Norfolk and Waveney Mental Health NHS Foundation Trust APR Strategy Document

Transcription

1 Norfolk and Waveney Mental Health NHS Foundation Trust APR Strategy Document 1

2 Template 1: Vision and key priorities The Trust s current position is summarised as: Norfolk and Waveney Mental Health Foundation Trust has been an NHS Foundation Trust since 1 February During this time the Trust has met all governance targets and mandatory services with a financial risk rating of 4. The Trust was awarded a double excellent for quality of services and use of resources in the last annual health check assessment by the Care Quality Commission. More recently the CQC awarded the Trust registration with no conditions. The Trust s integrated business plan approved as part of the foundation trust bid lasts until 2012/13 the same year as the final year of this Annual Plan. The key business developments identified within the business plan have been achieved or are in the process of being achieved as demonstrated below: Construction and opening of the new Psychiatric Intensive Care and Low Secure Unit in May Significant CIP delivered from the management of specialist mental health placements (secondary commissioning) with better services offered locally and less need to place patients out-of-area. Business case for Dementia Intensive Care Unit approved March 2010 Full integration of the West Norfolk Locality (previously managed within a Primary Care Trust). Expansion of in-house training function, including Prevention and Management of Aggression (PMA) as an income-generating centre. Full integration of social care services for adults of a working age, with all staff TUPE transferred to the Trust in November The last two years has seen a significant increase in the Trust s size and turnover with income growing from 110m to more than 130m. The Trust is now facing a muc+a19h more difficult economic and perhaps competitive environment with the prospect of the NHS having to make unprecedented levels of savings over the next few years. The key challenges for the Trust over the next few years are therefore: Continuing to provide high-class mental health services. Addressing the impact of the downturn on NHS funding. Delivery of 5% year-on-year CIP plans. Implementing Payment by Results for mental health. Expanding the range of services provided by the Trust, extending either geographically in mental health services or within current boundaries by moving into physical and community health care. Ensuring the full engagement of staff, key stakeholders and service users. Developing new services for patients, particularly those with dementia in response to the demographic changes expected over the next few years. Support key service developments such as the Dementia Intensive Care Unit and clinical academy. 2

3 The Trust s current position is summarised as: During this time the Trust has had a very stable Board of Directors and senior leadership, but in recent months there have been a number of changes in the top team of the Trust. A new Chief Executive Aidan Thomas was appointed during 2009 and 2010 will see the appointment of two new Directors. The Trust is progressively realising the benefits of the freedoms that Foundation Trusts have, this for NWMHFT is evident in its work to support closer community and staff engagement and the continued innovation and improvements to the available services. In particular the engagement of Members through the Board of Governors has enabled the Trust to test out its strategic direction and continue to align it with the aspirations of local people and staff. All of these groups helped the Trust to develop its current vision. Quality Assurance As part of the Trust s development of the Whole Life agenda the integration between the Trust s Older Peoples Community Mental Health Teams (OPCMHT) in all localities and Norfolk County Council Older Peoples services has reduced the amount of times that a patient has to tell their story during the assessment process. By being open to a multi-disciplinary team, a more holistic approach to the individuals needs is evident. Social care practitioners co-located to the OPCMHTs gain a lot of experience by working with other professionals in this manner, which aids the assessment of individuals with severe and enduring mental health difficulties. Equally, health professionals have been able to gain a considerable amount of insight into the social care role, available resources and legal responsibilities. Integration minimises the need for patients to wait between the health assessment and social care assessment, services can be accessed more quickly which has aided in the prevention of some hospital and residential admissions. This approach to the delivery of services is an illustration that the Trust is able to successfully work within a partnership and encourages confidence in this approach to service delivery. The Trust has made significant changes to policy and practice due to the implementation of new Mental Health legislation. This includes the Mental Health Act, the Mental Capacity Act and the Deprivation of Liberty Regulations. Board Matters Two Directors left the Trust at the end of April The Trust has benefited greatly from the dedication and hard work of two excellent Directors and can perhaps congratulate itself for the development opportunities it has given which has enabled Directors to achieve key leadership roles within the NHS. Two new appointments have been made and the executive directors will be at full complement by the end of the Summer 2010, while an interim director has been appointed in order to ensure stability until that time. During 2010 further consideration is to be given to the recruitment process for three non-executive directors whose terms of office were due to expire over the course of the autumn. The Nominations Committee of the Board of Governors has decided to conduct an open recruitment process in order to recruit replacements. Other Board changes include the retirement of another Director, which corresponds with a reduction in the number of nonexecutive directors, leading to a smaller Board. The Board of Governors membership has been refreshed by the Elections held in December New Governors have been welcomed and are already contributing to the work of the Trust. A great disappointment has been the problems associated with retention of Service User Governors. Work will continue in 2010 to address this. 3

