Medical Director Director of Quality and Nursing Version 1

Applies to: Committee for Approval Clinical Staff employed by Wirral Community NHS Trust Trust Board Date of Approval August 2014 Committee for Ratification Education and Workforce Committee Review Date: August 2019 Name of Executive Leads Medical Director Director of Quality and Nursing Version 1 2 P a g e

Contents Introduction page 4 1. Trust board commitment page 5 2. Trust vision and values page 6 3. Compassion in Practice page 7 4. Clinical engagement model page 10 5. Continuous quality improvement model page 13 6. Clinical strategy priorities page 14 7. Clinical priorities (Our patients) page 15 8. Clinical priorities (Our services) page 18 9. Clinical priorities (Our staff) page 23 10. Clinical priorities (Our sustainability) page 29 11. Clinical Forum page 32 12. Equality and diversity impact assessment page 33 3 P a g e

Introduction Welcome to our Clinical Strategy for 2014-18. In this document we describe our clinical ambitions for the next five years. The strategy demonstrates our commitment to providing the highest possible standards of clinical quality, and shows how we are listening to our patients, staff and partners, and how we will work with them to deliver services that are relevant to the people who use them. The strategy also confirms our commitment to contributing to the wider health and social care system locally, to help address the wider health inequalities experienced by local people and promote their overall health and wellbeing. Our vision is to achieve this in the most clinically effective, efficient and innovative ways, understanding that there is little new funding available for health services. We want to use the limited resources that we have to deliver the best possible services for our patients and their families and carers, which does not compromise on the quality of care received. We believe our knowledge and expertise in community services will help us to achieve these goals. This document reflects, and supports, the formal Commissioning Strategies of our local Clinical Commissioning Group, the Local Authority and NHS England and describes our vision for the future as an organisation, outlines our top clinical priorities and aspirations and how we expect to develop and improve our clinical services over the next five years. This will require a strengthened culture of co-operation with the people who use our services, both patients and their carers, and the organisations with which we are partners, particularly our colleagues in primary care, acute hospitals and social care as part of Vision 2018. As a specialist provider of community health services, our role is two-fold. It is firstly to focus on those parts of the care network which require our specialist skills, where we can use our specialist clinical expertise and resources most effectively. Our other, equally important role, is to support other parts of the care network, particularly primary care, so that more patients can be helped and supported in primary care, without needing to access specialist secondary services, unless they are clinically required. Dr Ewen Sim, Medical Director Sandra Christie, Director of Quality and Nursing 4 P a g e

1. Trust Board commitment to a clinical strategy and clinical engagement Wirral Community NHS Trust Board recognises that clinical engagement is an integral part of how it will deliver its business strategy and for the Trust to be most effective clinicians must feel they have a strong voice in how the organisation is led. The Trust Board is committed to ensuring that clinical engagement forms an integral part of its philosophy, practices and business plans with responsibility for driving the clinical strategy embraced at all levels of the organisation. The clinical strategy: Informs patients, the public, stakeholders, commissioners and staff, of the key plans to develop the organisation and provide a clear planning framework for staff, clinicians and managers to help focus on specific service developments and service improvement initiatives. Drives a clinically-led service delivery model. Helps foster a working culture which delivers safe care for all our patients, and to the highest standard. Develop the principles and goals within the trusts business plan and other enabling strategies, pulling all together to set the direction of travel for clinical services over the next five years. Ensures that Wirral Community NHS Trust services are fit for the future; leading in the provision of safe, clinically effective and reliable care that provides our patients, service users and carers with a positive experience Further develops an integrated partnering approach to the delivery of services 5 P a g e

Vision and Values As an organisation our vision is to be the outstanding provider of high quality, integrated care to the communities we serve and our quality strategy is a key part of that vision. Our values as an organisation, and which underpin this strategy are: Health is our passion, with patients at the heart of everything we do Exceptional care as standard Actively supporting each other to do our jobs Responsive, professional and Innovative Trusted to deliver The values are supported by the following behaviours which all contribute to delivering high quality care: Provide compassionate care, with empathy, kindness, respect and dignity Act with honesty and integrity Communicate openly with patients and colleagues Act with courage when things are not right Build effective partnerships Sustaining the pride, enthusiasm and commitment of our staff is achieved by sharing and owning the organisational vision and values, which underpins high quality clinical care in effective organisations and enables the culture of quality to thrive. For clinical staff the values of caring and compassion are what motivated them to work in health and are completely aligned with their professional values and aspirations. 6 P a g e

