Summary Operational Plan Pennine Care NHS Foundation Trust (Pennine Care)

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1 Summary Operational Plan Pennine Care NHS Foundation Trust (Pennine Care) 1

2 1.0 Pennine Care s approach 2016/17 Pennine Care believes that adopting a whole person care approach will allow the organisation to to drive service transformation at pace and scale, meeting the care and financial challenges ahead. Pennine Care s core purpose is to help communities to live healthy lives, acting with integrity and upholding our values. It means we will place the needs of patients and people at the heart of our service planning, working with local stakeholders to develop bespoke, place-based service offers that meet the needs of the six localities that we serve. Whole person care involves designing services in a way that provides holistic assessment and treatment, encompassing physical, mental and social health and wellbeing. It will help to improve quality of care, reduce fragmentation and duplication and have greater focus on prevention and recovery. In support of this, Pennine Care s overarching vision is to deliver the best care to patients, people and families in our local communities, by working effectively with partners to help people to live well. We believe that the best type of care for the majority of patients is provided outside hospital wherever possible, placing the person and their own home as a central part of future service delivery. If providers can begin to manage demand better, they can start to edge upstream and towards more preventative models of care. Our mission is to be the leading provider of whole person care across Greater Manchester, shifting more care into the community. We will achieve this through our refreshed strategic goals and supporting objectives for 2016/17:- 1. Put local people and communities first; 2. Provide high quality whole person care; 3. Deliver safe and sustainable services; 4. Be a valued partner; 5. Be a great place to work. This plan sets out Pennine Care s approach to progress our transformation programme in line with the Five Year Forward View and the local system s Sustainability and Transformation Plan (STP), whilst also continuing to deliver quality, financially viable services in line with the annual requirements set out by our local commissioning colleagues. 2

3 2.0 Approach to activity planning 2.1 Activity plans 2016/17 In developing our activity plan for 2016/17, Pennine Care has been influenced by the following: Commissioning requirements Pennine Care has developed its assumptions based on the specified commissioner contractual requirements for 2016/17. We are currently commissioned on a block contract basis across 15 CCGs, 6 Local Authorities, a range of NHS England contracts and associated contracts. A number of these contracts include indicative activity targets, against which performance is monitored. These are discussed and agreed as part of the annual contract negotiation process and monitored throughout the contract lifetime via a number of Contract Governance Forums. As part of recent contracting discussions with commissioning colleagues, there has been no indication that there will be any significant changes to contracted activity. Consequently, the plan has been forecast based on current levels of activity for 2015/16. These assumptions are routinely monitored and adjusted in line with commissioner intentions, contract variations and tenders. Trust contracts Unfortunately during 2015/16 we have failed to retain a number of services as a result of formal procurement exercises. This will impact on the contractual position of the organisation with a number of our commissioners, both CCGs and Local Authorities. While we are aware that a number of procurement activities for current service provision will occur during 2016/17, Pennine Care has modelled an up-side position of service retention. Current planning considerations While we have a large scale programme in place to review our mental health strategy a number of options are being developed. This work stream will form part of the refresh of the organisation s Strategic Plan, which is scheduled to conclude in July Therefore, in developing the activity plan, the assumption that occupied bed days will remain static during 2016/17 has been adopted. 2.2 Capacity and Demand As an organisation, capacity and demand has become a regular part of performance assessment. On a monthly basis our service line reports provide information on staffing levels and activity, from which services are asked to identify any specific capacity and/or demand issues. Where concerns are raised over capacity and demand, the organisation has developed a suite of tools to support more in-depth analysis. These include historic data analysis, use of Statistical Process Control 3

4 Charts, pathway analysis or a review of staffing. We have also developed a robust process that will support a much larger piece of capacity and demand work when required. The process combines outputs from the tools defined, to provide an insight into the relationships between staffing configuration, current activity and service demand. This intelligence is then used as evidence for service redesign to reduce demand or improve utilisation of staff, or on some occasions as a case for increasing capacity. Moving forward, demand and capacity modelling is taken place with commissioners, utilising national tools where available and developing local solutions where required. Pennine Care is currently undertaking work to un-pick its block contracting arrangements with commissioners. This involves working with CCGs/Local Authorities to identify if resources are allocated appropriately to meet demand. This will encompass areas where we are seeing growth in demand. As an organisation, Pennine Care is committed to looking at new ways to deliver care, including working with third sector agencies to support increased capacity. Partnership approaches form a key part of our commercial strategy and while this is currently limited in terms of contractual arrangements, the organisation has some defined examples (for example, a contract with Age UK Oldham to deliver specified service elements) to build upon. In summary, based on the current activity planning assumptions, as identified above, the Trust has a high degree of confidence that sufficient capacity is in place to deliver on the plan. 2.3 Key operational standards There are no identified risks to Pennine Care maintaining its adherence to the applicable key operational standards. This specifically relates to the referral to treatment performance targets for our consultant-led pathways (Audiology and Community Paediatrics) and diagnostic waiting times for Audiology. 2.4 System resilience During 2015/16, a number of system resilience schemes have been put into operation, including additional capacity for community teams (including our Children s Community Nursing Teams and rapid response service) and our liaison psychiatry model (RAID) as well as additional bed capacity (5 beds, Bury) to support a discharge to assess initiative. Discussions continue with commissioners across our footprint as to whether system resilience schemes will continue into 2016/17. Some schemes (Children s Navigator, Bury) will continue on a short term basis (to June 2016). In Oldham Community Services, the schemes will be rolled into April 2016 for review and evaluation pending ongoing investment or the identification of alternative provision. Any known activity has been modelled into the supporting activity submission. 4