4 The Trust s current position is summarised as: ICT and Finance Developments The Board of Directors has approved a new three-year strategy for its use of Information and Communications Technology (ICT), running from 2009 to This is supported by a significant investment programme to deliver a wide range of new technology, which will support the more efficient and productive delivery of services into the future. As a part of this the ICT Services have completed a major transformation of their service delivery approach. The Trust has introduced a new on-line system for understanding the costs of its activities (Abacus) this system is available to managers and senior clinicians. Much interest has been generated nationally about this project which resulted in the Trust becoming involved with projects with the Department of Health and the Audit Commission to gain a better understanding of the costs of mental health care. This system will fully support service line management and the development of Payment by Results for mental health. Environmental Matters The Trust is committed within its core values to being a good corporate citizen. In December 2009 the Board of Directors agreed an environmental strategy for the next 5 years. This strategy addresses the ten key commitment areas identified in the national NHS Carbon Reduction Strategy for England ( Saving Carbon, Improving Health ) and focuses attention on ensuring compliance with the various aspects of the Climate Change Act (2008). A Sustainable Development Committee that identifies actions and measures to demonstrate our improvement against the key performance indicators set by the NHS Sustainable Development Unit supports the implementation of this strategy. Contracts A new mental health and learning disabilities contract was issued for all services in 2009/2010. The new contract was a standard contract as required by the Department of Health. Within the contract were some new areas that in year the commissioning teams for the Trust and the two main commissioners needed to review on an ongoing basis. The contract was changed at the start of the contract term to be for one year only and this has resulted in rework for the Trust on another new contract for 2010/2011, this is now for 3 years. All of the Trust s services have been reviewed and the HERON website for patient and GP information will be updated in year, this has involved a collaborative approach across the Trust to ensure the services as described are correct and current. Additional work has been required around the establishment of baseline data for national and local performance schemes including not only contract monitoring but also Commissioning for Quality and Innovation (CQUIN) and Quality Accounts in which the Trust has been involved in a national pilot. 4

5 Template 1: Vision and key priorities The Trust s vision over the next three years is to: The Trust s vision is: To be recognised as a centre of excellence in mental health care that enhances the well being of the communities it is a part of. We will do this through the delivery of services that help people to stay well and that treat, support and care for people when they are ill, to enable them to get on with living their lives. This vision was originally set out in the Integrated Business Plan in 2008 and will continue in 2010/11 to drive the Trust s approach to the care of its service users. However it is recognised that with the many changes, both internally and externally to the Trust, the vision will need to focus more on the Trust's Foundation Trust status and what that means in the current economic and political climates as well as the new structure that exists to manage the organisation in the next three years. In particular this means looking at providing services that are not mental health and/or not in area. With this in mind the Trust proposes to review the vision statement, values and the strategic objectives outlined in this document (priorities section) during 2010/2011. As a result some of the milestones will end during 2010/2011, but there remains a commitment strategically to ensure the provision of high quality services and a financially viable organisation. The Trust Values: Seeing people in the context of their whole lives Being an accessible, proactive and responsive organisation Being a good corporate citizen Being an employer of choice Valuing the contribution of members and governors Being a learning organisation Being a provider of choice Being an efficient, effective and viable organisation The Trust s strategy is to protect its position as the current market leader in Norfolk and Waveney, by bidding for and acquiring contracts for new services from current commissioners, such as the full implementation of IAPT (Improved Access to Psychological Therapies), as well as contracts to deliver appropriate services outside of its current sphere, such as provider-arm community services, or other appropriate geographical areas should they become available. Criteria have been established to test whether potential tenders that fall outside of either the expertise or geographical area of the Trust should be bid for within the context of the Trust s development strategy. The Trust will market itself on its ability to provide the complete care pathway (without age boundaries) and/or discrete areas of service. In order to achieve this, the strategy will also focus on securing the most talented staff and then investing in their education and training. Attention to a programme of research will equip the Trust to promote its innovative services and its approach to redesign through publishing the 5