Compassion in practice The clinical strategy is built upon the six fundamental values enduring values and beliefs that underpin care wherever it takes and are essential to the delivery of high quality compassionate care: Care Care is our core business and that of our organisations, and the care we deliver helps the individual person and improves the health of the whole community. Caring defines us and our work. People receiving care expect it to be right for them, consistently, throughout every stage of their life. Compassion Compassion is how care is given through relationships based on empathy, respect and dignity - it can also be described as intelligent kindness, and is central to how people perceive their care. Competence Competence means all those in caring roles must have the ability to understand an individual s health and social needs and the expertise, clinical and technical knowledge to deliver effective care and treatments based on research and evidence. Communication Communication is central to successful caring relationships and to effective team working. Listening is as important as what we say and do and essential for "no decision about me without me". Communication is the key to a good workplace with benefits for those in our care and staff alike. Courage Courage enables us to do the right thing for the people we care for, to speak up when we have concerns and to have the personal strength and vision to innovate and to embrace new ways of working. 7 P a g e

Commitment A commitment to our patients and populations is a cornerstone of what we do. We need to build on our commitment to improve the care and experience of our patients, to take action to make this clinical strategy a reality for all and meet the health, care and support challenges ahead. Each of these values and behaviours carry equal weight. Not one of the 6Cs is more important than the other five. The 6Cs naturally focus on putting the person being cared for at the heart of the care they are given. These are the values that motivate clinical staff to want to work in health and care in the first place. Importantly, staying connected to these values is what gives us the strength to keep doing this challenging work every day. The 6Cs are contributing to a significant social movement of cultural change across the NHS and social care to improve the way we provide care for people. Strategic Leadership and Drive Organisational accountability for high quality, safe and effective clinical care sits with all Trust Board members who share responsibility for clinical engagement and the clinical strategy across the organisation. The board s leadership role is to set the ambition and drive the implementation of the organisations clinical strategy in order to facilitate transformation in care and continuous improvement. Without sound leadership from the board clinical innovation and transformation are unlikely to bring about sustainable change. The board oversees clinical engagement on behalf of the board and the clinical forum monitors the implementation of the clinical strategy. Focus on engagement Clinicians have a vital role to play in driving improvement in the organization. As the people working directly with patients they are the ones who can really improve care at a local level. Real sustainable care improvement calls for meaningful and effective clinical engagement because it is clinicians who are best placed to advice and lead on issues relating to clinical quality and effectiveness. They are 8 P a g e

the local care pathway experts who work closely with local people and understand clinical needs. It is vital that clinicians working in all parts of the organisation feel engaged, enthused and supported in the work they do and feel confident to take on the responsibility of improving care for patients at every opportunity. 9 P a g e

1. Clinical Engagement Model Supported Staff delivering Quality Care Figure 1: Clinical Engagement Model Supported Staff delivering Quality Care The clinical engagement model described in figure 1. ensures care delivered in the organisation is: Safe Caring Effective Responsive Well Led Sustainability The current financial challenge facing NHS organisations cannot be underestimated. The ambition of this strategy is to achieve consistent excellence in care delivery across all areas of provision whilst meeting the demands of the financial challenge. This will be achieved by embedding a system wide culture of clinical engagement and innovation which delivers efficiencies as well as quality. The Trust has developed an excellent reputation for innovation and research and will continue to deliver positive outcomes and experience for the populations we serve through this clinical strategy. 10 P a g e

Strategic Planning It is critical that all organisational strategies are aligned and contribute to the trust s overarching 5 Year business plan which articulates the vision and ambition of the organisation for the next five years. The clinical strategy shares the ambition of this plan and recognises the central role that clinicians play. Vision 2018 In order to ensure that high quality clinical care and innovation drives the organisations ability to meet the changing demands of the care system over the next five years, the Board have developed a visionary strategy in partnership with other local care organisations. The aim of the programme is to develop a system wide, integrated approach to local care delivery which promotes health and is person centred, safe, high quality and cost effective. It is the ambition of this strategy that Wirral Community NHS Trust will rise to the challenge presented by Vision 2018, leading the way in delivering integrated care services to the communities it serves. Foundation Trust Status In addition, Wirral Community NHS Trust s commitment to high quality clinical care and innovation underpins the organisation s determination to achieve Foundation Trust status. In pursuing the Foundation Trust application process the organisation can demonstrate not only the financial stability and efficiency of the organisation but most importantly that the staff deliver safe, effective and high quality services. The Trust Board recognises that high quality clinical care and innovation is a business imperative for a successful healthcare organisation. Foundation Trust status will give the Trust greater freedom and opportunity to deliver our vision and clinical strategy by: Promoting our independence and providing greater accountability to the communities the organisation serves Greater financial freedom including the ability to retain and reinvest surpluses in the provision of high quality clinical services Empowering and creating a new sense of purpose for staff and patients In order to achieve foundation trust status, the organisation faces a significant financial challenge faced by every other NHS organisation. This challenge includes: Making a 4% efficiency savings for each of the next 5 years 11 P a g e

