Estates Strategy. By Nigel Burchett, Director of Estates and Facilities. October

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1 Estates Strategy By Nigel Burchett, Director of Estates and Facilities October

2 Contents Item Title Page 1. Executive Summary 3 2. Vision for the Estate 5 3. Summary of Our Estate 7 4. Performance of Our Estate 9 5. Strategic and operating context Our Estate in context of Trust Priorities How our Estate may change over the next five years How we will deploy our Estate to recruit, retain and support our staff Conclusion 35 Appendix A List of sites 36

3 Executive Summary Welcome to the Sussex Partnership NHS Foundation Trust Estate Strategy. This Strategy compliments our other Trust Strategies, notably the clinical and digital strategies as we make progress towards delivering the Trust s 2020 vision. We also need to address the challenges set by Delivering the Forward View: NHS planning guidance 2016/ /21 and Lord Carter's Review on operational productivity and performance. This document sets out our ambition for a consistently high quality estate to support all our services to deliver outstanding care and treatment you can be confident in. Ensuring a safe and appropriate environment, maintaining our facilities and delivering excellent hotel services is the core of what we do in the management of our estate. Much of this work takes place behind the scenes, but a good experience of Sussex Partnership NHS Foundation Trust services depends on these being delivered efficiently and effectively. Over the last year, the Trust has been in the process of updating its Estate Strategy both in relation to the condition of its existing assets (i.e. asset management) and also in relation to the facilities it needs to support for its future strategy. This process has been prolonged to ensure that the Estate strategy is aligned to the Trust s clinical and digital strategies. In relation to asset management, the strategy addresses how we need to optimise our assets to ensure best value for money and release funding to investment in new capital developments. In relation to growth, work continues to develop our thinking around the masterplans for the Trust s key sites, taking into account our ambitions for service delivery and opportunities and constraints in developing capital schemes. Much has changed in the wider strategic landscape. We have seen a greater emphasis on partnership and collaboration across the health and care system, with work progressing on a Sustainability and Transformation Partnership (STPs) for the NHS across all the areas that we operate, including Hampshire but with a focus on our main area of operation within the Sussex and East Surrey STP footprint. We are also developing our plans in the context of commissioner led Local Estates Strategies (LES s), and deepening relationships with other partners, including our commissioners (both NHS England who are responsible for specialist commissioning and our CCGs who commission local secondary care services), our partner NHS Trusts, primary care and local councils that both commission and provide adult and children s social care. Furthermore, there is increasing emphasis across the NHS to improve our efficiency in the use of the estate to protect front line service delivery within available means. In particular the review of the productivity of the NHS by Lord Carter of Coles identifies how the estate can be better utilised, and sets targets for reducing the amount of void and under-utilised estate, as well as the proportion of the estate required for non-clinical functions. Achieving or bettering the Carter benchmarks will be a key measure for how we are delivering best value for our estate as a whole. It is timely, therefore, to review our own Estate Strategy to take account of these wider developments. The strategy tells the story about how we are using our buildings to change the way we deliver healthcare services, in particular how we are planning the use of our estate to support the Trust s 2020 vision. This Estate Strategy sets out the steps we will take to invest in and manage our estate effectively to ensure we have the right buildings in the right places to support the Trust. It also describes how we are harnessing the benefits of technology to ensure our environments can be secure whilst promoting the privacy, dignity and well-being of all who use our buildings. Our digital strategy sets out how we are harnessing the rapidly growing benefits of ICT to transform the way we deliver services and our Estate Strategy shows how we are adapting our facilities to support new ways of working to improve patient care and staff working lives. Estates Strategy

4 We face a number of challenges in ensuring we are able to meet the growing and changing needs of the population we serve. Sussex already has the highest proportion of older people amongst its population, with 25,000 people having dementia, and this is set to increase. We have a long way to go until we achieve parity in terms of funding and access to mental health services (three quarters of people physical health disorders receive treatment, compared to only one in four of people with mental health disorders). We need to do more to ensure the physical health needs of people receiving mental health services are met, and correspondingly that the mental health needs of physical health patients are addressed. We need to deploy our estate effectively to ensure that all patients benefit from the high quality estate they deserve as well as ensure that our Trust is a welcoming place to work for all our 5,000 members of staff. The Estate Strategy is a living document, and any specific proposals set out represent a point in time. Our planning will need to be sufficiently flexible enough to respond to changing demands as the local health economies work together to determine how best to configure services to meet changing population need within available resources. These levels of strategic planning will help to shape our own assessment for the future requirements for the estate. Whilst the specifics will continue to evolve our principals remain constant. Everything we do aims to deliver outstanding care and treatment you can be confident in. To do this we need to have the right buildings in the right places to support excellent service delivery now and in the future. Samantha Allen, Chief Executive 4 Sussex Partnership NHS Foundation Trust

5 Vision for The Estate Sussex Partnership NHS Trust provides care across Sussex for people with mental health problems and learning disabilities. We also provide a range of specialist services across south east England. We care for people all of ages, from children and young people through to older people with conditions such as dementia. We aim to improve people s lives by providing high quality care and the best possible experience of our services. We provide services in a wide range of places including hospital, community clinics, people s homes and GP practices. This means that we require a range of specialist facilities to support excellent healthcare through a high quality patient care environment. Providing a high quality working environment for all our 5,000 members of staff is also a prerequisite for delivering consistently high quality care. Resources are finite and we need to ensure that our estate is well used to deliver a consistent and excellent environment in a way that we can afford. Our aim is to achieve a consistently high standard of accommodation for patients and staff whilst managing our resources effectively. This means using our estate well and we will continue to look for opportunities to optimise our estate, using benchmark measures for the utilisation of the estate set by Lord Carter and others, to ensure we obtain best value for money from our facilities. The starting point for any strategy is our 2020 vision, and our more recently published clinical and digital strategies, all of which this strategy supports. This 2020 vision, published in April 2015, describes what we will do to improve the services we provide to patients. Although the way in which health and care services are planned and coordinated is changing, our ambition for mental health services has not. We know, from feedback from patients and carers, that it can often feel difficult for people to find the help they need and that it can often feel like they are passed around the system. Even where care is complex and involves multiple organisations it is our job to work so well with partners that patients and carers only notice the quality of care and support they are receiving and not the joins between members of different professions and agencies involved in delivering care. We are working hard to build on our existing partnerships, but clearly more needs to be done. Having the right facilities in the right place, with the IT infrastructure and flexibility and adaptability to improve coordination of care across organisational boundaries is essential to achieving our ambition. Our strategy sets out our journey towards achieving a consistently well utilised, high quality and well managed estate. However, it is about far more than the bricks and mortar from which we look after our inpatients, provide our outpatient clinics, and deliver administration and support services. Whilst this document is about building in the traditional sense of hospitals, clinics, offices etc., it is also about building the capacity, flexibility, partnerships and resilience to face the challenges ahead for our services. The development of the Estate Strategy has been through a process of engagement working with the Care Delivery and Support Services, the Board and wider stakeholders. Estates Strategy