6 The Trust s vision over the next three years is to: outcomes. This will contribute to active reputation management. The following sections set out where the Trust stands on a number of important work areas and initiatives. Quality Assurance All parts of the organisation are significantly contributing to the ongoing drive for higher quality services that improve the experience of people using NWMHFT services and their families and other carers. Many of the developments specifically relate to the improvement of service user safety and ensuring the services offered are based on what are known to be most effective in achieving the outcomes people desire. Pilots have been used to trial new ways to deliver services, for example a pilot for older people with dementia, the services are helping to put in place support arrangements for them and their families without the need for referral to secondary care. Such pilots are key to the Trust s strategy. The Trust continues to explore new ways to deliver services within primary care such as Intensive Support Teams with the aim of improving access to home treatment and crisis support to older adults and so avoiding admission to hospital. Other services are also being developed such as the Pharmacy website which includes a wide range of information for service users, carers, and professionals to use in order to support them in understanding and making choices about the use of medication. Commissioning/Tenders The Norfolk and Waveney position will mirror that of many places across the country. The two local PCTs have both struggled through the current year to curb increases in non-elective activity and their financial positions have come under threat as a result. The Trust can expect to get no inflationary uplift in 2010/2011 and probably in the 2-3 years thereafter. Norfolk will see the greatest increase in the over 65 population compared to any other area in the coming few years the implications for dementia services are huge and will present a massive pressure on service design and delivery. The PCTs have recently put forward their commissioning and financial plans for the next five years, which appear to leave mental health funding streams largely intact. There are some reductions in funding, but these are marginal and may not involve the Trust s services. However, these figures hide disinvestment if the inflation uplift is set at less than zero. The Trust is bidding to acquire the community services arm of NHS Great Yarmouth and Waveney and if successful would become one of the first Trusts in the country to be able to integrate mental and physical healthcare services. This would be in line with the Trust whole life philosophy, as well as delivering improvements in patient experience and efficiency. Marketing will play a key part in sustaining the Trust s strong relationships with stakeholders in the coming year, through developing greater understanding of their needs, improved communication and increased engagement. There will be a focus on communicating the Trust s successes and new developments clearly, enhancing the Trust s reputation and profile during a time of increased competitive tendering in the region. Contracting for Quality The introduction of payments linked to quality outcomes in 2009/10, the Commissioning for Quality and Innovation (CQUIN) framework, linked 0.5% of the Trust s NHS mental health activity income to quality outcomes. This has been increased for the year 2010/2011 by 1.0% and will be 6

7 The Trust s vision over the next three years is to: reviewed annually. A programme of quality improvements (CQUIN) has been agreed with all commissioners. For NHS Norfolk and NHS Great Yarmouth and Waveney contracts there are 6 overarching indicators included, with two sub sections representing a wide range of Trust services. For the medium and low secure contracts the CQUIN indicators have been defined nationally, the Trust welcomes the initiatives. The indicators specify the quality improvements to be achieved and a failure to do so will result in varying levels of financial penalty to the Trust. In order to ensure ongoing compliance with the CQC Essential Standards the Trust is linking the central governance role with localities. This will have the following advantages: Local ownership by the nine locations Release of the central resource to concentrate on strategic analysis of trends Improving the quality of the evidence Enabling localities to use their assurance systems to support local quality improvement There are also a number of developments related to encouraging efficiencies in service practice and reporting so that the correlation between service delivery and what is reported externally is clear in the minds of all staff. Other strategies such as data quality to ensure relevancy, accuracy and reliability of all data and Trust systems is being developed and implemented within the duration of this plan. Engagement with Staff, Governors and Members NWMHFT is committed to engaging with members in meaningful ways to shape the way it develops. The Trust is working with Governors to provide members with increasing and varied ways to engage, understand and influence, including the well attended Quality Accounts events, Meet Your Mental Health Service events and Meet Your Governor events. These will be expanded and improved in 2010/11. Further to this the Board is open to the Public and will accept actions on their behalf. The Trust has established a Board of Governors Marketing Subgroup with the specific task of recruiting members and communication Trust issues and objectives with existing members. An objective for 2010/2011 will be to increase the involvement of staff, service users, carers, governors and other local people in planning and influencing the work of the Trust. This will be possible through a wide range of new communication initiatives with staff and seminars and discussions with governors and local people on the Trust vision and values and will be released in a plan for 2011/2012. The Trust listens to its staff via the staff engagement programme The BIG Conversation and in-year a number of the staff identified outcomes have been delivered, such as a new staff magazine Onsite. The first Staff Awards Ceremony in September 2009 was a great opportunity to celebrate the achievements and commitment of some highly talented and inspirational staff. This programme and the celebration will continue and be developed in the future. Over the last year the Trust invested significantly in management and leadership development, in readiness for the hardship anticipated in the coming years. This investment will continue in order to mitigate some of the challenges faced that will require effective leadership, management and staff engagement. In order to strengthen relationships with staff, the Trust will be developing and commencing implementation of a clear strategy for development, for appraisal, and for succession planning with a focus on performance at all levels. The aim in year will be to establish a development strategy 7

