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Operational Plan Document for 2016-17

Camden & Islington NHS Foundation Trust

One Year Operational Plan 2016/17 – Final Submission

Operational Plan for y/e 31 March 2016 and 2017

NHS Improvement queries to be directed to:

Approved on behalf of the Board of Directors by: Name (Chair)

Leisha Fullick

Signature

Approved on behalf of the Board of Directors by: Name (Deputy Chief Executive)

Paul Calaminus

Signature

Approved on behalf of the Board of Directors by: Name (Finance Director)

David Wragg

Signature

Name Kevin Monteith Job Title Trust Company Secretary e-mail address [email protected] Tel. no. for contact

020 3317 7140

Date 8th April 2016

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mailto:[email protected]


CONTENTS

Page STRATEGIC CONTEXT

Introduction Local health and social care environment Mental health strategic context North Central London sustainability and transformation plan

4 4 5 6

QUALITY PRIORITIES

Trust approach to quality Key quality priorities Care Quality Commission

8 9 11

OPERATIONAL REQUIREMENTS AND CAPACITY

Current and forward planning activity assumptions Integrated Practice Unit activity assumptions

12 13

WORKFORCE

Approach to workforce planning key performance indicators Workforce priorities Organisational development

14 14 15 18

INFORMATION & COMMUNICATIONS TECHNOLOGY (ICT) AND DIGITAL DEVELOPMENT

Scope of the ICT and digital strategy 20

ESTATES STRATEGY AND CAPITAL PROGRAMME

Scope of the Estates Strategy Capital Programme

21 22

FINANCIAL PLAN

Key planning assumptions for 2016/17 Overview of the Trust’s CIP Plans for 2016/17 Planned balance sheet for 2016/17

23 24 25

MEMBERSHIP

Growing a sizable and representative membership Developing and active and engaged membership Elections Governor training and development

26 26 26 27

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STRATEGIC CONTEXT Introduction In April 2015, Camden and Islington NHS Foundation Trust (C&I) submitted an annual plan that reflected objectives set out in the Trust five year strategic plan (June 2014). These documents set out C&I’s overarching strategies for resilience and sustainability, which the Board of Directors has kept under review throughout the year through the Strategic Development Committee, a standing committee of the Board. This one year operational plan recommits the Board to these strategies, which remain in line with the underpinning planning assumptions. The Trust continues to work closely with commissioners on planning assumptions and service development plans, including the emerging North Central London (NCL) Sustainability and Transformation Plan (STP). The Trust’s high level corporate objectives have been refreshed by the board in February 2016 and are designed to keep the Board and organisation focused on the continued provision of high quality and safe care, innovative and integrated care solutions, and organisational resilience. The Board of Directors will continue to pursue its strategic objectives of Excellence, Innovation and Growth and will continue to focus on activities which support the development of the STP to ensure the long term sustainability and development of mental health services in North Central London.

Table 1: C&I’s 5 high level corporate objectives

C&I High Level Corporate Objectives

1. We will prioritise safe, high quality, compassionate care for service users, and promote equality and diversity through a workforce with the right skills, values and behaviours.

2. We will make measurable progress towards implementing our new clinical strategy, improve the integration of physical and mental health services and progress the rollout digital healthcare.

3. We will achieve our income target and deliver an agreed surplus as part of our long term financial plan and ensure that our plans are underpinned by affordable and sustainable service delivery and investment.

4. We will develop the trust’s estate in order to deliver our clinical strategy in safe, fit for purpose environments.

5. We will work in partnership with commissioners and providers in North Central London to develop and implement new care models to meet the mental health needs of local people, in line with commissioning priorities and resources.

Local health and social care environment C&I is situated in a complex health economy in north central London. There are three acute care providers within Camden and Islington, including two large teaching hospitals and three mental health Trusts serving five boroughs. The community services are a patchwork of four

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providers across the five boroughs, with two of these providers mainly based in North West London. The five CCG’s have begun work that aims to achieve clinical and financial sustainability – the financial challenge for the sector as a whole is in the region of £1.2 billion over the next five years. Camden and Islington Clinical Commissioning Groups (CCGs) remain in financial balance but they are very clear about the challenges ahead. The CCG’s in boroughs to the north of the Trust have been in significant financial difficulty, the analysis has shown they spend significantly more than comparator boroughs on acute care, with poor primary care and in two of the boroughs low spend on mental health. Both Camden and Islington Local Authorities, with whom the Trust is closely connected, are facing further budget reductions in 16/17. Camden, for example, is projecting a £70m budget gap by 2017/18 and there are reductions of up to 20% in mental health expenditure, although the impact of this may be mitigated to some extent by the creation of a Mental Health prevention fund. In Islington, the intention is to protect direct mental health services expenditure. However, the wider budget reductions affect general services and also housing support services, and these are likely to have important consequences to C&I’s acute and community care pathways. The Camden and Islington health economies are well integrated between mental health services and social care and between community services and social care; however, there remain many gaps in pathways of care in the health system. The local system, like all the NHS, is facing increasing quality and governance challenges, with reduced tolerance of quality failures, increased inspection and workforce challenges. Mental health strategic context Over the past few years there has been significant focus on mental health services and policy based on achievement of ‘Parity of Esteem’, which is probably better expressed as equality for mental health. Over the past year, Crisis Concordat actions have been delivered including some expansion of home treatment team staffing to meet demand, and the development of a 24 hour crisis helpline. Local services perform well against the standards expected; the key strategic issue for the Trust is capacity rather than services available. The Trust is also preparing for the introduction of the new access targets in mental health. These are currently being achieved, and the Trust is fully engaged with preparatory work at the London level. C&I welcomes the increased emphasis both nationally and locally on turning the ‘parity of esteem’ into a commissioning and contracting reality, and we look forward to working with our local commissioners in this and subsequent years to deliver the fundamental expansion and reorientation of mental health service delivery set out in current national policy. This shift in policy, the new CQC inspection regime and increasing demand will make mental health services more transparent, and will also increase pressure to deliver improved performance in a much wider range of areas.

