Operational Plan Refresh

Transcription

1 Operational Plan Refresh April 2018

2 2 Introduction 1. Introduction The Trust submitted a two year Operational Plan for on 23 December This was based on the NHS Operational Planning and Contracting Guidance published in September 2016 and reflected in the March 2017 document Next Steps on the NHS Five Year Forward View. Planning guidance has been subsequently updated and is set out in the February 2018 publication Refreshing NHS Plans for Given that two-year contracts are in place, NHS England and NHS Improvement have defined that will be a refresh of plans already prepared. The Trust is required to submit a narrative on updates to the plan together with a full suite of operating spreadsheet submissions in line with the published national timetable. The narrative within this document is intended to provide an overview and explanation of the changes to the plan for and not a revised version of the full two-year operational plan narrative that was produced last year. This refresh should therefore be read in conjunction with the previously submitted two year Operational Plan For consistency, an update has been reported against each Section heading reported within the original plan submission.

3 3 Section 1: Approach to activity planning 1. Approach to activity planning In refreshing its plan for the Trust has followed the approach to activity planning set out within the Operational Plan We have worked in partnership with our Strategic Commissioner to develop a bottom up do nothing activity plan which uses the activity forecast outturn and exit run rates as the start point for demand. Through engagement with divisional clinical teams we have been able to sensitise this to local service level changes to generate a do nothing plan which is both understood and owned by the clinical teams delivering the activity and with commissioners purchasing the activity. 1.1 Activity assumptions and pricing The forecast outturn activity has been increased using locally adjusted growth factors, taking full consideration of the local demographic changes and those nationally recommended by regulators. The Derbyshire CCG s will hold responsibility for ensuring the system wide plan is congruent with the national factors, recognising that each individual organisation will reflect local demand patterns. These growth factors have been further reviewed as part of the final plan submission and consistent with the activity in the Trust/Commissioner agreed contracts. Table Activity growth factors The Derbyshire System through March and April has worked together to ensure that commissioner and provider activity plans triangulate i.e. are based on the same level of activity. These plans include an element of agreed and contracted QIPP, predominantly relating to non-activity related funding. Work continues to identify further activity related QIPP which is needed to balance the wider Derbyshire system financial position with the whole systems regulatory requirement, across both NHSI and NHSE. As these further schemes are developed and implemented, jointly, they will need to be contract varied into our contracts. At this point no activity related QIPP is included within the final operational plan or agreed contracts. The majority of our contracts for will remain using Payment by Results HRG version 4+ as the pricing mechanism. 1.2 Winter resilience plan The Trust has established a robust approach to Winter planning and for will continue to apply this to develop a Winter Plan through engagement with clinical, nursing and corporate staff along with our commissioners and partners. In line with the plan developed will provide for additional capacity to meet demand and an agreed escalation process. The phasing of the activity plan reflects this seasonality. 1.3 National standards Draft Plan Final Plan Outpatients New 1.0% 5.6% Outpatients FUP 1.0% 0.2% Elective 0.0% 0.2% Non-Elective 1.0% 1.0% A&E 2.0% 2.0% The Trust is committed to delivery of all national standards and our activity plans have been aligned to secure performance against these. The Trust has an agreed recovery plan for the cancer 62D standard and we are working hard to implement the changes needed to mitigate the source issues. For February 2018 the Trust has achieved compliance against all seven cancer standards and work is ongoing to secure sustainable compliance against the 62D standard into Delivery of the 18 week Referral to Treatment standard will be challenging for the Trust over as the Trust seeks to manage routine activity within the agreed cost envelope and create capacity for increasing urgent referrals into the cancer pathway.

4 Section 2: Approach to quality planning 2.1 Approach to quality improvement Named Lead for Quality Our Executive Lead for Quality is unchanged, being the Director of Nursing and Patient Care, Ms Lynn Andrews Quality Strategy Since the launch of the Trust s current Quality Strategy in July 2016 work has progressed on all of the ambitions to improve the quality of care provided to our patients. We have made significant progress against the implementation plan and in many cases we have achieved our ambitions and have subsequently identified further improvement actions. Our success measures show that in most cases our actions are having the desired impact, and in a small number further work is required to fully achieve the improvements identified. We will review and refresh our strategy this year with the aim of launching our revised Quality Strategy in June This review will focus on: Ensuring that changes are embedded and sustainable; Identifying resources to support delivery; Broadening the scope of our Quality Strategy to encompass our children s, community and primary care services; and Ensuring the Trust refreshed transformation programme and Quality Strategy are aligned Quality Governance The Trust s Quality Governance System remains as described within the Operational Plan Following the Divisional restructure in 2017 and the establishment of Care Units, the governance system is currently under review to reflect the new structure Capacity and Capability The clinically led model for delivery of care remains as set out within the Operational Plan As described above, Care Units were established in 2017 (made up of a clinical lead, senior matron and a service manager) to support Divisions in achieving the aims of our Quality Strategy. The Trust is also refreshing its approach to transformation and quality improvement methodology with a re-launch planned for quarter one of