8 The Trust s vision over the next three years is to: and to have made significant progress on all elements along with improvements in staff survey outcomes. Partnerships and consultation with stakeholders The Trust is committed to partnering with other appropriate local organisations to bid for services. The Trust recognises the need to achieve pluralism of delivery, and will act to ensure that a range of organisations can contribute to the successful outcomes of new services for which it becomes responsible. The productive partnerships with Norfolk and Suffolk County Councils, to which the Trust is committed, will become continually more important to the effective delivery of integrated health and social care. The Trust is working with Suffolk Mental Health Partnership to investigate ways in which efficiency savings could be made by working collaboratively. Should this lead to any formal partnership the appropriate regulatory process will be followed. No public consultations outside of the ongoing interaction with partners, service users, carers, members and the LINk are currently planned, but in the event that contracts are acquired, or relevant formal partnerships developed during the year that have a significant impact on the shape of service delivery, the Trust will undertake appropriate consultation. HIEC and research The Trust is committed to establishing a strong research base (academic and practical), building on the Health Innovation and Education Cluster (HIEC), and DeNDRoN, and supporting NIHR participants. In 2010 the Trust will establish a HIEC, and establish a clear plan for working with the University of East Anglia (UEA). The Trust is working with the UEA and other health partners to try and maximise the amount of funding that can be used to develop clinical academic posts and thus further boost the research credentials of the Trust. Improving Access to Psychological Therapies (IAPT) The Trust is working closely with NHS Norfolk and NHS Great Yarmouth and Waveney to develop Improving Access to Psychological Therapies which is an ongoing new service development from 2008/2009. NHS Norfolk has been allocated approximately 1.5m for IAPT in 2010/11 and has also committed local funding. NHS Great Yarmouth and Waveney has been allocated approximately 480,000 and has similarly committed additional local funding to this development. Plans for 2010/2011 include working with partner organisations to submit bids in response to request to tender for the full IAPT services, to continue with recruitment and training of new staff, to develop care pathways working with the multiplicity of services available and service providers to ensure cooperative and efficient use of all our local resources and in particular to develop strong working relationships with employment services. Dementia Strategy, the Dementia Intensive Care Unit (DICU) and the Norfolk Clinical Academy for Dementia The key policy for the Trust is undoubtedly the national Dementia Strategy, and there will be a real challenge in Norfolk to address the growing problems of dementia, alongside the financial downturn and an increasingly elderly population. The new provision for the Older Peoples` continuing care wards and the building of a new 36 bedded Dementia Intensive Care Unit was approved in Work will start in late 2010, as planned, with completion of the 13.7m state of the art building scheduled for Spring

9 The Trust s vision over the next three years is to: The DICU replaces the 28-bedded wards at Hellesdon Hospital and is positioned to the rear of the Julian Hospital, in close proximity to existing older people in-patient areas on the site. Service users, carers and staff have contributed to the building design. Within the Hellesdon Dementia Unit considerable efforts are being made to prepare the workforce for the move to the DICU and their place within the new Norfolk Clinical Academy for Dementia. This involves additional education programmes and the development of new ways of working including embedding dementia care mapping and extending initiatives with a focus on person-centred care. The academy aims to become a nationally recognised centre of excellence for dementia. The centre of excellence concept draws together best clinical practice approaches, research and education and training under one roof. This allows our strong research and education base to be linked to clinical care in a dynamic and unique way giving the Trust an opportunity to lead on the changes that are being implemented through the National Dementia Strategy. Finance A key objective for 2010/2011 will be to ensure the Trust produces and delivers a long-term plan for the financial down turn faced by the NHS, and delivers its financial plan for This will be achieved through the delivery of a 4 year Plan by June and a financial plan delivered by April Further to this the Trust will look to implement a local tariff (payment by results) for the majority of our Mental Health Services by April 2011 as required by Department of Health Guidance, to this effect a tariff is to be in place for April 2011 Estates and Facilities Environment strategy key plans and developments In 2010/2011 the Trust will develop and implement the estates strategy. The strategy covers all major sites managed and by April 2011 the aim is to have an agreed plan for futu+a14re development of Northgate, Kings Lynn, 80 St Stephens and the Hellesdon site. ICT strategy and SHAPE key plans and developments In the coming years the Trust has committed to develop its information infrastructure and systems to support the visions. This will be achieved according to the detail in the ICT Strategy and in addition the specific commitment to a new patient and clinical recording system will be delivered against agreed milestones for the year as defined in the SHAPE programme. NHS Constitution The Trust believes in the principles of the NHS Constitution and has already committed to ensuring adherence to these principles. In order to reflect this all papers for the Board of Governors and the Board of Directors will have a cross reference to show compliance to the Constitution criteria. CIP The Trust is completing a detailed plan to achieve net cost improvement over the next four years of 20% in response to the economic downturn. These plans are focussed on several initiatives: Significant reductions in overhead and support function costs including improved productivity schemes for these areas and also the sharing of some functions with other areas such as Suffolk Mental Health Trust and Local Government. Standardisation of clinical services across localities utilising the most cost effective models 9