6 Across our organisation we have identified the following as the overarching aims for our estate: Safe, secure and effective environments Right property in the right location Reducing overall costs Improve the appropriateness and quality of environments for patients and staff Develop more environmentally sustainable buildings and services Generate income from property where possible Enhance security across the Trust Tie in with the Trust s Digital Strategy. The following pages describe how we intend to do this across our Trust. In doing so we set out the key drivers for change; key considerations when planning capital expenditure; how we master plan for key sites and our approach to the optimisation of our assets. 6 Sussex Partnership NHS Foundation Trust

7 Summary of Our Estate We provide hospital and community mental health services across Sussex, as well as more specialist mental health services across a wider footprint. Our estate comprises of approximately 96,000m Freehold properties 41 Leasehold properties 6 PFI properties This includes 45 inpatient wards & homes with a total of circa 702 beds, some 70 community team bases and 30 corporate buildings. We operate mainly across Sussex, but we also provide children s and young people s services across Hampshire with some specialist services supporting patients from further afield. A map of our main locations is shown on the following page. We manage and maintain our own estate, as well as provide our own hotel services (cleaning, catering and portering) for many of our facilities. We also provide Facilities Management services to other owners and occupiers of healthcare estate. We employ 223 WTE staff across our estates and facilities services, representing one of the largest staff groups. Our team includes electrical and mechanical engineers, as well as cleaning, catering and portering staff in addition to asset and facilities managers. It costs 25m each year for us to hold and service our estate. This comprises of 18.2m of running costs, 9m capital charges and 2.5m income. A list of our main locations is provided in Appendix A. Estates Strategy

8 Map of our locations 8 Sussex Partnership NHS Foundation Trust

9 Performance of Our Estate Performance Management of the NHS Estate In all our estates and facilities management activities we adhere to best practice and governance. There are a number of standard tools used across the NHS to support the effective management of the estate. This allows for a common set of measures that enable more effective performance management and benchmarking with peers. Over the past 5 years we have already made considerable progress in improving the performance of our estate. In particular we use the NHS Premises Assurance Model (PAM) and Estates Return Information Collection (ERIC) and the Patient Led Assessment of the Care Environment (PLACE). These can be summarised as follows: PAM measures the effectiveness of the management and governance of the estates and facilities management. This includes an assessment of how decisions are made; how resources are allocated; how estates information is reported to the Trust Board and Governors; how the Trust manages risk and responds to events; and how well the planning and management of estate is integrated with the leadership of the Trust as a whole. ERIC collects information relating to the costs of providing, maintaining and servicing the NHS estate. This includes the costs of providing certain patient-focussed services such as food and laundry. In addition, the collection includes a number of non-financial aspects of the operation of buildings such as information relating to fire safety and an organisation s progress in meeting carbon reduction targets. PLACE applies to NHS inpatient facilities and assessment is carried out by independent teams that have patient and professional representation. This focuses on the quality of estates and facilities services as they impact on the patient experience. PLACE looks at how well facilities meet standards on privacy and dignity, cleanliness, quality of meals, dementia friendly care environments and other aspects of estates performance that affect patient care. The Trust, like all health care providers in England, is regulated by the Care Quality Commission (CQC) and the CQC requires that the Trust provides its services from safe and suitable premises. Estates operational performance and benchmarking The Estates Returns Information Collection (ERIC) provides detailed information on the costs incurred in the provision of the NHS Estate used in the delivery of secondary care. In 2014/15 the responsibility for collating ERIC returns moved from the Department of Health to NHS Digital (the Health and Social Care Information Centre) and new performance dashboards are being set up to enable Trusts to monitor how their own performance may change over time, as well as allowing for better peer based benchmarking between similar Trusts. Estates Strategy

10 Some of the key benchmarks, showing our own comparative performance are summarised below: 10 Sussex Partnership NHS Foundation Trust

11 Benchmarking indicates a high degree of cost effectiveness in our FM service delivery, but there needs to be a focus on improving our utilisation and reviewing our approach to high cost of occupancy premises within our estate. Our PFI Estate (20% of total floor area) does affect our occupancy costs overall. Facilities Management Our Facilities Management services are assessed primarily through the PLACE (Patient Led Assessment of the Care Environment). This is a means for assessing the performance of all Trust inpatient units (our community hospitals) for the performance of soft Facilities Management Services as determined by independent assessment led by teams that comprise of FM experts accredited to carry out such assessments and patients and carer representatives. The 2017 scores for our hospitals are set out below (with comparison against our 2016 scores): PLACE scores 2016/17 comparison Amberstone Beechwood Chalkhill Chichester Centre Connolly House Crawley Road DOP Harold Kidd Unit Hellingly Centre Iris ward Cleanliness Food & Hydration Privacy & Dignity Condition, appearance & maintenance Dementia Disability % % % % % % N/A n/a N/A n/a N/A n/a N/A n/a n/a N/A N/A n/a Estates Strategy

12 Langley Green Lindridge Centre Meadowfield Mill View Oaklands Centre Rutland Gardens Selden Centre Shepherd House St Anne's The Burrowes Woodlands n/a N/A n/a N/A n/a N/A N/A n/a N/A n/a n/a N/A N/A Sussex Partnership NHS Foundation Trust

13 The table below shows the overall scores for SPFT against the national average. Cleanliness Food and Privacy, Condition Dementia Disability Hydration Dignity and Appearance Wellbeing and Maintenance Overall Trust scores National average In general SPFT performs close to the organisational average in all measures, with a slightly higher score than the England average for all measures except for food and hydration which, whilst better than 2016, falls just short of the National average. Our aim is to improve consistency of overall service delivery achieving the standards in our best performing properties across the board. This will entail an understanding of all factors that may be behind the variations in scores, including age and condition of building, responsibility for FM service provision and other local factors that could influence the score. Estates Strategy