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North Central London Sustainability and Transformation Plan The Trust is fully engaged in work within the North Central London sector to develop a North Central London Sustainability and Transformation Plan (STP). Part of this work is a specific mental health workstream, led by Camden CCG. Acknowledging that there are significant mental health needs in the five boroughs of North Central London, and that Camden, Islington and Haringey all have higher than average prevalence of mental health problems, the work on the STP for mental health sets out the following shared ambitions: Table 2: North Central London Sustainability and Transformation – shared ambitions

North Central London Sustainability and Transformation – Shared Ambitions

1. To transform the nature, value and outcomes of local services close to home, through building partnerships that deliver around the needs of individuals and communities.

2. Work with individuals and communities to support good mental health resilience.

3. Build high quality specialist services for those with complex and intensive needs, that are as close to home as possible, and allow connection to local community services.

4. Develop alternative responses for service users with Mental Health needs who do not

respond, or prefer not to engage with current commissioned services.

5. Develop systems of early interventions which ensure people with Mental Health crises receive a prompt and appropriate response.

6. Breakdown barriers between mental health physical health in a way which delivers better

outcomes for patients and better value to the system.

7. Workforce training to better equip health and social care workers to support patients with Mental Health needs.

The Trust is part of the workstreams developing this approach, and has developed a revised Clinical Strategy for Camden and Islington. This sets out the Trust’s aims to promote recovery, resilience and independence, based around a service model that delivers services in practice-based services and specialist care pathways. There are ten overarching themes and principles on which this clinical model is based:

• We will co-produce with our service users and carers their treatment and support • We will work in a recovery-orientated way; • We will offer evidence-based interventions; • We will choose outcomes that measure things that matter to service users and carers

and use these to shape our services; • We will integrate with other services so that service users have their mental, physical

and social needs met in a coherent way;

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• We will prevent mental illness deteriorating or relapsing in all our service users and we will contribute to initiatives that prevent mental health problems in children and young people;

• We will equip all our clinical staff to address drug and alcohol problems; • We will improve access to our services for everyone, regardless of gender, race,

ethnicity, disability, sexual orientation and other protected characteristics; • We will choose a quality improvement methodology and implement it; and • We will grow our already strong interest in research.

To deliver a service that is able to achieve this, we have agreed that we will:

• Develop practice-based teams: that work locally with GPs and other services in primary care, such as the IAPT services. They will offer rapid assessments near to where people live by senior clinicians who can make decisions about treatment, access services in the community or, if needed, refer to the specialist care pathways. They will link people into the local community resources and services. They will be better placed to see people who won’t engage with secondary care mental health services. They will support GPs in managing people with chronic mental illness who are stable. Along with acute services, these will be the entry point into specialist care pathways. To date, these services have, on average, worked with 63% of all service users without use of specialist care pathways.

• Continue to develop our specialist care pathways: that deliver treatment and support to people with similar needs due to mental illness. The focus of these services will be to help people achieve their recovery goals and link into their local social networks and community resources. Access to these pathways is based on risk, intensity and the need for specialist treatment.

• Improve the physical health of the population with psychosis through the creation of an Integrated Practice Unit: for which the Trust has recently been awarded lead provider status – using a set of co-produced experience and clinical outcomes that aim to incentivize the delivery of services that deliver effective outcomes and that, over time, reduce the mortality gap for people with psychosis.

This approach is at the core of our work as part of the STP, and closely mirrors the approach of the other main provider in North Central London – Barnet, Enfield and Haringey Mental Health Trust. Furthermore, we have begun the process of exploring areas where joint working at scale may help to address the challenge of transformation; such as rehabilitation pathway; opportunities in perinatal care; the scope for transformation of continuing care pathways; and the potential for estates changes to underpin the delivery of significant transformation – not least given the potential represented by the St Pancras and St Anne’s hospital site development plans. More broadly, the Trust continues to work with partners in Islington and Haringey specifically (building on previous vanguard application work) to develop integrated working within North Central London, and is part of specific project streams led by Islington Council on the better use of estates across the North Central London geography.

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QUALITY PRIORITIES

Trust approach to Quality C&I’s Clinical Strategy outlines our ambition and vision for transforming our services with a strong focus on quality underpinning the principles set out in the strategy. As well as setting out the strategic direction over the next 5 years, we will also

focus on the immediate local quality issues and the following section of this plan outlines these in further detail.

Risk Management The Trust has an established process for managing risk, and detecting and responding to quality concerns. Each Division has a risk register that is monitored regularly to ensure that any risks that cannot be managed within the Division are escalated to the corporate risk register. The risk management strategy is reviewed annually, with the Audit and Risk committee having oversight of this process. Quality within clinical areas is monitored via the service quality assurance reviews which consist of site visits, document review and staff interviews. External stakeholders are invited to take part in the service quality assurance reviews and help provide additional independent scrutiny in this process. Service improvement plans are put in place to address any areas identified in these reviews.

Approach to Quality Impact Assessment

The importance of assessing the quality impact of any transformation initiatives and cost improvement programmes is well understood within the organisation and the Trust has with commissioners, an agreed process for assessing the impact of CIP programmes with an agreed template that provides assurance on a number of key considerations for commissioners.

