Leeds Community Healthcare NHS Trust Operational Plan 2016/17

Transcription

1 Leeds Community Healthcare NHS Trust Operational Plan 2016/17 March2016 1

2 Contents Page 1. Executive Summary 3 2. Strategic Context 3 3 Organisational Vision and Strategic Goals 5 4. Achievement and Challenges in 2016/ /17 Corporate Objectives Quality Service Plans Workforce Financial Plan Risks & Mitigations 33 2

3 1. Executive Summary 1.1 This operational plan for 2016/17 sets out the Trust s priorities and objectives for the coming year in. These are; Ensure the foundations are in place to consistently deliver and improve high quality care (as defined by CQC Good and Outstanding ) Consolidate and develop the integrated neighbourhood teams Retain services which we expect to be tendered in 2016/17 (CAMHs T4, Community Dental, York Street, Healthy Living Services, IAPT, West Yorkshire Police Custody) Continue to improve staff engagement and morale Influencing system transformation and new models of care 1.2 Recruitment and retention of staff will continue to be a key enabler for how we deliver on these objectives. 1.3 The budget proposals in Section 9 underpin the delivery of the Trust s corporate objectives and business as usual for 2016/17. They have been prepared in line with the financial strategy approved by the Board and set out in the Integrated Business Plan submitted to the TDA in June Whilst the financial principles remain consistent, the actual figures have been updated to reflect the prevailing inflation expectations, guidance on contract inflators and known changes in costs. 1.4 For 2016/17 the TDA have set a control total surplus for the Trust of 2.0m; when the draft plan was submitted to the TDA in early February the Board was not in a position to accept the control total. 2. Strategic Context 2.1 The Trust s operational plan for 16/17 has been developed within the challenging context facing the NHS; particularly providers. The size of the national provider financial deficit means increased financial rigour for the whole sector. The challenge for all providers is to deliver the right quality outcomes within the financial resource available, neither priority is more important than the other. This is how the Trust will be regulated by NHS Improvement and the CQC going forward. 3

4 2.2 Transformation is the only way that the national and local health and care systems will be sustainable in the mid to longer term. Every health and care system is developing a Sustainability and Transformation Plan (STP) to set out how it will accelerate implementation of the 5 Year Forward View. This will be a placed based plan built around the needs of the local population. The city s Health and Wellbeing Strategy will provide the strategic framework for the STP setting out the major health and wellbeing challenges for the city in order to improve outcomes for the people of Leeds. 2.3 The Leeds Health and Care Partnership Executive has been established comprising the chief executives of all partner health and social care organisations; this operates as the Board for the city; ensuring a place based approach to planning and decision making. 2.4 Work is underway to develop the local STP building on recent system work reviewing the transformation programme and the governance structures needed to drive forward the transformational change needed in the city over the next few years. 2.5 The emerging STP sets out how the three gaps highlighted in the Five Year Forward View (health & wellbeing, care & quality and finance & efficiency) will be addressed. It also starts to set out a vision of what services will look like in the city including the community offer. 2.6 It reinforces the ongoing system commitment (and Trust strategy) to provide more care in the community; a more proactive focus on maintaining people at home and within their communities for as long as possible via improved primary care and integration with community services, that wraps around the patient with tailored specialised support available as and when needed. 2.7 This will require a new service model of accessible integrated primary care service, including primary prevention and public health initiatives, working in partnership with the 13 neighbourhood teams and care services, each team caring for a designated part of the population. Each patient will know their team by name with an individual point of contact. The staff within teams will be enabled 4

5 to work across organisations utilising the Leeds shared care record, with flexibility in employment arrangements including aligned seven day services. The patients/users will be enabled to take more responsibility for their care and education supported by digital enhancements such as self-care management, the use of telehealth for those patients who will benefit from the advantages of self-monitoring and who will be better assisted to take control of their own health as well as ensuring ownership of health. It will build on the established thirteen integrated neighbourhood teams (aligned to GP practice populations) that the Trust has been instrumental in driving forward over the last few years. 2.8 The development of primary care is also critical to future models of care. Over the last year joint working of individual practices has further developed to include innovative approaches to extend and improve access to care, and to improve capacity. In Leeds South and East, 29 of the practices have come together to create a federative group and all practices (whether federated or not) are starting to work together in 4 localities. There is a 4-locality approach in Leeds North CCG and a single network of 38 practices in Leeds West, with agreed localities. From April 2016 all 3 CCGs will become accountable for co-commissioning primary care; this is a key enabler for the system to transform General Practice and the development of New Models of Care. 2.9 Despite this emerging clarity on the strategic direction and articulation of the service offer the system is not at the stage where it has translated this into clear service developments and/or an increase in service levels in 2016/17 for the Trust. The operational plan does therefore not include any commissioner led developments for 2016/17. The Trust will ensure through the development of the STP, the increased and critical role for community services. 3. Organisational Vision, and Strategic Goals 3.1 Leeds Community Healthcare Trust is a community based organisation providing coordinated and seamless care to people in (or near to) their own home; wrapped around local neighbourhoods. Our services are in day to day contact with some of the most vulnerable people in society. They work with everyone from birth to end of life, everywhere from the hospital to home; from 5