14 Strategic and operating context This Estate Strategy is written in the context of an NHS that is evolving in terms of policy and structure. The key drivers for change relate to both national policy and strategy as well as more local plans. These have been identified as: Five Year Forward View Care Review on productivity Sustainability and Transformation Partnership CCG Local Estate Strategies Trust local strategies, specifically: o 2020 vision o Clinical and commercial strategies o Care Delivery Service Plans National policies and priorities A combination of population growth, demographic change, the advent of new technologies and growing public expectations all put pressure on the NHS which is challenging to support in the context of prolonged financial restraint. In fact the Five Year Forward View estimates that the impact of growing demand and no change in operational efficiency or funding would lead to a 30bn mismatch between patient needs and available resources. There is growing consensus that the NHS needs to change the way it plans and delivers its services. This is set out in the Five Year Forward View (NHS England 2014). This advocates a multi-pronged approach to reshaping health and care that includes: Increased emphasis on prevention and public health Patients taking greater control of how they receive their own care and the option of shared budgets combining health and social care The need to break down organisational barriers in how care is delivered, particularly between primary care, hospital, community based and social care services and also between physical mental health There is no one size fits all model for future service delivery but a number of different models, such as the multispecialty community provider and accountable care organisation that are being proposed to support better integration between different parts of the health and care system. Even within the area that our Trust operates it is likely that different models of collaboration will emerge. What is certain is that we will need to adapt our services to give greater emphasis on primary and preventative mental health interventions, working alongside our colleagues across health and social care. This will require greater use of IT and shared use of facilities, and these factors drive our estates related investment decision making. In addition to changes to the way we work there is greater emphasis on productivity as set out in the NHS Review of Productivity carried out by Lord Carter of Coles (The Carter Review), published in This sets out a number of productivity improvements which, taken together, could save 5bn. Specifically Carter sets out two estates measures relating to the amount of void space and the proportion of a Trust s footprint required for non-clinical functions. We benchmark our own performance against these Carter metrics and set out plan for improvement below. Regional and local plans There is increasing emphasis on identifying and reducing inefficiencies across the NHS as a whole, but it is also recognised that there is no one size fits all and partners within local health and care systems need to work together to develop the most appropriate solutions for their areas. The system-wide planning process creating Sustainability and Transformation Partnerships (NHS England, 2015) tells us that the journey toward organisational and structural integration is gathering pace. This approach will require NHS Trusts and other organisations delivering NHS and social care services, to prioritise partnership over competition (at least) within STP footprints. 14 Sussex Partnership NHS Foundation Trust

15 All parts of the health and care system are being asked to increase collaboration through the Sustainability and Transformation Partnerships (STPs). Our main STP footprint covers of all of Sussex, together with East Surrey, and taking in the health systems around 4 acute Trusts (Western Sussex Hospitals NHS Foundation Trust, Brighton and Sussex University Hospitals NHS Trust, East Sussex Healthcare NHS Trust, Surrey and Sussex Healthcare NHS Trust). We are active participants within the Sussex and East Surrey STP footprint, which covers the counties of West Sussex, East Sussex, the unitary authority of Brighton and Hove and the area served by East Surrey CCG. We also provide children and young people s service in Hampshire, although many of our sites are mandated in this area and our participation in the STP planning processes of relevant adjacent areas is of a lesser extent to our involvement within the Sussex and East Surrey STP. The STP plans are emergent, but they are likely to propose major changes to the health and care economies to ensure their ability to meet future need in the context of continued financial restraint. This could have far reaching implications for how services are delivered in the future. However, one certainty is that greater collaboration and coordination will be required and we expect that over time the boundary between physical and mental health services will become increasingly blurred. We know that there are strong associations between physical ill health and mental health, and we will be delivering more of our services from a wider range of care settings in order that care is organised around the needs of patients rather than patients having to travel to different care settings organised around specific disciplines and specialisms. Since the advent of the STP process collaborative relationships between Estates and Facilities Directors of all main NHS Trusts have matured. There are four priority areas within the estates and facilities work-stream to help ensure that all parts of the NHS in Sussex and East Surrey work together to ensure estates and facilities planning is aligned across the system rather than on an organisational basis alone: Capital: The Capital work-stream takes an overview of all the current and pipeline strategic capital projects identified within the STP. (NB, this does not include minor or Trust s operational capital programmes required to address backlog and planned and preventative maintenance). The purpose is to ensure that investment needs can be prioritised across organisations, that plans are aligned to STP system change plans, and that partners work collaboratively, e.g. in the development of business cases and identifying how capital projects could be funded and resourced across the system. Property: The property work-stream is looking to collate intelligence about the existing estate bringing together data on property performance (including six facet survey data, assessment of voids and under-utilisation) in order to develop a shared view about the existing estate in terms of whether a facility should be held, retained but subject to refurbishment and/or rationalisation or should be earmarked for vacation and disposal. The property work-stream complements the capital work-stream although the emphasis here is more geared towards the performance of buildings rather than how the infrastructure needs to change to support STP changes Operational: The third area within the STP is operational facilities management. This group is looking at how facilities are managed in terms of planned and reactive maintenance as well as performance of soft services. The operational group facilitates internal benchmarking within the STP to ensure that all can work towards local best practice standards, as well as seek opportunities to achieve economies of scale, potentially through the amalgamation of some back-office functions across organisations. Sustainability: This work-stream aims to reduce carbon across the STP. Expertise within sustainability is shared, in terms of each Trust s Sustainable Development Management Plans (SDMP). Through collaboration we are seeking to achieve greater carbon reductions that can be supported by any individual Trust acting alone. For example, the sustainability work-stream is looking to achieve economies of scale in the procurement of an energy performance contract that can work STP wide. This saves on transaction costs (one procurement rather than several) and achieves economies of scale that would, in turn, deliver greater financial savings. The sustainability workstream is looking at how courier and fleet management as well as waste management services Estates Strategy