5 5 Section 2: Approach to quality planning (continued) Quality Measures We continue to use a range of outcome and process measures to assess progress against the Quality Strategy ambitions. The high level indicators are reported to the Board via the Integrated Performance report and then more specific measures are reviewed by the relevant sub-committees and working groups. A range of essential nursing care 'bundle' measures have been developed and implemented in 2017 to further assist the Trust approach to quality improvement. In this will be embedded and an accreditation system developed for our matrons to aspire to. 2.2 Quality improvement plans Our quality improvement plans are set out within the Quality Strategy and remain as documented within the Operational Plan As set out at Section work has progressed on all of the ambitions and we are in the process of reviewing our forward strategy. 2.3 Quality impact assessment (QIA) process The quality impact assessment process remains operational, as described within the Operational Plan : Mandatory QIA pro-forma completed by Project Lead with clinical support QIA risk assessment completed with Quality Governance Team support Score <8 QIA risk recorded, monitored and managed via Project Board or Divisional Governance Group Score >8 QIA presented to Quality Delivery Group for support, challenge and recommendation on approval QDG Recommendation fed back to Transformation Steering Group or Divisional Governance Group for action QIA reviewed at agreed timeline (minimum at concept, prior to commencement of change and 3 months post change) QIA closed once impact on quality has been reviewed post change, lessons learned and action taken as a result Six monthly QIA assurance report presented to Board via Quality Assurance Committee The cost improvement programme as set out at Section is subject to quality impact assessment in line with the above process. QIA are being presented to individual Project Boards and the Quality Delivery Group over April and May Seven Day Services As highlighted in the Trust risk register, we have not currently achieved the four key Seven Day Service standards, however we are showing continued improvement in compliance. The Trust is maintaining its focus on a whole system approach for implementation, developing and embedding our workforce models as described at Section 3 to support achievement of the standards. 2.5 Triangulation of indicators The process remains as described within the Operational Plan and indicators within the IPR have been reviewed and updated for to ensure that we are monitoring relevant metrics and driving quality forward. 2.6 Alignment with the Sustainability and Transformation Plan (STP) As set out at Section 5, our Quality Strategy and quality improvement plans remain aligned with the priorities and critical transformation programmes of the STP. For example, the Joined Up Care Derbyshire plan for transformation of Maternity Services is fully aligned with our internal quality improvement plans for these services.

6 6 Section 3: Approach to workforce planning 3.1 Workforce planning approach Our workforce planning approach for is consistent with the detail set out within the Operational Plan , developed with clear engagement from divisional and corporate leaders. Our draft Trust level workforce plan has been approved by the Transformation Steering Group and Hospital Leadership Team, prior to presentation and approval by the Board in February In addition to continued workforce transformation and development of new roles, additional investment in clinical education has been approved to support recruitment and retention of new staff, trainees and students, along with existing learners. There has been an increased focus on apprentices and apprenticeships in as a result of the Apprenticeship Levy, and this will continue into This has included the establishment of an Apprenticeship Levy Board chaired by the Director of Workforce and OD to oversee the implementation of the levy. The Trust is continuing to explore opportunities for working together regionally through the Derbyshire Workforce Implementation Group which reports into the Derbyshire Local Workforce Action Board (LWAB). Through continued involvement with the Working Together HR network across South Yorkshire, North Derbyshire and Mid Yorkshire, we have completed a joint procurement exercise for non-medical bank with three other trusts. This has resulted in cost savings with planned quality improvements and opportunities for wider access to bank workers as an alternative to agency. A pilot has also recently been developed for a regional medical bank for junior doctors, working with three other trusts. The collaboration on regional banks for nursing and medical staff is a key aspect of our strategy to achieve a reduction in agency spend in In addition we will continue to negotiate with agencies regarding rates and remain part of the East Midlands MOU in relation to medical locums. There is constant scrutiny on agency usage at both a divisional and Executive Director level, to ensure that agency workers are only deployed when this is necessary and other options have been exhausted. Safe staffing guidance is followed with a comprehensive six monthly review presented to the Board by the Director of Nursing and Patient Care, along with the operational decisions made each day in relation to overall staffing numbers and skill mix across the wards. There are a range of work streams arising from our People Strategy priorities which will also support a reduction in agency spend/ usage. For example, focus on improving staff engagement and retention, the Board s ambition to be a more flexible employer and associated actions to support work streams. The Workforce Delivery Group meet monthly with Executive, divisional and corporate attendance to have oversight of agency/ bank, recruitment and retention. The Workforce Delivery Group provides an update to each meeting of the People Committee to provide assurance on progress being made Alignment with Sustainability and Transformation Plan (STP) The Trust has continued to be an active member of the Derbyshire LWAB and our workforce plans at Trust and divisional level are fully aligned with the three Joined Up Care Derbyshire STP priority work streams: Workforce Planning Workforce Optimisation Organisational Development The Chief Executives and HR Directors have been engaged in determining priorities for linked to these work streams along with national and regional priorities. For example creating an environment to further support the mobility of individuals across different organisations and maximising opportunities for sharing best practice.