6 the streets to the prison; from the health centre to the local school. They provide the full spectrum of care from universal through to specialist interventions. 3.2 The organisation has a simple and clear vision with quality at the heart; to provide the best possible care to every community we serve. This is underpinned by our four strategic goals setting out how we will achieve our vision over the longer term. Strategic Goals 3.3 This operational plan for 16/17 sets out how we will continue to deliver high quality services supported by sustainable financial, workforce and activity plans. 6

7 4. Achievements and Challenges in 2015/ Operational performance /16 has been a positive but challenging year for the organisation. We have strived to protect front line staff and service delivery from the stretching financial delivery requirements and to improve staff morale which was impacted by the service reviews and redesign the year before. Recruitment was a top priority to address staffing pressures in a context of national workforce shortages The Trust invested in a significant programme of work to attract and recruit clinical staff, particularly community nurses and therapists in a context of national workforce shortages which was highly successful. We have had 594 new starters this year and we reduced the recruitment time by 22% for nursing staff by speeding up processes. Vacancy rates in the adult neighbourhood teams have significantly reduced and staff turnover has started to fall resulting in clinical capacity now more closely matching demand. We are working innovatively with partners in education and adult social care to attract bank staff and recruit permanently. Whilst, like all NHS organisations we continue to face supply challenges of qualified nursing, therapy staff and some specialty doctors, we go in to the year with a significantly improved position and one which we believe will continue to improve Throughout the year the integrated neighbourhood teams have sought to maintain quality of care with staffing pressures combined with increased demand and a very significant change agenda to develop and embed new and integrated ways of working, processes and systems. We completed a competency and skills analysis of our Neighbourhood Team registered and non-registered nursing and therapy staff which will inform training and development in core clinical skills and enable us to further refine our staffing models. The much improved staffing position places us in a much stronger position to progress the programme of change and team development. Inpatients safe staffing targets have been met consistently throughout the year The 2015 national staff survey results have given us encouragement that the recruitment efforts and our wider OD approach are enabling us to turn the curve in improving staff morale and staff engagement which is fundamental to us 7

8 delivering quality care. There were improvements in scores for many questions and the response rate was significantly above the national average. In the autumn we launched our behavioural framework, How we Work, through a series of staff road shows. It has been welcomed by staff, will underpin many of our leadership activity and forms a core part of our refreshed appraisal system We have made significant progress in improving the appraisal rate which has been a key organisational focus throughout the year We were delighted to achieve a 31% reduction in the number of falls in our inpatient units, exceeding our Sign up to Safety target, 5% due to a number of initiatives including evidence based training for all clinical staff, the development of an inpatient falls risk assessment tool and the implementation of safety huddles in all bed bases Our greatest quality challenge in 2015/16 has been the rise in pressure ulcers. We did not meet our target to reduce category 2 and 3 pressure ulcers by 5% and pressure ulcers were also the biggest factor contributing to the overall increase in the number of serious incidents. In response we have reviewed all our pressure ulcer and incident management systems and processes and have implemented a fresh plan. A pressure ulcer steering group has been established with oversight from the Director of Nursing and we have launched a pressure ulcer prevention campaign. We remain a high reporter of incidents We have made significant progress in strengthening governance, in particular risk management and reporting on quality, key developments being team and service level heat-map reporting on quality and workforce indicators, developing an outcome reporting pilot in each of the business units and improving reporting to Quality Committee through a new Director of Nursing report The national Improving Access to Psychological Therapies (IAPT) targets for numbers entering the service and numbers completing and moving to recovery have continued to be significant challenges for the Trust despite concerted effort The Trust implemented a programme of work to meet agency controls, which along with recruitment to vacant positions resulted in significant reduction in 8

9 agency costs. Higher numbers of staff leaving the adult prison service as a resulting of the organisation losing the contract plus key nursing agency suppliers not complying with the cap contributed to breaching the 4% nursing agency ceiling for the period October March Business Retention and Development There was substantial investment in service initiatives to improve system flow and deliver more integrated care closer to home through the Better Care Fund and System Resilience Funds. Due to financial constraints commissioners are not continuing to fund these schemes in 2016/17; this is disappointing as these schemes were pilots and as such as opportunity to test the effectiveness and impact of new services to improve flow and provide more proactive care for people in the community We did not retain the contract for Adult Prison healthcare when tendered by NHS England early in the year. De-mobilisation, transferring staff and maintaining service have been significant focuses in the final quarter. We were delighted to win the contract to deliver an integrated health care service within the children s secure estate across two of our community sites. We will deliver this in partnership with South West Yorkshire Partnership Foundation Trust (SWYPFT) which has significant experience in delivering mental health services in secure and forensic settings Commissioners invested in Child Adolescent Mental Health Service (CAMHs) including establishing an Eating Disorder Service and creation of a single point of access for all emotional and mental health and well-being services for children and young people. Commissioners also supported the development a service to ensure Looked After Children transitioning into adulthood are supported to access health services. 9