16 could be planned across the STP to reduce the level of total related mileage and carbon footprint related to travel required to support the local NHS. Work on the STP is complemented by CCG led local estates strategies, which are continuing to evolve. For the first time CCGs, as local health system leaders, have taken on responsibility for developing local estates strategies to reflect their commissioning intentions, improve integration with primary care development and align individual organisational plans within developing models of care. Whilst it is not possible to set out the detail of each Local Estates Strategy (there are 7 CCGs and 5 Local Estates Strategies for Sussex) there are number of common principles: There is a need to improve the coordination of care between different agencies Whilst the local needs and geographical requirements vary each CCG is setting out the organisation of patient centred care with a focus on localities or communities of practice each serving population clusters of between 30,000 and 50,000. There are number of common themes. Clinicians from across the health and care system will need to work more collaboratively and we expect the benefits of ICT and greater flexibility in how partners and the Trust use buildings to support the breaking down of artificial barriers. There will always be distinct variations in specific implementation planning, for example in the East Sussex Better Together plan (which covers Eastbourne, Hailsham & Seaford, and Hastings & Rother CCGs) there is an emergent plan to establish an Accountable Care Organisation. However, at this point in time there are no such plans in other areas where the Trust operates. We therefore need to be sufficiently nimble to be active shapers in the local planning process and to able to respond in locally specific ways. Partnership in estates planning is also extending beyond health and social care. Through the One Public Estate initiative we are seeing increased collaboration across public sector bodies and agencies to improve strategic estates planning as a whole, looking at opportunities to consider how the property needs of public service providers (including government departments, local authorities, NHS and other public agencies) can provide further opportunities to improve value when looked at in the round. We are active participants in multi-agency one public estates groups covering West Sussex, Greater Brighton (Brighton and Hove unitary authority and adjacent districts) and SPACES (Strategic Property and Asset Collaborate in East Sussex). Irrespective of local collaboration arrangements and related projects, we are delivering populationfocused health and social care through individualised care focused around local communities of practice which naturally form around GP surgeries, children and families centres and schools. We have long established relationships with health and social care commissioners and providers to ensure services work well for all our population affected by mental health. Partnership is in our name! Nevertheless, as we set out in our 2020 Vision there is more than we can do to improve coordination and collaboration, both in the planning of our services and in the delivery of care directly to our patients. Our aim is for care to be so well coordinated that where our service users depend on the services of multiple agencies that they do not notice organisational boundaries. Our investment in our estate enables more effective partnership working, as well as the deployment of modern ICT systems that support more remote and flexible working. This will allow our staff to work more in patients homes, collaboratively with colleagues from other agencies (through more co-locations and ICT enabled communication) as well as offer new ways to engage with patients, e.g. through Skype consultation. Whilst our primary focus is, rightly, on delivering high quality patient care, we recognise that without the right staff, it would not be possible for us to live up to our ambition of providing outstanding care and treatment you can be confident in. The best way to value our patients is to value our staff, and one way to value our staff is to provide a pleasant and supportive working environment. We are therefore focusing on how our estate can support our ambition to make Sussex Partnership NHS Trust an 16 Sussex Partnership NHS Foundation Trust

17 excellent place to work across all our services and locations, alongside the provision of a consistently high quality care environment throughout. Trust strategies and plans 2020 Vision We set out our overall vision for how we want to provide services in our 2020 Vision which we published in Our vision sets out five strategic goals. These are: 1. Safe, effective, quality patient care 2. Local, joined up patient care 3. Put research, innovation and learning into practice 4. Be the provider, employer and partner of choice 5. Live within our means. How we deploy and manage our estate has a bearing on how well we can meet our strategic goals. For example: 1. Safe effective quality patient care requires that the environment is appropriate for all clinical activities, that our service users and staff can enjoy a comfortable and pleasant environment in all our facilities. Security requirements should be met in as unobtrusive way as possible, although in some of care environments security considerations may override others. 2. Local, joined up patient care requires facilities across our localities to deliver services according to need. Joined up care also requires our staff to work from premises outside of our estate. We have a responsibility to ensure their working environments are appropriate for their role, as we have reciprocal responsibilities towards colleagues from partner agencies who work from our facilities to provide joined up patient care. Clearly, it would not be possible to locate our more specialist services within each locality but when planning the location for more specialist facilities that serve larger populations, accessibility will be a key consideration. 3. Put research, innovation and learning into practice. To support this we require appropriate meeting and educational facilities on our main sites, as well as the right IT connectivity to facilitate lifelong learning and collaboration into all our clinical service. From an estate point of view it also means keeping abreast of all the latest best practice knowledge on healthcare environments. For example, our knowledge of what constitutes a dementia friendly or an unobtrusive secure environment has advanced considerably in recent years. Furthermore, technological advances provide new opportunities to address the often competing needs of security (e.g. management of ligature risk) with the need for privacy and dignity, and we are at the forefront of applying new adaptations in the design and construction of the healthcare environment. Not only do we need to plan with the most up to date knowledge of therapeutic environments in mind, we need to contribute to this growing body of knowledge. 4. Be the provider, employer and partner of choice. Fundamentally this means delivering excellent health and care, and supporting our staff to do so. This is supported through a high quality clinical care and staff working environment throughout. 5. Live within our means. We face the challenge of improving the quality of our facilities whilst also reducing cost. We can make progress towards both, but this requires us to ensure we use our facilities well and, where appropriate, we need to vacate some premises and make our retained facilities more flexible and adaptable. Clinical Strategy and clinical service directorate plans Our clinical strategy, published in 2017, sets out how we are building on our aspirations set out in our 2020 vision to promote a more positive service user, carer and staff experience. Our clinical strategy reflects the fact that mental health trusts across the country are being required to save significant amounts of money year on year on top of the savings we have found in previous years. Staff are experiencing more pressure and we can find it difficult to recruit to some clinical posts. We cannot continue delivering services in the way that we do now and we need a new model of care that is focused on: Health promotion and early intervention Estates Strategy