Introducing new forms of 7 day working to improve the quality of care for patients Making major changes to the Urgent and Emergency Care Pathway Moving care out of hospitals Creating new integrated new models of care Improving quality by ensuring staffing is safe and staff ratios are right The clinical strategy strives to strike a balance between high quality clinical care, maximising patient safety and creating a positive patient experience. This will be achieved whilst working within our allocated resources and is based on a belief that improving the quality of clinical care can bring financial and productivity benefits for the organisation. 12 P a g e

3. Culture of Continuous Quality Improvement The quality curve cited in figure 2 illustrates the journey from adequate quality care through to excellent quality care. It is the ambition of Wirral Community NHS Trust to achieve consistent excellence in quality across all areas of provision and this strategy articulates how we plan to achieve this by implementing our clinical strategy and clinical engagement model, making progress year on year. Figure 2: Quality Curve 13 P a g e

4. Strategic Priorities The five year clinical strategy, underpinned by our clinical engagement model Supported Staff delivering Quality Care will expedite our progress towards continued excellence in care delivery and will be structured around the organisations strategic priorities which are; Our Patients, Our People, Our Services and Our Sustainability. The strategic priorities are: Our Patients Our Services Our People Our Sustainability We will put quality at the heart of our services. We will listen and respond to our patients. We will deliver safe, effective care twenty four hours a day. We will develop better integrated healthcare. We will develop and support our staff. We will develop clinical leadership at every level of the organisation. We will support our staff to work more effectively using new IT systems We will creating a culture of clinical innovation. 14 P a g e

Our patients Priority 1. We will put quality at the heart of our services As the main provider of community healthcare across Wirral, we are committed to ensuring continuous improvements to the quality of services we provide. Quality is at the heart of our agenda with our vision being to be the outstanding provider of high quality, integrated community care to Wirral and beyond. We will do this by building on the quality strategy to further develop a culture of high quality, compassionate care for all patients. The quality strategy ensures we maintain annual CQC registration and builds on a strong history of delivering against contractual quality standards including the Commission for Quality and Innovation (CQUIN) payment framework where financial incentives are attached to the delivery of key quality indicators. The strategy ensures that quality services are delivered in the organisation in response to the specific requirements of our patients, the public, our commissioners and regulators. It will also support the delivery of the organisations Integrated Business Plan (IBP) 2014 2019. By establishing a shared understanding of quality and a commitment to place it at the heart of everything we do, Wirral Community NHS Trust s quality strategy represents a unique and important opportunity for us to work together to ensure Wirral Community NHS Trust is the outstanding provider of high quality, integrated community care to Wirral and beyond. Implementation of the quality strategy builds on the confidence and pride in Wirral Community NHS Trust with people who access our services knowing that they are amongst the best and are safe, effective and responsive to their needs, every time and all of the time. This priority is monitored by the Quality and Governance Committee using the monthly quality report and by the board in the annual Quality Account. A key development in 2014/15 will be the introduction of the quality dashboards at team level. 15 P a g e

Priority 2. We will listen and respond to our patients At Wirral Community NHS Trust we care deeply about the quality of the care that our patients, service users, their families and carers receive from us. We are committed to delivering high quality and efficient services which provides patients and carers with the best possible experience whilst using our services and this is a strategic priority for the Trust. Our patient experience strategy ensures a cycle of continual listening, learning and service improvement; working together with our patients and partners in care, to ensure that feedback from experience is routinely captured, and used to drive quality improvement. Our patient experience aim is to ensure that patients, their families and carers receive an experience that not only meets but exceeds their expectations of services at the Trust, delivering service which delights our patients, their families and carers and to be an organisation where the culture places the quality of patient experience at the heart of all we do, where doing the extraordinary daily is the norm. Care is the trusts core business and the care we deliver helps the individual person, their family, and their carers. Our combined services contribute to the delivery of national public health outcomes to improve the health of the whole community. People receiving this care expect it to be right for them, consistently, throughout every stage of their life. The involvement of patients and carers is at the heart of the NHS agenda. Patient feedback and engagement supports a deeper understanding of how users view NHS services and learning from their experiences is essential to us to make services better and ensure patients have excellent experiences. It is Wirral Community NHS Trusts ambition to engage effectively with all our patients and carers, in order to continue to develop services and ensure their experiences of our care services are of the highest quality. This in turn will strengthen confidence and pride in Wirral Community NHS Trust. High quality patient, carer and family experience:- has been linked to better health outcomes for patients is integral to the Trust s Quality Strategy is a right under the NHS Constitution for England helps the Trust maintain and increase public confidence contributes to sustaining the Trust s reputation as a healthcare provider of choice 16 P a g e