5 2.5 Managing unplanned changes in demand In the event of a significant shift in demand, services can call upon Pennine Care s clinical and non-clinical temporary workforce, if additional capacity is required. This well-established temporary workforce covers all staff groups and represents the diverse range of professional staff Pennine Care employs. Pennine Care has recently invested in a full review of the temporary workforce, and its supporting systems and processes, to ensure it can continue to respond effectively and efficiently to unplanned staffing requirements. Pennine Care also has several NHS Framework agreements with employment agencies in place, whose workers form part of the wider flexible workforce. Pennine Care operates across a wide and diverse geographical area and so has in place a large internal network of clinical and professional leads, who are able to be deployed to respond to changes in demand in a particular location/service as required. 3.0 Approach to quality planning 3.1 Approach to quality improvement Effective quality governance continues to underpin all existing service delivery and improvement. Pennine Care s newly refreshed Quality Strategy describes the Trust s approach to quality improvement. The purpose of the strategy is to act as a framework of accountability, outlining the direction planned to achieve quality excellence in relation to:- Patient Safety; Patient Experience; Clinical Effectiveness. The strategy has been developed by working closely with service users, their carers, commissioners and local stakeholders to ascertain the priorities for those who use our services, in a co-produced manner, via our Spotlight on Quality engagement event held in February Pennine Care s strategy promotes our approach to providing safe, high quality care by measurement against the five key questions in the CQC inspection process. Our methodology is outlined in the project plan Countdown to CQC. This will provide a Trust-wide benchmark against the expected standards with targeted improvement plans for services. This methodology will be the organisation s framework for quality improvement, along with the Trust s strategic quality aim and objectives. The key aim of the strategy is to set the direction for further development and implementation of quality care delivered by Pennine Care over We will do this by implementing set objectives with implementation plans reporting to the Trust s Quality Group and reporting by exception to the Performance and Quality Assurance Committee. 5

6 Dr Ticehurst, Medical Director, has the lead role for quality meetings and committees within the Trust, in the capacity as Chair of the Quality Group. The new reporting structures, developed and implemented during 2015/16, have seen greater connection between quality and performance across all of the organisation s six Divisional Business Units (DBUs). See Section 3.4 below. Additionally, the Trust Board provide scrutiny on quality indicators as a routine part of the monthly Board meeting. The governance structures will be the framework for the Quality Strategy assuring delivery of high quality care, promoting an open and fair culture, in line with the requirements of the CQC s Well-led Key Line of Enquiry. Pennine Care s Patient Experience Strategy will underpin the work to ensure service users and their carers feedback influences service improvement. Our Quality Account contains the mandated quality sets that measure our performance against key national priorities and core standards, and articulates our quality priorities, as follows:- Sign up to Safety, including falls prevention; safe discharge transfer and leave; reducing hospital and community acquired avoidable pressure ulcers; and reducing omitted and delayed medications; Suicide Prevention; Collaborative Care Planning. These priorities have been finalised following consultation at the quality engagement event ( Spotlight on Quality ), discussion at the Council of Governors, debate at the Quality Group and approval by the Board of Directors. The quality priorities will be monitored via progress reports to the Pennine Care s Quality Group with exception reporting to the Performance and Quality Assurance Committee. Pennine Care is to be formally inspected by the CQC in June We remain in Band 4 of the CQC priority banding, which is the lowest risk. The CQC regularly publish their intelligence monitoring report; this has continued to record minimal risk for Pennine Care. Following the publication of the Mazar s Report (Independent review of death of people with Learning Disability or Mental Health problems in contact with Southern Health) and in line with NHS England s new Serious Untoward Incidents framework (March 15), Pennine Care has reviewed governance systems and processes relating to deaths of service users and subsequent investigations. Pennine Care has established a Mortality Review Panel and will commit to participate in the associated work regarding avoidable deaths. Pennine Care can provide assurance that the recommendations in the Academy of Medical Royal Colleges 2014 report Guidance for taking responsibility: accountable clinicians and informed patients have been fully implemented. 6

