Staffordshire and Stoke on Trent Partnership NHS Trust Operational Plan 2016-17
Contents Introducing Staffordshire and Stoke on Trent Partnership NHS Trust... 3 The vision of the health and care system... 4 Strategic direction of Staffordshire and Stoke on Trent Partnership NHS Trust... 5 The MCP model of care... 5 Key priorities for the Partnership Trust 2016/17... 5 Strategic commissioning intentions... 5 Multi-specialist Community Provider (MCP) development... 6 Home care services... 6 Social care contract... 6 Changes in management of community hospital beds... 7 Children s services... 7 Information Technology (IT)... 7 Delivering cost improvements... 7 Tendering for contracts... 8 We put quality first... 9 Approach to quality planning... 9 Quality improvement priorities 2016/17... 10 Priority 1: Safe Reduce avoidable harm... 10 Our aim: Improve our safety culture and workforce, eliminating avoidable harm of all types... 10 Priority 2: Caring Improve Service User Satisfaction... 10 Our aim: Sustain and maintain our overall service user experience... 11 Priority 3: Effective improve our outcomes... 11 Our aim: Improve the outcomes and personalisation of our services... 12 Mortality... 12 Care Quality Commission (CQC) inspections... 13 We focus on people... 14 Recruitment and retention... 14 Skill mixing and different models of delivery... 14 We take responsibility... 16 2
Introducing Staffordshire and Stoke on Trent Partnership NHS Trust The Partnership Trust is one of the UK s largest integrated community health and adult social care providers. Established in September 2011, the Trust successfully integrated with Staffordshire County Council s Adult Social Care on 1 April 2012. We employ over 6,000 staff and have an annual turnover of over 370million. The Partnership Trust is located within the geographical boundaries of Staffordshire County Council and Stoke-on-Trent City Council, with sexual health services in Leicester, Leicestershire & Rutland and infection control services in East Cheshire. We serve a diverse population of over 1million people. Our vision is to deliver personalised care of the highest quality, with the best outcomes for users and carers, empowering them to remain independent. This vision is underpinned by three values. We have five strategic goals. We put quality first We deliver quality and do the very best we can We focus on people We treat people as individuals and take time to respect and understand their point of view We take responsibility We take personal ownership of things and see them through. We focus on finding solutions We will provide high quality and safe services which provide an excellent experience and best possible outcomes We will work with users and carers to deliver integrated services, simply and effectively Our organisation will develop and deliver sustainable, innovative services that support independence Our workforce will be empowered and supported to deliver care in a way that is consistent with our values We will make excellent use of our resources and improve levels of efficiency across our services. More information about the Partnership Trust can be found on our website: www.staffordshireandstokeontrent.nhs.uk 3
The vision of the health and care system The Staffordshire and Stoke on Trent health and care system has embarked on an ambitious transformation programme Together We re Better. The vision of Together We re Better is that Staffordshire and Stoke on Trent will be vibrant, healthy and caring places where people will be as independent as possible and able to live happy and healthy lives, getting high quality health and care support when required. How we will deliver the vision is represented in the following diagram. 4
Strategic direction of Staffordshire and Stoke on Trent Partnership NHS Trust The NHS Five Year Forward View, published in October 2014, set out five new models of care. 50 sites (called vanguards) are testing these across the country. In Staffordshire and Stoke on Trent, we are following the developments of the vanguards that are testing the multi-specialist community provider (MCP) model. The aim of this model is to provide enhanced community care for the populations we serve. The MCP model of care To enable new ways of delivering care, the Partnership Trust will work with GP federations, voluntary and community sector networks, local councils and other NHS organisations to enable a shift of care out of hospitals and into the community. The model of care will be developed to: work across organisational boundaries deliver integrated health and social care to its service users ensure that each individual receives the care they need where and when they need it maximise the independence of the population. Key priorities for the Partnership Trust 2016/17 Strategic commissioning intentions The Partnership Trust receives its funding by holding contracts with commissioners. Commissioners can be from Clinical Commissioning Groups, local authorities, other NHS organisations and the independent sector. Each commissioner sets out its commissioning intentions for the next financial year. In line with the strategic commissioning intentions for 2016/17, the Partnership Trust will work closely with commissioners to identify the true costs of services. Our focus will be on delivering a sustainable health system that is able to deliver better outcomes at lower cost. We will also work closely with commissioners on: Developing new and sustainable ways of delivering community care Revising the specifications that describe how our services will improve the health and independence of the people in our care (for 2017/18) Ensuring our plans to improve quality and reduce cost match Transforming services for those with long term conditions; improving quality, better co-ordination of care and efficiency 5