A refreshed summary of C&I’s key quality goals C&I’s quality priorities reflect our commitment to developing and maintaining a culture of continuous quality improvement, and to providing care that is safe, effective and accessible. The quality priorities reflect the Trust’s strategic aims of excellence, innovation and growth, reflect our Trust values and are closely linked with the NHS outcomes frameworks. The quality priorities presented here are developed with input from our stakeholders, including staff, commissioners, service users and the Care Quality Commission (CQC). They reflect themes from the CQC comprehensive inspection in 2014, from our robust internal quality assurance framework, from work developing outcomes based services in North Central London and from the Commissioning for Quality and Innovation (CQUIN) targets agreed in collaboration with our commissioners. The quality priorities reflect areas that will make a meaningful difference to service users and carers, and that will improve safety, clinical effectiveness and patient experience.

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A summary of our key priorities which are linked to the quality domains of safety, effectiveness and experience are provided below:

Table 3: Patient safety quality priorities Clinical/Quality priorities Key actions required Key milestones

2016-2017 Patient Safety Establish a mortality and morbidity review process (Local priority – ‘Stolen Years’ Keogh Recommendation)

Nominate a Trust Lead for Mortality Establish M&M meeting within each division (sub- specialty) Establish Trust Mortality Review Group which will be a sub –committee to the Board

Quarterly mortality report to Board and /Quality Committee Benchmarking data against other Trusts Completion of thematic review of unexpected deaths Mortality data to be included on divisional dashboards (link to IPU outcome data on mortality)

Ensure lessons are learned from serious incidents (CQC Action Plan)

Continued delivery of Learning the Lessons workshops after serious incidents Implementation of the serious incident review group to ensure senior leadership in sharing lessons and in developing meaningful recommendations and action plans Implement a quarterly quality half day to provide a learning exchange environment for teams

ToR for serious incident review group revised Quality Half days established

To promote safe and therapeutic ward environments by preventing violence, reducing restraints and supporting staff and patients following assault incidents (Local Priority – Staff and patient wellbeing)

Training staff in preventing and managing violence Staff and service users working together to formulate strong relapse signatures which support identification of deterioration in service user mental state, and enable early intervention to prevent escalation to violence Promoting safe restraint practices when violent incidents occur Implementing reflective practice on all acute wards

Monthly reflective practice established on each acute ward

Template for relapse signatures agreed

Equip staff, through raising awareness and appropriate training, to identify, prevent and reduce domestic violence and abuse (NICE Guidance and Local CQUIN)

The Trust will work with other agencies to prevent and reduce domestic violence and abuse. Staff will be trained to follow best practice guidance when disclosures of domestic abuse are made. Adopt clear protocols and methods of information sharing between agencies

Results from quarterly audits, and necessary action plans developed and implemented throughout the year to ensure best practice guidance is adhered to

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Clinical/Quality priorities Key actions required Key milestones 2016-2017

Offer specific training to health and social care staff on how to respond to domestic violence Strengthening of safeguarding processes

Table 4: Clinical effectiveness quality priorities

Clinical/Quality priorities Key actions required Key milestones 2016-2017

Clinical Effectiveness Compliance to 18 weeks referral to treatment targets

(National Guidance)

Achievement of new IAPT and EIS access and treatment targets Delivery of crisis concordat standards

50% of people experiencing first episode of psychosis treated with a NICE approved care package

95% of people referred to IAPT receiving treatment within 18 weeks

Finalise and implement evidence based outcomes for the Integrated Practice Unit for Psychosis (Local priority)

Outcomes defined and agreed with commissioners

Reporting framework for the agreed outcomes confirmed and ability to report on at least 5 selected outcomes by Q2

Stopping smoking & substance misuse

(CQUIN)

To increase the smoking cessation offer, as evidenced by:

- Number of successful quit attempts

- Number of nicotine replacement therapy inpatient prescriptions

Number of service users with substance misuse assessments and management plan

Development and implementation of Integrated Practice Unit for psychosis during 2016/17. Consolidation of smoking cessation programme within inpatient services.

Understanding outcomes of the specialist care pathway

(Local priority)

Identify the specialist care pathways Review the outcomes for each pathway Evaluate outcomes and adapt pathways as necessary

Evaluation of specialist pathways outcomes reported to board in Q2

Increase staff knowledge and understanding of Mental Capacity Act to enable practical application

(CQC Action Plan)

Delivery of training to ensure that staff have appropriate knowledge and skills in MHA and MCA Implement quarterly MHA Law application workshops to enable staff to develop their knowledge through case study and scenario discussion

Quarterly MH Law application workshops established.

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Table 5: Patient experience quality priorities Clinical/Quality priorities Key actions required Key milestones

2016-2017

Patient Experience Involving service users and carers in the implementation of the clinical strategy

(Local Priority)

Launch of Patient Experience Strategy Consult with service users and carers on how they wish to be involved Launch of a refreshed Service User Strategy

Confirmation of method of service user and carer engagement following consultation period

Medication

(CQUIN)

To assess, monitor and improve information and engagement with service users over medication. Auditing records for evidence of information given for new prescriptions about: purpose, dose, route, any special instructions, side effects, monitoring and to develop action plans to ensure positive performance.

Development and implementation of Integrated Practice Unit for psychosis during 2016/17.

Ward transfers (CQC Action Plan)

To continue to embed and develop ward transfer protocols to ensure effective handovers and to ensure ward transfers are for clinical purposes. The Quality Committee, through the Quality Review Group, will monitor the implementation of the action plan to deliver the improvements and the on-going review of bed pressures and bed availability.