10 The Trust s vision over the next three years is to: Reductions in the provision of some services in agreement with commissioners Significant remodelling of some services to enable the provision of more cost effective service models Rationalisation of Estate Reduction in Community infrastructure costs through the introduction of improved ICT systems 10

11 Template 1: Vision and key priorities - Key priorities for the Trust which must be achieved in the three years of the annual plan to underpin the delivery of the Trust's vision Key priority (and timescales) To increase the market share of the Trust How this priority underpins the strategic vision Key to the strategy. Public health data and service user feedback will be used to challenge and shape the trusts services to ensure that the programme of services are efficient and effective and meeting the needs of existing and potentially future service users in the region with the aim of offering real choice To be the market leader for the provision Supports the trust vision of being a of mental health services in the Eastern centre of excellence, innovation and region with an international reputation for choice. The Trust aims to expand its excellence, innovation and choice. research profile and is looking to work more closely with the UEA to develop additional clinical academic roles. To attract the very best staff, retain them by rewarding them well in ways that motivate them further, and provide every opportunity for them to develop to their fullest potential. In order to achieve its vision the trust will need to employ and retain the best staff, only by investing in them will the vision be possible. Key milestones (2010/11) IAPT tender process completed Suffolk Mental Health Trust partnership working discussions and implementation plans and protocols The Trust is bidding to acquire the community services arm of NHS Great Yarmouth and Waveney DICU work commences according to project plans HIEC early implementation roll out within the region Talent management strategy implemented. Wellbeing strategy implemented. Key milestones (2011/12) Annual Planning process In year tenders (not yet known) although Trust expectation is that Substance Misuse services will be open to tender this year. DICU project completion HIEC operational plan fully established and operating. Total reward strategy implemented. Increased flexibility demonstrable within the workforce Key milestones (2012/13) Annual Planning process In year tenders (not yet known). DICU admissions and successful implementation of the care pathway HIEC is self funding. Ongoing review of staffing requirements and success of strategies implemented 11

12 Key priority (and timescales) To have a workforce that is fit for purpose and delivers first time, every time. To ensure the Trust makes the best use of existing resources and constantly explores opportunities for increasing income and generating surplus, which can be used to underpin innovation, research and development. How this priority underpins the strategic vision By ensuring that staff skills remain current and in line with the requirements of their roles staff can perform to the best of their ability. With the programme of service line reporting, all services will be tested for efficiency of services and service models. This will be an opportunity to learn from developments and ensure that innovation is encouraged, the investment of profit will support this approach. Key milestones Key milestones (2010/11) (2011/12) Reduced sickness in response to absence. Greater unplanned and motivation reported planned demands via staff survey. and development needs. Organisational development strategy implemented. Engagement strategy implemented Review of staff engagement in Staff Survey. Staff survey action plan implemented and improved responses identified Increase in completed appraisals ILM and Good to Great programmes running Continuation of 2010 milestones and additionally Annual organisational culture surveys undertaken and year on year improvements demonstrated. Continuing improvements in staff survey results and high levels of satisfaction identified in patient surveys. Key milestones (2012/13) Continuation of strategy with ongoing review and development as required and identified in annual plan. PbR work with DoH PbR work with DoH and EoE SHA, and and EoE SHA, and PCTs PCTs Service line Service line reporting via SLR reporting via SLR Programme Board Programme Board HIEC is self CIP implementation CIP implementation funding. Local PbR system in operation from April CIP implementation. 12

13 Key priority (and timescales) How this priority underpins the strategic vision Key milestones Key milestones (2010/11) (2011/12) HIEC roll out in HIEC operational year and other plan fully Trust supported established and research operating. programmes. Increase in the number of NIHR portfolio studies. Review of existing SLAs to ensure fit for purpose. Implementation of a new financial system and financial services provider. Key milestones (2012/13) 13

14 Template 1: Vision and key priorities - Key priorities for the Trust which must be achieved in the three years of the annual plan to underpin the delivery of the Trust's vision (cont.) Key priority (and timescales) To improve the mental health of the local communities by providing accessible, timely and effective services that are diverse and culturally sensitive. How this priority underpins the strategic vision The trust has a good reputation for the delivery of innovative services this would not be possible without a conscious approach to understand the community that it serves. By engaging with service users, carers and the wider community the trust will ensure that when it does expand it continues to deliver services that the community requires and deserves. Key milestones (2010/11) Continue to commit to the provision of national data for ethnicity, housing and employment etc and surveys such as the Count Me In Census, Childrens Service Mapping or their replacements. Engage with cultural competency assessments locally and regionally. support the CAMHS needs assessment review in Norfolk. Engage with members, service users and carers to understand their needs and inform service redesign Key milestones (2011/12) To be reviewed in line with contract requirements and review of changes implemented through a change in government using lessons learnt from 2010/2011. Develop 2012 priorities and milestones. Working with PCTs and partners to implement the Dementia Strategy Key milestones (2012/13) To be planned in 2011 Annual Planning process 14