Strengthening approaches to identifying those people who would benefit from our services and supporting them to co-ordinate all the services they are receiving Helping people to manage their conditions better Making better use of technology Building alliances with other organisations that provide health and care; focusing on out of hospital care co-ordination and delivery. Multi-specialist Community Provider (MCP) development A key priority for the Partnership Trust is the roll-out of the model of care delivered by the Multi-specialist Community Provider. In North Staffordshire and Stoke on Trent it is intended that this will be complete by the middle of 2017, based on the adoption of two additional populations every four months. Two pilot sites will continue to evolve their new model. South Staffordshire commissioners have taken a different approach. They have confirmed that service developments should deliver improvements to quality, innovation, productivity and prevention. They view this development work as a vehicle to enable a broader multi-specialist organisational form in the future. Home care services There is more demand for domiciliary care than capacity available. This means that our Living Independently Staffordshire services take on people requiring care at home. This prevents them from doing the work that they are commissioned to do; providing re-ablement. Re-ablement is the term used to describe care provided to people living in their own homes that supports someone to maximise or regain their independence following a period of illness or hospital admission. Re-ablement supports people to be discharged from hospital earlier than would be the case without the service. Staff working in this area have more training than those working in domiciliary care, and so are paid more. Ensuring there is more domiciliary care available will mean that more re-ablement can be offered. Re-ablement significantly increases the number of hospital beds available and reduces the length of time people stay in hospital because it supports earlier discharge from hospital. The Partnership Trust is developing an integrated re-design and workforce plan (2016/17) which offers re-ablement earlier to patients with long-term conditions as part of our multi-specialist community provider model. The proposal would comprise a home care service that supports people with long-term conditions and provides specialist district nursing support. Social care contract In 2015, a review of the Partnership Trust s contract with Staffordshire County Council was undertaken. The review recognised the progress that had been made in the first two quarters of the year and also recognised that, the full year anticipated 6
savings to which both parties aspired will not be achieved in 2015/16. The review predicts continued growth in demand for adult social care which makes the achievement of the savings required in 2016/17 unachievable without significant changes to the current partnership agreement. Further work is being done to identify savings and negotiations continue on the value of the contract for 2017/18 and beyond. Changes in management of community hospital beds In conjunction with University Hospitals of North Midlands NHS Trust (UHNM), the Partnership Trust is looking to change how its community hospital beds are used; moving more towards providing care for people who are not well enough to stay at home but don t need to go to a bigger hospital. Community hospitals are currently used to support discharge from the bigger hospitals. It is the intention to move to a situation where more patients will be sent directly home from the bigger hospitals, with support. Significant cultural change will be needed for the whole system; not to see beds as the first package of care and on developing assessment for home care rather than bed-based care. Children s services The Partnership Trust continues to work closely with partner organisations to improve children s services. Considerable work has been undertaken on developing the way children move through services. Significant cross-learning has been undertaken between children and adult services. The next 12 months will see further development of links to social care and education to embed change. Analysis will also be conducted into the viability of an MCP model of care that provides care and support to all ages. Information Technology (IT) The Partnership Trust is using information technology to improve the way it manages its business, including the care and support it provides. The Partnership Trust participates in a local economy health care record programme that supports the provision of joined up care and the reduction of Accident & Emergency attendees. Delivering cost improvements The Partnership Trust continues to operate within a series of health economies with considerable pressures. Significant work is being done to ensure a sustainable financial position is achieved. The Trust has a Quality Impact Assessment (QIA) panel which meets monthly to review proposals to reduce costs and assess their impact on patient safety, clinical outcomes and patient experience. 7
The panel is chaired by the Medical Director with the Director of Nursing and Quality as part of the membership along with further clinical representation from professional leads (nursing, social care, allied healthcare professionals). Tendering for contracts During 2015/16 The Partnership Trust won a total of six tenders, four of which were existing business. The Trust has retained existing business for the North Staffordshire and Stoke Integrated Sexual Health Service. This includes an expansion of services of psychosexual and young people s support services to cover North Staffordshire. New business has been won in Leicester where we already deliver services and we have recently won a new service in Cheshire East. 8