May 2016 – CQC report following inspection in February 2016 Re-opening of acute ward at Highgate Mental Health Centre, following period of decanting for ligature works.

Care Quality Commission

The Trust was inspected by the Care Quality Commission in February 2016. It is expected that the result of the February inspection will be known in the first quarter of the 2016/17 financial year, and the Trust will work to address any identified issues in a robust manner.

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OPERATIONAL REQUIREMENTS AND CAPACITY The Trust’s service profile is made up of 274 inpatient beds, of which 166 are acute inpatient beds. This includes 24 crisis beds and 12 male psychiatric intensive care unit beds (PICU). We continue to outsource female PICU beds to the private sector.

Our 2 year operational plan submitted in April 2014 provided a detailed analysis of the drivers and assumptions informing the Trust’s activity planning, including 2015/16. This analysis was set out against the Trust’s divisional services and related care clusters. These estimates have now been revised based on more complete cluster data and in line with guidance for Year of Care tariffs for 2016/17.

Current and forward planning activity assumptions Based on our on-going analysis and performance data, C&I’s best estimate of activity for 2016/17 is provided below set against the related super clusters and care clusters and out of scope services. Table 6: Activity planning assumptions

Service Category

Services Activity

Information Care

Clusters 2015/16 Outturn

2016/17 Activity

Comments

Assessments Assessment Assessment Clusters 11,088 11,282

Non Psychotic

Mild/Moderate/Severe Episodes/ YoC 1 – 4 1,329 1,351 Very Severe and Complex Episodes/ YoC 5 - 8 1,781 1,812

Psychosis

First Episode* Episodes/ YoC 10 427 435

Ongoing or recurrent Episodes/ YoC 11 – 13 2,534 2,579

Psychotic crisis Episodes/ YoC 14 – 15 1,009 1,027 Very severe engagement Episodes/ YoC 16 – 17 439 446

Organic Cognitive impairment Episodes/ YoC 18 - 21 2,769 2,819

Out of Scope

Overseas Visitors in Cluster 14/15 Episodes/ YoC 14 – 15 19 19

IAPT Contacts N/A 48,317 48,749

Based on 15% prevalence at 4.8 contacts per episode

SMS Episode starts N/A 2,052 2,474

Based on tendered activity levels for 2016/17

Perinatal Contacts TBC TBC

Sexual problems Contacts TBC TBC

In order to deliver this capacity, we are assuming that our current capacity will remain in place across both community and inpatient services, with some increased capacity to deliver

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a range of 7 day a week services, particularly in areas such as Home Treatment Teams, where additional national funding has been announced. This includes re-opening one inpatient acute ward that has closed (and temporarily replaced with 16 acute beds at East London NHS Foundation Trust) whilst refurbishment has taken place. We also assume that we will continue to roll out Primary Care Mental Health services in both Islington and Camden, subject to the outcome of contract negotiations. To date, these services have diverted an average of 66% of referrals from primary care, whilst providing an effective and popular service for both service users and primary care practitioners. The impact of these teams therefore forms an important element of our clinical strategy and our contribution to the STP. Within our activity plan, we are also assuming that we will reach agreement with Camden and Islington commissioners in relation to the Integrated Practice Unit for psychosis. This aims to bring together all elements of the mental health care, and physical health care relating to long term conditions for those people in Camden and Islington who have a psychosis. Based on a five year contract term, the aim is to work to co-produced clinical and service user experience outcomes, with increased income stability, in return for greater levels of payment for outcome. The activity we expect to be covered by the Integrated Practice Unit arrangements is as follows: Table 7: Integrated Practice Unit activity assumptions

Services Activity

Information Care

Clusters 2015/16 Outturn

2016/17 Activity

First episode in psychosis Episodes/ YoC 10 387 394

Ongoing recurrent psychosis (low symptoms) Episodes/ YoC 11 956 973 Ongoing or recurrent psychosis (high disability) Episodes/ YoC 12 811 825 Ongoing or recurrent psychosis (high symptom and disability) Episodes/ YoC 13 539 548

Psychotic crisis Episodes/ YoC 14 701 713

Severe psychotic depression Episodes/ YoC 15 206 209 Dual diagnosis (substance abuse and mental illness) Episodes/ YoC 16 154 157

Psychosis and affective disorder difficult to engage Episodes/ YoC 17 240 244

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WORKFORCE Approach to Workforce Planning Our workforce plan is owned and informed locally and gives clear indications of current and future workforce requirements to ensure continuous high quality delivery of care. In formulating the workforce plans, C&I has fully considered our clinical strategy, professional strategies and our modelling of future local populations and how this translates into the skills, competencies and knowledge that we will require of our future workforce. Divisional services, the nursing directorate, human resources and finance work together, reviewing factors such as CIP plans, new business and any organisational development and workforce issues each Division, the Trust and the NHS as a whole may be facing over the life span of the plan. This also takes in to account the supply of qualified staff and HENCEL commissioning intentions. The workforce plan is approved in detail by the Trust Workforce Committee and progress against the plan will be monitored by the Resources Sub-Committee of the Board. The Trust budgeted FTE posts are detailed in the table below: Table 8: Budgeted FTE posts1 Staff Group Budgeted FTE posts (March 2016) Professional Scientific and Technical 246.57 Clinical Services 405.70 Administrative and Management 340.35 Allied Health Professionals 50.01 Estates and Ancillary 7.00 Medical 128.08 Nursing Registered 425.46 Other 8.27 Total 1611.44

The Trust currently has a vacancy factor of 11.3%, with the majority of the vacancy factor in corporate services and the rehabilitation &r recovery division. Targeted recruitment campaigns are underway in the R&R Division for hard to recruit to posts and a number of corporate areas are being reconfigured, with plans to recruit to new posts or to delete posts.