is a key component of high quality care, as demonstrated by the national NHS England s Outcome Framework This priority is monitored by the Quality and Governance Committee using the monthly quality report and by the board in the annual Patient Experience report. A key development in 2014/15 will be the introduction of real time monitoring of patient feedback using kiosks. 17 P a g e

Our Services Priority 3. We will deliver safe, effective care twenty four hours a day. Our vision is to deliver services in the most clinically effective, compassionate, efficient and innovative ways, over a twenty four hour period, 365 days a year while understanding that there is little new funding available for health services. We want to use the limited resources that we have to deliver the best possible services for our patients and their families and carers, which does not compromise on the quality of care received. We believe our knowledge and expertise in our areas of work will help us to achieve this vision. As an organisation we understand that the on-going assessment of market demands/trends and commissioning intentions will be crucial to the development of our clinical services and the way in which we evolve our organisation to support the healthcare needs of patients. This approach supports our commitment to long term sustainability under the three key areas of: Business development; ensuring our business strategy reflects the commitment to promote integrated service delivery, identifying opportunities to develop into new clinical markets, and embedding business development processes within the clinical service delivery areas Business planning; ensuring our clinical services embed the discipline of effective business planning processes into their annual planning cycle Responsiveness; building in processes to allow the organisation to react to the changing healthcare landscape The healthcare environment within which we operate is changing rapidly, and will require the organisation to be flexible in its responses without diluting the quality of care provided. We intend to maintain a competitive business position in the local healthcare market. This has helped to inform and shape our clinical service developments and workforce plans over the course of the next five years, and will support the delivery of long long term sustainability through; a proactive approach to knowing our market, our services and the direction commissioning at a local and national level is taking, 18 P a g e

assessing the contestability of our services, their ability to respond effectively, and undertaking analysis of the competitors within the environment both current and prospective, and their potential impact developing locally held and embedded 3 year business development plans which support defence and strategically appropriate growth of services positioning our organisation to be the preferred provider through the development of strategic relationships, collaborations and our relationship with patients who choose our services; To support this work effective discharge should be planned from the point of admission to hospital. On many occasions community services are informed very close to discharge, which does not allow adequate planning to occur, increasing the likelihood of a failed discharge and therefore readmission. These discharges often result in bed shortages or pressure in A&E, further highlighting the need for well-planned whole system coordination. It is acknowledged that the clinical interface between ward and community is crucial, and a key priority is to develop a more effective simple discharge pathway underpinned by close working relationships between clinicians from both organisations. This would enable effective discharge into community services over seven days, and that community services should focus on in reach, providing support to ward staff creating a better understanding of community skills and capacity. Patient Safety Wirral Community NHS Trust is also committed to delivering high quality clinical care free from avoidable harm, ensuring patient safety. When patient safety incidents do occur, they will be managed in an open and transparent manner, in accordance with the duty of candour, ensuring a culture of continuous improvement as a result of learning from experience. To facilitate learning from incident and near miss reporting, the trust has a robust framework embedded throughout the Organisation evidencing a commitment and proven ability to effectively manage and demonstrate sustained learning from incidents reported by staff. Incident reporting is more likely to take place in an organisation where there is a welldeveloped safety culture and strong leadership. We are committed to nurturing a strong safety culture underpinned by the promotion of incident reporting and supported by ensuring that investigation is focussed on learning and improving. This will be achieved by ensuring that all staff throughout the organisation report incidents and 19 P a g e