7 3.2 Seven Day Services Our mental health services provide a seven day a week service, delivered through our Access and Crisis and RAID (liaison psychiatry) frameworks. These cover all ages at the point of access for service users who are either new to the service and require assessment, or are known to the service and experiencing a crisis or need support. These services have full access to junior and senior medical practitioners to support their risk assessments and decision making processes. The service is 24/7 and is further enhanced by the delivery of the street triage scheme and helpline systems. This ensures emergency services and service users/carers that require help at any day or time, have immediate access to a trained practitioner who will be able to provide appropriate advice and support. Within our community services, we continue to work with commissioners to improve our out of hospital care offer, working in partnership with local stakeholders to improve integration and patient care. Ways in which we currently deliver on the out of hospital offer seven days a week include:- Adult Community Nursing service (24/7) supporting people to be cared for in their own homes, preventing admissions and facilitating discharge; Community therapists in A&E - reducing inappropriate admissions, supporting timely discharge and follow up in the community; Intermediate care and enhanced intermediate care services (24/7) - strong partnership with social care staff based on site, facilitating effective packages of support in the community, including community IV services preventing hospital admission; Hospice Helpline (24/7) - for patients/carers and professionals, provides support and signposting to relevant agencies; Children's Community Nursing Team for children with acute, chronic, complex and palliative needs. This helps to reduce secondary care attendances, acute in-reach and increase discharges into the community; Homeward Bound Initiative - supporting medically fit patients in the acute setting back home by the introduction of a seven day pathway (including seven day admissions to intermediate care). This is being managed with a small additional investment from system resilience funding. Plans for 2016/17 We continue to work with our commissioning colleagues and local partners to understand how Pennine Care can support the ambition for extended healthcare provision to ensure all service users, regardless of age and need, will have their needs met despite the day or time these are presented. Easy Access is a core principle of service delivery and ongoing service development/improvement processes. Services are constantly looking to improve access opportunities, and this includes trialling extended service offers i.e. evening and weekend provision. This is embedded within the individual business plans of our Divisional Business Units and Clinical Business Units for 2016/17. Any change of this manner is always undertaken based on engagement and feedback from users of the service and other key stakeholders. 7

8 As part of the ongoing competitive tendering requirements, we are finding that extended provision is a common feature of new service specifications. Redesigned service models are developed in accordance with these requirements e.g. we have recently retained the Trafford MSK service via a competitive tendering process. This will have an extended access model, including weekend provision. In mental health, we are active participants in the Greater Manchester Child and Adolescent Mental Health Service (CAMHS) forum and one of our senior managers is currently leading a work stream for crisis support and 24/7 care for under-16s. This work stream has recently been initiated with a clear project plan in place, however, it is envisaged that the work will span a 6-12 months period before any changes to provision are realised. This will focus attention on the tailoring of services to under-16 year olds, enabling services to be more responsive. Additionally within our CAMHS service we will be mobilising two new services during 2016/17 a community eating disorders service across all our six key boroughs, with seven day access, and an emotional health and wellbeing service for children and young people in Heywood, Middleton and Rochdale which will also be modelled across seven days. In our Oldham borough, we are currently working as part of a formal alliance to develop a comprehensive urgent care offer with a paediatric programme budget approach across all acute paediatric providers, looking to ensure resources are targeted appropriately to allow children to be cared for in the right setting, at the right time, based on their needs. This has provided additional investment into Pennine Care services to enhance the existing Children s Community Nursing team (currently 7 days, 8am-12midnight) by providing a see and treat facility for paediatric patients at the Royal Oldham Hospital. This will enable us to provide ambulatory care in a more effective way, preserving paediatric A&E for true accident and emergency patients. During 2015/16, Pennine Care participated in a review of the Urgent Care Pathway in Bury. This includes the Prestwich Walk-In Centre (WIC), Bury Urgent Treatment Centre, out of hours provision, ambulatory care and extended GP hours. We are awaiting the outcome of the review and will respond as part of an alliance with partners to improve the pathway as identified. During 2015/16 we were successful in procuring a new wound care service in Bury. This will be delivered over seven days to support a reduction in activity within the urgent care pathway. Weekend clinics are currently being trialled to monitor clinic utilisation and this will be supported by extended hours drop-in sessions over the coming months. Additionally, we are in discussions with Bury CCG and Bury Council regarding the development of intermediate care across the borough. Part of this strategy will be to understand how we can enhance the current seven day offer and dovetail to existing community and acute services. 8