We put quality first Approach to quality planning Our Quality Framework 2013-2018, agreed during 2012/13, is our overall quality strategy. The Quality Framework aim is that all service users receive the highest quality of care, by ensuring that front line teams are empowered by the organisation to provide this. The Framework contains six quality goals. Goal 1 Empowering our front line teams to deliver quality Goal 2 Providing quality services in a joined up way Goal 3 Providing the highest quality services that are viewed as excellent Goal 4 Providing effective services with good outcomes for our service users Goal 5 Providing services that meet essential quality standards Goal 6 Ensuring service users help us to deliver quality. The Quality Framework is supported by three key strategies that detail the policies, systems and processes that we will use to achieve our six quality goals. Safety Strategy Effectiveness Strategy Experience Strategy The three strategies have been revised for 2016/17 and aligned with the Trust s Quality Improvement Priorities. Implementation of the Quality Framework, and its supporting strategies, is monitored by the Trust s Quality Governance Committee. 9
Quality improvement priorities 2016/17 The following three priorities are proposed for 2016/17. Priority 1: Safe Reduce avoidable harm Our aim: Improve our safety culture and workforce, eliminating avoidable harm of all types Measures for 2016/17 Why this is important 2016/17 target Links to Number of avoidable and attributable grade 3 and 4 pressure ulcers developed in our care Number of serious incident falls reported whilst in our care We want to half avoidable harm by 2018 Reduction, in line with our Related to NHS aim to half avoidable harm outcomes framework by 2018 domain 5 Zero grade 3 and 4 avoidable Safety Strategy and attributable pressure Related to our Sign up to ulcers developed in our care safety pledge in community hospitals NHS mandate Minimum 10% reduction in the incidence of avoidable and attributable community grade 3 and 4 pressure ulcers developed in our care (i.e. a tolerance of 21 cases maximum in community services)* *Tolerance targets will be subject to rebasing due to the changing nature and profile of our services Reduce serious incident falls in all our care settings, by a minimum of 10% for 2016/17 (with a tolerance of 11 cases maximum in our community hospitals and bed-based rehabilitation services) Related to NHS outcomes framework domain 5 Safety Strategy Related to our Sign up to safety pledge 10
Total number of adverse incidents reported (all incidents) (Aligned to indicator 5.6 in the 2015/16 NHS mandate) Safety is everyone s job; staff on the lookout to improve safety will see and report more incidents and near misses. Our ambition is to increase NHS outcomes the number of incidents framework 5.6 reported by 10%, for all Safety Strategy reporting services compared to those reported by the same services in 2015/16* Percentage of reported serious incidents applicable to the Trust (Aligned to indicator 5.6 in the 2015/16 NHS mandate) Safe staffing dashboard (Community Nursing and hospitals): Number of RED flag safe staffing occurrences instigated via safe staffing dashboards Services that report more near misses have a better safety culture If a team has an increasing proportion of serious incidents there may be a safety issue. Services that report more incidents, with a low proportion of serious incidents, have a better safety culture Our staffing escalation policy traffic light system includes the requirement to escalate and report RED staffing levels *Measures and tolerances will be rebased due to the change in our profile of services Reduction in the proportion of serious incidents from all reported incidents Baseline to be developed Priority 2: Caring Improve Service User Satisfaction NHS outcomes framework 5.6 Safety Strategy Safety Strategy Our aim: Sustain and maintain our overall service user experience Measures for 2016/17 Why this is important 2017/17 target Links to Friends and Family Test The Friends and Family Test has been in use across many parts of the NHS since October 2013. It is now in use in almost all NHS services. Feedback gathered can be used to stimulate improvement in our services. More than 90% would recommend our services to their friends and family if they needed similar treatment and less than 5% would not recommend us. Indicator 4c (Friends and Family Test) from the 2017/17 NHS outcomes framework 11
Measures for 2016/17 Why this is important 2017/17 target Links to Feedback from service users and carers on the quality of care that they have received from our services In 2014/15 we consulted with our service users and carers; this was a core theme from their feedback Priority 3: Effective improve our outcomes At least 90% of our service users and carers are extremely satisfied with the quality of our services Our aim: Improve the outcomes and personalisation of our services Measures for 2016/17 Why this is important Target Links to Number of teams utilising outcome measures Care plan audits: proportion of people offered a copy of their care plan or equivalent care plan information Feedback from service users and carers that they feel involved in decisions regarding their individualised plans of care. Compliance with relevant NICE guidance Mortality all unexpected deaths reviewed by the mortality review group identifying any risks and learning Focussing on outcomes reflects a whole-systems approach to health and social care. The ADASS national survey highlighted good practice around copying care plans to service users, compared with our 2014/15 baseline audit In 2014/15 we consulted with our service users and carers; this was a core theme from their feedback. Ensuring that our service provision is in line with best practice guidance offers assurance that care is safe and effective. Monitoring and investigating unexpected deaths occurring within our services enables lessons to be learned and applied moving forwards Key services collect and analyse outcome data, and have plans for improving the outcomes of their service. Target: continued trajectory increase to 75% The baseline audit results: 2014/15-55% 2015/16-63% 90% of our service users and carers agree that they feel involved in decisions regarding their individualised plans of care. Newly published NICE guidance is reviewed for relevance and compliance assessed within set timeframes Mortality review to be completed for all unexpected deaths within the care of trust services. Related to Domain 4 (Ensuring that people have a positive experience of care) of the 2015/16 NHS outcomes framework Quality Framework goal: Effective Outcomes and Effectiveness Strategy 7.9 Related to Adult Social Care Outcomes Framework domain 3 NHS Standard Contract section 12 2015-2016. Related to Domain 4 of the 2015/16 NHS outcomes framework Effectiveness Strategy NICE policy Effectiveness Strategy NICE policy 12