18 Delivering evidence based outcomes Treating people in the community rather than hospital Working more effectively in partnership. What this requires is a series of detailed and ambitious plans. The key priorities are summarised as follows: Offering support to develop teams Implementing new roles such as non-medical prescribers, associate care coordinators, peer workers and graduate mental health workers to help us address recruitment difficulties and use resources more effectively Integrating community, crisis and acute services by joining up care pathways and enabling staff to accompany service users through their journeys Create capacity and move care upstream by creating more capacity in community teams so they can spend more time on the needs of people with more severe and acute mental health needs Developing new youth care pathways to address the needs of people aged Developing our crisis care pathways to improve our ability to provide crisis home treatment, working towards 24/7 mental health crisis care for everyone who needs it Reducing length of stay and standardise admissions working with our own community services and partner organisations Ensuring a single point of access to help people in crisis get help from us 24 hours a day. Developing ways of strengthening partnerships and working more effectively with communities Supporting our teams to collect and use clinical care intelligence (such as outcomes) to enable learning from best practice within the Trust and elsewhere and to support continuous improvement in our services. In order to develop and implement our Estate Strategy, we have organised our clinical service delivery into eight Care Delivery Services (CDSs). Each CDS is tasked with providing overarching leadership for a particular care group and/or geographical area. Overall leadership of each CDS is provided by a service director and a clinical director, with a multi-disciplinary leadership team (including different clinical professions and business, finance, HR, IT and Estates and Facilities support staff) providing additional leadership and governance oversight. The move towards a CDS structure has helped us: move away from central command and control to more devolved and improved leadership provide services that can flex to local needs encourage clinical engagement within services promote more local accountability develop new partnerships with local third sector organisations make more decisions taken closer to where patients are treated The CDS model has helped us continue to improve services for patients and carers. However, the intention was never to create completely independent services where decisions about service offer and standards could be developed in isolation. Providing consistently high quality services means: working together in partnership with each other, the people who use our services and other organisations pooling our expertise, experience and resources embedding the learning from what we do well, and where we need to improve, across all our services defining a commonly agreed set of strategic, clinical priorities. Each of the CDSs has prepared their own delivery plans to set out how they will support Trust operational efficiencies and develop services along with plans to realign services to better support local need and the overall objectives of the clinical strategy. Each CDS is supported by the Estates and Facilities team, who works alongside clinical and service directors to develop the plans and establish 18 Sussex Partnership NHS Foundation Trust

19 options for investing in and, in some cases, divesting in the estate. Whilst the clinical strategy per se makes little direct reference to estates planning, it actually is the starting point for all estates planning as we look to align our facilities to the way that services need to change. Estates Strategy

20 Our Estate in the context of Trust Priorities We have identified five strategic goals which will steer us towards where we want to be in five years time. We will continue to review and refresh these, working in partnership with people who use our services, who work here and work with us, including our commissioners. 1. Safe, effective, quality patient care 2. Local, joined up patient care 3. Put research, innovation and learning into practice 4. Be the provider, employer and partner of choice 5. Live within our means. These frame the priorities for the estate. Effectively we are committed to continuing to provide excellent patient care, to supporting our staff and achieving these in the context of a tough funding climate. Safe, secure and effective environments Right property in the right location Reduce overall cost Improve the appropriateness and quality of the environments for patients and staff Develop more environmentally sustainable buildings and services Generate income from property where possible Ensure operational services are optimal Tie in with our IT Digital Strategy Safe, secure and effective environments This means that our facilities need to be fit for purpose and meet current NHS guidelines for estates and facilities relative for use. Our patients, staff and visitors alike deserve an environment that protects their security, but in a way that is proportionate to the risks involved and is conducive to the therapeutic environment. Our patients have a range of needs. For example, people resident in our low and medium secure units would have a different profile of risk to, say, patients with advanced dementia. Yet, appropriate measures to protect patients, staff and visitors requires specialist intervention both in the way that care is managed and delivered and in the built environment itself. The key principle is that patients should be managed in the least restrictive environment possible in order to facilitate safe treatment and, wherever there is the potential, rehabilitation and recovery should be promoted. Nevertheless, we do need to ensure that the design of the patient care environment has in place appropriate measures to ensure the safety and security of service users and all building users. This can often lead to trade-offs between the competing requirement for security balanced against the requirement to ensure that care environments are as homely and non-institutional as possible. The example below shows how the Trust works to find innovative ways to address often competing design requirements that address the needs and risks associated with our care groups. 20 Sussex Partnership NHS Foundation Trust

21 Ligature Reduction Programme Estates work with Clinical Services to assess environmental risks for suicide and self-harm in in-patient wards and adjacent clinical environments totalling sixty-one locations. The total Trust risk assessment data is used to formulate the annual Estates fixed ligature anchor point reduction programme, based on targeting the elimination or reduction in the highest identified risks as a priority. Estates meet monthly with Clinical Services and Risk & Safety to coordinate the ligature reduction anchor point programme, organising the on-going ward risk assessments, planning ligature reduction works and reviewing the latest anti-ligature products available within the industry, working with suppliers to develop new and innovative solutions to providing safer ward environments for patients. An example of this is a new ensuite shower door being fitted at Woodlands Adult Mental Health Ward The new ensuite shower door is constructed from lightweight 4kg soft foam then coated with a resilient antimicrobial, stain resistant vinyl material designed to withstand daily patient and client use in mental health environments. Harnessing the natural forces of short range magnetism for its fixing points means that this also has 100% fail-safe anti-ligature functionality. Right property in the right location Population need and service delivery models are always changing. Having the right property in the right location is essential to ensuring optimal delivery of our operational services. The way we deploy our estate requires that we adapt to the needs of services and this estate model follows the needs of our Care Delivery Services (CDSs). Reduce overall cost A growing and ageing population, coupled with technological advances in medicine and a constrained funding climate only serve to increase the need to look at productivity as a whole. After staffing, estates costs represent the highest cost to the NHS. At 26m the Trust s expenditure on the estate is more than 10% of its total income. We are therefore looking to improve the productivity of the estate to help us achieve our goals. Estates Strategy

22 A review of the productivity of the NHS carried out by Lord Carter of Coles (the Carter Review) sets out 15 recommendations to improve productivity across the NHS. Two of these relate to the efficiency of the estate. These are: - That Trusts should operate with no more than 35% of the estate being non clinical - Trusts should have no more than 2.5% of their accommodation as void space. The Carter review requires Trusts to have a plan in place for achieving these in 2017, with a view to meeting or exceeding these targets by Whilst we are working towards these targets and aiming to better these where we can, the metrics themselves have been developed largely in the context of acute healthcare, and the nature of services provided in community and mental health settings may mean that different targets may be appropriate. We have met with the Carter team, who are developing equivalent metrics appropriate for the community and mental health estate. We will review these targets and where these stretch from the acute target we will develop plans to meet these. We strive to continuously improve on these measures to drive productivity from our estate. Percentage of non-clinical estate Our total calculation of non-clinical space is 22%. This is already an improvement on Carter benchmarks. The trust will continue to drive efficiencies, to ensure this figure does not increase. Percentage under-utilisation At present the amount of empty and under-utilised space is 5.6%. Our void reduction plan shows how we intend to reduce this figure to 3.1% by March 2018, and to 0.6% by March 2020 by:. Continuing to drive efficiencies across the estate. Ensuring better-utilisation of space across the estate. Generate income from property where possible We are adopting an entrepreneurial approach to the management of our property portfolio to maximise the return from these assets. This is achieved through: - The roll out of service line reporting across the Trust so that all services have transparency in the cost of properties, and clear incentives to make best use of the value tied up in the estate. - Working collaboratively with our partners in the health and social care economy and more widely across the public sector through One Public Estate forums to generate opportunities to better space sharing, leasing estate to third parties, levering in commercial tenants where appropriate, as well as the re-investment of the proceeds of asset disposal to improve the quality of our retained estate. Improve the appropriateness and quality of the environments for patients and staff We are proud to boast some excellent clinical facilities. However, the quality of our estate is not consistent across the board. We will use our knowledge from ERIC and PLACE, supported by our 6 facet surveys and audit programme to prioritise attention as follows: - Reduce instances of under-utilisation through a combination of site rationalisation, asset disposal and consolidation - Prioritise our capital programme to facilities that require refurbishment or modification to meet the high standards we aspire to for all our premises - Review the costs of all our premises and prioritise attention to reducing commitments to high cost to occupy premises, in order to release resources to invest in an estate that will have a 22 Sussex Partnership NHS Foundation Trust