10 5. Corporate Objectives 2016/17 Corporate Objective Key Actions Measures of Success 1. Ensure the foundations are in place to consistently deliver and improve high Strengthen focus on pressure ulcer prevention through the Ten Priorities campaign and significant staff training programme Reduce avoidable category 3 pressure ulcers by 15% No category 4 avoidable pressure ulcers Reduce the number of avoidable falls that have caused harm to patients by 10% (inpatients and quality care (as defined by CQC Good and Introduce safety-huddles and quality dashboards in all our clinical teams neighbourhoods) Reduce waiting times for CAMHs secondary onward Outstanding ) Continue to strengthen incident management and ensure all investigations are completed within the expected timescales internal referrals: waiting times for autism assessments to not exceed 12 weeks; waiting time targets for other assessments to be agreed in Q1 Organisation and business unit targets for clinical Ensure staff participate in clinical supervision supervision to be achieved QIA process in place: on-going monitoring and reporting Further develop outcome reporting across services in all 3 business units established in relation to all service changes Incident investigations completed within the expected Renewed focus on the quality impact assessment process for service change timescales Achieve CQC Good rating Maintain CAMHs waiting times and reduce waiting times for internal onward referrals Develop outcome measures and reporting in 3 services in each Business Unit; Continue to agree, refine and publish staffing models for all services Roll out the refreshed Quality Challenge ensuring service level focus and assurance on CQC standards Progress the move of CAMHs inpatient service Ensure financial resources are in place to All services to complete the revised Quality Challenge self-assessment in Q1; programme of external review and service re-assessment implemented 10

11 2. Consolidate and develop the integrated neighbourhood teams support achievement of this objective. Whilst much of this work is business as usual, specific provision to support the objective is included in the budget proposal. Establish integrated pathways, systems and ways of working supported by team coaching Fully implement the Electronic Patient Record Establish the new shift patterns Start the roll out of the e-rostering system Further develop skill mix in the NT that reflects local needs and supports career progression and recruitment Develop skills and competency training plan for each team based on the skills and competency analysis Ensure financial resources are in place to support achievement of this objective. Whilst much of this work is business as usual, specific provision to support the objective is included in the budget proposals. This includes protecting neighbourhood team budgets from CIPs, providing funds to enable backfill of maternity leave and providing funds for the premium cost of agency staff where their utilisation is necessary. The budget also Electronic Patient Record being used in all teams Establish effective case management: case managers in all clusters actively managing caseloads and handover happening consistently in teams at cluster level Increased patient satisfaction (FFT: 95% of patients recommend LCH care) Improved staff morale for neighbourhood team staff (target TBA) 30% reduction in use of agency staff Improved GP satisfaction with the service 11

12 includes specific investment in continuing roll out of EPR and new investment in an e-rostering system 3. Prepare services expected to be tendered in 16/17 (CAMHs T4, Community Dental, York Street, Healthy Living Services, IAPT, West Yorkshire Police Custody) Agree and implement a tender management resourcing model Services supported with a programme of work to ensure they are tender ready Ensure financial resources are in place to support achievement of this objective. Specific provision to support the objective is included in the budget proposal. Tender management resourcing model agreed and operationalised in Q1 16/17. Complete assessment of all services expected to be tendered in Q1 16/17 Success in retaining business 4. Continue to improve staff engagement and morale Embed the Magnificent 7 behaviours within the appraisal process Implement a staff led plan to address improvements highlighted by 15/16 staff survey Continue with focussed recruitment Ensure financial resources are in place to support achievement of this objective. Much of this work is business as usual but achievement of this objective has influenced decisions on reducing overhead costs in response to losing the adult prison contract. Increase in number of staff reporting that they feel engaged in the organisation and its work (NHS National Staff Survey) Staff that report sickness absence due to work related stress: target maximum 4% (Friends and Family Test). Achieve organisational turnover target: 8-13% Achieve organisational vacancy rate target: 6.8M 12