Key Performance Indicator projections for 2016/17 are shown below:

1 Excludes Psychology Trainees and Local Authority funded staff.

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Turnover is reported month by month, cumulatively and is anticipated to be around 16.7% annually. The same assumption is made for vacancy rates, factoring in our robust annual recruitment plans and streamlined time to hire, preventing high levels of vacancies that are unfilled for any length of time. The Trust recognises that there have been a number of initiatives from NHSI in recent times, regarding temporary staffing, most notably the maximum agency rate caps, the requirement to limit agency spend to framework agencies and the agency expenditure ceiling applying to all staff from 1 April 2016. Steps have already been taken to ensure that all agency expenditure is, and will remain to be within the caps, and only with approved frameworks, and we are working towards meeting the circa £3.5m annual agency ceiling set by NHSI. The Trust is aware of the challenges associated with meeting this ceiling, not least as i) meeting the ceiling will require a reduction in existing levels of agency usage (of approximately £100k per month), ii) the Trust operates social care services, under delegated authority from local boroughs, which require the employment of social care staff which are difficult to source via bank arrangements, and iii) the Trust operates in a central London employment market which is highly competitive for the recruitment of certain back office staff, leading to potential faster turnover in these functions. However, the Trust remains committed to a reduced level of expenditure consistent with the given ceiling, and has included a consistent level of agency spend in our plan submission. The Trust is also mindful of the recommendations of the Carter review regarding administrative and management costs, and is considering and formulating its approach to meeting these recommendations. Workforce priorities for 2016/17

To successfully meet future challenges, our workforce will need to be flexible; they will need to work across health and social care with independent or private sector providers, be flexible in the provision of care at differing points of the patient pathway, provide care and treatment for both physical and mental health care, support those with learning disability to receive care and treatment in mainstream pathways, provide care in different locations (including the home) and use new technological developments. The future workforce will have the skills, values and behaviours required to provide co-productive and traditional models of care. They will need to be adaptable, innovative and able to provide ‘whole person’ care. Some of the principles from the Lord Carter Review are being responded to in our approach to reducing vacancy rates and thereby reducing our reliance on bank and agency staff and associated costs. During 2016/17, the Trust will scope ways in which the recommendations from the Carter Review can be fully adopted and embedded within the Trust to ensure sustained improvement in workforce performance and effective utilisation of resources.

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The Clinical Strategy captured 10 overarching themes has areas to prioritise over the course of the next five years. During 2016/17, the workforce priorities aligned to the Clinical Strategy will include the following themes and programmes of work: Development of capability to deliver changing models of care

• Engage with staff as part of the overarching campaign on the Clinical Strategy about new models of care delivery and the impact this will have on staff in terms of their practice;

• Co-ordinate arrangements for divisional wide skills mix reviews to identify skills gaps • In partnership with staff side, develop agreed processes for the implementation of

change programmes; • Explore options for increased flexibility through the use of new technology to facilitate

mobile working , leading to more effective use of the estate, and delivery of care in primary care and nearer to patients homes;

• Development of pathways for RGN’s as well as RMN’s aligned to new service models which link mental to physical health;

• Map out the core competencies and skill sets required of staff to work using the principals of co-production and strengthen governance arrangements to support this approach as a new way of working;

• Ensure that the annual learning needs analysis for the trust is fully aligned to the new Clinical Strategy and to the specific developments linked to the move into primary care and the IPU – and that budget priorities and commissioning reflect those needs.

Embedding values and improving staff engagement

• Co-develop with staff side a refreshed framework for partnership working within the Trust;

• Further develop the innovation greenhouse approach to facilitate opportunities to engage with staff on issues that matter to them, including crafting suitable responses to concerns expressed through the annual staff survey;

• Implement a values based approach to recruitment; • Develop and implement a staff engagement strategy co-produced with staff side and

the workforce; • Plan and deliver the four medium to short term work streams identified in the OD

Strategy that were derived from staff discussion through innovation greenhousing events.

Supporting staff to keep healthy, maximising health and well being • Successfully transition from the old to the new OH and EAP service provision. • Undertake an organisational health needs assessment to determine the specific

priorities for the Trust and develop a targeted action plan. • Roll out across the Trust the health and wellbeing toolkit developed by NHS

Employers. • Linked to health and mental wellbeing, ensure early diagnosis at work for staff and

facilitate fast track access to good quality psychological intervention and support linked to causal factors.

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Identification of talent, building clinical leadership and enhancing opportunities for staff development

• Enhance the learning experience for staff through the use of e-learning, increased use of evidence based teaching and simulation;

• Further develop coaching and supervision skills to maximise the learning experience for staff;

• Develop a portfolio of learning activities based on a core set of management and leadership competencies and behaviours for existing and aspiring managers/leaders;

• Develop and roll out a physical health and psychological therapies training programme;

• Develop and roll out organisational wide training in recovery delivered by service users and staff;

• Support staff by delivering development interventions, including action learning sets and toolkits to enhance learning as a way of building staff capability of working in a way which promotes co-production;

• Monitor the embedding and qualitative feedback on the new appraisal process; • Develop our support workforce through the implementation of the Advanced

Development Programme, vocational, and build robust plans to progress development of our apprenticeship schemes;

• Establish a transparent and fair system of talent management that engages the workforce and interprets talent in the most appropriate way.

