Best Care Clinical Strategy Principles for the next 10 years of Best Care. Dr Caroline Allum, Executive Medical Director

Transcription

1 Best Care Clinical Strategy Principles for the next 10 years of Best Care Produced By: Produced For: Dr Caroline Allum, Executive Medical Director NELFT Board Date Produced: 17 th July 2017 Version: Final v1

2 Table of Contents Plan on a page... 3 Introduction... 4 Why we need a Best Care clinical strategy... 4 Aim & Principles of Best Care... 6 Enablers of the Best Care Strategy and how it fits with other strategies... 9 Engagement and communication of the strategy... 9 Monitoring and Evaluation Appendix 1. Engagement work

3 NELFT Best Care Clinical Strategy Best Care right at the heart of people s lives Our Aim A vision for To provide the best care for our patients, families and communities who use our mental health and community services, right at the heart of peoples lives. Our best care means improving the health of our population by providing high quality, effective, safe care, delivered by the best people who are caring, compassionate and treat patients with dignity and respect, whilst providing the best value Best Care principles The Best Care Strategy is about how we deliver best care in NELFT. The principles drive how each of the services and individuals deliver best care. Services will be supported to develop plans of what their service does to deliver best care based on the principles. How will we know? There will be multiple ways in which we will show if we are achieving our strategy, at an organisation, locality and team level. Some of the organisation wide measures include: Achieving a GOOD or OUTSTANDING CQC inspection rating Benchmarking in the top 20% of FFTs within 2 years Move to top 20% of best employers within 2 years How our NELFT strategies support Best Care Best People (Workforce) Training, development and apprenticeships Engagement of staff and listening and acting on feedback to improve retention and performance Developing a resilient workforce Developing new non-professional qualified workforce Extended scope training for professionals Job Centre plus and raising awareness of opportunities in NELFT Linked to Stronger Together EMN strategy IT Technology and systems that support for a mobile workforce, wireless and agile working Introduction of personalised benchmarking data for clinicians Electronic Patient Record Embedding a data/performance/bi culture across the trust Improving data capture, relevance and quality Use of technology to support effectiveness efficiency, safety and improve patient experience Clinical portal Quality Improvement Underpinning the delivery of Best care Strategy Developing skills to undertake QI Embedding QI methodology and culture of improvement across the organisation Identifying further areas of improvement or best practice and focus on things that will lead to excellence Supported by Communities of Practice or newer arrangements Service User & Carer Strategy Involvement of services user/patient and carer in individual care, quality improvement, operational and strategic decision making informing all that we do over our next 10 year journey Forums and forms for gathering feedback Friends and Family Test Estates Remote and mobile technology Co-located teams, Locality based Fit for purpose Utilising existing estate differently for delivery of care and wider projects Research & Development Training, teaching and supervision Building research capability Publications disseminating innovation and best practice Delivery of Clinical trials and clinical research Research awards, sponsorship for clinical trials, grants, scholarships and other funding opportunities Training and conference days

4 Introduction Neil is a complex patient with learning disabilities and mental health problems who spoke to us about about his current experience of his conditions and use of health and care. We asked Neil about what mattered to him. We identified what his care and support might look like if we worked towards the principles of Best Care set out in this strategy. We have other examples of how care might look for our patients if they were more aligned to the Best Care principles. NELFT is committed to providing the Best Care possible for people like Neil and all the people we serve. To achieve this, we need to ensure we have a clear strategic vision with shared goals for our staff and services. In this strategy, we are setting out principles to deliver Best Care over the next ten years. Why we need a Best Care clinical strategy We are a growing mental health and community trust serving over 2.8 million people who live Waltham Forest, Redbridge, Havering, Barking and Dagenham, Basildon and Brentwood, Thurrock and the Emotional Wellbeing and Mental Health Services across Essex. From September 2017 this will extend to Kent. We already provide good care in many areas of mental health and community health services. NELFT is recognised as an innovative organisation and many of our specialist services are nationally recognised for high quality and performance. We want to build on our heritage of being nationally recognised for areas of high quality, performance and innovative care and spread learning and best practice across the organisation and beyond. 4