7 7 Section 3: Approach to workforce planning (continued) Organisational Workforce Transformation As detailed within the Operational Plan , the Trust has an established approach to workforce transformation that underpins our workforce plan and is aligned with the Joined Up Care Derbyshire STP. Our workforce transformation project has three work streams; supported by milestone plans: Advanced Clinical Roles Focus includes further development of the Advanced Clinical Practitioner role, along with other roles such as Enhanced Pharmacists and a wider range of advanced practice roles across nursing and therapy disciplines Support roles Focus includes development of Assistant Practitioner role in imaging, along with other roles such as Audiology Assistants and embedding Maternity Assistants Grow our own Focus includes development of Apprentice role which is integral to our workforce plan with increased clinical and non-clinical roles planned for Progress on work stream delivery is regularly reported to and monitored via the Strategic Workforce, Education and Training (SWeET) Group. In addition to the above work streams the Trust is working to deliver actions against a number of other priorities driven by national policy or legislation, including: Nursing Associate The Trust continues to be a partner within the Derbyshire and East Midlands for the second year with a new cohort of starters in March Lord Carter s productivity programme Workforce optimisation is a key theme being progressed in collaboration through the LWAB and STP. Apprentices/ Apprenticeships - Focus remains on development of clinical and non-clinical roles Governance process for workforce plans The governance arrangements detailed within the Operational Plan have been operational throughout 2017 and will continue into The Strategic Workforce, Education and Training (SWeET) Group remains the forum for first stage development of the annual workforce plan. SWeET then receive an update on the workforce plan for a divisional or corporate area at each meeting, to provide oversight, scrutiny and support. The People Committee receives an update from SWeET and the Workforce Plan at every meeting, along with regular updates on the apprenticeship levy and workforce transformation.

8 8 Section 4: Approach to financial planning 4.1 Financial Position and modelling Key Movements since Draft Plan Submission (8 March 2018) The Trust submitted a draft Operational Plan Refresh on the 8 March Since then work has continued to further develop our plan with specific focus on the triangulation into the broader Derbyshire system and commissioning position. This has included a final negotiation on the contract variation, development of the cost improvement plan and a detailed granular review of the operational expenditure plan and associated accountability within the organisation. In the broader context the Trust has also been in discussion with NHS Improvement which has subsequently resulted in a reduction in our Control Total and Provider Sustainability Fund (PSF). The key movements from the draft submission are described below; The Trust Control Total has been reduced from m surplus to a 5.296m surplus, a reduction of 5.1m. The reduction consists of a non-recurring reduction in Control Total ( 3m) and an accompanied reduction in PSF ( 2.1m). The Total PSF available to the Trust is therefore 6.399m The movement in Control Total is summarised in table 2 on the following page. Table 1 Movement in SOCI from draft to final plan m s Draft Plan Final Plan Movement Patient Care Income Other Operating Income Employee Expenses Other Expenses & Finance Costs Net I&E pre PSF PSF Total I&E Control Total Basis (158.3) (79.7) (158.5) (81.8) (1.1) (1.2) (0.2) (2.1) (3.0) (2.1) (5.1) CIP Embedded within plan (12.8) (7.9) 4.9 The Trust is now in a position to sign a contract with Derbyshire Commissioners which covers 86% of total patient care income, and expects to have done so within the 30 April 2018 deadline. The plan and contract includes 3.1m of non-activity QIPP, relating to funding previously included in our Trust contract, but excluded from All other activity related QIPP is excluded from both our final plan and the commissioner contract and will therefore be contract varied into the contract during and throughout the year as schemes are implemented, following due contractual process and as agreed through the Derbyshire STP board. The Trust has critically appraised the investments planned within the year alongside the level of slippage on such investments and has consequentially been able to reduce the scale of CIP required by 1.8m. In addition to the change in Control Total, this has enabled a reduction in the CIP requirement, resulting in a final Operational Plan CIP requirement of 7.9m. The amount of CIP identified has increased from 5.4m (draft) to 6.7m (final). Against the total CIP requirement shortfall of 1.2m (15%), the Trust is actively pursuing additional schemes, linked to the outputs from the Model Hospital, and is confident it will be able to sufficiently identify and embed the required additional savings in order to achieve the Control Total (see section 4.2.1)