9 3.3 Quality impact assessment process Pennine Care has delivered financial efficiencies year-on-year since These have been achieved without significant disruption to service delivery and without detracting from the expectations of commissioners in respect of quality and value. However, the current financial climate and changes in commissioning expectations mean that Pennine Care has to adapt and develop a new strategy and associated Transformation Programme. The Transformation Programme is developing Cost Improvement Programme (CIP) schemes that deliver a step change in service redesign, underpinned by a set of the design principles for delivery of whole person care. The Board takes responsibility for ensuring that a full appraisal of the quality impact assessments is completed and recorded and that arrangements are put in place to monitor work going forward. Given the dynamic nature of the CIP schemes, this exercise is part of the Trust s core business and a feature of our Quality and Performance Governance Framework. This process has been informed in part by Delivering Sustainable Cost Improvement Programmes (Audit Commission/Monitor, Jan 2012) and Quality Impact Assess Provider Cost Improvement Plans (National Quality Board, July 12-Mar 13). All appropriate CIP schemes are subject to an assessment of their impact on quality. This is undertaken and led by the relevant clinical team and covers an analysis of patient safety, clinical effectiveness and patient experience. The Quality Impact Assessment process has continued to be refined throughout this year; in particular improvements will be made to assess more effectively the cumulative impact of schemes across a pathway. All CIPs are managed via a robust performance management process and require a named lead (in the majority of cases this will be a Service/Corporate Director). Regular reports on progress are made into Pennine Care s assurance forums and actions taken promptly in response to any variance. Additional scrutiny is also provided through the Quality Assurance Panels, with approval for all schemes via the Medical Director/Director of Nursing and AHPs. Specifically the Quality Group, chaired by the Medical Director, has a crucial role in reviewing the quality impact of CIPs and where quality risks are identified, ensuring effective mitigation plans are in place. KPMG has also undertaken an internal audit of the CIP programme, including a review of the CIP governance system, review of 2014/15 and longer term schemes. Substantial assurance was reported and specific findings and recommendations were fed into the Trust Audit Committee in March Externally all CIP plans for 2016/17 were formally presented at a joint CCG Commissioning Board prior to implementation (on 24 February 2016). This approach will ensure a consistent understanding across our local health economy. In addition, regular monthly reports are made into the CCG Mental Health and Community Quality Groups in respect of any impact on Clinical Effectiveness, Patient Safety and Patient Experience. 9

10 Discussions have also taken place with CCG Quality Leads with an agreement to hold a quarterly sub-group with the aim of analysing the impact of certain 2015/16 schemes. This may involve a patient story approach, as well as a forward looking discussion, with focus on 2016/17 schemes and beyond. 3.4 Triangulation of indicators Pennine Care has recently implemented a new integrated performance management framework. The framework includes integrated performance reporting from team to Board level covering:- Quality; Activity; Finance; Workforce; Compliance. The new performance reports contain key measures and indicators based on internal core standards, statutory and contractual requirements and a review of business plan objectives. In additional to the integrated reports, a new assurance system has also been introduced. Performance and Quality review sessions are held quarterly where each Divisional Business Unit presents an integrated performance and quality report to a panel made up of Executive Directors, corporate heads of service and a Non-Executive Director. The sessions seek to provide assurance against internal core standards, statutory and contractual requirements and business plan objectives and provide strategic support to divisions where required. Following the sessions, an overarching performance and quality report is produced for Executive Directors, prior to being presented at the formal Performance and Quality Governance Board Subcommittee. The new process enables and drives the use of information at all levels of the organisation, supporting the improvement of the quality of care and enhancing productivity. 4.0 Approach to workforce planning The significant changes in care delivery expected in 2016/17 will provide a focus for both workforce planning and transformation. Key drivers for this work in Pennine Care will be:- Greater Manchester Devolution; The procurement landscape; Difficulty in recruiting to specific clinical posts, including district nursing and the mental health workforce, and the impact of the ageing workforce in these key areas. 10

