Our Strategy 2016 to 2021
Introduction The changing health system This document describes Norfolk and Suffolk NHS Foundation Trust s five year strategy. It incorporates input gathered from engagement events with staff, service users, carers, stakeholders, commissioners and regulators throughout 2015. All NHS organisations work within a larger health community; this is the group of acute hospitals, primary care services, GPs, social care and commissioners who work as a system to deliver health and social care to their local populations. We are clear that we need to deliver quality driven mental health services; embedded through an organisational culture of continuous improvement and co-production. This must be underpinned by an engaged workforce, financial sustainability and our shared values: positively, respectfully, together. To realise this, our strategy has three core goals: 1. Improving quality and achieving financial sustainability 2. Working as One Trust 3. Focussing on prevention, early intervention and promoting Recovery. These support our mission to be a champion for positive mental health, by providing safe, effective, trusted services together with our partners. This document explains how and what we will be doing over the next five years to achieve this clear ambition. L ike the wider health and social care community, our Trust faces long-term challenges, often outside of our control. Demand for our services continues to increase, whilst our funding declines. While we must control our own costs, we recognise that parity of esteem is yet to be reflected in parity of resources. Our Board will continue to campaign to improve this position. Though our strategy is driven by quality rather than finance, we are currently running at a financial deficit. We spend more on delivering services than we receive from commissioners; this is unsustainable and services must be delivered within our means. Nationally, the NHS is responding to the Five Year Forward View, the NHS blueprint for the future. This acknowledges that to meet the challenges around demand, efficiency and funding we must operate differently as organisations; working collaboratively and openly within the wider health community. National guidance requires local health community leaders to work together to create five-year Sustainability and Transformation Plans (STPs) to achieve this. In support of the Five Year Forward View an independent mental health taskforce was commissioned to report specifically on the transformation needed in mental health services. It acknowledges that the NHS often treats minds and bodies separately and that mental health services have been underfunded for decades. It makes recommendations for the NHS to achieve the ambition of parity of esteem between mental and physical health, including prevention, early intervention, access to crisis care and better integration of mental and physical health care with particular emphasis on tackling inequalities. It also indicates additional funding in the years to come. Gary Page Chair Michael Scott Chief Executive NSFT Trust Strategy 2016-2021 3
...so that parity of esteem for mental health is achieved and people s needs are recognised and addressed as a whole... The Five Year Forward View also describes options for future care models. Our preferred model for the local health system is as a Multispeciality Community Provider (MCP). In this model, mental health, community and social care services would wrap around GP practices, breaking down the boundaries between providers and transforming the way people receive care in their communities and reducing hospital admissions. We will explore the opportunities for creating MCPs with our wider health community as we collectively develop our local Sustainability and Transformation Plans. This locality based integration would place mental health at the centre of local care, giving better access to physical healthcare for our service users and to mental health care for the wider population. Within our wider health system our Clinical Commissioning Groups (CCGs) and Local Authorities are working to develop Integrated Care Organisations, which bring services from different organisations together around patients and their carers to reduce the need for hospital admissions. In addition, Norfolk and Suffolk County Councils have expressed interest in taking devolved responsibility from central government which, if successful, could have implications for the health budgets for Norfolk and / or Suffolk. Our Trust will play a central part in this transformation of health and social care in Norfolk and Suffolk. Pursuing the integration of mental and physical health services will help enable parity of esteem for mental health; ensuring people s needs are recognised and addressed as a whole, and making no health without mental health a reality. Local demand for services Over recent years we have seen a sustained increase in demand for our services across all age groups throughout Norfolk and Suffolk. Over the next ten years Norfolk and Suffolk will have fewer people under 45 and more people over 60 than the national average. T he two counties already have amongst the highest proportions of people aged over 75 in the UK and this is set to continue and increase over the lifetime of this strategy. This will mean greater demand for later life services and increased co-morbidity with over the next 10 years... fewer people under 45yrs old long-term physical health conditions. We are now planning services to meet this demand; however, for our Trust and the NHS as a whole to remain sustainable we must focus on keeping people mentally and physically well at a much earlier age. more people over 60yrs old NSFT Trust Strategy 2016-2021 5