15 Key priority (and timescales) To have a quality mental health service that protects and instils confidence for patients, the public and staff through well-governed systems and processes. To contribute to collaborative working arrangements in order to improve the experience of people using or referring to the services; e.g. children s trusts, strategic alliances, local strategic partnerships, crime reduction partnerships and joint ventures. How this priority underpins the Key milestones strategic vision (2010/11) The trust will develop and expand its CQC Registration services only if its reputation is for high requirements. quality health care. This reputation will Contract and require evidence, the internal systems in Monitor place ensure that clinical governance requirements - and quality are ensured. CQUIN, Quality accounts. Member and Governor events The trust aims to market itself as a provider of the complete care pathway without age boundaries and working collaboratively when the opportunity is available. Annual patient survey, Annual Report will highlight collaborative arrangements. Review of CAMHS reporting for LD, IST and LAAC to ensure that collaborative working is reported effectively to commissioners and areas of difficulty addressed. Key milestones (2011/12) CQC Registration requirements. Contract and Monitor requirements - CQUIN, Quality accounts. Member and Governor events To be reviewed in line with contract requirements and review of changes implemented during 2010/2011 and SLR and CIP outcomes. Develop 2012 priorities and milestones. Key milestones (2012/13) CQC Registration requirements. Contract and Monitor requirements - CQUIN, Quality accounts. Member and Governor events To be planned in 2011 Annual Planning process 15

16 Key external impact Risk to the plan Competition comes from the Failure to win tenders independent sector or third specifically Substance sector for tenders Misuse Tender Change of policy due to change in Government Change in policy towards NHS and MH specifically. Most likely to be a reduction in income, structural changes and PBCs Template 2: Key external impacts Mitigating actions and residual risk Creating collaborative consortia with third and independent sector subcontractors. Develop strengths of tendering team and ensure that developments remain in the best interests of the Trust. Continue to create a team to support the tenders that have the skill set to best inform decision making. Continue with Board level accountability to members and governors on any new proposed tender. Timescales to implement changes will allow for service re-development as necessary. Existing projects have funding in place and cost efficiencies are already under way. It is unlikely that any of the Trust's planned projects would be at risk following the change in Government, other than ICT (see separate impact assessment). The Trust might need to re-phase Measures of progress and Overall expected outcome accountability Success of previous Review of what went wrong collaborative ventures with tenders that have been suggests that this will be a unsuccessful. Commercial successful approach to Developments Director developing new and extending existing services Trust will need to respond and adapt, experience leadership team will drive through current CIP and will ensure that staff have the skills and competencies so that service user or their carers are not impacted upon adversely. Projects are monitored at Programme Board level. Financial accountability via Monitor and governance through CQC will ensure that the political changes do not impact adversely on existing client groups. The Finance Committee and Investment Committee oversee delivery of CIP programme and Capital Investment programme 16

17 Key external impact Competitive threats those that threaten existing business Risk to the plan Loss of existing contracts Mitigating actions and residual risk projects to live within reduced means or press more quickly on savings programme. Working closely in partnership with commissioners to help ensure that the services continue to mirror their needs and best practice. By raising and maintaining the Trust profile as the local leader in mental health. Ensuring pricing is competitive and costs are controlled. Measures of progress and Overall expected outcome accountability respectively. The Trust has developed a good working relationship with commissioners and is developing relationships with new members of the commissioning teams. The intention would be that this is an event that would have had prior discussions. Plans would be developed should discussions between all parties lead to a notification to terminate contracts. Finance Director Competitive threats - those that are competition for new business Failure to win new business will impact on expansion plans The Trust is developing alliances with both private sector and voluntary sector organisations to help identify more effective and efficient ways in which services could be delivered. Developing and exploiting existing networks, contacts and relationships to identify opportunities and put longer-term building blocks in place. Sharing ideas and opportunities with commissioners and other The Trust at this point in Commercial Developments time does not identify major Director threats to its existing core services. New tenders will be monitored and discussed in relation to existing contracts with commissioners. 17

18 Key external impact New CQC standards being introduced Risk to the plan Failure to achieve the required standards would impact on authorisation Mitigating actions and residual risk Overall expected outcome partners, engaging in consultation and instigating service development initiatives. Service performance and Unlikely to be a risk to the compliance with known Trust based on recent national and locally authorisation process. determined targets and standards is monitored through the Business Performance Report, received by the Board of Directors and the Executive Operational Team. Any potential lapses are identified and action plans are put in place to achieve compliance Measures of progress and accountability Continued reporting should illustrate issues and allow for implementation of action plans to any challenge to standards. 18

