the new Trust and operational requirements. It is important that disruption is kept to a minimum so that the majority of staff and patients or service users have continuity in service delivery. There will need to be a rationalisation programme to deliver efficiencies and improve patient, service user and staff estate. How the organisation uses estate will be linked with utilising remote/flexible working and technology. The organisation wants to make space as accessible to services and local people as possible. Plans will be developed to support operational integration where relocations make sense and this will take time. We are already starting area estates reviews because we can see how the estate can be Better Together. Until structures are confirmed we do not know what space is required for corporate teams. There is not one current location between the two trusts that is large enough to centralise all staff so certainly in the short term the answer is no. At present no decision has been made on estates in connection to the merger of trusts, though it would be expected that there will be moves when the two trusts come together. In the future there will be more integration and moves will be driven by co-locating services. This will centre on what is best for service users and patients and set against the backdrop of the needs of our staff.

9 social care 42. How are we going to address the cuts to social care? social care 43. Will it become a generic social work service rather than the current split of mental health/physical health/older people? social care 44. Are SSSFT taking over the budget for social care? 45. How will best practice be identified and agreed? First and foremost demand needs to be managed differently. There is a pilot currently underway within Staffordshire Cares, the County Council's service for all new referrals, which is reviewing the impact of having professionals working within the Staffordshire Cares team on demand. This pilot is being evaluated and the different ways of moving the project forward are being considered. At this stage we know that the pilot is having some impact but it needs to be increased significantly; the best way of doing this still needs to be understood. Internally we have a number of other pilots underway to help us work differently and more efficiently. These pilots are also being evaluated to enable us to assess the impact that they have had. It is critical that we deliver only what we are obliged to through the s75 and not any additional tasks. Therefore we are also looking at various aspects of work that we need to stop doing as we are not contracted to deliver this work. The outcomes of this piece of work will be shared with all staff. We are constantly reviewing the impact of the reductions to social care to ensure that the services post April remain safe and of high quality. We need to develop how social care will look in the future. To do this we need the engagement of social care staff from both organisations but also the other professions that we work closely with such as District Nurses and CPNs to understand the best way to deliver social care in the future. What we are clear about is that we need to deliver all services in such a way that there is a team of people around the individual, with one person co-ordinating the care to ensure continuity and good communcation. At this stage there is no clear model for the way that social care will be delivered and we would encourage staff to get involved in the shaping of the future service. Assuming this relates to the social care budget for community care services, that is presently managed by Staffordshire County Council, then the answer is no. The current arrangements are clearly set out within the s75 and there is no proposal from any party for this to change. There are different ways to determine 'best practice.' Wherever possible, this is based on published evidence. Where this doesn't exist (for example, how a particular team is structured or a contract is delivered), then we will use approaches to explore what seems to have the best and safest outcomes with the least waste and/or the most measurable added value.

10 46. Between now and 1st April what information are services allowed to share with each other? Ops 47. Will the social care/social work teams remain in the organisation or move back to county, or even a new provider? Ops 48. How will long term conditions be merged? Is there any for SSSFT? Ops 49. Do we have a vision for children's community nursing services? Ops 50. Who will be responsible for one care plan? Ops 51. Will we have a central single point of access (SPA) that can signpost for all services? The sharing of information will be covered by an Information Sharing Agreement between now and 1st April but nothing will supersede the requirement to continue to comply with legislation e.g. Freedom of Information Act, Data Protection Act etc., as well as other considerations including consent, Caldicott and NHS guidance. If you have any specific queries please speak to the Information Governance lead in your organisation. Section75 agreements are in place for both organisations. There are no plans stated by the local authority to change this. This is work that will be developed and shaped by relevant service lead and staff in due course. Commissioners have set out clear expectations for the CCN service to become a single service by the end of this year in South Staffordshire. This needs to be part of an integrated children's service. Both Trusts are working, under the lead of SSSFT with Commissioners and key staff to develop the service model and subsequent implementation plan. Through the development of integrated care models this will be made explicit. The expectation is that staff will be fully involved in the shaping of this. This is a great suggestion. These are precisely the sort of things that we need to be progressing as an early priority in each geographical area but as part of carefully managed projects.