11 2015/16 has seen the embedding of systems and processes to support workforce planning and transformation in Pennine Care as follows:- Implementation of the Adult Community Nursing group to review the existing roles and plans for the development of roles for the future; Implementation of training for staff to support the shift to new ways of working in self-management, using a self-management toolkit approach, motivational interviewing and shared decision-making. Alongside this, training for patients has been made available to support their confidence in caring for their condition; Implementation of phase 1 of our fundamental care certificate approach, enabling the development and trialling of a number of models, to determine best fit for service and new staff development; Agreement of integrated HR Policies across all staff groups, supporting alignment and integration ways of working; Implementation of an electronic ideas/crowd-sourcing platform Spark to support Pennine Care s staff engagement agenda; Use of Pennine Care s People Planning Toolkit alongside business planning processes; Review of Pennine Care s performance management process and the provision of information to services has resulted in improvements in the system, enabling managers to triangulate and report on wellbeing indicators and information about service provision on a monthly basis. This has enabled local focus and targeted action. Quarterly divisional quality and performance assurance meetings use the information collated to highlight best practice, identify areas for local action, workforce risk areas and provide the opportunity to understand and address issues that are common across more than one service/division; Implementation of a Quality Review Panel and governance processes for any service change. This includes completion of Equality and Quality Impact assessments to highlight areas of concern or unequal impact on individual staff members, patients or groups. During 2016/17 additional focus will be placed on the following:- Redesign work with services to support tender requirements GM Devolution will result in significant changes in the care model. Although the detail of this is not yet clear, different employment models, roles, ways of working and organisational forms are expected. Engagement with staff during this period will be essential to the effective delivery of services and design of the future model. An Organisational Development (OD) programme will be developed to support this work; As well as developing options for future delivery of care and staffing structures, existing pressures on capacity will need to be managed. Mental health and community services are both seeing a pattern of difficulty in recruiting qualified staff and the ageing workforce will only increase this pressure. New models both for recruitment, retention and role redesign will be a focus during the next year. This will include continuation of the work started in the Adult Community Nursing group and partnership working with academic 11

12 institutions to look at future training models. This will inform and support the development of a clinical education strategic approach; Implementation of phase 2 of the fundamental care certificate and strategy to support staff development; Implementation of Pennine Care s revised People Planning Toolkit focusing on different approaches for workforce planning versus workforce transformation and development of a people planning hub supported by HR, Information, and Learning and Development specialists. This will provide information, tools and support to clinical services undertaking business planning and review of services; Focus on our temporary workforce will continue following the implementation of a new computerised system for booking and management of shifts in 2015/16. We will be reviewing the quality and usage of temporary staff to realise the anticipated efficiencies enabled by the agency cap (see section below); Partnership work within the Stockport footprint will continue to develop appropriate staffing models in aligned services to support the Vanguard approach; Modelling of future workforce requirements and methods of recruiting will be supported through partnership work with Central Manchester Foundation Trust, Manchester University and Stockport Foundation Trust, with funding provided through Health Education North West to invest in a career and engagement hub. Additional funding provided by Health Education North West will also support our implementation of best practice from the Talent for Care and Widening participation strategies. 4.1 Reduction in Bank and Agency spend Pennine Care has developed a comprehensive action plan monitored by its Strategic and Tactical Operations Bank and Agency group, co-chaired by two senior managers. The key areas addressed in the plan, encompass a range of actions within each, with SMART objectives are:- Procurement; Quality Review; Reporting/Business Intelligence; Skills Analysis; Medical locums; Recruitment and retention. Each action has clear allocated timescales and will be RAG rated and updates documented. There is dedicated resource centrally in place to support this key project to support and engage with services, and ensure that tasks are completed, in line with the plan. The Executive team and Board will be receiving regular reports of progress against the plan and reduction in spend against trajectory. 12

13 4.2 Workforce Planning Governance Workforce plans are developed at team, service, division and Trust-wide level depending on the needs identified. Support including the People Planning Toolkit and capacity and demand analysis tools are provided to services. Governance processes are in place to ensure that workforce plans are developed and agreed at the appropriate place. This includes:- Work with staff side colleagues through our formal consultation processes for any organisational change, identifying impact on staff, supported by the Equality Analysis process; Quality review panels for all Long Term Financial Model (LTFM) planning using Quality Impact Assessments to triangulate service and staff impact; Board level sign off and review of the annual workforce plan, developed for Health Education England, to support education commissioning; All plans are reviewed by appropriate service leads, Service Directors, Executive Directors/Board members as required. Pennine Care continues to work with Health Education North West using the Workforce Planning Tool and linking closely into the Clinical and Professional Education groups. This enables us to identify specific developments and needs and supports the commissioning of the education of our future staff. Detailed plans for staffing transformation are included in the data pack for this plan. These projections will be developed further during the year to understand the transformation implications and work with and across GM to look at new roles and ways of working. 4.3 Staff wellbeing In conjunction with plans for our workforce requirements for the future, we also focus on retention of our existing workforce. Continued focus in 2016/17 will be on the holistic approach to managing sickness absence including:- The agreement of standardised triggers and approaches across the organisation for management of absence; Support and training for managers to understand the wellbeing needs of staff; Support for individual staff members to review their own wellbeing and develop self-management skills. Pennine Care commissions an innovative Staff Wellbeing Service led by psychologists which runs alongside the more traditional Occupational Health service provision to support mental wellbeing. At a Trust-wide level, the annual staff survey provides valuable information that we use in conjunction with staff feedback through focus groups, our on line SPARK platform and staff suggestion scheme together with service quality metrics to highlight areas of best practice and areas for focus and support. 13