19 Key external impact Risk to the plan National Programme For IT Failure of the programme or discontinuation of the programme could impact on the Trust commitment to implement new patient and clinical systems Implementation of PbR Financial impact of applying care pathways Template 2: Key external impacts (cont.) Mitigating actions and residual risk N3 network could be at risk if a national provider is removed. Trust plans currently to use N3 as part of future developments. To replace would have a cost impact. Removal of networks would require time to plan and implement alternative provision. CSCA withdraws from the LSP contract or has its contract terminated or restructured due to not meeting contractual obligations, changing the cost implications or requiring additional procurement The Trust is working with PCTs, SHA and DoH on initial pilots on how this will look for MH. Current position is that the Trust has a good understanding of the implications of the implementation of PbR and is involved in prework to ensure risks are limited. Measures of progress and Overall expected outcome accountability Trust perspective is that Commercial Developments N3SP removal is an unlikely Director to monitor with outcome. Head of ICT and SHAPE Trust view on CSC contract Programme Board is that timeframes are delayed and that NWMHFT should continue to monitor the new governments commitment to sign a renewed contract with CSC. Trust feels well placed to inform discussions based on evidence on its own implementation Medical Director leads the Programme Board. Contract Management meetings with Commissioners involve updates on regional and national meetings 19

20 Key external impact Increase in elderly population and impact on services Risk to the plan Increased numbers of patients in treatment or in contact with the services and increasing costs of service delivery may impact on other MH services Mitigating actions and residual risk Overall expected outcome A joint project Board will be established with PCT and County Council representatives to ensure health system understands impact and performance management implications of a move to PbR. Development and 2010/2011 contract implementation of a negotiations have resulted dementia strategy in in General Pressures association with PCTs, Funding from NHS Norfolk acute Trusts, voluntary and NHS Great Yarmouth & sector and social services. Waveney, however this will Monitoring through PbR and other reporting mechanismsto gauge impact on services. When necessary contract negotiations will be used to ensure there is no detrimental impact on service delivery. remain an area to monitor in coming years. Measures of progress and accountability Ongoing monitoring - Finance Director Economic downturn and impact on resource availability Reduced income from 2010/11 onwards may result in the need for further efficiencies than currently planned. Development of the DICU and clinical academy. The Trust has significant engagement with clinicians, Trust CIP plans are recurrent. The Trust's CIP plans are based on 5.7% in 2010/11, and 5% each year thereafter. Additional CIP The Trust anticipates that it will maintain the Financial Risk Rating of 3. Director of Finance, maintain Financial Risk Rating. 20

21 Key external impact Risk to the plan Mitigating actions and Measures of progress and residual risk Overall expected outcome accountability plans could be worked up including local negotiation around terms and conditions and opportunities from QIPP initiatives. National Pay agreements If agreed payment is high this will have a negative long term impact on trust finances. The Trust has secured additional funding in 2010/11 to reflect general cost and activity pressures from its commissioning PCTs. Trust survey to gain understanding of staff views on pay and benefits.review of survey findings will inform any action that the Board feels is necessary to ensure that services are protected and staff remain in post. Current forecasts are cautious. If national pay agreements are viewed as higher than anticipated in this plan action would be considered to reduce the local agreements rather than reduce posts. Trust plans currently accommodate 3.5% per annum over the 3 years. The Trust is confident any additional pay inflation can be absorbed via additional CIPs. If pay is limited through national negotiations then the Trust has significant scope for saving against the 3.5% included. Director of Finance and Head of Human Resources. Ongoing monitoring of national pay agreements and review of workforce strategy accordingly. 21

22 Clinical quality priorities Contribution to the overall vision Improved access to services for people with a dual of their whole lives diagnosis of learning National priority difficulties and mental health. (Quality Accounts) Expand the ways of capturing service user and carer experience in all age groups to inform service improvement (CQUIN And Quality Accounts) Template 3: Clinical quality Key actions and delivery risk Seeing people in the context Implement action plan in line with CQC national priority Access to health care for people with a learning disability Failure to deliver this national priority may result in a visit from CQC inspectors or ultimately change of registration status and enforcement action. Being an accessible, proactive and responsive organisation Explore options for capturing service user and carer experience in conjunction with appropriate groups, to complement the mandatory National patient survey. Agree patient and user experience methodology and sample. Plan for the implementation of agreed methods. Implement Review results and prepare action plan based on results. Financial risk to the Trust as Performance in 2009/10 The Trust has reported to the CQC in 2009 and May 2010, demonstrating progress on the implementation of the action plan to meet the indicators. The Trust actively seeks the feedback of service users and carers utilising a number of methods:- National patient survey. Patient experience tracker (PET) Compliments/complaints. Service User representation 3 year targets / measures 2010/ / /13 In 2010/11 and ongoing. The Trust will continue to implement the action plan across the trust until full compliance is achieved. n 2010/11 The Trust aims to achieve the key actions as stated. 2011/12 The trust will utilise the results of the feedback to plan service improvements. 2012/13 The Trust will continue to review feedback and develop action plans to 22