11 Ops 52. When staff are told that we are being commissioned to deliver a "bronze" service, why are we being told to deliver good/excellent? This ultimately results in staff using their own personal time to deliver what the service user wants and deserves and results in staff stress and low morale. Ops 53. What will we need to change to maintain a CQC "Good" rating? Ops 54. Will the merger mean more geographically diverse services being tendered for? Ops 55. Is a "true" shared care plan legally correct as each profession requires different legal standards and all need more detail than is possible in a shared single care plan? Ops 56. How will practitioners ensure they provide the service user with a quality (joined) up experience? Ops 57. How will we reduce multiple visits by professionals whilst utilising the professional knowledge and specialisms? Ops 58. As social care & health care staff would our remit in the community change? Commissioners and each Trust have agreed service specs and contracts in place. We often want to provide more or in a different way which is not possible due to the constraints of the funding or specification. However, we take pride in ensuring that the what, how and by whom we provide care for is the best it can be in our pursuit of the perfect experience for service users. We do not expect staff to deliver care in their own time. If individuals or teams are working in this way routinely then this is a matter that local managers should be resolving or escalating so that this can be changed. This is not a matter for the Trust merger but something that each team should already have in place on its journey to outstanding. The new organisation will have clear plans identified which will be shaped as part of the due diligence process. The benefits of the new organisation mean that we have significant skills and experience to be able to consider relevant opportunities provided this fits with the Directorate business plans. All professional bodies are clear that multi professional team working is key and an integrated care plan is essential. Mental health services in particular have operated in this way for many years. Through the development of integrated care models this will be made explicit. The expectation is that staff will be fully involved in the shaping of this. This will be part of the service development associated with the design of new service models. In the new organisation the expectation is that all Trust professional leads will provide a coherent and shared vision for how MDT's work, with shared staff understanding of each others roles. Staff will continue to work in a way that supports the agreed service specification.

12 Ops 59. Will staff be expected to travel across the whole geographical area of the SSSFT? Ops 60. Home First is an integrated health/social care service launched in September Does SSSFT have a similar team and if so can you share any learning? Ops 61. How do small specialist teams fit into the "one care plan" model? Ops 62. Question is related to the Children's Service Integrations. How can we deliver an equitable service with one team having all band 6s and another team having band 5s and band 6s? Ops 63. Would there be a large impact on our teams with regards increased referrals or is this merger more about joint working and partnership? Ops 64. Are services going to be governed by criteria - this has failed patients/people who do not fit into a criteria? Ops 65. Are you aware of the innovative work that is already happening between the two trusts? Ops 66. Will there be a more consistent approach to risk assessment? Currently confused regarding risk/safety balance across area. The need to travel across the geographical area will depend on your role. For example corporate departments would be expected to support all services in the new Trust so should expect to travel to different teams/services if required. SSSFT do not have a similar team but we have teams that have been fully integrated with social care or third sector organisations so there is plenty of positive experience that can be shared. This is work that will be developed and shaped by relevant service lead and staff in due course. One of the benefits of the trusts coming together is to ensure that a standard approach and model and skill mix is in place across relevant services. Joint working and partnerships. The true benefit for staff and for patients/service users is it having a much more joined up approach to care. All of our contracts and specs have criteria set out. This is only to be expected. The expectation is, and this will be reinforced by the Trust professional and quality leads, that there needs to be a considered, pragmatic and mature approach to enabling service users to receive care that is essential. Yes. There are many great examples and this enables the case for bringing the two organisations to be even stronger. The new organisation will have clearly stated SOPs and expected ways of working which staff will be made of aware of. Consistency is key.

13 Ops 67. How will we showcase best practice across organisations? Ops 68. How can we bridge the gap between children's and adult's services? Trust professional and quality leads will work with services to showcase best practice and ensure that staff can share and learn from each other. There are some good examples of transitional protocols in existence across both trusts. Standard approaches will be developed as part of service development and new models of care work.