14 Strategic objectives have been identified for 2016/17 that summarise the key priorities to achieve these areas of focus and the strategic goal of being a Great Place to Work. We will:- Develop and implement a comprehensive workforce plan that meets the aims and requirements of the organisation s Strategic Plan and locality Sustainability and Transformation plans (STPs). This will include skills analysis, learning and development plans, permanent and temporary resourcing plans, talent management and succession planning; Pennine Care will also commence the development of a refreshed OD programme to improve the employee experience, which will include clinical and management supervision, IPDR, staff engagement, wellbeing and reward and recognition. 5.0 Approach to financial planning 5.1 Funding assumptions Pennine Care delivers both mental health and community services via contracts with CCGs, NHS England and Local Authorities primarily throughout Greater Manchester. As its contracted income is mainly derived through block contracts activity generated fluctuations are negligible. Pennine Care is anticipating, where contracts are continuing into 2016/17, that indicative activity plans will underpin each contract, but that there will be no risk to income based on any shifts in activity. Across Greater Manchester all mental health trusts have agreed with all commissioners that a block contract arrangement will remain in place for 2016/17whilst work continues via the Greater Manchester Devolution project to develop alternative payment mechanisms for the future. Pennine Care has agreed the vast majority of its finance schedules with most commissioners and the Trust is confident that all contracts will be signed before the end of April The 2016/17 plan includes the final outturn figures for 2015/16, delivering an underlying surplus of 0.19m which is slightly in excess of the plan of 0.05m surplus. Pennine Care has responded positively to local commissioning intentions and has worked to secure an additional 3.5m of funding for mental health services ( 2.5m recurrent, 1.0m non-recurrent), most notably for Early Intervention in Psychosis, IAPT, CAMHS and Eating Disorders. Addressing increased acuity on the mental health wards has created financial pressure, and staffing levels need to be redesigned to ensure Pennine Care can move towards compliance with what is expected to underpin the Safer Staffing guidance due out later this year. Pennine Care has identified internal investment of 1.0m to support this ( 0.2m for each of its five localities), and following initial conversations with commissioners has secured match funding from four out of the five boroughs, giving an additional 0.8m to be invested in mental health services. This income, and matching expenditure, has been included within the plan. 14

15 Following a large number of local procurement exercises across the majority of our community services, Pennine Care has been unsuccessful in re-securing existing contract income of approximately 17m. Whilst most of the direct staffing costs will be offset (via TUPE transfer), these exercises have created a significant cost pressure due to lost contribution to overheads of circa 3.2m for which Pennine Care will need to find recurrent solutions in 2016/17. CQUIN has been assumed at 2.5% of block contract values for patient care income commissioned via health organisations ( 4.2m in total). This is a reduction from previous years due to a reduction in income detailed above resulting in circa 0.4m loss, and also a further loss of circa 0.4m due to the transfer of a number of community contracts from NHS England to Local Authorities who have stipulated that CQUIN funding will not be paid on these contracts. An assumption that 100% of CQUIN payments will be received has been included. At this stage, no income or costs have been included in the plan in relation to the proposed Manchester Mental Health transaction. Pennine Care is keeping Monitor fully briefed of the situation and any associated developments. 5.2 Efficiency savings The efficiency requirement for 2016/17 is affected by a number of factors that, combined, increase the target for Pennine Care to a level above the national average. Whilst the national efficiency target is on average approximately 2.0%, the Trust has a higher proportion of pay expenditure than most provider Trusts (77/23 split compared to national average of 66/35) and we therefore estimate that our baseline efficiency target is 2.3%. Added to the pressures of increased acuity in mental health, and the loss of contribution to overheads, the total cost pressures for 2016/17 are approximately 4.4%. The following table shows the breakdown of Cost Improvement Programme (CIP) targets, both those derived from the national efficiency requirement and those driven by lost contribution to overheads Target Identified Front Line Services National Efficiency 4.9m 4.9m Corporate National Efficiency 0.8m 0.8m Corporate Efficiency re Lost Contribution 3.2m 3.2m TOTAL 8.9m 8.9m Where there is a requirement to deliver non-recurrently, due to either slippage in implementation of approved plans, or lack of identification of plans, Pennine Care is focussed on delivery of its plan and will ensure that services deliver the targets given. Close monitoring in the monthly Board report will ensure that any deviation from delivery will be addressed and rectified. 15