23 lower footprint, but with capacity maintained through improved utilisation and with a higher quality patient care and staff working environment overall. How the Estates and Facilities engage with Art/ Design to create and transform our patient environment An example of is the community out-patients clinic, The Bedale Centre. The aim was to create a tranquil feeling throughout the facility, which in turn would help users of the centre to feel relaxed and comfortable during their visits. The décor was previously very plain and didn t engage any of the character from the nearby town, neither did it encompass any of the Trusts values. Inspiration was drawn from the seaside beach huts and architecture of the local Bognor Regis seafront. Using digital graphics of Bognor Beach huts we were able to re-create the fresh appeal and relaxing ambiance of the seafront within the centre. Another project was the Family Room at the Hellingly Centre. It was important to soften the feel of the Family Room; the room itself was aesthetically pleasing and had good ambience, however the secure perimeter fence in the courtyard was daunting and cold for visiting families of the patients. This was addressed by cladding the fence with a digital graphic of the nearby country side which has transformed the view and environment of the area where the patient and families meet. Estates Strategy

24 Develop more environmentally sustainable buildings and services One of our core objectives is to be a strong sustainable business, grounded in our communities and led by excellent staff. The Trust s 2011/2012 carbon footprint baseline is 6,969 tonnes CO2e, of which 99% is directly related to the operation of the Trust s estate (energy and water consumption). Staff travel between Trust sites would represent a significant element of the footprint; however, there is currently insufficient data to allow it to be included. The only travel element that has been included in the baseline calculation relates to a small number of Trust-operated vehicles. The footprint has remained relatively constant since 2011/2012 with virtually no progress in reducing emissions. The Trust s original Sustainable Development Management Plan (SDMP) set a target to reduce its carbon footprint by 34% by 2020 (an NHS-wide target) this target remains and there is clearly much work needed to achieve this over the next three years. The NHS has the largest public sector carbon footprint in the UK, and is required to deliver a saving of 34% of peak CO 2 emissions by We are committed to a reduction of 20,000 tonnes CO 2 emissions through our SDMP. Through the emerging STP work streams the Trust will also explore the opportunity to benefit from a centralised energy procurement. In addition the Trust acknowledges the need to strengthen its inhouse energy management skills in order to improve day-to-day energy and carbon management and implement tighter cost control. It will therefore, as a priority, establish a more proactive, demand-side energy management programme focused on improved monitoring and reporting, improved operational control of energy using plant and equipment and good housekeeping measures. This will be rolled out during Sussex Partnership NHS Foundation Trust

25 The Trust recognises the need to invest capital resources in energy conservation measures and in response an energy investment programme will be developed during The Trust has already investigated establishing an Energy Performance Contract (EPC) as a means of progressing this; however, it is still considering options and would benefit from following an energy strategy that leads with effective demand-side management before considering major capital spending opportunities. Data on waste volumes produced by the Trust is only available back to 2012/2013 and does not include data from the PFI sites operated by Veolia. Data available show a progressive year-on-year increase in overall waste volumes produced, with the average annual increase in total waste produced since 2012 at 6%. Recycling rates (proportion of recyclable waste as a proportion of all non-healthcare, non-hazardous waste) have improved slightly, from 21% in 2012/2013 to 27% in 2015/2016. However, this is a long way short of what leading Trusts are achieving. The Trust will therefore establish a new target to boost recycling rates to 60% by The volume of clinical waste produced by the Trust has almost doubled between 2012 and 2016, although information on the composition of this waste is not available. A major opportunity for all NHS Trusts is the segregation of infectious (hazardous) healthcare waste from non-infectious (non-hazardous) healthcare waste. This is not only a legal requirement, but represents a better environmental solution (since it reduces the volume of waste that needs to be rendered safe through steam sterilisation) and also presents a significant cost saving opportunity. The Trust will undertake a full waste management review during 2017/2018, in conjunction with the introduction of new waste contracts for general and healthcare waste (which are being collaboratively tendered across the STP). This is expected to bring cost savings against the current contract rates; however, it also provides an opportunity for the Trust to introduce more sustainable waste management practices aimed at, for example, doubling the recycling rate and reducing the amount of hazardous healthcare waste being produced (through improved segregation). It is important that the estates strategy supports the Trust s Health & Wellbeing Strategy. One important way it can do this is by ensuring the working environment facilitates actions and behaviours that result in enhanced personal health and wellbeing including access to rest areas (internally and externally e.g. green spaces), healthy food options for staff and sustainable/green travel infrastructure. Estates Strategy

26 Tonnes CO2e The Estate Strategy can be an important facilitator in delivering several key elements of the SDMP, most notably the Buildings section, but also: 1. Journeys building location and infrastructure directly influence staff travel options and decisions and can help reduce travel impacts, time and costs; 2. Adaptation building location and design not only helps to mitigate climate change, but also has a role to play in dealing with the predicted effects of climate change, for example summer over-heating. 3. Wellbeing ensuring the design and operation of our estate supports staff wellbeing, e.g. we offer an effective work environment with adequate rest/break facilities for all staff. 8,000 annual carbon emissions reduction target 2011/2012 baseline 6,000 4,000 2, /122012/132013/142014/152015/162016/172017/182018/192019/20 Tie in with our IT Digital Strategy Our model of service is built around the needs of the patient and our infrastructure must support this. The ambition of our Estates Strategy is that our facilities do just that, but this cannot be achieved without a close alignment with our IT Digital strategy, the key components of which are illustrated graphically below: 26 Sussex Partnership NHS Foundation Trust