Recruitment and retention of staff embodying our values and supporting the delivery of quality safe care

• Delivery of agreed annual workforce, recruitment and training plans , including strategies to develop new roles and recruit hard to fill vacancies, including the introduction of nursing associates and apprentices through skill mix reviews;

• Development of a robust month-by-month recruitment plan with vacancy and pipeline monitoring data being reported against the plan at Safer Staffing Group and Workforce Committee. We will undertake urgent work to ensure access to and reporting on all data for Local Authority staff on secondment to C&I;

• Ensure that establishments are adequately resourced, skill mix reviews identify where roles can be redesigned and vacancies are actively and quickly recruited to, with key data reported at the Safer Staffing Group, in order to minimise reliance on bank and agency staff;

• Continue to invest in the rapid response teams to build an internal flexible resource • Implement rotation schemes to facilitate the development of experience in a range of

different care settings; • Development of links with local job centres, advertising in local press and attending

local and other careers fairs to promote the Trust as an employer of choice for local people;

• Implement a package of initiatives for newly appointed nurses to provide pastoral support during the first 6 months of employment and pulse check new recruits to track their on-going experience during the first 12 months of their employment;

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• Use feedback from staff via the staff survey, exit questionnaires and targeted engagement campaigns, plus benchmarking against appropriate organisations and utilising relevant research to develop robust, evidence-based retention strategies;

• Rolling out improvements in the health roster system and improving capability within the Trust to realise the full benefits of the system – including the roll out of a mobile system, providing live staffing data.

Promoting an inclusive environment that recognises difference and promotes equality. The Equality Delivery System and Workforce Race Equality Scheme Action Plans are being monitored on a quarterly basis via the Equality and Diversity Committee. Actions being progressed from the plans and Workforce Strategy during 2016/17 include the following:

• Equality and diversity principals and practice including unconscious bias, will be included in leadership and management development programmes;

• A census will be undertaken to refresh our workforce information on the protected characteristics of our workforce;

• Local action plans will be implemented in each Division to address areas which are out of balance in terms of representation of the main characteristics across our workforce;

• Equality impact training will be prioritised and rolled out across the Trust; • Implementation of a BME network will be supported and we will explore with the

workforce how best to engage with other key staff groups Provide the opportunity for staff to apply internally for management roles prior to being advertised externally and we will actively work towards removing the barriers to progression of our BME workforce through a range of proven HR practices in this area;

• Undertake an assessment of BME staff learning needs in respect to progression within the trust – and make provision of practical support in light of the feedback received.

Organisational development

The Trust will be implementing the revised Organisational Development strategy, approved by the Trust Board in January 2016. Our OD activity at this time is intrinsically linked with ensuring the effective delivery of our new Clinical Strategy. Our work in this area includes delivering on projects that seek to enhance communication across the trust and to insure the organisation against silo working at a critical time when integration is central to our internal practice and our engagement with the wider health and social care economy. The Organisational Development model is firmly underpinned by the trust’s six Changing Lives values and aims to support the further embedding of those values in the day to day practice of the trust, from ward to Board and with each and every member of staff, so that they inhabit everything that is done within the trust. Additionally, the strategy is built around four key themes: Collaboration, Adaptability, Transparency and Environment. Each theme has a set of activities designed to be implemented in 2016 and 2017. The themes were identified as enablers to build an environment where staff are able to live and work by

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the trust values and by that deliver on the challenges of the Clinical Strategy and Strategic Plan. To reinforce embedding of our Trust values, each theme also corresponds to at least one specific trust value, as follows:

• Collaboration – working as a team; • Adaptability - being professional; • Transparency- being respectful; and • Environment- being welcoming, kind and positive.

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INFORMATION AND COMMUNICATION TECHNOLOGY (ICT) AND DIGITAL DEVELOPMENT Over the last three years, we have made considerable investment in new ICT Infrastructures that have facilitated significant change in working practices and culture throughout the Trust. Service led demand for more flexible and agile working solutions has been driven by previous investments in flexible mobile working solutions. In four years we have moved from thirty-five (35) laptops to over six hundred plus (600+) laptops and tablets, the future is to ensure that efficiency opportunities offered by the Trust’s new EPR are exploited to improve clinical care. Our procurement process towards ICT investment is to conduct assessments with our user population in order that we can provide fit for purpose devices and systems, to enable more agile working solutions. All mobile devices are encrypted and underpinned by fast, secure remote access, allowing access to systems from anywhere within the UK. These investments have allowed C&I to work beyond its traditional geographical boundaries and to take advantage of working uninhibited by geographical location. The current ICT Strategy will continue to support the Trust’s growth potential and support working in new locations and service areas. We will be developing our new Digital ICT Strategy during 2016 to address the NHS England Digital Maturity Assessment. Scope of Strategy The key priority of the current strategy is to continue to focus on building upon the previous investments already made and ensuring the return on those investments are achieved. Some of the key objectives in progress are:

• Deployment of a replacement Electronic Patient Record (EPR). The Carenotes system has been operational since September 2015, with mobile working currently being piloted. Implementation issues continue to be resolved, with the aim to move to the next stage of system development to create a more bespoke solution during the 2016/17 financial year.

• Work with CCGs to implement effective clinical and patient portal arrangements that support integrated working, and, not least, the implementation of the psychosis Integrated Practice Unit.

• The implementation of action plans relating to the Trust digital self-assessment. • Improved scope and analysis of data, reporting and dashboards; • Deployment of Wi-Fi across all Trust sites.

To support these developments, the Trust is assuming a capital programme for ICT of £1.5M for 2016/17.