16 5.3 Lord Carter Although the recent productivity work plan developed by Lord Carter focussed mainly on acute organisations, Pennine Care has adopted a number of key practices that aim to deliver savings on agency and bank expenditure, estates utilisation, procurement of goods and service including pharmacy services. Pennine Care is committed to delivering a reduction in the expenditure relating to agency staff in 2016/17 and, as described in section 4 above, there are a number of actions being developed to address this. It is anticipated that initially these changes will generate minimum savings of 1m and this has been reflected in the plan. These savings will be utilised to fund the investment in safer staffing initiatives. Pennine Care is heavily involved in the Greater Manchester Devolution project and it is hoped that opportunities for further efficiencies may emerge through system-wide transformation. Additionally, Pennine Care awaits further guidance from Lord Carter that specifically targets areas of efficiency in mental health and community settings. 5.4 Capital planning The Capital Investment Plan has been developed in line with the Service Development Strategy and required investment to reduce risks and lifecycle maintenance. It covers the areas of:- Resilience - investment to ensure the Trust continues to perform at its current level, addressing investment into buildings, medical equipment and ICT lifecycle maintenance and essential works. This includes meeting priorities under fire, health and safety risk assessments; Sustainability - investment to facilitate growth, major refurbishments and new business. The proposed Capital Investment Plan, considering requirements versus affordability and risk, is 6.7 million (including an element of carryover schemes from 2015/16). This investment is targeted and is addressing all essential resilience schemes including investment into new technology to enable patient facing staff to work more agile and respond to the change in service provision. Investments include, but are not limited to:- Refurbishment of Parklands Ward, Royal Oldham Hospital; Refurbishment and Estate Utilisation, Lee Street Clinic, Ashton; Refurbishment of Outpatients Department, Royal Oldham Hospital; Refurbishment of Outpatients and ECT Suite, Stepping Hill Hospital; Reconfiguration and Refurbishment of Stockport Community Services; Investment into increased fire compartmentation, detection and safety; Medical equipment replacement, including ECT equipment; Lift refurbishment; ICT Lifecycle investment and software replacement; Mobile and agile working investment into technology to support community teams; Estate rationalisation investment to contribute to changing working patterns. 16

17 Pennine Care is conscious of the need to ensure that we maximise the use of existing estate while delivering services in environments which are fit for purpose. The estates strategy will form a core component of the developing Integrated Business Plan to ensure that any decisions made, both in terms of current estate and capital investment, are considered in line with the overarching strategy to allow resource to be invested in the schemes of most strategic and clinical value. 6.0 Link to the emerging Sustainability and Transformation Plan (STP) 6.1 The Greater Manchester Devolution Programme Greater Manchester was the first city-region to be given greater decision making and budgetary controls over its 6 billion health and social care services. In December 2015, the devolution programme published an ambitious five-year plan for health and social care across the region, focusing on four key areas:- 1. Fundamental changes in the way people and our communities take charge of, and have responsibility for their own health and wellbeing; 2. The development of local care organisations, which will see GPs, hospital doctors, nurses and other health professionals come together with social care teams, other public services, the voluntary sector and managers to plan and deliver care. This means that when people do need support from public services, it will be mainly in their community, with hospitals only needed for specialist care; 3. More collaboration between hospitals across Greater Manchester, to make sure that expertise, experience and efficiencies can be shared across the whole area in a consistent way; 4. Other changes to ensure that standards are consistent and high across Greater Manchester, as well as saving money, include exploring sharing some clinical and non-clinical support functions; investing in workforce development across Greater Manchester; sharing and consolidating public sector buildings; investing in new technology, research and development, innovation and ideas. 6.2 Pennine Care s contribution Table 1 (below) summarises Greater Manchester s key areas for transformational change and the planned contribution from Pennine Care, as well as the desired future state. A key part of the GM Devolution approach is a focus on people and places, not organisations. This philosophy has a strong alignment with the Pennine Care approach (section 1.0). As well as our place-based out of hospital commitment, as an organisation we aim to ensure that mental health services receive parity of esteem within the transformation discussions and approach. In addition to the overarching Greater Manchester Strategy, each Locality of Greater Manchester has developed its own Locality Plan for transformation. Across Pennine 17

18 Care, our local Divisional Business Unit plans will have a strong interface with each of the relevant locality plans. To support the implementation of the GM Devolution plan, Pennine Care has identified the following there key enablers:- Leadership the ambitious plan requires substantial change and strong leadership to keep the workforce informed, motivated and able to deliver the best care; Sustainability services must be viable and increasingly efficient over time; Flexibility the plan prompts both opportunities and uncertainty. Pennine Care must be sufficiently flexible to identify opportunity and drive change while monitoring risk, e.g. new payment systems, models of care, models of commissioning etc. In addition, Pennine Care is currently liaising with the GM Devolution team and local partners to identify and develop evidence-based propositions with the intention of securing transformation fund investment. 18