9 9 Section 4: Approach to financial planning Financial Control Total The Trust submitted a two year financial plan in December 2016 incorporating both and The headlines within the second year ( ) of this plan can be compared to the revised Control Total offer received 6 February 2018, described below (Table 2). The Trust financial position remains very strong in the context of the wider national acute provider sector whereby 79% of acute providers are in deficit year to date at month 10 of and also needs to be seen in the wider context of the Derbyshire Health Care System. The current month 10 Derbyshire health system forecast outturn is a 65m variance to plan in and a 123m system wide gap in , weighted 80m commissioning and 43m provider side efficiency challenge. Table 2 - Year 2 of Operational Plan m s Plan Original Year Plan Original Year Draft Plan Final Plan Control Total Surplus (a) Provider Sustainability Funds (PSF) (b) Control Total Surplus net of PSF (a-b) (0.027) (1.103) CIP inherent within plan The regulatory requirement with regards to financial performance through the Control Total, when compared to the original year 2 plan, is significantly better (lower) by 4.339m. The table below helps describe the logic within the numbers: Table 3- Adjustment to Control Total Steps 'm Surplus /(Deficit) Comments a) Original Control Total. Year 2 of plan b) Control Total Flexibility (0.803) c) Non recurring reduction in control total (3.000) d) Net impact of CNST changes (income and expenditure) e) creation of risk reserve through national pricing CNST benefit (0.536) = Underlying requirement surplus (1.103) f) PSF = Control Total Reward - assuming we achieve the Control Total As agreed with NHSI 24 April 2018 This has been tested internally and proven to be materially accurate Reward assuming item d is correct (b+c+e) = 4.339m improvement in the Control Total offer versus Following the April Trust Board the Operational Plan is submitted on the basis of agreement to our Control Total and therefore access to the Provider Sustainability Fund.

10 10 Section 4: Approach to financial planning (continued) Outturn The original start point for the refreshed financial plan for was our month 10 forecast outturn position ( 6.7m surplus including 6.1m S&TF and 0.6m tranche 1 winter funding), which assumed we will achieve our Control Total, adjusted for all non-recurrent and full year-effect impacts to generate an underlying position ( 5.6m deficit). This is shown in the following Bridge 1 diagram. Key adjustments to generate the normalising position of 5.6m deficit from the forecast outturn are: Removal of Sustainability and Transformation Funding (6.1m); Removal of winter funding (tranche 1 and 2) with no impact on costs, consistent with plans for delivery of the Winter Plan ( 2.1m); Removal of commissioner arbitration items ( 0.9m); Removal of technical benefits in ( 3.0m); Removal of penalties incurred in e.g. CQUIN ( 0.5m); Full Year-Effects of previously agreed new investments ( 1.0m); and Non Recurrent cost benefits in ( 1.4m). Bridge 1 Forecast Outturn ( 6.7m surplus) to Normalised I&E Position ( 5.6m deficit) Whilst the actual outturn is now known to be worse than the M10 forecast outturn by 2.6m ( 2.4m+ 0.2m S&TF), the underlying position remains similar given (c 2.4m) less non recurrent technical benefits were applied to the year-end position.