prevented safety incidents via the trust s incident reporting system, promoting an open and transparent culture of learning from experience, maximising patient safety and experience. The trust utilises a Root Cause Analysis (RCA) approach to incident investigation for significant, high risk rated incidents causing patient harm. Learning from moderate risk rated incidents is achieved via a Situation, Background, Assessment and Recommendation (SBAR) investigation. All RCA and SBAR investigations result in the development of an action plan which evidences how the trust ensures appropriate quality improvement actions are implemented to minimise the likelihood of incident reoccurrence. To ensure greater ownership and impact of the quality improvement, all staff involved in an SBAR or RCA investigation, contribute to the development of the action plan to maximise lessons learned. The root cause of many incidents is attributable to systems and processes that do not support logical clinical decision making when faced with the increasing complexity of healthcare. As a result, the trust has successfully developed a Human Factors training programme for staff, and has incorporated the fundamental principles of the psychology of human behaviour into the Essential Learning training for all clinical staff. This enhanced awareness of Human Factors across the organisation has positively contributed to achieving a dynamic culture where incidents are seen as a real opportunity to learn, and to improve patient care. Communication to enhance patient safety across the wider health and social care economy is achieved via established internal and external escalation pathways to all relevant partner organisations, including Hospital Trusts, Clinical Commissioning Groups and the Local Authority. The trust has a robust process to ensure that patient safety incidents are reported monthly to the National Reporting and Learning System, and where required to the Care Quality Commission. Infection Prevention and Control Infection prevention and control are a core element of the Trust s clinical strategy. Understanding how infections occur and how different micro-organisms act and spread is crucial in preventing infections and the Trust has a statutory duty to comply with the Code of Practice on the prevention and control of infections. Compliance with the code of practice is statute under The Health and Social Care Act 2008. As a provider of regulated activities in England, we are required to meet or exceed the requirements of the Code, and compliance is determined through self-assessment, 20 P a g e

accompanied by external scrutiny by regulatory bodies such as the Care Quality Commission (CQC). Safeguarding Safeguarding is a core element of the Trust s quality, patient safety and governance system. Wirral Community NHS Trust has extensive experience of working to Local Safeguarding Children and Adult Board Policies and is committed to supporting vulnerable people and families. Wirral Community NHS Trust is committed to ensuring that all staff are aware of their role in relation to safeguarding vulnerable children and adults and deliver high quality services underpinned by strong safeguarding principles. Wirral Community NHS Trust has a household as opposed to caseload approach to safeguard patients thereby ensuring that staff can be proactive to protect and provide support for any person they encounter whilst undertake their duties. This priority is monitored by the Quality and Governance Committee using the monthly quality report and by the board in the annual Patient Experience report. This priority is monitored by the Quality and Governance Committee using the monthly and quarterly assurance reports and by the board in the annual assurance reports. A key development in 2014/15 will developing a patient safety strategy based on the national sign up to safety campaign. 21 P a g e

Priority 4. Developing better integrated healthcare Developing and implementing an enhanced and focussed model of integrated care is the driver for our service developments planned between 2014 to 2019. The board has approved an internal divisional restructure which will see two divisions created from the current five. These divisions will reflect Unscheduled and Scheduled care. This will fully align our services to the key work streams of the Vision 2018 programme. The modified divisional structure also reflects the local system priorities ensuring our staff are working in full alignment with local Vision 2018 strategy. We will work to develop new care pathways in community settings for people with a wide range of long term conditions currently cared for in acute hospitals as Community Trust services are pivotal to enabling new models of care to develop. Working in partnership with all key stakeholders across Wirral we aim to transform the delivery of care to people who have a long term condition. Community Trust services are pivotal to enabling new models to develop, which is reflected in our position as a lead organisation within the Vision 2018 programme. A further key clinical priority for us it to improve dementia patients experience by ensuring that safe and effective care is given, communication channels are clear, and cross boundary working is achieved across mental health, community and acute sectors, resulting in a better quality of life for both inpatients and outpatients under the care of the local health economy. This priority is monitored by the board in the monthly integration update. A key development in 2014/15 will be the introduction of the new divisional structure, the four integrated care hubs and alignment of our clinical services to them. 22 P a g e

Our Staff Priority 5. Developing and supporting our staff Staff development The quality of our clinical services is dependent on the quality of our clinical staff. We expect the highest quality standards in the performance of every staff member and seek to achieve this by the careful recruitment of the right people; ensure their rigorous and continuous training, line-management, coaching and performance management. Our workforce represents over 80% of the costs of the organisation, and is therefore our most important and valued resource. How we manage, develop, motivate and engage our workforce will be key to our success as a Trust. To deliver high quality care, clinical staff must possess a high level of knowledge and competence combined with excellence in practical skills, whilst also showing kindness, compassion and respect for patients. Our Human Resources strategy sets out the organisation s approach to the delivery of its vision and strategy through its people. It has been developed in consultation with the Board, Staff Side and taking into account views from across the organisation through Staff Council. The focus of Learning and Development activity for clinical staff is based on professional guidance, national, regional and local (organisational) imperatives and mandates including NICE guidance, Care Quality Commission Outcome 14 Standards, implementing learning plans following review of critical incidents, learning from the Francis Report, training needs analysis cycle and to support successful service redesign. Quality, Innovation, Productivity and Prevention (QIPP) benefits can be realised through learning and development and the Trust aims to maximise these benefits by: promoting multidisciplinary learning building on skills and knowledge for a flexible and innovative workforce fostering improvements in the quality of health care provision and patient safety improved efficiency through a standardised framework for education and training tangible quality improvements 23 P a g e