Mortality The Partnership Trust has a Mortality Review Group (MRG), which aims to support the continuous quality improvement through the promotion of ongoing quality assurance programmes in relation to mortality. The MRG will co-ordinate a review framework across the Partnership Trust and will monitor and review the systems in place for promoting and supporting programmes of work, ensuring that learning is embedded within clinical and nursing practice. It will ensure that the Trust s Quality Governance Committee is kept fully informed of all significant clinical risks, and any associated developments or issues. The MRG will oversee the Partnership Trust s participation in the annual publication of avoidable mortality. Care Quality Commission (CQC) inspections The Care Quality Commission (CQC) inspected the Partnership Trust in November 2015. The CQC provided their initial feedback in writing on 13th November. On 15 December 2015, the Care Quality Commission issued a warning notice under Section 29A of the Health and Social Care Act 2008. The Trust has developed a comprehensive quality improvement plan identifying the key improvement actions associated with all of the feedback. The Trust responded with the actions that it had taken with respect to the areas identified within the warning notice on the 30 December and again on the 26 February. The feedback from the Care Quality Commission has influenced our quality improvement priorities for 2016/17, notably to continue our focus on safe staffing as part of our safety priority. Three reports have so far been issued, two services were rated as Good (Living Independently Staffordshire Moorlands and Living Independently Staffordshire Lichfield & Tamworth) and one as Requires Improvement (Brighton House). On 29 March, the CQC issued drafts of seven further inspection reports, which we expect to be published in May 2016. 13
We focus on people The Partnership Trust ensures staffing levels are safe by using a mixture of professional judgment; ensuring staff have the appropriate competency to perform a task and analysis of demand for the services. Regular workforce planning training sessions and workforce drop-in clinics are held to develop a culture within the organisation where all managers are aware of a standardised method to workforce plan, have an understanding of workforce planning (both in terms of the methodology and responsibility) and its importance to service delivery. Workforce planning masterclasses are held for the Trust Leadership Programme to convey the importance of workforce planning at the strategic level also. Recruitment and retention The Partnership Trust has recently undertaken an end to end review of our recruitment process which identified a number of improvements. Considerable changes have been implemented. Identifying new ways to attract high quality candidates via use of social media, open days, articles in professional journals etc. Time to recruit we have piloted one stop shop recruitment days interviews, occupational health and ID checks all completed on one day. Candidate experience actively seeking feedback from candidates in order to improve the experience and help with retention. Extending the temporary staffing bureau to provide an alternative to using agency staff The Recruitment and Retention policy has been refreshed to ensure that more innovative ways to attract, empower and sustain our workforce are implemented; a fundamental element of the Trust s Workforce Strategy. We will continue to develop our 1 Vision events which are led by the Chief Executive and directors. They offer an opportunity for staff to meet directors face-toface and raise any concerns or issues they may have. It is also used as an opportunity to share good practice amongst teams. Skill mixing and different models of delivery In 2014, the Trust developed a programme to identify tasks that could be safely delegated to non-registered staff such as phlebotomists, health care support workers and assistant practitioners. A review of the amount of administration done by registered nurses was also undertaken and as a consequence tasks were identified which could be delegated to clerical workers. The combination of these two processes identified time that could be released for registered nurses to concentrate on the more complex cases. 14
Over the last 12 months the Trust has recruited to these support posts and teams are now starting to see the benefit of the skill mix. Due to the national shortage of nurses and other professions the Trust is actively considering different models of delivery for some of its other services i.e. use of assistant practitioners. 15
We take responsibility Whilst the strategic objective remains to return the Trust to financial balance, this is going to be extremely challenging in 2016/17. For the financial year 2016/17, we are assuming a deficit of 6.2m at the end of the year. To achieve this would require a 12m cost reduction over one year. A challenge of this magnitude in this timeframe will need strong leadership and tough decisions to be made. Whilst the strategic objective remains resolutely to return the Trust to financial balance, it will be necessary for the Trust Board to further reflect on these key challenges, and the sustainability of achieving a stepped improvement of this size in 2016/17 whilst also rising to the challenge of maintaining or improving performance. 16