5 However, like other organisations, we need to make improvements and changes in the care we provide and we are facing challenges with increasing and changing demands and and we have an imperative to deliver greater value. We want our services to be sustainable to meet the current and future needs of our population. This Best Care Clinical Strategy will shape the delivery of healthcare in NELFT over the next ten years and is our response to the challenges and opportunities presented here. This strategy builds on previous work in 2016 to articulate the vision for Best Care, and recognises the diversity of the population and complexity of services provided by the Trust. In order to get maximum buy in across the Trust and with our external partners we want to simplify the Best Care strategy. We have developed some principles to ensure that people who use our services get Best Care. These are cross cutting principles that apply to all services. An earlier version of these principles have received feedback from the Board and the senior team. During the summer of 2017, we have engaged with more than 150 staff and patients through locality engagement events, meetings and forums to get feedback on the content of the strategy and feasibility of delivering the strategy. 5

6 Aim & Principles of Best Care Our aim, set out below, has been adapted from the IHI triple aim and aligns to NHS England Five Year Forward View. It has been developed and tested with staff and patients. This aim is underpinned by a set of principles with objectives which aligns to and feeds into NELFTs overall organisational strategy, 5Ps values and objectives of Well Led, Safe, Responsive, Effective and Caring. 6

7 The Best Care clinical strategy is organised around a set of eight guiding principles. These are wrapped around patients, families, carers and communities to deliver Best Care right at the heart of peoples lives. There are 4 principles that are more closely linked to patient care, and 4 surrounding principles that enable and support this. Focusing on the 4Bs were suggested by staff during the engagement events, as a way of remembering the Best Care Strategy, and linking closely to the 5Ps of the overall Trust strategy. 7

8 We have developed and refined the objectives within the 4B s through extensive engagement work, aligning to Trust priorities and the wider context. We have also described what the supporting and enabling Best Principles mean. 8

9 Enablers of the Best Care Strategy and how it fits with other strategies This is not a stand alone strategy, but sits under the overall organisational strategy. It needs to be enabled by other NELFT strategies. These are not exhaustive. There are many other strategies, programmes and committees that link to the Best Care Strategy, including the quality strategy, and activities supporting audit and assurance. This also needs to closely aligned to the quality strategy, quality account and annual plan, and CQC action plan work. As well as aligning our strategy with other strategies within the organisation (Best People, Quality, IT) and the external context including STPs and the Essex success regime. Engagement and communication of the strategy So far we have engaged a significant number of people with this strategy. They have shaped the development to this stage. 9

10 We will work through existing involvement channels to engage with more patients, carers and families of all ages and varied needs. We will work in partnership with staff to further develop the aims and deliver the strategy at locality and service level, supporting staff to understand what this might mean for their services and engaging patients from their services. This strategy is underpinned by a quality improvement approach. One of the ways in which we have talked about this strategy to staff is using a driver diagram, a QI tool, to help convey the message of how we will achieve our aim. So far, this approach has received very positive feedback from staff it has been tested with, some of whom have had QI training. The strategy needs to be underpinned with QI methods and capability building to enable people to make changes. Localities and services would take the principles and identify how current services meets these and identify areas for making change, or continuing or spreading good practice. Services would identify measures of how they will know they are achieving best care which will also link with the Trust wide measures of evaluating the Best Care Strategy. How will the strategy become a reality discussions with teams (See Appendix) We don t want to be too prescriptive one size fits all won t work and services and users hold the much of the knowledge about areas for improving care We have received positive feedback on the Best Care principles and we need to work with services to support them to understand what they are currently doing to provide 10

