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Providing outstanding mental health, learning disability and children’s services nationally, regionally and to our local communities

Trust Board of Directors

Thursday 26 January 2017 0930 hrs

Seminar Room 1, The Redwoods Centre, Shrewsbury

Distribution List: Martin Gower, Chair Paul Bunting, Non-Executive Director Alison Bussey, Director of Nursing/Chief Operating Officer Neil Carr, Chief Executive Richard Cotterell, Non-Executive Director Jayne Deaville, Director of Finance & Performance Steve Grange, Director of Business & Commercial Development Abid Khan, Medical Director Jane Landick, Company Secretary David Matthews, Non-Executive Director Greg Moores, Director of Workforce and Development Therèsa Moyes, Director of Quality & Clinical Performance Sue Nixon, Non-Executive Director Megan Nurse, Non-Executive Director Ian Wilson, Non-Executive Director

BOARD OF DIRECTORS’ MEETING THURSDAY 26th JANUARY 2017 AT 0930 HRSSeminar Room 1, The Redwoods Centre, Shrewsbury

A G E N D A Timing Enc. Lead

0930 1. Welcome and Introductions Martin Gower

0930 2. Apologies for Absence Martin Gower

0930 3. Minutes of the meeting held on 24th November 2016 A Martin Gower

0935 4. Matters Arising Martin Gower

0940 5. Chief Executive Report and Environmental Scan B Neil Carr

0955 6. Trust Assurance Report

6.1 Quality and Clinical Performance C Therèsa Moyes

6.2 Finance and Performance Jayne Deaville

6.3 Business Development Steve Grange

6.4 Workforce and Development Greg Moores

6.5 Medical Director Dr Abid Khan

7. Strategy

1025 7.1 Service User and Carer Involvement Framework (andPatient Story)

D Therèsa Moyes

1045 7.2 Annual Plan 2017/18 E Jayne Deaville/ Steve Grange

1105 7.3 Workforce Plan F Greg Moores

8. Governance

1120 8.1 Charitable Funds Annual Accounts 2015/16 G To follow

Jayne Deaville

1135 8.2 Register of Interests H Neil Carr

1140 8.3 Use of the Seal I Neil Carr

9. Assurance

1145 9.1 Safer Staffing: Ward Establishment Review and Analysis

J Alison Bussey

Any Other Business

1200 10. Summary of Decisions and Agenda Items for Next and Future Meetings

K Martin Gower

1205 11. Date of Next Meeting: Thursday 23rd February 2017 (St George’s Hospital, Stafford)

Martin Gower

1205 12.

Questions from the floor Martin Gower Neil Carr

Board Story Programme During the course of the meeting, the Board will receive a story which brings to life the real experiences of the individuals who use our services or who work in our services. When the individual is attending the meeting in person, the timing of these stories will be agreed to meet the convenience of the individuals who are giving up their time to tell their story and there will be a short break in the agenda for refreshments prior to this item.

1030 13. Patient Story L Therèsa Moyes

Minutes of the meeting of the Board of Directors of South Staffordshire and Shropshire Healthcare NHS Foundation Trust

Thursday 24th November 2016 Page 1 of 11

Corporation Street, Stafford ST16 3SR Tel: 01785 257888

Fax: 01785 258969

ENC A

MINUTES OF THE MEETING OF THE BOARD OF DIRECTORS OF SOUTH STAFFORDSHIRE AND SHROPSHIRE HEALTHCARE NHS FOUNDATION TRUST, HELD AT THE REDWOODS CENTRE, SHREWSBURY AT 0930 HRS ON THURSDAY 24TH NOVEMBER 2016

16/192 Present

Membership 04 05 06 07 08 09 10 11 12 01 02 03

Martin Gower, Chairman X X Dr Abid Khan, Medical Director X Alison Bussey, Chief Operating Officer /Director of Nursing

X

Paul Bunting, Non-Executive Director X X X Neil Carr, Chief Executive X Richard Cotterell, Non-Executive Director X Jayne Deaville, Director of Finance and Performance

Steve Grange, Director of Business and Commercial Development

X X

David Matthews Greg Moores, Director of Workforce and Development

Therèsa Moyes, Director of Quality and Clinical Performance

X

Sue Nixon, Non-Executive Director X Megan Nurse, Non-Executive Director X Ian Wilson, Non-Executive Director X