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ESTATES STRATEGY AND CAPITAL PROGRAMME C&I has a property portfolio of just over 57,000 square metres, located across 33 sites in Camden & Islington. Space occupied by the Trust is approximately 45,000 sqm, after deduction of accommodation occupied by a small number of NHS organisations and other tenants. The Trust’s property portfolio is predominantly freehold, representing 50% of the sites and 80% of the accommodation. St Pancras Hospital (SPH, transferred from the dissolved Camden Primary Care Trust from 1st April 2013) represents 43% of the Trust’s entire portfolio. The next largest building is Highgate Mental Health Centre, which at 10,996 sqm, represents 18%. By comparison, all other 31 sites within the Community are relatively small. Scope of Estates Strategy Long Term Objectives 2016-21

• To commence the redevelopment of St Pancras Hospital as the centre piece of the Trust’s operations and service provision. This represents a fundamental once in a corporate lifetime opportunity for the Trust to best achieve its strategic objectives;

• Continued consolidation of the Community Estate in order to provide local services more efficiently from a smaller number of more efficient buildings; and

• To align estates requirements to the Trust’s recently updated Clinical Strategy. Short Term Objectives 2016-17

• In respect of the redevelopment of St Pancras, the Trust Board has agreed a strategic outline case (SOC). This was completed in early 2016 and the Trust will prepare an outline business case by the end of 2016. This will look at the two favoured options of total vacation of the SPH site and partial vacation of the SPH site. It has agreed to develop a plan for the total estate of the Trust in light of these two options, and that a range of measures will be tested to ensure that the proposed development choice is affordable for commissioners. C&I will also work in a structured way with any public bodies who may have an interest in the site. Private sector partnerships and strategic estates partnerships will also be evaluated.

• The Trust is maximising its use of accommodation at SPH until there is clarity over timescales for the site’s redevelopment. The current assumption is that redevelopment will still not commence for 4-5 years. This enables short term maximisation of an existing asset and avoids further space acquisition or supports vacation of other accommodation. The site is now effectively full.

• Reduction of Community estate through vacation of leased properties where possible.

• Disposal of surplus freeholds. Two in particular are likely to be confirmed. Tottenham Mews which has been vacant for some time and Hanley Road2 which is significantly underutilised and poorly located for Trust services.

2 Hanley Road is not included in the 2016/17 financial plan due to uncertainty regarding the timescale.

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Capital Programme The Trust Estates capital programme for 2016-17 is £3.2m. Approximately £1.25m of this relates to continuing services infrastructure works required at St Pancras required to ensure appropriate resilience and statutory compliance pending redevelopment of the site. Approximately £600k is allocated to compliance and backlog maintenance issues at HMHC and a similar amount is allocated for the acquisition of Blenheim Court in Islington for SAMH’s services displaced from Hill House and new Primary Care facilities. The remaining capital is spread across a number of environmental and backlog projects throughout the Estate. The Trust’s approach is to employ capital investment in such a way as to directly support and enhance service delivery, efficiency and the patient environment. The strategic direction is to continue to focus on reducing the estate footprint through consolidation and improved space utilisation. A focus on ICT mobile working is regarded as a key facilitator in space reduction.

Table 9: Trust capital expenditure projects for 2016/17 Capital Expenditure Projects £000

Estates 2016/17

Trustwide (274)

St Pancras Hospital (512)

St Pancras Hospital Electrical Infrastructure (750)

Highgate Mental Health Centre (597)

Community (342)

Blenheim Court – new premises (600)

Environment Group (125)

Sub-Total Estates (3,200)

ICT

Hardware and Software Project (450)

Data Centre Project (700)

Data Infrastructure Project (250)

ICT relocations Project (100)

Sub-Total ICT (1,500)

Total Capital Programme (4,700)

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FINANCIAL PLAN

2015/16 Performance The Trust is likely to achieve a continuity of service risk rating of 3 for 2015/16, with key financial planning assumptions for 2016/17 as set out below: Key Planning Assumptions for 2016/17 The Trust is planning to deliver a surplus of income over expenditure of £0.9M for 2016/17. We expect this position to deliver a planned financial sustainability risk rating score of 3, however we note that the position is consistent with a score of 4, with the overall score being reduced by the Variance from Plan metric being capped at a lower level due to 2015/16 performance. Table 10: The Trust’s planned I&E performance for 2016/17: Income & Expenditure

15/16 4cast 16/17 Plan

£k £k

Income

135,542 132,223 Expenditure

-126,487 -122,579

EBITDA

9,055 9,644

PDC

-4,218 -4,650 Depreciation

-4,501 -4,258

Interest

164 164

Normalised Surplus

500 900

-1,100 0

-600 900

EBITDA Margin

6.7% 7.3% Normalised Surplus Margin

0.4% 0.7%

The Trust is planning for an income reduction over the whole year due to changes in Substance Misuse income as a result of re-tendering activity in 2015/16, a reduction in Estates & Facilities recharges (offset by a reduction in the provision of services) and a reduction in deferred income that was carried forward into 2015/16. The general financial assumptions being made by the Trust for its 2016/17 financial plan are:

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• Tariff will be funded by CCGs in line with national guidance, meaning inflation will be funded at 3.1%, with the national cost improvement programme at 2%, giving a net 1.1% uplift;

• The re-opening of one acute ward at Highgate Mental Health Centre which will address a current non-recurrent cost pressure on external bed usage;

• That c£48M of costs will be covered by the arrangement for the psychosis Integrated Practice Unit;

• That Parity of Esteem is delivered via the full application of CCG uplifts to mental health funding (via either CIP reductions or growth funding);

• That there is a risk of income loss associated with payment for outcome; • A £2,677k CIP Target (which is consistent with a £900k surplus), will be required. This

equates to 2.0% of turnover, which is increased to 2.8% to include £1,000k headroom and £3,677k overall programme;

• That the Trust will be compliant with all relevant NHSI financial and cost improvement requirements, including those on staffing and procurement arrangements;

• That additional funding relating to the Prime Ministers’ fund for Mental Health will be allocated within the plan in line with announcements as they are made.