27 The following table describes our 2020 digital vision for each theme we identified during the strategy review process. Estates Strategy

28 Theme Enhance patient engagement placing the patient at the centre of their care Our 2020 digital vision Our patients and their carers can choose from multiple channels to engage with our services. Patients can access and contribute to their clinical record, book appointments, communicate with our staff and receive care in innovative ways. We use digital tools to capture real time feedback and use this wisdom to ensure our patients needs remain at the heart of our services. Engage, educate and empower our staff Deliver true innovation, optimisation and transformation Provide a complete and secure single source of trusted information Digital ways of working are part of our culture. Staff have the right tools for the job and access to the right training to ensure they are confident in their use. Staff can use digital tools and applications to access and share information and deliver exceptional patient care. Staff are encouraged to think creatively and feedback mechanisms ensure the views of our staff are heard and can help optimise the way we work and the care we deliver. Digital technology is embedded into the way we deliver care. We continue to invest in transformation and continually optimise our solutions to meet the needs of our staff and patients. We use innovative solutions and learn lessons from other industries. We ensure digital tools meet our needs by validating their adoption with end users and piloting their use before full implementation Excellent data quality is our standard. All staff (including clinicians) enter information in real time and feel accountable for its accuracy. Peer review and benchmark reporting is used to help ensure accountability. Where appropriate staff correct their own data. All changes to the Carenotes system are fully tested for their impact on data quality and information. Leverage our data to achieve clinical care intelligence There is a culture of valuing information. Clinical care intelligence is business as usual and we use dashboards, heat maps and proactive information alerts as standard. Self-service, proactive, flexible and visually appealing information is available for all tiers of managers and staff. There is close collaboration between operational staff and the Clinical Care Intelligence team to harness information to plan, transform services and improve the quality of the care we deliver. Use joined up information to deliver improved care Staff (regardless of their location) have a holistic view of a patient s mental and physical health record, plus any involvement with other organisations such as social care. Effective handover of care via electronic methods helps to ensure the safety of patients. Clinical, financial and workforce information is integrated and the Trust can accurately attribute the costs of delivering care and understand the impact of resourcing decisions. 28 Sussex Partnership NHS Foundation Trust

29 The following set of objectives were agreed with our stakeholders and outline what we need to achieve to deliver our 2020 digital vision in line with our strategic themes. These objectives focus on building on our current capabilities and infrastructure. Patients and Carers We will harness the power of digital tools and information to provide multiple channels for patient and carer engagement and feedback, ensuring their needs are at the heart of our services Educate We will educate and empower our staff to use digital tools and information to help transform patient pathways and improve the safety, effectiveness and efficiency of our services, including those delivered in conjunction with our partners. We shall also use technology and apps to make our staff more safe e.g. a lone worker app Validate We will validate the adoption of digital tools with clinicians, support staff and patients (as appropriate), and pilot their use before full implementation Culture We will develop a culture of excellent information use, working with clinicians, managers and support staff to ensure they have the right tools for their role, developing measures of their success and helping them to use the clinical and support systems to capture good quality data for all purposes Information We will introduce innovative ways of presenting useful information to staff, and combine information from multiple sources, including physical health and social care to provide insight into the quality our patients care, its effectiveness, efficiency and safety Integration We will work with our partner organisations, including social care, across the Sustainability and Transformation Plan footprint to collaborate on shared digital services, records and other initiatives which support the agreed digital roadmap, reduce costs and improve quality Infrastructure We will maintain and continually improve our infrastructure to meet the needs of our patients, their carers and our staff. Accurate and timely information is required if our services are to ensure high levels of patient safety, clinical effectiveness and excellent patient and carer experiences. Information, like the estate, is a key enabler to the Trust s 2020 Vision document, our clinical strategy and CDS operational plans. Investment in both the estate and IT infrastructure must be planned in a coordinated way to deliver benefits. The Trust is committed to harnessing the benefits of Information through the deployment of Carenotes as the main electronic patient record. This will gradually supersede the paper record. Estates Strategy

30 On the whole our main sites and wards will have Wi-Fi connections, for the benefit of patients as well as staff. However, the nature of our service provision may mean that in our more secure environments security requirements may override the benefit of Wi-Fi access (e.g. in our low and medium secure units). A number of our premises already have COIN access to facilitate access across a number of NHS premises, but we are also looking at options that can extend such inter-operability across public sector buildings more generally, and from 2017 we will be working with partners in local government and independent providers within the health and care system to develop successor connecting networks that allow for secure communication on an as required basis across the health and care system. Our IT Digital strategy will enable smart clinic scheduling and the use of generic consultation and treatment spaces for the majority of our services. This will enable us to ensure that all our clinical facilities are used well and that many different services using the same room are supported in their own ICT needs. Our digital strategy will enable changed ways of working with the potential to support administrative functions across a number of sites, including within the premises of other organisations, as well as at home. ICT will also enable patients to engage with our services in new ways. Investment in modern estate and new ICT will not realise such benefits unless we take full advantage of the new ways of working that are enabled by such development. We will be supporting new models of working through training, communicating clearly our expectations with frontline staff about the deployment of ICT and agile working practices and using ICT to support the management of performance overall in the Trust. Through this approach we intend to reduce staff sickness and absence, improve recruitment and retention and make flexible working a genuine win-win, becoming more responsive to patient needs and allowing our staff to better balance their work commitments with carer and other responsibilities. Financing our capital investment requirements Given the continuing financial challenges facing the Trust and the wider NHS, the Trust made a decision a number of years ago to ensure that the capital programme was self-funding. The reasons for this are threefold; firstly, the Trust is no longer in a position to deliver significant annual surpluses; secondly, the Trust s borrowing capacity is constrained by the current PFI debt; and thirdly, the Trust wants to maintain its sound liquidity position to help support its overall financial rating with NHS Improvement. The table below sets out the funding and capital expenditure over the last 5 years. It should be noted that 51.7m has been made available through deprecation, asset sales and national funding ( 2.5m to support the IT programme) that has been used to support 44.7m capital investment. The Trust needs to continue this strategy into the future as the asset management review has identified that further investment would be needed to support our estate and service developments in line with our overarching strategies. Each case would need to be assessed on its individual merits but the following could be considered as means of finance: Refinancing options for existing PFI commitments; Consider alternative public private partnership (PPP) financing models such as income strip leases, local asset backed vehicles; Consider access to other off-balance sheet procurement vehicles, e.g. Project Phoenix; Seek access to central capital funding where available, e.g. through DH capital or via the STP. 30 Sussex Partnership NHS Foundation Trust