16/193 In attendance

Jane Landick Company Secretary Martin Evans Associate Director of Communications Robert Graves Director of Facilities and Estates (agenda Items 8.2 and 8.3) Dawn Crowther Mental Health Legislation Manager (agenda item 6.6 and 14) Fiona Moore Customer Services Manager (agenda item 9.2) Kate Ross Consultant Clinical Psychologist (agenda item 9.4) Stuart Middleton Head of Human Resources (agenda item 9.5) Mike Ball Staff Side Chair (agenda item 9.5) Karl Bailey Public/Service User/Carer Governor (Shropshire) Julian Birch Shropshire Patient Group

Minutes of the meeting of the Board of Directors of

South Staffordshire and Shropshire Healthcare NHS Foundation Trust Thursday 24th November 2016

Page 2 of 11

Peter Jetson Public/Service User/Carer Governor (Shropshire) 16/194 Apologies Paul Bunting Non-Executive Director Steve Grange Director of Strategy and Strategic Transformation 16/195 Declaration of Interests In addition to interests previously declared, Jayne Deaville’s joint appointment as

Director of Finance of Staffordshire and Stoke on Trent Partnership Trust was formally noted.

16/196

Minutes

The minutes of the Board of Directors meeting held on Thursday 27th October 2016

were agreed and signed by the Chair as a true and accurate record. 16/197 Matters Arising from the 27th October 2016 minutes There were no matters arising not covered by separate agenda items. The winner of

the monthly flu vaccination prize draw was won by Amanda Edwards, Hotel Services Supervisor at the George Bryan Centre.

16/198 Research and Innovation: Psychologically Healthy In-Patient Wards Kate Ross presented the paper summarising a piece of national development work

she had been i nvolved with completed under the auspices of the Faculty of Psychology of Older People and t he inspiration for which came from a period of research undertaken in Bromley Ward with the support of a year-long research placement with the R&I department. The action research on Bromley demonstrated that it is possible to make huge improvements in the quality of patient experience and the effectiveness of the ward processes by the application of a ps ychological approach to the patient journey throughout their admission. Therèsa Moyes highlighted work taking place in the Forensic Directorate around the healing environment and the potential for shared learning between these initiatives. In response to a question from Sue Nixon around psychologists working in the community, it was noted that this was being picked up through the community remodeling work and in response to a further question about action to improve the lower ratings on the scale, Kate Ross advised that the focus had latterly been directed to improving these two metrics. Therèsa Moyes commented that it was this sort of work which differentiated the good from the outstanding and t hat it was important to share the learning with other wards. Neil Carr referred to the value of clinical psychology input on wards and Kate Ross advised that in future it would be equally important to focus on the non psychology workforce and the roles that non medical consultants could play. Abid Khan concurred that it was vital for all clinical staff to be more psychologically minded to bring about change and improvement in the care provided.

16/199 Chief Executive’s Report and Environmental Scan Neil Carr reported on the following events, activities and issues: • The success of the Inclusion Team in winning the Health Service Journal

Award for Patient Safety for the Naloxone Project. The Board commended and congratulated the team for this significant achievement.



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• The MIND report on i mproving mental health training for GPs and practice nurses was noted as important in the context of the community remodeling project aiming to align services more closely with GPs and primary care through education and co-working in tandem with the locality focus of the Sustainability and Transformation Plans (STP).

• The focus of the Royal College of Psychiatrists highlighting the focus on physical healthcare needs of services users was welcomed. It was noted that the AHP Lead for the Trust, Debbie Moores was also leading a piece of work with sports therapists, dieticians and others, to address this issue and weight gain in particular.

• The YMCA report on stigma experienced by young people with mental health problems was highlighted in the context of the contract awarded to the Trust for the delivery of child and adolescent mental health services in Shropshire, Telford & Wrekin and that the opportunities this presented for the Trust to take services to a different level and improve transition to adult mental health services where there was evidence nationally that 60% of service users were lost to services during this transition period.

• The Staffordshire STP Workforce Redesign Workstream was reported to be focusing on a system wide approach to the reduction of agency usage, which it was anticipated would have a s ignificant impact on c ost reduction. Within the Trust a reversal in the use of agency staff was being reported through the sustained efforts of Abid Khan, Alison Bussey, Greg Moores and Jayne Deaville.

• The POD staff awards event on 30 th November was eagerly anticipated, with over 370 staff attending.