13 5. Influencing system transformation and new models of care Support the development of new model of care prototypes in each CCG area Support the development of the city s STP Ensure the trust can effectively monitor and evidence the impact of new services and new care models Ensure financial resources are in place to support achievement of this objective. Much of this work is business as usual but achievement of this objective has influenced decisions on reducing overhead costs in response to losing the adult prison contract New care model initiatives commenced in each CCG area building on the neighbourhood model The trust actively engaged in development and implementation Clear plan for learning and sharing from experience Positive feedback from patients and stakeholders 13

14 6. Quality 6.1 Over the past year the Trust has worked hard to ensure that quality is at the heart of everything that we do. We have continued to strengthen our quality governance, deliver on our quality priorities and address the compliance and improvement actions identified by the CQC from their inspection of the Trust in November The Trust s quality strategy has been refreshed. It sets out our programme of work for 2016/17. Delivering the quality strategy will be underpinned by: A relentless drive and focus on quality and continuous quality improvement Continued implementation of the Trust s organisational development strategy, including embedding the Magnificent Seven, a set of behaviours developed over the past year with staff to guide our interactions with each other and with the public. This will inform our appraisal system. A focus on real patient engagement in every aspect of care The promotion of independence and self-management through the use of approaches such as health coaching Improved flow of data to teams and use of team level data including quality boards Development of initiatives to further support a safety culture e.g. introduction of quality huddles 6.3 Outstanding CQC Quality Concerns Significant progress has already been made in addressing the CQC s 2 compliance and 24 improvement actions. We are confident that we will complete the remaining outstanding CQC actions and make the necessary improvements in the coming months to ensure that we achieve a good rating when the CQC reinspects the Trust. The key CQC outstanding actions are: Concluding, jointly with partners, the identification and securing of safe, fit for purpose premises for the CAMHS in-patient service. (compliance action: safe domain) Ensuring safe staffing levels in adult neighbourhood teams. We will maintain the focus on recruitment and retention building on significant success in 14

15 2015/16. We will complete the re-organisation of the Twilight and the Neighbourhood Teams shift pattern review to ensure we have appropriate, safe staffing levels 24 hours a day, 7 days a week. Systems for monitoring daily capacity and demand and escalation based on recognised REAP levels have been strengthened and a standard process embedded. (improvement action: safe domain) Ensuring safe medicines transcribing processes in place - pharmacy technicians have been recruited to transcribe so that nurses only need to do so in exceptional circumstances which will be consistent with national guidance. New ways of working will be embedded in the 1 st quarter of (improvement action: safe domain) Reducing CAMHS waiting times having successfully reduced the maximum waiting time for consultation clinics to 12 weeks the service is now focussed on reducing waiting times for autism assessments (improvement action: responsive domain) 6.4 Quality Improvement The Trust s primary focus is to ensure the foundations are in place to consistently deliver and improve high quality care (as defined by CQC Good and Outstanding ). This needs to underpin quality governance, decision-making and all that we do Key quality improvement initiatives for 2016/17 include our Sign up to Safety targets, our locally agreed CQUINs and quality account priorities, CQC inspection action plan and Quality Challenge action plans. We have drawn on best practice in refining our in-house Quality Challenge a self-assessment framework based on the CQC fundamental standards and key lines of enquiry. This is central to ensuring all services are focussed on achieving and maintaining the standards required to achieve a good or outstanding rating Quality monitoring will be enhanced in 2016/17 by the further development of outcome measures and reporting, development of on-going monitoring and reporting of quality impact assessment of service changes and heat-map reporting. 15

16 6.4.4 The Trust has defined its organisational approach to continuous quality improvement, building on work over recent years. It will be a front-line team / service based approach with a systematic intention to improve outcomes owned and driven by teams and underpinned by measurement. It will align with organisational quality improvement priorities and secure active partnership with service users in designing improvements. In 2016/17 we will continue working with the regional Improvement Academy and the Leeds Institute of Quality Healthcare who have been supporting the neighbourhood teams in their use of data analysis to drive improvements in falls and pressure ulcer reduction. 6.5 Quality Priorities for 2016/ The Trust s key quality priorities for 2016/17, which are aligned to the quality account, are: Ensure we have the right staffing levels, a key focus being the adult neighbourhood teams, building on significant success with recruitment in 2015 and developing further use of capacity and demand management tools and analysis Protect patients from harm by reducing the number of patients who develop a pressure ulcer or have a fall while in our care pressure ulcers and falls being the biggest causes of harm. Our pressure ulcer prevention campaign is focussing initially on the neighbourhood teams and will then be rolled out across all the services. The key aim is for staff to understand their role in pressure ulcer prevention and that it is everybody s responsibility. Improve learning from incidents and complaints across the organisation and timely incident investigation. Develop reporting on outcome measures. Reduce waiting times to improve patient experience. A particular priority is reducing the waiting time for children and young people accessing CAMHS autism assessments. 16