31 Funding Expenditure Year Depreciation Disposal Proceeds National Funding Total Cash Available Capital Expenditure m m m m m 2016/ / / / / Total Estates Strategy

32 How our Estate may change over the next five years The NHS is undergoing a period of transformative change in the way it commissions and delivers services. This is being driven by the STP and the CCG s local estates strategies. The first and foremost change is already underway, and this is to refocus strategic thinking away from the perspective of individual organisations to the needs of populations as a whole. Partnership working has always been central to the way the Trust operates, but there will be a stepchange in the level of collaboration between all NHS providers, primary care and local authority services, with an increase in multi-organisational service delivery models and multi-occupancy of buildings. It is no longer appropriate or effective to plan from the perspective of an individual organisation. We are a full participant in the planning processes led by the STP and the LES s led by CCGs as local system leaders. Furthermore, the Cabinet Office s One Public Estate initiative, where seed funding can be made available to support the development of projects that support the government s objectives for the public estate as a whole, is accelerating collaboration. Future iterations of the Trust s plans for the estate will increasingly focus on the local delivery and implementation of changes required to support change across a wider system. Our plans, therefore, will be taken forward through greater collaborative working through our partners. Given how the planning landscape may continue to change, and the development of strategic projects increasingly involves multiple partners, it is difficult to say for certain exactly how the Trust s estate will look 5 years from now, and any proposals set out here are also subject to further stakeholder engagement and public consultation. However, from work being carried out currently within the STP and LES s it is possible to make a prediction of the likely changes we will see over the next five years. We predict that we will: Further reduce our footprint Achieve greater co-location of staff, not only amongst our own services but with partner organisations as well Have fewer but better quality facilities Have reduced our footprint yet increased our capacity to provide services, using benchmarks for estates operational efficiency (such as Carter) to assess our progress on this journey Improve the patient care environment Continue to be at the forefront of research and best practice in the design and management of the healthcare environment including the incorporation of new technologies Provide non-clinical accommodation in non-clinical buildings and our non-clinical footprint will decrease as we realise the benefits of agile working, the proportion of non-clinical space as a total of our occupied space will decrease (in line with Carter efficiencies) Align the planning of the estate with the Trust s digital strategy to enable an ICT rich environment throughout. Achieve a high utilisation of estate (thereby improving both quality and value for money) and enable new ways of working that support the Trust s clinical strategy and vision. 32 Sussex Partnership NHS Foundation Trust

33 How we will deploy our estate to recruit, retain and support our staff We are committed to recruiting, retaining and supporting our staff to ensure they have productive, healthy and happy working lives, as well as recognising that our staff work best when there is a healthy work life balance. Each member of our staff is unique and requires different things from the Trust to ensure we can achieve working arrangements that support the needs of the organisation and our patients, as well as fitting around the needs of each member of staff. We are committed to supporting flexible working and to making this a win-win-win for our patients, our staff and the Trust. We have already described in the section above how informatics for example, can enable improvements in staff productivity, reduce unnecessary journeys, and offer greater flexibility to planning clinical rotas etc. How we develop and deploy our estate has the potential to make a marked impact on our success, not only on recruitment and retention, but on staff morale and well-being. How we will use our estate to improve health and wellbeing As a minimum all staff should have the right to be comfortable within the workplace. This means that staff should expect the following: Attractive work-places. This means that furniture is clean and comfortable, we follow our decorating schedules and, where necessary, we commit to the refurbishment of staff working environments. The attractiveness of staff working environments sends a strong signal about how we value our staff, and we want all our workplaces to demonstrate that we value and support all who work within our Trust Well-lit workplaces (ideally all working environments should afford good levels of natural lighting, but where this is not possible, e.g. in some clinical and FM environments, work patterns should limit the time staff are working in rooms without natural light). Environmental controls, including temperature and ventilation Work station assessments, including display screen equipment Staff amenities, with all staff having access to beverage and rest areas Fully compliance with all equalities legislation, including mobility access and reasonable access to enable the comfort and productivity of disabled staff Support for active travel, such as the provision of cycle storage and showers etc. for all our main sites. Making flexible working a win-win Work life balance means different things to different people. However, we are committed to supporting staff through: Flexible shift patterns and rostering reflecting the need for staff to build their own working lives around family, carer and other commitments Use of IM&T, including the deployment of Carenotes and accompanying agile working to reduce unnecessary journeys Building a network of flexible office hubs across our geography with touchdown facilities, to enable staff to have access to flexible office facilities within close range across our geography. Through our relationships with partners in the NHS and public sector more widely we intend to extend inter-operability to enable a greater range of flexible desking options to suit staff needs. We are working with partners through One Public Estate boards and other collaborative bodies Estates Strategy

34 such as SPACES (Strategic Property Asset Collaboration East Sussex) to extend this beyond NHS properties but across the public estate as a whole Active promotion of teleconferencing, to support meeting participation but reduce the number of journeys staff are required to make. Rolling out of Skype to support video/web conferencing and in some cases patient consultation. Travel light We are looking at ways we can reduce the impacts of CO 2 emissions further whilst also supporting staff. We recognise that for some staff (essential travellers) they must travel in order to fulfil their duties. Other staff may need to travel occasionally to fulfil their duties and other colleagues do not need to travel to fulfil their role. Our response must recognise that different staff groups have vastly differing travel requirements. These include: Extension of pool car provision and promotion of lease car options for essential travellers Looking at video/web conferencing options to support travel avoidance Use of pool cars and encourage public transport and active travel for shorter journeys Provide rebates on parking costs for staff who offer lift Consideration of travel requirements for all new sites being considered. We will ensure facilities for active travel across our sites, including cycle storage and showers. We have recently engaged with Sussex Community NHS Foundation Trust s fleet management division to ensure roll-out of best practice in active travel policy and to look for economies of scale and scope given the community based nature of our services and the substantially overlapping geographies of the two Trusts. 34 Sussex Partnership NHS Foundation Trust