2 Working as One Trust Our strategy for local mental health services Our over-arching vision is to work together for better mental health. We are putting Recovery at the heart of what we do and, for us, Recovery means people living the best life they can, with or without a mental health condition. This means we will: Work together as one organisation, for better, sustainable mental health services, realising the benefits of our merger Embed our values and behaviours across all our services, and measure ourselves against them Give clear accountability and responsibility to our staff throughout the organisation via our operating model Play a central role in the system-wide response to local health and social care challenges, increasing our collaborative working with other agencies To achieve this we will: Implement Trust-wide clinical models wherever it is possible, that are needs-led and flexed to local commissioning arrangements Reflect our values and behaviours in everything we do Share performance information with our staff and hold people to account for delivery Work together, sharing best practice and learning across the organisation, and with the wider health community Develop strategic partnerships, where appropriate, to deliver effective and sustainable services within our county boundaries and beyond 1 Listening to our staff, service users, carers and stakeholders, we know we need to be clear about our strategy to achieve this, which we will do through delivering our three core strategic goals. The following explains what they mean for our Trust. Improving quality and achieving financial sustainability This means we will: Deliver trusted, effective, quality-driven services Support and empower our staff to be the best they can in delivering services which are trusted and valued by local people Involve service users and carers in development and decisions about the care and support they can access Staff services safely to make sure we have time to care Ensure accountability and responsibility sits at the right level, so business and clinical decisions are made quickly and effectively Become financially sustainable; delivering services within our means To achieve this we will: Embed a continuous quality improvement culture Lobby for appropriate funding for mental health services Embed our service user and carer involvement strategy Develop our leadership and management capability Employ and retain a skilled and responsive workforce Implement our cost improvement programmes and effectively manage our budgets Only deliver services where we are appropriately funded to do so 3 Focusing on prevention, early intervention and promoting Recovery This means we will: Increase our focus on primary care and prevention, whilst providing good quality in patient care for those who need it Continue to positively promote Implementing Recovery through Organisational Change (ImROC) principles Reflect local needs and deliver improved outcomes for our population Seek integration, across Norfolk and Suffolk, with primary care, local authorities and other providers To achieve this we will: Develop evidence-based clinical strategies for each service; co-produced with service users, carers and commissioners, which improve outcomes Balance NICE and other national guidance with local commissioning priorities and funding Adopt Lean-based processes to underpin the delivery of needs-led pathways, and identify and address clinical improvement opportunities Maximise face-to-face clinical time, supported by more efficient ways of working and technology Centralise services where it is not possible to deliver them safely and sustainably at a local level Work with other agencies to keep people well and to support Recovery NSFT Trust Strategy 2016-2021 7
...person-centred, co-ordinated care... One Clinical Strategy We are engaging our clinicians, service users, partners and commissioners in developing a Trust-wide clinical strategy of core pathways and packages of care which incorporate best practice and guidance. Pathways will reflect what is needed and valued by our service users, in order to achieve more consistent outcomes, increased choice and improved patient experience regardless of location. T hrough this we will continue our commitment to Implementing Recovery through Organisational Change (ImROC). This focuses on helping people who use our services find ways to lead meaningful lives, with or without ongoing symptoms of their condition; where more people receive care which is, as far as possible, self-directed and reflects their own preferred goals and outcomes. We will work in partnership with carers, adopting Triangle of Care principles across the Trust; valuing and supporting them so that service users receive the best possible care. In developing this model we will work with the wider health and social care system to integrate mental health care into their services to meet people s health needs in a person-centred, co-ordinated way, reducing duplication and improving people s experience and outcomes. This means: To deliver quality services we require the right level of funding and resources. Where evidence shows an investment in enhanced pathways creates greater savings elsewhere in the local health and social care system, agreement on appropriate funding will be sought from commissioners. This means: Service users will be seen in a timely manner by the person with the right skills first time. They will be listened to and their needs understood from the beginning of their care. There will be fewer repeated assessments. Care plans will be developed with service users and their carers to meet their needs in a co-ordinated manner The core pathways will be sufficiently flexible to accommodate the local needs and requirements of each CCG and their population. For example, a CCG with a largely rural population and a higher proportion of older people may have different requirements to a more urban CCG. The standard pathways may require locally agreed enhancements to reflect this Local delivery will evolve over the lifetime of this strategy, reflecting the local response to the Five Year Forward View, increased integration between providers and new delivery models The importance of meeting service users physical health needs and accessibility for people with learning disabilities will be reflected in all pathways Quality will be more easily maintained and monitored, with clarity for staff and