17 Increase the number of returns received each month to bring about an improved level of understanding of patient experience and satisfaction. Demonstrate responsiveness to patient feedback or co-production with service users to change the shape of services and improve patient care. Ensuring staff are effectively supported through appraisal and supervision in their role and development and continually reflecting and learning. An important focus in will be ensuring the quality of appraisals, including embedding the behaviours framework within appraisals. Developing leadership within teams and services, particularly middle managers is a key plank of the organisational development strategy. Behaviours expected of leaders will be identified and shared with staff as part of embedding our behavioural framework, How We Work. The Trust will also review leadership training offered. Experiential learning through projects is a key plank of our approach to leadership development. A significant organisational priority continues to be to strengthen staff engagement and morale. The NHS National Staff Survey and Staff Friends & Family Test (FFT) will continue to help gauge the impact. Continuing to strengthen the way in which we care for our staff and support their health and well-being is a key focus. Ensure we are fully compliant with Duty of Candour requirements which are consistent with our values and commitment to developing an open, transparent and quality focussed culture. 7. Service Plans 7.1 We have a clear vision for our services and what we want to achieve for patients and carers over the 5 year period This clearly positions patients at the centre of everything we do and a commitment to providing and evidencing high quality services: More care closer to home with the development of community based alternatives to hospital and reducing length of stay in hospital. 17

18 Better integrated care with a single point of access for patients and carers. A clear focus on prevention and early intervention to improve health outcomes for patients. Value and use patients as a resource, empowering them to self-manage their own care. Reduce health and social care inequalities particularly for vulnerable groups within the community. Improve emotional health and wellbeing Improve the value and sustainability of services by making them as efficient and effective as possible. The following identifies the high level service plans for 2016/17. More detailed plans have been developed through each of the business units operational plans. 7.2 Integration with Primary Care A significant focus this year will be further developing and consolidating our integrated Neighbourhood Teams as we establish a new structure for the Twilight service, new staffing rosters, roll out the Electronic Patient Record, embed case management roles and responsibilities, develop team leadership and embed integrated and new processes and ways of working including allocation systems We will continue work to develop effective and closer working across the wider team: primary care, social care and mental health workers. The teams will use an intelligence-led approach (there are already mini-jsna profiles for each neighbourhood area) to support a tailored approach to need within a city framework Central to the ethos of the neighbourhood teams is the development of a culture where the service user is seen as truly resourceful and an equal in the clinicianpatient relationship. We want to empower individuals to increase their awareness of their own health and well-being and take greater control of their own health. We are investing in developing health coaching to support the setting of meaningful goals, providing expert information enabling people to make decisions about their own health and well-being. 18

19 7.2.4 We will continue to work with partners on new models of care prototypes in Armley, Beeston, Crossgates and Chapeltown based on a robust understanding of local need and segmented populations. The focus being on: Closer integration with clinicians from Leeds Teaching Hospital Trust and Leeds Partnership Foundation Trust Local leadership and team development Building models of care based on a robust understanding of local need and segmented populations Delegated local budgets and new currencies. The city is one of the national Year of Care Commissioning Early Implementer sites and work is underway to look at developing capitated budgets to test in shadow form. 7.3 Developing child friendly flexible services We will continue implementation of the planned changes in community paediatrics services (ICAN), which includes clinical pathway development, establishing outcome reporting and embedding new processes and ways of working including triage, management of follow-ups and administrative and management support Children s services are committed to optimising waiting times through the use of capacity and demand management tools, a priority being reducing the time children and young people wait for CAMHS autism assessments and other internal onward referrals In 2016/17 we will work with commissioners to make personal budgets available to families of children with complex disabilities accessing therapy services. 7.4 Operational Performance An important priority for the Trust for 2016/17 will be to work with commissioners to review service specifications to ensure that they accurately reflect the totality of activity and where feasible include outcome measures. Significant omissions in 19

20 some services specifications are non-face to face activity and group interventions. This is a particular concern for the neighbourhood teams specification. We have agreed with Commissioners the need to revise some children s services specifications It is important that the Trust addresses concerns about data quality in some services. The Trust will maintain its focus on improving Neighbourhood Team data quality and will increase capacity in business analysis to support this work We will work with commissioners to review aspects of the IAPT service model and potential opportunities to improve productivity in light of a recent report by NHS England. 7.5 Business Retention and Development Ensuring the successful mobilisation of integrated health care service within the children s secure estate across two of our community sites will be an important focus in 2016/17. We will deliver this in partnership with South West Yorkshire Partnership Foundation Trust (SWYPFT) who has significant experience in delivering mental health services in secure and forensic settings A key focus for the Trust will be to ensure the services that we expect to be tendered in 2016/17 are tender ready. These services are: CAMHS In-Patients Community Dental York Street Practice Healthy Living Services and Watch IT IAPT West Yorkshire Police Custody Suite We ensure we have the right capacity and capability do to this, building on our recent learning, by investing in additional bid management resource for the forthcoming 12-month period. 20