Clinical Revalidation The primary purpose of revalidation is to provide greater assurance that clinical staff remain fit to practise and capable of safe and effective practice, follow professional standards, both in terms of conduct and competence and that they have continued to keep their skills and knowledge up to date. These aims also form part of our clinical strategy as clinical revalidation brings a greater public confidence in the clinicians regulated by the professional bodies. It is also important that revalidation raises standards of care and promotes a culture of continuous improvement amongst all clinical staff. Staff wellbeing All the people working in health and care are contributing to the same aims, to provide high quality, compassionate care and treatment, and to achieve the best possible health and wellbeing outcomes for each of the people we care for. The evidence on what enables us to do that is overwhelming. To ensure that patients receive good care, we all need to care about our colleagues. If we feel supported and cared about, we are enabled to support and care about our patients. Recognising that the wellbeing of staff has a direct relationship to the quality of clinical care delivered, Wirral Community NHS Trust is fully committed to supporting staff wellbeing and creating a culture where staff feel values and listened to. Staff wellbeing is of paramount importance and is supported by the Trusts Wellbeing and Organisational Development Strategy. Clinical engagement The recent reforms in the architecture of the NHS brought about by the Health and Social Care Act (2012) have re-emphasised and re-prioritised the significance of clinical engagement and leadership in the shaping of service development and delivery. It is essential that providers of services to the NHS create mechanisms that are capable of drawing upon a clearly articulated clinical perspective in relation to future quality developments. The publication of the Francis Report, the Keogh Reviews and the Berwick Report gives further 24 P a g e

emphasis to ensure that issues of quality and safety have a primary role in the delivery of services. In response, the trust has introduced a clinical forum where collective knowledge and advice on clinical issues can be shared and offered to board of directors. The forum provides a mechanism for increasing clinical participation from all clinical groups within the Trust in the development of the quality strategy and the quality goals for the organisation and offers an opportunity for the expression of a unified clinical perspective on important development and delivery issues facing the organisation. The clinical forum ensures that issues of quality and safety are at the centre of the Trust's agenda and provide an opportunity for clinicians of a multi-disciplinary group to ensure that their concerns and propositions for development and improvement are heard and acted upon. Staff engagement in the NHS is a critical component for consideration when implementing a clinical strategy as recent evidence from the NHS has shown that higher levels of engagement is linked to (Staff Care 2014 Point of Care Foundation):- Improved levels of patient satisfaction Lower levels of absence Overall measures of financial effectiveness The link between staff engagement and patient satisfaction is not unsurprising. However, culture cannot be influenced by the words, actions and behaviours of the Board alone nor measured in a formal, linear way. Therefore a range of methods will be used to ensure that we accurately hear and effectively respond to staff suggestions and complaints. Safe staffing There is also a growing body of research evidence which shows that staffing levels make a difference to patient outcomes (mortality and adverse events), patient experience, quality of care and the efficiency of care delivery. As part of corporate accountability Wirral Community NHS Trust has a duty to ensure that patients are cared for by appropriately qualified, experienced staff in safe environments with appropriate staffing levels. Demonstrating sufficient staffing is one of the essential standards that all health care providers must meet to comply with Care Quality Commission (CQC) fundamentals of care. In response to the National Quality Board Paper, Getting the right staff, in the right place at the right time, Wirral Community NHS Trust has initiated a comprehensive safe staffing 25 P a g e

programme to ensure that we achieve the national ambition set out in the strategy cited above. This priority is monitored by the Education and Workforce Committee using the monthly and quarterly assurance reports and by the board monthly in the safe staffing report Key developments in 2014/15 will be the introduction of revalidation for nurses, increased use of E-Learning and the use of electronic roistering tools. 26 P a g e