more efficient use of resources Where we are providing a clinical service which has not been commissioned, this will not continue unless appropriately funded Where pathways cannot be developed that are safe and effective within the allocated budget, despite every effort, we will seek appropriate funding from commissioners or agree alternative interventions. In the event that this is not achievable, we will reserve the right to give notice on this element of our contract, rather than deliver them at the cost of other services or put our service users or staff at risk The clinical strategy will make best use of the available resources, requiring changes to practice to increase service user contact time for clinical staff. This will be supported by better use of technology and greater integration with the wider health system The long-term use of temporary staff is neither financially sustainable nor conducive to team working and continuity of care. Where it has proven impossible to recruit to vacancies for an extended period, safe alternative means of delivery will be identified, tested and implemented This work will be led by senior clinicians and operational managers working collaboratively with service users, carers and commissioners and be delivered and embedded over the lifetime of this strategy. NSFT Trust Strategy 2016-2021 9
Workforce and Organisational Development Strategy: Putting People First We have a workforce that has been commended for the care of our service users. We value and are proud of the commitment and contribution of every member of staff and want our staff to be equally proud to work for our Trust. We want staff to feel fulfilled, treated fairly and valued in their roles, recognised for the important contribution they make every day and engaged in positively shaping the services they provide and the culture of the environment they work in. Our model shown below illustrates organisational development through our workforce and forms the basis of our Workforce and Organisational Development Strategy 2016 2021: Putting People First. It reflects the strong evidence base linking excellent workforce capability with excellent organisational capability and higher levels of staff experience with higher levels of patient experience. We believe that if we can develop our staff to be the best they can be within a supportive but accountable leadership culture, wider organisational improvements will follow. The focus of how we achieve this is based on developing a more engaged, skilled, and responsive workforce, operating within a supporting infrastructure of effective systems and processes. Therefore, the three core domains of the Workforce and Organisational Development Strategy are: An engaged workforce A skilled workforce A responsive workforce The pillars represent the enabling strategies underpinning delivery. The model also highlights the fundamental importance of developing a culture of equality, diversity and inclusion, which wraps around all three domains. This will positively impact on the culture of the organisation and improve its effectiveness and quality by: Embedding the operating model with clarity on leadership roles and responsibilities Developing a culture that necessitates the taking of responsibility with clear consequences for non-delivery Trust objectives being cascaded from the Board down into the individual objectives of every employee in a timely way Developing an ethos of learning from challenges and mistakes; creating new solutions and sharing knowledge Minimising bureaucracy and maximising attention on what adds value Using systems and data to drive quality and efficiency improvements Using data to measure impact Supporting the development of a culture that is supportive, cohesive and positive where every employee lives and operates by our values Honest and timely communications Whilst recognising the existing and emerging challenges we face, through delivery of our Workforce and Organisational Development Strategy we will create a sustainable and thriving organisation with an excellent reputation for high quality patient care; delivered by a proud workforce, who positively shape our services and culture. Organisational Capability...supporting our staff to be the best they can be Leadership and Management Engaged workforce Vision, Values and Behaviours Staff Wellbeing Staff Recognition Patient Experience Equality, Diversity and Inclusion Skilled workforce Recruitment, Reward and Retention Workforce Planning Education, Training and Development Talent and Succession Planning New Roles and Career Pathways Equality, Diversity and Inclusion Staff Experience Organisational and Role Design Responsive workforce E-Rostering Temporary Staffing Electronic Staff Record Volunteer Workforce Our values and behaviours: Positively... Respectfully... Together... Our values were created by 1,300 staff members, service users and carers, and reflect what we believe makes the most positive difference to the care we offer Our values mean we will all: Involve people Support people to set and achieve goals Be professional Recognise people Keep people updated Value everyone Have two-way conversations Step into others shoes and the way we work. They underpin our strategic planning, all we do and how we behave within the Trust and with our service users, carers and stakeholders. Speak up Take time to care Be proactive Share knowledge and learning Take pride Be effective Take responsibility Workforce Capability NSFT Trust Strategy 2016-2021 11