21 7.6 Enabling Initiatives The use of technology is a key enabler to support delivery of integrated, quality care and the development of services going forward. We are rolling out the Electronic Patient Record to services. Our priority for 2016/17 is to complete the roll out to our Neighbourhood Teams. This is a key enabler for the future rationalisation of our estate. Work is already underway to refresh our estates strategy in line with citywide work and the recommendations in the Lord Carter review. This will enable a clear plan to be developed setting what we need to do to our estate to increase efficiencies We have completed the first phase of the roll-out of the Leeds Care Record to our Neighbourhood teams and some of our children s services enabling shared access to the patient record and more effective working with primary care, LTHT and LYPFT We have established e-referrals as the primary means of referral for a significant proportion of our services. Having completed a cost-benefit analysis we will not extend this to any further services this coming year. 8. Workforce 8.1 Recruitment and Retention Recruitment and retention will continue to be key enablers in 2016/17 ensuring we have the workforce needed to consistently deliver good quality care and improve further staff morale. This was an area of significant success in 2015/16, with 517 staff permanently joining the organisation between April 2015 and February 2016, a 94% increase on the prior year. In 2016/17 the focus will be on sustaining levels of recruitment to maintain the current low level of vacant posts. Improvements made to the selection process will support continued success with recruitment and build the Trust s reputation as a good employer. 21

22 8.2.2 We have a specific aim to attract and retain a more diverse staff with better representation of younger generations and BME communities and will develop our approach to achieve this with our recently created BME invited network. Our retention strategy and retention plan activities has the following elements: Developing Leadership behaviours - through embedding our behavioural framework, How We Work, in appraisals and all that we do, developing a framework to ensure shared understanding of core line management expectations, one to one and team leadership coaching and support, identifying and developing talent through project or other focussed work Offering more flexible employment terms / benefits, for example o Family: flexible working / retirement, child voucher and salary sacrifice schemes, option to buy extra holidays o Health and wellbeing: priority MKS and mental health referrals, access to mindfulness, coaching, counselling o Travel: car lease scheme, cycle to work scheme, o Discounts Providing clinical and professional leadership and strengthening career development. There has been enthusiastic engagement by nursing and therapy staff about development of an Allied Health Professional and Nursing strategy for professional development. We are exploring opportunities to make clinical careers in the Trust more rewarding as opportunities for roles at more senior levels lessen. Work underway to review training and development currently offered against organisational requirements and development of the Nursing and AHP Strategies 8.2 Establishing the right culture We were pleased to see improvements in our latest (2015) staff survey; the number of staff recommending the trust as a place to work or receive treatment, staff feeling motivated and fewer staff suffering work related stress. There was a slight improvement in the overall score for staff engagement but it was still below 22

23 the average for Community Trusts. Of concern were the percentage of staff who said they did not feel able to make improvements at work, had witnessed a potentially harmful error or near miss and the increase in number of staff who do not have confidence in reporting unsafe clinical practice. We will work with staff in 2016 to develop plans to address issues of concern and build on success. We recognise there is more to be done but the results give us confidence that we are heading in the right direction We will build on good progress made in the past year to continue to build the right culture and will focus on; improving consistency of management and communication to embed a culture where communication is everybody s business and we listen and involve front line staff in everything we do. We will do this through the Leaders Network - a group of 65 senior leaders meeting monthly to discuss key issues and agree actions, the Chief Executive s weekly blog which is widely read, regular engagement of senior staff service visits and attendance at team meetings, developing clinical forums, use of Pulse surveys up in Specialist Business unit and feedback leading to supported action. involving staff in decision making so that actions follow listening activities sustaining staff side relations, an invited network for BME staff, broad membership and activity by the 50 Voices group, and involvement actions within business units. generating positivity and sign-up to the Trust vision and values and future strategy through consistent and frequent conversation about the future for community services through Board member service visits, Community talk (weekly electronic communication and Chief Exec blog) and road shows. Health coaching is an evidence-based approach to develop skill sets in staff which encourages/activates the patient towards agreed goals. This philosophy and approach has been well embraced in order to improve patient outcomes. 6 staff have been trained as in-house trainers with over 100 staff trained as health coaches to use this in their day-to-day work. The Trust is 23