Priority 6. Developing clinical leadership at every level of the organisation The strong relationship between leadership capability and performance is well demonstrated in the evidence. Good leadership leads to a good organisational culture and a good organisational culture leads, via improved staff satisfaction and loyalty, to a sustainable, high performing organisation. Within the organisation s leadership framework, the Trust recognises that clinical advice and leadership are pivotal to bringing about the necessary improvement in quality envisaged in the Government s proposals for modernising the NHS. Leaders and managers need to create supportive, caring cultures, within teams, within organisations and in the system as a whole, in the way that organisations relate to each other. Leaders at every level have a responsibility to shape and lead a caring culture. Working in healthcare and in the care sector, caring for vulnerable, sick and dying people, is inherently stressful and emotionally demanding. Time and space is needed for individuals and teams to reflect, to share experiences and seek support and to build emotional resilience. Clinical Leadership within Divisions Leadership of clinical services is a crucial part of an effective clinical strategy and is firmly embedded within our structures. The Trust s leadership structure includes Divisional Managers working with heads of service or clinical service leads at senior levels and together with the Head of Quality and Nursing they support the Director of Operations, the Director of Quality and Nursing and the Medical Director in providing clinical quality leadership within the organisation. Clinical Leadership at the board Both the Director of Nursing and the Medical Director play key roles within the trust in: Leading the formation and implementation of the clinical strategy Leading the formation and implementation of the quality strategy To advise the Board on and lead on the fundamental and clinical standards of care required and how to monitor them within the organisation Leading the clinical governance structures in the Trust Being clinical ambassadors representing the Trust to external organisations, such as Universities, Commissioners, other providers and professional bodies, Providing clinical advice to the board The Medical Director and the Director of Quality and Nursing are both members of the executive management team and executive directors of the board. As such, they lead the 27 P a g e

development and achievement of the Trust s clinical quality strategy and act as a strong culture carriers and signal generators in embedding the clinical strategy, and the organisations values and goals and for jointly ensuring delivery of high quality clinical performance of the organisation. Both the Director of Quality and Nursing, the Medical Director and other clinical leaders regularly spend time working with clinical teams. This priority is monitored by the Education and Workforce Committee using the quarterly Learning and Development report and by the board in the annual Learning and Development report. A key development in 2014/15 will be the introduction of the revised divisional structure.. 28 P a g e

Our Sustainability Priority 7. Supporting our staff to work more effectively using new Information Technology (IT) systems Increasing our use of IT by our clinical staff will increasing help our staff, particularly those working in patients homes, to work more flexibly and more effectively by increasing mobile working and their ability to access patients information remotely. This will increasingly help improve the integration of patient care and help our staff to be more effective and efficient in how they work. This priority is monitored by the Information Management Board monthly. A key development in 2014/15 will be the introduction of mobile technology. 29 P a g e

Priority 8. Developing a culture of clinical innovation Innovation is the conversion of knowledge and ideas into a benefit, which may be for commercial use or for the public good. The benefit may be new or improved products, processes or services. Innovation is also about delivering value through the implementation of new ideas; whether those ideas are adopted or entirely new. It is essentially about weaving together different knowledge strands clinical, technical, market, financial and so on to create value. The collective value of NHS innovation is in delivering high quality, efficient and costeffective services that meet the needs of those who use them. Innovation is recognised as essential to the future of the NHS for three important reasons: Innovation improves and extends lives Innovation connects and drives quality and productivity in the NHS Innovation will support the UK economy as the NHS remains a major investor and wealth creator in the UK The demand, nationally and internationally, to do more health care with less resource means that business as usual is no longer an option. However, it is difficult to find a problem for which innovation is not the solution. As a progressive, dynamic, forward thinking organisation a clinical priority is to embed a culture of research and innovation throughout the trusts clinical services, ensuring that we continuously make a real difference to people s lives, by advancing knowledge and learning. The Trust values empirical research and recognises the requirement to sustain and enhance partnership with local Higher Education Institutions (HEI). Close working already exists between the Trust and the HEI sector and it is a priority in this strategy to further develop these links and strengthen learning through development and implementation of a 5 year research plan for the organisation. The Trust is committed to building a clinical research and innovation infrastructure through the development of a Practice Development Research Partnership, which will provide opportunities for University academics and NHS staff to collaborate on a range of research 30 P a g e

with patients, service users, families, carers and staff. This infrastructure will enable the Trust to effectively translate research into clinical practice. Wirral Community NHS Trust s Research and Innovation Strategy will provide a detailed commentary about how we aim to develop a culture of innovation over the next five years. A key development in 2014/15 will be the introduction of Research and Innovation Strategy with an action plan for implementation. 31 P a g e