11 11 Section 4: Approach to financial planning (continued) Key financial planning assumptions Income The following key assumptions apply to the income included within the Final Operational Plan Refresh: +2.1% tariff income price change (+ 3.8m); -2.0% tariff income efficiency factor (- 3.6m); Net +0.1% tariff price change (+ 0.2m); 3.9m activity growth including 0.5m pass through drugs and consequential marginal cost capacity growth; 1.7m full year effect net marginal benefit of acuity increases; Assumes no winter funding in ( 2.2m); Adjusted for all non-recurrent income impacts; Net CNST benefit of 2.4m ( 1.2m income + 1.2m cost base reduction), adjusted for in the Control Total; Reduction in non-tariff Funding ( 3.3m) ( 2.2m block payment plus 1.1m Frailty Service top up funding, with no cost base impact factored in); and No impact of activity related QIPP included in final plan or contracts Key financial planning assumptions Expenditure The expenditure plan is based on the outturn exit run rates, adjusted for known divisional non recurrent and full year effect impacts, as described in Section At this point no new significant investments have been included as stepped costs recognising the challenging financial environment in which we operate. A challenge and confirm of opening budgetary positions by all divisions has now been completed with the Trust Executive, including CIP, ensuring ownership and accountability of the financial plan across the leadership community. The following key assumptions apply to the expenditure position included within the final Operational Plan Refresh: Circa 1m of full year effect investments, made throughout These include ongoing investments to support projects such as EMRAD, Easy PATH and workforce plan investments; The Trust expects to reduce its liability to agency supply in , consistent with the NHS Improvement agency spend target albeit marginally above the agency cap. However this is considered a more realistic, yet remaining stretching, plan, as described at section 4.2.2; Activity growth has been estimated at a marginal (50%) cost rate; Pay inflation using the national tariff inflation assumptions (1%) with no assumption made of the Trust being able to fund any pay award greater than this amount. ( 1.5m); Incremental drift of existing staff ( 0.8m); Non pay inflation ( 0.4m); and 1% trust contingency held ( 1m) Sensitivity analysis The top risks at the final submission stage are: i. CIP delivery in The scale of challenge ( 7.9m) and current unidentified gap ( 1.2m). ii. iii. System QIPP Impact of reducing demand and ability to release semi-fixed and fixed costs in-year. Continued reduction of agency spend towards the NHS Improvement cap.

12 12 Section 4: Approach to financial planning (continued) 4.2 Efficiency Savings Cost improvement programme The updated cost improvement requirement to achieve the Control Total is 7.9m (3.3% of Trust turnover). To support delivery of this scale of change, and at pace, the Trust is currently redesigning its Improvement infrastructure through the appropriate internal governance processes. A refreshed direction of travel is proposed with a robust improvement methodology and appropriate staff training and development in its core principles. This is based upon a core team that can effectively support project delivery and ensure robust tracking and project oversight is in place to deliver quality, safety and cost improvement. The proposal also recognises that staff engagement is fundamental to the empowerment of cultural change and suggests how we can harness this energy to ensure we have a continuum of improvement ideas and improved staff engagement. We understand that this will require a joined up approach across the system and are fully engaged in the transformation efforts of both the Joined Up Care Derbyshire STP and South Yorkshire and Bassetlaw ICS. Key Improvement themes and initial savings are shown in the following table: Table 4 Cost Improvements identified Themes Draft Plan 000 Final Plan 000 Beds / LOS Theatres Outpatients Diagnostics Agency Spend 2,031 1,557 Other Clinical Workforce Back Office Workforce Procurement 749 1,074 Wholly Owned Subsidiary 1,630 1,630 Income schemes a) TOTAL (Bottom up) 6,383 6,654 b) TARGET 12,786 7,916 c) Unidentified (b-a) 6,403 1,262 In order to identify further CIP, work is already ongoing to critically appraise: Maximisation of benefit from existing schemes; Headroom opportunity via the Model Hospital and other benchmarking; Value added review as roles become vacant; Opportunity to deliver growth in activity at less than funded rates; Non recurrent savings opportunities; and Technical opportunities.