• The emerging GP Federations in North, Mid and South East Staffordshire were noted and it was agreed that it was important to work with them to understand and support their aspirations and aims going forward.

16/200 Board Committee Summary Report: Quality Governance Committee (10th

November 2016) The summary report was received and noted. Therèsa Moyes highlighted the

quarterly Mental Health Act Report and the quarterly NICE guidance report, the latter of which was currently the subject of an RPIW aiming to reduce the lead time to implementation. It was noted that the Committee had also received assurance regarding the implantation and service delivery quality review process for new contracts in Inclusion Services. In response to a question from Neil Carr, Therèsa Moyes confirmed that the reference to “no action” against the CQC action plan update report, referred to no specific actions for the committee, not that no action was being taken.

16/201 Board Committee Summary Report: Workforce and Development Committee (28th September 2016)

The summary report was received and noted. Sue Nixon highlighted assurance

received and discussion regarding agency spend, community remodeling and the apprenticeship levy. Neil Carr referred to the Staff Opinion Survey and commented that whilst it was good to see the improved response rates, it was important to be sensitive to the fact that more than 900 staff in community mental health and inclusion services were currently undergoing management of change processes.

16/202 Board Committee Summary Report: Senior Leadership Forum (12th November

2016)



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The summary report was received and noted. Neil Carr summarized work currently taking place to review the form and function of this Forum and the Trust Management Team. It was noted that proposals were being consulted on for agreement in December 2016 and implementation of new arrangements in January 2017. Martin Gower referred to the briefing on the use of Nursing Associates and it was noted that Alison Bussey was taking a national lead on this work.

16/203 Board Committee Summary Report: Audit Committee (14th October 2016) The summary report was received and noted. David Matthews referred to the

intention to seek market competition of the internal and external audit function. Jayne Deaville confirmed that a procurement process would be confirmed and that the appointment of the external audit function would involve the governors, as required. In response to a question from Neil Carr, Therèsa Moyes advised that the absence of controls referred to in connection with the Board Assurance Framework, related to new risks which had been added and that the controls were in place, but had not been reflected in the report at the time of the meeting.

16/204 Board Committee Summary Report: Finance and Performance Committee (14th

October 2016 and 11th November 2016) The summary report was received and noted. Richard Cotterell highlighted the focus

on the Cost Improvement Plans (CIP) and the review undertaken of the Single Oversight Framework implications. In response to a question from Martin Gower, Jayne Deaville advised that the tariff guidance was not applicable to mental health care clusters and that no further movement in this respect was anticipated.

16/205

Policy Ratification

The Board formally ratified the Mental Health Act Section 117 Aftercare Policy and

Standard Operating Procedure. 16/206 Trust Assurance Report: Quality and Clinical Performance Therèsa Moyes reported on a c hallenging but constructive discussion at the

Staffordshire County Council Joint Health Scrutiny Accountability Session and advised that video and audio footage of the session was available. It was noted that the shadow ratings for the Trust with respect to the NHS Improvement Single Oversight Framework (SOF) placed the Trust in Segment 1. Therèsa Moyes advised that the impact of the notification of a new programme of intelligent monitoring by NHS England Specialised Commissioning Quality Surveillance Group was currently been assessed and in response to a question from Neil Carr about how the Group would review services provided through Accountable Care Organisations, advised that it would also be i mportant to monitor their intentions in this respect, in light of the Trust’s participation in the Reach Out Project. Therèsa Moyes concluded her report by advising that matters reported through the safety dashboard continued to remain within control limits for the reporting period.

16/207 Trust Assurance Report: Finance and Performance Jayne Deaville advised that at month six the year to date surplus margin (3.0%) and