24 committed to further developing use of health coaching across services and in partnership across Leeds health and social economy. The Trust has a coaching strategy which involves coaching as a management support, either offered to individuals (based on 5 sessions with in-house coaches trained to ILM 5 standard), or as team coaching whereby team leaders are encouraged to work in a coaching way with their own team. This has been well spread across clinical and corporate departments. Strengthening staff communication and engagement through revision of our internal communications strategy and further iteration of the 50 voices group. 8.3 Workforce Planning The loss of the adult prison healthcare service results in a reduction in the workforce in 2016/17. As a result of the commissioner s decision not to continue Better Care Fund and resilience schemes in 2016/17 there are a small number of posts that we will redeploy to ensure we retain these highly skilled and valued staff We expect the workforce profile throughout the year to be relatively stable as a result of continuous and steady recruitment, the associated reduction in use of agency staff and there being no pay related CIP schemes. We anticipate a smaller number of newly qualified nurses and Health Visitors joining the Trust upon completion of courses in the Autumn of 2016 than in 2015, as vacancy levels are now lower. We are confident of remaining within the 3% nursing agency ceiling for 2016/17 as a result of: concluding negotiations with suppliers and only using agencies that are compliant with the controls. demand for temporary staff reducing as a result of continued success with recruiting new staff. no longer providing the Adult Prison healthcare service from 1 April 2016 which contributed significantly to agency costs in 2015/16. 24

25 8.3.3 Workforce planning will be enhanced by the procurement and implementation of an e-rostering application for the Trust. This will streamline work around the rostering of staff, provide enhanced management information, improve demand and capacity management both within Neighbourhood Teams and across the city supporting patient safety, clinical effectiveness and increased productivity An important focus for workforce planning will be to work with commissioners and staff to manage the 800k cut in Public Health funding due in 2017/ City-wide workforce transformation The Trust is working with partners across the Leeds Health & Social Care economy to ensure systems are in place to develop a city-wide workforce that meets service users needs. Partner organisations are working to the following outcomes: The workforce is aligned to the design of future health and social care and meets future citywide needs. There is a sustainable and affordable workforce that meets the health and social needs of the population of Leeds. An integrated and shared resourcing approach is in place for the education and training of the health and social current and future workforce Outputs already delivered include a Memorandum of Understanding around mandatory training and the creation of a repository of information about the city s health and care workforce. Analysis of this data is supporting conversations about workforce planning, new models of care in line with the Five Year Forward View and development of new roles. 25

26 9. Financial Plan /17 Summary Financial Plan The budget proposals underpin the delivery of the Trust s priorities and business as usual as expressed in this 2016/17 Operational Plan The budget proposals for 2016/17 have been prepared in line with the financial strategy approved by the Board and set out in the Integrated Business Plan submitted to the TDA in June Whilst the financial principles remain consistent, the actual figures have been updated to reflect the prevailing inflation expectations, guidance on contract inflators and known changes in costs As a result of contract expectations, prudent financial management and realistic service plans the Trust can expect to achieve a 1% operating surplus of 1.5m in line with the financial strategy For 2016/17 the TDA have set a control total surplus for the Trust of 2.0m. When the draft plan was submitted to the TDA in early February the Board was not in a position to accept the control total. On the basis of current assumptions the Trust can only achieve the control total surplus of 2.0m on the condition that it receives 0.5m contribution from Commissioners towards the 900k increase in LIFT charges levied by Community Health Partnerships At the time of writing the contract negotiations have yet to conclude. The plan has been prepared on the expected outcome of this process. At the Board meeting we will consider downside plans if the income levels are not as assumed in this paper. 26

27 9.1.6 The summary income and expenditure budget is as follows: Income & Expenditure Summary Annual Plan Income Contract Income (135.8) CCG Income contribution to LIFT (0.5) Other Income (5.7) Total Income (142.0) Expenditure Pay Non pay 34.4 Total Expenditure EBITDA (4.5) Depreciation 1.8 Public Dividend Capital 0.7 Interest Received (0.0) Retained Net Surplus (2.0) m Capital expenditure plans total 3.15m These budget proposals deliver a Financial Sustainability Risk Rating (FSRR) of 4, the maximum, across the accounting period. 9.2 Income 2016/17 Detailed Financial Plan Total income assumed for the Trust for 2016/17 is: Income Summary Annual Plan m Contract Income (135.8) CCG Income contribution to LIFT (0.5) Other Income (5.7) Total Income (142.0) The national guidance for NHS commissioners includes a net tariff uplift of 1.1%, comprising a 3.1% cost increase assumption and 2% cost improvement 27