13 13 Section 4: Approach to financial planning (continued) Agency rules The Trust has received an agency control target for of 9.975m from NHS Improvement and is continuing to develop the detailed action plans that will support delivery of this target. The final plan submission includes planned agency spend of 10.6m, which is a reduction of 21% from the outturn position ( 13.5m). This level of spend is embedded within the Operational Plan Refresh Procurement Procurement transformation is a key focus for the Trust and an established transformation scheme is in place, focussing on the output opportunities identified within the Model Hospital and the PPIB tool in addition to scrutiny of tail-end organisational spend. 4.3 Capital planning The table below describes the key changes to the Capital programme for against our draft plan submission. These changes are reflected in the final Operational Plan Balance Sheet and all expenditure is from Trust cash other than the Urgent Care Village scheme which is funded via Wave 2 STP capital funding PDC. Table 5 Capital Programme Changes Scheme Draft Plan Refreshed Final Plan Comments Additional substation (UCV dependant) Divisional Equipment, minor works & Applications ED Extension including GP streaming ,000 3,000 Additional equipment deferred from ,392 1,192 Revised final cost estimate due to increased expenditure in Estates Maintenance Estimated additional minor work schemes Imaging Reorganisation 1,977 2,070 Revised final cost estimate due to reduced expenditure in IT purchases and development 1,160 1,160 PACU/HDU/ITU Pharmacy Aseptic refurbishment Revised final costs estimate due to additional expenditure in Urgent Care Village 1,000 1,000 Ward refurbishments 1,200 1,200 TOTAL NHS CAPITAL EXPENDITURE 9,872 10,992

14 Section 5: Sustainability and Transformation Plan Link National to the Context local Sustainability and Transformation Plan (STP) STP footprint As set out within the Operational Plan the Trust works across two footprints being a full partner of the Joined Up Care Derbyshire (JUCD) STP and an associate to the South Yorkshire and Bassetlaw ICS. Over 2017 the Board has formalised relationships within both systems and for will continue to maintain its focus on developing strategy in alignment with emerging system arrangements and plans System management and governance Within the Joined Up Care Derbyshire STP, a new SRO has been appointed and the Trust Director of Finance has taken on the role of system finance lead. Work took place in February 2018 to confirm and challenge progress and plans across all STP work streams, to support a refresh of governance and system management arrangements that will enhance delivery for Work over March and April has focused on the process to confirm and challenge proposed QIPP schemes and ensure alignment with provider CIP. Over South Yorkshire and Bassetlaw has developed into an Integrated Care System (ICS), bringing partners closer together and taking further responsibility for finances in return for greater flexibility in delivering NHS services. The ICS has been operational in shadow form and will go into formal operation at the beginning of the financial year STP links with Operational Plan A robust schedule has been established to ensure alignment of provider and commissioner operational plans with the Joined Up Care Derbyshire STP. Work is ongoing to map the 80m system commissioning gap to the revised STP delivery architecture which will better inform contracting and organisational and service level impacts Critical Transformation Programmes Joined Up Care Derbyshire STP The Trust is working collaboratively within the Joined Up Care Derbyshire STP to deliver the following transformation programmes: Critical Transformation Programmes South Yorkshire and Bassetlaw ACS The Trust is currently participating within the Hospital Services Review, commissioned to review how services could be provided so that everyone in South Yorkshire and Bassetlaw has equal access to high quality, safe hospital services now and into the future. Work is focused on urgent & emergency care; maternity services; hospital services for children; gastroenterology and acute stroke (early supported discharge and rehabilitation). Outcomes from the review are due to be published in April 2018 and will inform the programme of work.

15 Section 6: Membership and elections 6.1 Membership and elections As set out within the Operational Plan , public governors on our Council represent more than 400,000 local people who live in North Derbyshire, Southern Derbyshire and West Nottinghamshire, and South Yorkshire and Rotherham. Our 19 public governors work alongside four staff governors and seven partner governors who are appointed, rather than elected. They come from local authority, commissioning, education and voluntary services Governor elections In 2017, five public governor seats, one staff seat and one partner appointment seats were up for re-election and re-appointment was made to all of these seats. A further two seats have also since become vacant and the process for election to these will be progressed in Governor involvement The Trust has continued to deliver a programme of training and induction in line with the arrangements set out within the Operational Plan All new governors elected since the previous plan submission have received an intensive five-day induction programme over the period of a month Membership As set out within the Operational Plan , the Trust s membership stands at 15,000 across its seven constituencies and is around 1.8% of its eligible population. Our strategy remains centred on improving engagement through membership evenings and events. The annual member s meeting in 2017 attracted around 200 people and gave governors a platform to share the work they ve done with their constituents. A further event is planned for 2018.