Table 11: An overview of the Trust’s CIP plans for 2016/17: CIP

£k Pay

Non-pay

15/16 headroom b/f 1,000 750 250 Staffing efficiencies in service areas 260 250 10 SAMH Home Treatment* 250 0 250 IPU savings 100 100 0 Estates savings (incl 15/16 efficiencies relating to FM provider, energy pricing and estate rationalisation)**

350 50 300

Corporate teams rationalisation 350 310 40 Capital Charge savings on disposals 30

30

Other misc schemes 337 250 87

2,677 1,710 967

*The Home Treatment CIP has delivered £510k prior to 16/17 ** Ongoing E&F CIP workstreans have previously delivered £212k prior to 16/17

Upsides to the plan include any contribution generated to the Trust’s surplus by the provision of extra activity and new services, but currently the Trust is not planning on any income generating CIPs in its’ 2016/17 financial plan. The capital plan is limited to £3.2m for Estates schemes and £1.5m for IT and equipment schemes for 16/17 in order to manage capital charges and liquidity after several years of capex being greater than depreciation. In addition, the Trust plans to progress 2 potential

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property disposals in 2016. The first, the disposal of Tottenham Mews is more advanced, and is currently the only disposal included in the financial model. The Trust currently maintains a balance sheet with good levels of liquidity, and intends to maintain this liquidity throughout the coming financial year. The following table shows the Trust’s planned balance sheet for 2016/17: Table 12: Planned balance sheet for 2016/17: Balance Sheet

31.3.16 4cast 31.3.17 Plan

£k £k

PPE

131,626 129,911

Current Assets

12,000 12,000 Cash

41,000 42,085

Current Liabilities

-22,491 -20,982 Non current Liabilities

-39 -18

162,096 162,996

PDC Reserve

60,348 60,348 Reval Reserve

59,621 59,621

I&E Reserve

42,127 43,027

162,096 162,996

Memorandum Items

14/15 4cast 15/16 Plan

£k £k

CIP requirement

5,000 2,677 CIP headroom

1,000 1,000

CIP programme

6,000 3,677

CIP programme %age turnover

4.4% 2.8%

Capex

9,521 4,700

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MEMBERSHIP

The Trust continues to make good progress against the four objectives set out in its membership strategy:

• Growing a sizable and representative membership; • Developing an active and engaged membership; • Enhancing governance; and • Learning and improving.

A high level summary of the Trust’s accomplishments over 2015/16 is set out below, alongside details of key areas which will be the focus of further development over 2016/17. Growing a sizable and representative membership:

• Public members: In 2015/16, the Trust exceeded its growth target of 3% within its public constituency, taking the total number of public members to 4300. The public membership remains broadly representative of C&I’s local communities and the Trust’s aim in 2016/17 will be to achieve a marginal increase the number of members coming from ‘Asian or Asian British’ and ‘Black or Black British’ backgrounds.

• Service user members: Despite a targeted campaign being carried out in year,

growth within C&I’s service user constituency was less successful - 7% growth against a target of 15% - and the number of service user members remains relatively low (around 800). One reason for this is that many service users continue to choose to join the public rather than the service user constituency. As such, a key area of focus in 2016/17 will be to strengthen the Trust’s messaging around the unique benefits of joining the service user constituency.

• Staff members: To date, no staff have chosen to opt out of the Trust’s membership.

Developing an active and engaged membership 2015/16 saw a marked increase in the number of engagement opportunities held by the Trust, as well as in member turnout at events. The Trust ran regular expert talks, a community open day, a ‘become a governor’ event, and an Annual Members Meeting. C&I also held two events to seek members’ input on our new Clinical Strategy. A key aim in 2016/17 will be to establish membership subgroups to enable regular targeted communication with members interested in informing and shaping delivery of the strategy. Enhancing governance

• Council of Governor Elections: 2015/16 saw the introduction of online voting and an election microsite to improve accessibility and ease of voting, provide richer information to voters, and to begin the move towards more cost-effective and environmentally friendly elections. The Trust was successful in attracting a healthy number of candidates (at least 2 candidates for every contested seat), however voter turnout was less successful. The Trust will be using the findings from a voter profiling study (which analyses demographics of non-voters to help identify any patterns) and

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the Trust’s annual member survey to help improve performance in this area in 2016/17.

• Governor Training and Development: C&I continue to invest in the training and

development of its Governors. In addition to running an in-house induction programme, C&I sponsors and actively encourages its Governors to attend the full range of GovernWell training programmes offered through NHS Improvement. C&I has also recently developed a partnership with UCLH to commission joint bespoke GovernWell training modules (e.g. on Accountability and Representing / Engaging with Members). The Trust will continue to identify new opportunities for training and development into 2016/17.

• Accountability: The Trust has continued its efforts to facilitate engagement between

Governors and members (as well as between Governors and NEDs). Governors are encouraged to attend membership events to interact with their constituents and they report back on their activities and achievements through a ‘Governor Annual Report’. Members are invited to provide feedback on the degree to which they view Governors as representing the interests of the membership and the wider public through an Annual Members’ Survey.

Learning and improving The Trust has worked hard to ensure that mechanisms for learning and improving are in place so that we can continue to improve our membership offering. Our newly introduced ‘Annual Members’ survey is a good example of this in that it asks for members to provide honest feedback on all areas of membership. The learning from this survey, which is currently being analysed, will be used to benchmark membership performance and to highlight further areas for development over 2016/17.

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