EBITDA margin (5.8%) were ahead of the annual planned levels of 1.7% and 4.4%



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and that the year to date favourable variance was being mainly driven by operating expenditure being £2.5m lower than plan, off-set by a net £1.8m unfavourable variance against operating income. With respect to supplementary staffing, Jayne Deaville advised that the agency spend cap was one of the key financial metrics under the new SOF which came into force from October 2016 and was being closely monitored by NHS Improvement. She advised that the Trust has been set an agency ‘cap’ of £5.8m for 2016/17 by NHS Improvement and that at month six the cumulative expenditure on agency usage was £4.7m which poses a significant challenge to the Trust with regards to remaining within the ‘cap’ during the financial year with the forecast showing an outturn agency spend of £8.4m. However, she advised that the run rate was now at an acceptable level and in response to a question from Richard Cotterell, confirmed that whilst no formal response had been received to the letter sent to NHS Improvement regarding this, the indications were that NHS Improvement would be flexible in allowing overrides where Trusts were able to demonstrate a clear rationale for agency spend, strong performance against other metrics and action to ensure use of agency was reducing through robust action plans. It was agreed that the Trust’s shadow SOF rating indicated that this was the case. Neil Carr commented that he was confident that there was ample justification for the agency usage that was being incurred as well as evidence of significant action to address spend including recruitment of consultant psychiatrists where there was a national shortage. Alison Bussey confirmed that seven of the eight graduating nursing students had chosen to come and work for the Trust. In response to a comment from Megan Nurse about the inclusion of the target of reducing agency spend to below £480K per month within the report, Greg Moores confirmed that he would reflect this and the progress towards achieving the target figure in his section of the report in future.

Jayne Deaville advised that the Trust’s CIP target was £7.76m for the financial year

2016/17 and was currently forecasting to deliver £6.3m (81%) resulting in an in-year CIP shortfall of £.5m. It was noted that the forecast CIP position had improved by £0.8m compared to the previous forecast outturn and that a CIP Contingency reserve of £1.5m was being held to help off-set any in-year CIP shortfall. Therefore the forecast ‘net’ CIP position was a favourable £0.04m. It was forecast that 64% would be delivered on a recurrent basis carrying forward a recurrent shortfall of £2.8m into 2017/18 with the financial planning assumptions showing an estimated CIP target of £8m for 2017/18.

Jayne Deaville reported that the latest forecast outturn position for the financial year showed a surplus of £3.13m, representing an unfavourable variance of £0.03m against the Trust’s flexed annual budget of £3.16m. It was noted that the Trust was currently reporting to NHS Improvement that it would achieve its surplus control total of £3.13m by the financial year-end and that the current forecast outturn position assumed that any excess above the control total would be utilised on non-recurrent expenditure plans prior to the year-end.

16/208 Trust Assurance Report: Information Governance Jayne Deaville summarised the numbers of Freedom of Information Act and Access

to Records requests received and confirmed that there had been no s tatutory breaches since the last report. Of the information governance incidents reported during September 2016, none were classified as serious.

16/209 Trust Assurance Report: Contract Monitoring



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It was noted that all contract monitoring and performance targets had been met but that at 6.4% the minimising delayed transfers of care target was creeping close to the 7.5% tolerance threshold and was therefore being closely monitored.

16/210 Trust Assurance Report: Business Development Martin Evans highlighted the POD Awards taking place on 30th November 2016 and

advised that a press release had already been issued regarding the HSJ awards success. H e also summarised the work of the STP Communications Workstream and in response to a question from Ian Wilson about public consultation, advised that consultation would need to take place on relevant parts of the STP relating to service change, rather than on the STP as a whole, but that public engagement on the STP would also be taking place and that in Staffordshire, this was being co-ordinated through Engaging Communities. The update report on the Reach Out Partnership was also received and noted. Jayne Deaville commented that this was an important project as it was a nat ional pilot for the establishment of the Accountable Care Organisation (ACO) model and had the potential to be able to repatriate patients within the West Midlands generating cost savings and improved locally based care for patients.

16/211 Trust Assurance Report: Mental Health Act Quarterly Report Dawn Crowther presented the quarterly report and highlighted the spike in Section 3

admissions, which was being monitored through the Mental Health Legislation Committee and the Quality Governance Committee but the reasons for which were likely to be m ulti-factorial. Delays in managers’ hearings and tribunals were also noted to be being addressed through a Listening into Action project and sharing best practice from other Trusts. Delays in DOLS authorisations within local authorities nationally continue to present problems. Dawn Crowther advised that applications where patients were discharged before being authorized were recorded as “not authorized” rather than reflecting an inappropriate referral. She also confirmed that the Mental Health Legislation Committee had agreed that a formal letter would be sent to escalate the matter, each time an application breached the 14 day threshold. Neil Carr referred to the issues arising from the Care Quality Commission inspection visit to Holly Ward which had been routinely picked up on other visits and expressed frustration that they were still being reported and not being consistently addressed by responsible clinicians and ward managers. Abid Khan and Alison Bussey agreed to follow this up. It was noted, however, that recording of consent had now improved significantly although the quality of information contained in the entries in clinical records required further improvement. In response to a question from Megan Nurse about the interpretation of the data around Community Treatment Order (CTO) recalls and revocations, Dawn Crowther agreed to review the presentation of this information in the next report to provide more clarity and explanatory narrative to contextualise the data. Ian Wilson referred to the Care Quality Commission Annual Report on the use of the Mental Health Act, which reflected similar issues to those reported within the Trust but added that he was disappointed to see no reference to the judicial review.