Clinical Forum The purpose of the Clinical Forum is to provide an opportunity for clinicians to champion new initiatives, service reconfigurations and transformation opportunities to address the challenges faced in the current NHS climate. The forum assists in the development of clinical leadership among the body of multi-professional clinicians across the trust and provides support to clinicians in driving service change and improvement. The clinical forum ensures that issues of quality and safety remain at the centre of the trusts agenda and provides an opportunity for clinicians from a multi-disciplinary group to ensure that their concerns and ideas for development and improvement are heard. The clinical forum provides an opportunity for the trust to deliver and develop an improving clinical vision for future community health services within the Trust. It contributes to the development of strategic and operational plans from a clinical perspective and provides clinical ownership. The forum helps to support the trust in determining its clinical priorities and provides a clinical perspective on performance, indicating both how organisational issues could be remedied whilst ensuring any such improvement is delivered from within a perspective of maintaining quality and safety. As such it will be the group that monitors the impact of the implementation of this strategy for staff. The terms of reference for the forum can be found at Appendix 1. The forum plays a key role in the innovation fund process, reviewing and agreeing projects to fund. 32 P a g e

Equality and Diversity Equality Analysis Under the Equality Act 2010 the Trust has to demonstrate how we are meeting the General Duties. The General Equality Duty is set out in section 149 of the Equality Act. In summary, those subject to the general equality duty must have due regard to the need to: Eliminate unlawful discrimination, harassment and victimisation Advance equality of opportunity between different groups Foster good relations between different groups We need to analyse the effect on equality for all of the protected characteristics, and all aims of the general equality duty, equality analysis is a way of considering the effect on different groups protected from discrimination by the Equality Act, such as people of different ages. There are two reasons for this: To consider if there are any unintended consequences for some groups To consider if the policy will be fully effective for all target groups. We need to hold a written record to demonstrate that due regard had been taken. To achieve this, the Trust has developed a consistent approach to Equality Analysis across the organisation. The Equality Analysis undertaken on this strategy will be available on the Trust s public website. 33 P a g e

Appendix 1 Clinical Forum Terms of Reference Introduction 1. This document comprises the terms of reference, constitution and modus operandi of the Clinical Forum. Purpose 2. The purpose of the Clinical Forum Staff Council is will provide an opportunity for clinicians to champion new initiatives, service reconfigurations and transformation opportunities to address the challenges faced in the current NHS climate. It will assist in the development of clinical leadership among the body of multiprofessional clinicians across the trust and provide support to clinicians in driving service change and improvement. 3. The clinical forum will ensure that issues of quality and safety remain at the centre of the trusts agenda and provide an opportunity for clinicians from a multidisciplinary group to ensure that their concerns and ideas for development and improvement are heard. 4. The clinical forum will provide an opportunity for the trust to deliver and develop an improving clinical vision for future community health services within the Trust. It will contribute to the development of strategic and operational plans from a clinical perspective whilst providing clinical ownership. It will help to support the trust in determining its priorities and will provide a clinical perspective on performance, indicating both how organisational issues could be remedied whilst ensuring any such improvement is delivered from within a perspective of maintaining quality and safety. 5. The Clinical Forum will not replace the existing arrangements for negotiating and consulting with Staff. Membership 6. Membership of the clinical forum will include: A joint chair which will be shared by the medical director and the director of quality and nursing. Both directors will provide a direct link between the forum and the board A vice chair. The clinical forum will be invited to elect a vice chair from the membership There will be 15 professional seats at the forum with the following clinical professional groups represented: Nursing Medical and Dental Allied Health Professionals 34 P a g e

7. The number of seats at the forum by profession has been based on the following breakdown of clinical staff groups in the organisation: Nursing: 54.08% of total workforce and have 7 seats on the forum Medical and Dental: 4.34% of total workforce and have 2 seats on the forum Allied Health Professionals: 15.71% of total workforce and have 5 seats on the forum Quality and Governance staff will have one seat on the forum 8. The meeting will be quorate if one Chair plus seven elected members of the Council are present. 9. The Director of Quality and Nursing Human Resources and the Medical Director will make arrangements to ensure that the Forum is supported administratively. Duties in this respect will include taking minutes of the meeting and providing appropriate support to the Chairman 10. Agendas and supporting documentation will be circulated at least 5 working days (or 4 working days plus a weekend) in advance of the meeting Frequency of meetings 11. The Forum will meet bi-monthly. The meetings are indicated below: January March May July September November Duties 12. The scope of the Clinical Forum includes all matters of clinical engagement with the staff of Wirral Community NHS Trust and key examples are: Vision and strategy To support the board in developing an overall vision and strategy for the future of health services in the trust, in the context of national priorities. To contribute to the trusts strategic and operational plans and provide clinical ownership and championing of these plans. To support the trust to achieve financial balance and value for money. To provide a clinical perspective on key areas of performance across the trust and where necessary how these might be remediated. Developing clinical leadership To support clinicians to act as leaders within their professions, specialties and organisations and to drive service change. 35 P a g e