19 Table 1 Key Areas Pennine Care response Current examples Future state 1. Radical upgrade in population health prevention Patient activation, behaviour change and self-care Support healthy children and young people Promoting living and ageing well Use of technology, e.g. Flo tele-health Universal children s services My Health, My community All patients facing staff trained in patient activation and self-management skills. Universal access to a comprehensive My Health, My Community offer, to include the Recovery College programme. 2. Transforming care in localities 3. Standardising acute hospital care 4. Standardising clinical support and back office services Integrate health and social care Models appropriate to the locality Wrap teams around GPs Urgent care in the community Integrate physical and mental health Safe and sustainable Deliver most services locally Standardised treatment and pathways Collaborate and work together Collaborate to offer back office efficiencies Co-ordinate access for all referrers Collaborate to identify opportunities to share clinical services 5. Enabling better care Embrace innovation and effective technology Business intelligence Build and enhance staff skills, capability and wellbeing develop alternative career pathways Joint appointments with social care Integrated services (Trafford) Trafford Community Enhanced Care team RAID (liaison psychiatry) Robust monitoring and evaluation Specialist mental health beds optimised Strong partnerships locally and across GM Co-ordinated access arrangements Paris implementation Mobile working Online consultations Estate planning New roles and alternative careers Comprehensive locality model that offers transformed care pathways from community care co-ordination, through urgent and intermediate care in the community, through to bed based care with a focus on restoring independence and self-management. Refreshed mental health strategy that provides standardised treatment and care pathways, optimises bed utilisation and repatriates out of GM placements. Redesigned and refocused back office function. Services to better support local care models and lean but effective central governance structure. Further work on care co-ordination linked to the electronic patient record programme. Effectively support six Local Care Organisations, Greater Manchester provider collaboratives and core Trust business. 19

20 7.0 Membership and Elections In April we will commence our well established election process to replace 12 governors whose terms of office are due to end on 30 June A programme of pre-election roadshows across all boroughs took place in February to publicise and provide information to any potential candidates. UK Engage has been appointed as the Independent Returning Officer. During 2016/17 we will consult with the Governors and members on the future composition of the Council of Governors to ensure it better reflects the structure of the organisation, which has changed significantly since the Trust was authorised in An ongoing Governor Development programme commenced with a welcome and induction for new Governors. Existing Governors are invited to participate to refresh their skills and knowledge and also share learning. Monthly development session include both formal sessions linked to statutory duties and informal sessions linked to Pennine Care services. Additionally, Governors are given the opportunity to attend a range of external events, such as the Governwell programme (NHS Providers), and the North West Governors Forum. Future joint sessions between the Board of Directors and the Council of Governors include the development of Pennine Care s Strategic Plan and preparation for the forthcoming CQC inspection. Governors are invited to attend all Board and Sub-Committee meetings by rota to familiarise themselves with the Board as a whole and specifically to see the Non- Executives (which supports their decision-making on Non-Executives remuneration and/or re-appointment). Governors will continue to be invited to attend service visits with Non-Executive Directors. To keep the Governors informed of plans and developments within their respective communities, the Trust has organised monthly Local Constituency Meetings (LCM) to bring the Governors into regular contact with their local service areas and management teams. During 2016/17, a number of member recruitment opportunities will be used, including pre-election roadshows; media adverts; the Trust website; mailings (post and ) to members; communication via third sector organisations (i.e. Healthwatch, Mind, RBUF etc.); communication via LCM s; attendance at staff meetings, events, councils etc.; Pennine Post; Public notice boards; local events. Governors will be invited to participate in all events. The Trust s publication (Pennine Post) is being reviewed, with a proposal to move from quarterly to bi-annual newsletters, supplemented by monthly, borough-specific briefings. A number of members events are being planned including a Pilot Bury Focus Group: Medicine for Members in April 2016 and a Stockport Mental Health Event in June. Pennine Care is running a range of educational health, wellbeing and recovery 20

21 courses through its self-management college as part of its My Health, My Community initiative, which are being publicised and offered to all members. Governors are also invited to participate in the implementation of the organisation s Patient Experience Strategy, with representation at both the central Strategy Group and local experience forums. The recruitment of Membership and Engagement Officers will form part of a work programme to increase recruitment and engagement opportunities with both staff and public members. Two planned recruitment campaigns in the Stockport and Trafford constituencies will focus on working age males and increasing representation among the Asian communities. The membership team will continue to work with the Trust s Equality and Diversity team and local services to identify appropriate events to ensure engagement with a diverse range of members such as LGBT, ADAB (Asian Development Association of Bury), third sector organisations (e.g. Voluntary Action, Oldham). Additionally through the My Health, My Community initiative, bespoke training in diverse communities can be arranged on request. 21

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