How we will deliver this locally Involving service users and carers Our operating model provides a framework for the management, governance and delivery of all our services. For clinical services this is delivered through a locality manager, modern matron and lead clinician(s) working as a team to manage services locally. Modern Matron Locality Manager Lead Clinician In October 2015 we launched our service user and carer strategy Improving Services Together. Co-produced with service users and carers, it brings together six commitments designed to ensure people can positively engage with the Trust and have a say in the way services are developed. Its aim is to ensure the same standards of excellence are in place across all services and localities. We will embed these commitments over the lifetime of the strategy through our annual operational plans and individual objectives. 6Our model has six objectives: 1. Simplify and standardise structures 2. Specify responsibilities so lines of accountability are easily visible 3. Align governance and support structures to provide effective support to front line services 4. Strengthen how Trust objectives are cascaded to align everyone s efforts 5. Strengthen how issues are escalated for additional support or intervention 6. Support devolved / earned autonomy by providing a risk-responsive assurance system that encourages innovation and safeguards against quality failure The lead clinician sets the clinical direction with the modern matron monitoring and promoting practice standards; led by the locality manager who ensures resources are available and wellmanaged. Whilst these three roles have distinct responsibilities they work together to ensure the delivery of strategy, quality care, staff engagement, financial balance, stakeholder management and contract requirements. They are supported by corporate team members, including HR business partners, management accountants, and the governance team. Our specialist and corporate services are also managed, governed and delivered using these six operating model objectives. 6The six commitments are: 1. Service users and carers will be able to have their say in Trust business 2. There will be opportunities for service users and carers to use their skills and experiences to improve services 3. We are changing the way we provide our services in line with our commitment to organisational change 4. We will strengthen links and create partnerships with other agencies and service user and carer-led organisations 5. We will reach out to diverse and other under-represented groups 6. Service users and carers will judge whether this strategy is being delivered NSFT Trust Strategy 2016-2021 13
How our strategy fits together Transforming care through technology Our aim is to give staff the skills and tools to work smarter and spend more time delivering care. What this means to me How we all deliver this locally My objectives Locality and service plans Trust operational plan Reviewed yearly Our focus is to provide a robust, responsive infrastructure and support service to all our staff through effective technology solutions which support clinical care. We know that through technology we can improve service delivery, increase face to face contacts and better support our service users and their carers. Our technology strategy will be developed in partnership with our service users, carers and clinicians and as part of the digital road maps all NHS providers are developing. Initiatives include: Using Skype so we can talk to each other and our service users (where appropriate) across counties, saving travelling time Sending service users and GPs instant and up-to-date electronic communication on progress and decisions, keeping people involved and informed about their care and progress to support safety and quality Ensuring our single electronic patient record fully supports clinical decisions and care, keeping everyone involved in a service users care informed Safely sharing information with other health providers, so we support people, whenever they need it and wherever they are, through having the right information How and what we will do to deliver our strategy Our over-arching plan and goals to achieve our mission Supporting strategies Clinical, workforce and organisational development, service user and carers, technology, estates Five-year Trust strategy 1. Improving quality and achieving financial sustainability 2. Working as One Trust 3. Focusing on prevention, early intervention and promoting Recovery Reviewed every 3-5 years Consolidating our estates How we all act with each other, our service users and carers Our values and behaviours Positively, respectfully, together Revisited every 6-10 years Effective estates management plays an important role in providing quality care and our estates strategy will be developed and delivered alongside our clinical strategy. As part of our commitment to the national Sign up to Safety campaign, a fundamental principle for all our estate is to provide an environment that reduces the risk of harm. As part of this our focus remains on reducing the number of costly and / or unsuitable sites and developing health campuses; where possible, in partnership with other agencies. We will also play a key role with other health and public sector groups on the sharing of accommodation and working towards one public estate. April 2016. NSFT. Leaflet code: 16/015. Review date: April 2021. GFX: 4125 Our future why we come to work Our purpose what we want to achieve for everyone Our vision Working together for better mental health Our mission To be a champion for positive mental health, by providing safe, effective, trusted services together with our partners Doesn t change NSFT Trust Strategy 2016-2021 15
Patient Advice and Liaison Service (PALS) NSFT PALS provides confidential advice, information and support, helping you to answer any questions you have about our services or about any health matters. If you would like this leaflet in large print, audio, Braille, alternative format or a different language, please contact PALS and we will do our best to help. Email: PALS@nsft.nhs.uk or call PALS Freephone 0800 279 7257 Trust Headquarters: Hellesdon Hospital Drayton High Road Norwich NR6 5BE 01603 421421 nsft.nhs.uk @NSFTtweets NSFTrust Norfolk and Suffolk NHS Foundation Trust values and celebrates the diversity of all the communities we serve. We are fully committed to ensuring that all people have equality of opportunity to access our service, irrespective of their age, gender, ethnicity, race, disability, religion or belief, sexual orientation, marital or civil partnership or social and economic status.