11 Best Care, where things need to improve and change and empower them to make this happen including developing their skills to make improvements There was a lot of enthusiasm to take this forward but staff need time and support to identify how to do this, including development of QI skills We need to involve staff, patients, carers, families and the public in this journey to delivering the Best Care Monitoring and Evaluation The Best Care Strategy governance will be via the Clinical Executive Group that meet monthly. In order to monitor this strategy, SMART Objectives are required. Some of these have been detailed below. Others are less specific where timelines are unknown and the development of these metrics needs to align to Trust EMT dashboard development work that is currently underway. Localities and services will also need to identify metrics to measure how successfully they are implementing the Best Care strategy. Some of the data will be routinely available, other data may need specific collection. We will focus on both quantitative and qualitative data (e.g. what people say about working at NELFT). Although we collect a lot of data about services, further work is required to assess if other data may need to be collected to understand how successfully we are meeting the aims of the strategy, particularly around improving health and value. We will do this and work in conjunction with patients and staff. We will continually seek feedback from patients and staff. Staff also told us that agreement on some priority areas to focus immediate action would be helpful. This would involve the trust identifying priority areas to tackle with specific aims such as falls prevention, violence and aggression. The following table highlights some of the measures we will use to monitor how well we are implementing the best care strategy. As well as looking at our own change over time and achieving relevant standards, we will also measure success through benchmarking to peers. How will we know? Across all of Best Care Achieve an inspection rating of GOOD by 2018 Achieve an Inspection rating of OUTSTANDING by 2020 Benchmarking in the top 20% of FFTs by 2019 Move to top 20% of best employers by 2019 Reduction in number of complaints Number of QI projects and outcomes 11

12 Best Place Best Time Best Skills Trust wide measures Reduction in length of stays, re-admission rates, admissions rates Reduced delayed transfers of care Improved patient feedback Improved staff engagement Maintaining our position in the top quartile of NRLS Reducing harm and improved patient safety 10% of contacts to be carried out virtually by 2019 Reduced DNAs and missed service appointments by 10% by 2019 Service specific measures or specially collected measures Increase in % of discharges followed up within one week Reduction in % mental health emergency admissions for ambulatory sensitive conditions Increase % of patients treated at home/appropriate place Increase % percentage of patients on self management programmes, access to peer education Increase % percentage of patients treated via video consultation Trust wide measures Increase productivity by delivering an additional 5% of face to face contacts in the community by 2019 Over 10% of patients and staff undertaking a health risk assessments by 2018, increasing to 30% by 2020 Service specific measures or Specially collected measures Increased awareness of prevention services amongst staff and patients Increase in percentage of patients treated in place of choice at end of life Trust wide measures Within 2 years moving to the top 20% of best employers Staff sickness to achieve the 4% target from 2017 Reducing our staff vacancy rate to 10% by 2018 Reduce staff turnover to below 10% Reduce number of days lost due to stress and anxiety compared to 2015/16 Improve NHS staff survey scores for staff engagement and satisfaction by 2019 compared to 2015/16 Increased satisfaction in trainee surveys Reducing harm and improved patient safety align to Trust dashboard Improved patient feedback about staff Pro-actively multi skill 25 % of our nursing staff in community and mental health services by % staff trained in health risk assessments by 2019 Improved under reporting of patient safety incidents Service specific measures or Specially collected measures Increase in staff reporting a meaningful appraisal 50% of QI projects initiated by staff % staff trained in QI (as per QI strategy) 5% staff trained in health coaching by 2018 increasing to 10% by

13 Best Pathway Trust wide measures (routinely collected data) Achieving 90% OF CQUINs Increased level of satisfaction in patient surveys domains include informing and involving our patients in their care, improvement and decisions about the Trust Reduced waiting times Increase in patients and carers actively involved, Improved access to services Increased number of patients trained in and involved with QI Service specific measures or Specially collected measures 5% of services to introduce patient activation measures by 2018 increasing to 20 by 2020 Increasing use of PROMs and PDOMs Increase % of patients offered family therapy by 2019 Reduction in % of patients discharged without a crisis plan documented Increase in % of patients with recorded risk factors e.g. alcohol intake 13

14 Appendix 1. Engagement work 14