28 expectation. In line with this the Leeds CCGs have proposed a 1.1% inflator to the recurrent block contract baseline The Leeds CCGs are proposing the contract for 2016/17 contains a risk reserve in respect of non-delivery of contract activity. This would put additional financial risk on the Trust as the total value of block contract income would only be achieved if the activity was delivered. The Trust continues to negotiate on this matter This budget does not include any income (or costs) for system resilience of Better Care Fund schemes CQUIN income of 2.5% of contract income has been included in the planned CCGs contract. The budget assumes that the CQUINs will be achieved at no cost to the Trust. National CQUINs guidance for 2016/17 has recently been published. No CQUIN targets, local or national, have yet been agreed with Commissioners The Leeds CCGs contract for 2016/17 has yet to be signed; the deadline is 31 March This may not be achieved given the number of issues still to be resolved The NHS Commissioning Board NHS England Local Area Teams commission services over five distinct service lines; CAMHS inpatient services, Public Health, Community Dental services, Young Offender Health services and primary care services for homeless people, asylum seekers and refugees. All the contracts have had the 1.1% inflator applied in the planning assumptions. The Commissioners have yet to agree all of these contracts. The only area of dispute at this time is around the 1.1% uplift for the Young Offender contract that the Trust successfully bid for during 2015/16. The deadline for the signing of these contracts is also 31 March The planned income from the four police custody is as per the tendered sums Local Authority contracts are still being negotiated. These include; 1.3m for the Leeds Equipment Service; 28

29 2.1m for South Leeds Independence Centre; 10.0m for Public Health services (after a cut of 0.3m); this includes the contract for sexual health services; 10.0m for health visiting and FNP services; 9.3 Expenditure Material changes to planned rolled forward pay expenditure include: Reduction to the pay costs baseline in respect of incremental drift of 0.5m; this is as a result of staff turnover. Pay award at 1.0m. Increased employer s national insurance costs, of 2.0m Planned pay costs assume an in year saving of 6.8m for vacancies. This represents a 6.25% vacancy factor. In 2015/16 this was 3.6m and has been increased in respect of the 2016/17 CIPs. Current turnover is circa 10%. This approach to CIP delivery is a significant financial risk which will require active local management and close monitoring m is included in the plan for inflation on non-pay expenditure; this is derived from the national inflation assumptions as applied to the Trust s expenditure profile. Of this 0.4m is required to contribute towards the efficiency savings During 2015/ m of service review savings and 0.45m of estates savings were not delivered recurrently. These have been added back to the appropriate budget baselines New expenditure proposals are made in the context of the need to ensure delivery of the Trust s priorities as detailed in the Operational Plan and manage cost pressures for 2016/17. Budgetary provision has been made for the for the following unavoidable cost increases: 0.9m LIFT building rents. 0.5m SystmOne IT licences. 0.35m IT support contract. 29

30 0.13m for Enteral feeds volume and practice changes due to safety alert The budget also provides for two key strategic investments: 0.34m continued roll out of the Electronic Patient Record 0.3m e-rostering project 9.4 Cost Improvement Programme (CIP) and Other Planned Savings The need to deliver cost improvement programmes will continue to be a significant challenge for the Trust next year and beyond. Efficiency plans are monitored throughout the year and revised annually. In addition to the planned efficiency savings the Trust needs to reduce its corporate overheads by 0.8m in respect of the loss of contribution from the loss of the adult prisons and a further cost reduction of 0.3m for Public Health services which have been decommissioned The efficiency expectation nationally for 2016/17 is 2.0%. The Trust s plans require CIP savings of 2.7% or 3.9m The table below details the planned recurrent CIP savings for 2016/17. Cost Efficiency Savings 2016/17 Annual Plan m Increase in vacancy factor Drugs Inflation Other non pay inflation Estate Maintence Contract (procurement savings) Travel costs Total Cost Efficiency Savings Confidence of delivery The most significant savings relate to the planned increase in the vacancy factor. This represents a recurrent savings that is delivered non-recurrently each year by the reduction in costs as a result of recruitment lag Non pay inflation savings will be delivered directly from the inflation reserve and will not require actions from budget holders. 30

31 9.4.6 The new estates facilities management contract is expected to yield a saving of 158k There is a significant underspending in respect of travel costs as a result of the national changes to the re-imbursement rates. It is proposed this is removed from budgets in 2016/17 to deliver this saving. 9.5 Contingency The Trust has released all of its contingency and other reserves in delivering this financial plan. This is the first time the Trust will have set a plan without a contingency reserve and will necessitate tighter financial management to mitigate the additional risk this poses. 9.6 Capital The Department of Health has informed all Trusts that permission to spend capital in 2016/17 on for the foreseeable future will be severely restricted During 2015/16 the Trust slipped 0.785m capital expenditure on estates refurbishment and equipment at the request of the TDA to support the national position. The Trust has been guaranteed that it will get permission to spend capital to this value in 2016/ The Integrated Business Plan states that the Board has set capital expenditure at 1.2m being the average depreciation charges over the period. This budget proposal report proposes no change from that strategy resulting in a capital budget of 1.2m for routine minor capital with a notional split 0.7m for estate maintenance and 0.5m for equipment. Detailed plans for this resource will be drawn up in year once the Trust has received notification of its capital resource limit The continued roll out of the electronic patient record will require a further 1.2m capital investment. 31