23 Clinical quality priorities Contribution to the overall vision Improve healthcare of the local population through increasing opportunities to access smoking cessation (CQUIN) To improve the inpatient experience, particularly in relation to discharge through use of recovery folders (CQUIN) Rates of smoking are 2-4 times higher among people with psychiatric disorders and substance use disorders. Seeing people in the context of their whole lives. Mental Health Act monitoring report recommendation. Introduction of the recovery folders will improve the inpatient experience by providing a range of information to each service user. Seeing people in the context of their whole lives and Key actions and delivery risk this is a CQUIN target. Risk to the reputation of the Trust as perceived by service users and carers. Ensure that at least one member of the Trust s Assertive Outreach or community recovery teams for people of working age and older adults receive (L1) training in very brief anti-smoking interventions, to improve delivery of effective stop smoking advice to smokers. Brief advice can consist of three simple steps - Ask, Advise and Act. Financial risk to the Trust as this is a CQUIN target. To develop and plan for the implementation of recovery folders in conjunction with patients and carers in two specified sites (TBA) To implement the use of recovery folders within 2 pilot sites (TBA) Undertake audit of Q2 and provide report by 31st October 2010 Performance in 2009/10 During 2009/10 the Trust has increased the availability of smoking cessation assessments to in patients. This has resulted in an increase from 13% to 36% of service users receiving assessments, advice and help to stop smoking. Recovery folders have been developed in conjunction with new CPA. Additionally, recovery folders have been developed differently in different areas of the Trust to meet individual service requirements 3 year targets / measures 2010/ / /13 implement further improvements in conjunction with users and carers. 2010/11 To achieve the key actions as stated. 2011/12 To review and revise the action plan as appropriate. 2012/13 The Trust will continue to review its obligations to meet public health targets with the commissioners and take action as appropriate. 2010/2011 To achieve targets as set out. To consolidate the work already undertaken. 2011/12 To ensure full implementation of recovery folders across the Trust and that they are updated regularly. 2012/13 The Trust will review the use of recovery 23

24 Clinical quality priorities Contribution to the overall vision Improve medicines reconciliation on admission (CQUIN) Key actions and delivery risk being a provider of choice. Undertake audit of Q3 and review progress. Review folders and plan further implementation as appropriate in light of the audit results. Report of findings required by 31st January 2011 Failure to implement the above action will result in financial penalty for the Trust. There is also a risk to the reputation of the Trust if service users are not engaged or feel that the folders are not helpful. NPSA/NICE guidance 2007 guidance to improve medicines reconciliation CQC standard. Seeing people in the context of their whole lives, being an accessible, proactive and responsive organisation and being a provider of choice. Audit to inform baseline. Develop monitoring system and plan implementation. Report required by 30th April 2010 Implementation. Progress report required by 31st October 2010 Audit of patients who have had medicines reconciliation within the 72 hour period. Report required by 31st January 2011 Risk to the Trust rating if Performance in 2009/10 Throughout 2009/10, medicines reconciliation has been a component part of admission procedure and recorded on the new CPA paperwork. 3 year targets / measures 2010/ / /13 folders and continue to build on good practice to identify future developments. 2010/2011 To achieve the key actions as stated. To raise awareness of the guidance and importance of recording reconciliation activity. 2011/12 To consolidate improvements made in 2010/ /13 The Trust will continue to review NICE guidance and implement any required changes as well as building on 24

25 Clinical quality priorities Contribution to the overall vision Key actions and delivery risk adherence to NICE/NPSA guidance is not adhered to. Financial risk to the Trust as this is a CQUIN target. Performance in 2009/10 3 year targets / measures 2010/ / /13 improvements made. Improve access to consultant advice in primary care to reduce the necessity for referral to secondary care. (CQUIN) To ensure that patients receive timely appropriate intervention To improve cost effectiveness. Being an efficient, effective and viable organisation Review data in South The appointment of a 2010/11 To achieve the key locality and identify changes consultant in one locality actions as stated in referral patterns has demonstrated a 2011/12 To review and Implementation in North and reduction in complaints from revise the action plan as Great Yarmouth localities Review the reduction of GP s and a reduction in the appropriate. number of referrals made to 2012/13 The Trust will direct referrals to secondary secondary care. care and identification of changes in referral patterns. Review targets and actions for 2011/12 continue to review its obligations to meet public health targets with the commissioners and take action as appropriate. Financial risk to the Trust as this is a CQUIN target. Financial risk to the Trust in light of the current financial climate. 25