16/212 Patient Story: Use of the Mental Capacity Act (MCA)



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Dawn Crowther presented the story which illustrated how easy it was to look at a situation, take things at their face value and jump to the overly restrictive method to ‘get something done’. The story described how staff took considerable time to explain, acclimatise, de-sensitise and support the patient in order to accomplish recommended treatment/investigations, paying particular attention to the premise of the MCA, in that it aims to protect people who lack capacity, and maximise their ability to make decisions or participate in decision-making; and also to the Trust’s ‘Living Our Values’, particularly those of being respectful, caring and compassionate, taking the time to talk and listen, and working together. The Board agreed that the story showed how staff put people who use our services at the centre of everything we do. Neil Carr thanked Dawn Crowther for her quarterly report and the story and paid tribute to Dawn’s professionalism, knowledge, expertise and commitment to getting it right for service users.

16/213 Workforce and Development Strategy 2012-17: Half-Year Update Report Greg Moores reminded the Board that in April 2016, a report summarising delivery

over the four years of the Workforce and Development Strategy was presented to the Board and that the paper he was presenting was intended to update Trust Board on delivery of the Workforce and Development strategy over the six months from April to October 2016. He summarised progress with each of the strategic aims and t he highlights including targeted work to improve staff health and w ellbeing, work to reduce agency expenditure, improvements in learning appraisal and m andatory training systems and compliance. He also listed a number of challenges in delivering the strategy including a difficult recruitment climate for registered nurses, meeting the NHSI agency expenditure ceiling and or ganisational change impacting on s taff engagement levels. In response to a question from Megan Nurse on how the quality of appraisals was monitored, Greg Moores advised that a paper regarding this was due to be submitted to the Workforce and Development Committee on 30th November and that the findings which were based on a survey were generally positive. He also confirmed, noting that that the current Workforce and Development Strategy covered the period to 2017, that discussion on a new five year strategy would also be taking place at next week’s Workforce and Development Committee meeting. S ue Nixon asked that congratulations be r ecorded by the Board for the work undertaken by Clare Boulton and Kelly Woods in organising the recent staff health and wellbeing days.

16/214 Review of the Joint Staff Partnership (JSP) (November 2015 – October 2016) Stuart Middleton introduced the annual report of the Trusts Joint Staff Partnership

(JSP) covering the period November 2016 – October 2016 and summarised the role of the forum as being for negotiation and consultation between the Trust and i ts recognised Unions with a common objective to work in partnership to ensure the efficiency and success of the Trust for all those it serves. Mike Ball then highlighted the successes, changes and challenges that the partnership has faced over the last 12 months and the main areas of focus for the next year. Stuart Middleton referred to the significant time commitment and contribution of staff side members, for which the Board wished to formally record its appreciation.

16/215 Estate Development of Section 136 Facilities Robert Graves attended the meeting to present a paper concerning the capital

commitment made by the Board to address the CQC requirements on t he development and ne w provision needs to address shortfalls in the current Section 136 accommodation at the George Bryan Centre, St George’s Hospital and t he



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Redwoods. To ensure compliance with Standing Financial Instructions for Board approval for capital schemes and tenders over £500k, the Board formally ratified the decision to award the tender for £516.5k to Bespoke Construction Services and to approve the total capital scheme of £700k. In response to a question from Sue Nixon, he advised that subject to completion of staff training, it was anticipated that the new facilities would be in use shortly after Christmas and that he hoped to have a closure date for the Section 136 suite at the George Bryan Centre within the next few weeks.

16/216 Anti-Ligature Capital Works Robert Graves advised that in auditing capital projects Internal Audit had noted that

Standing Financial Orders had been breached in that the anti-ligature capitals works project did not have Board approval as required by Standing Financial Orders, for a contract above £500k. To address this oversight the Board formally ratified the decision to award the contract to CLC Construction limited, for the contract value of £559k + VAT, for the anti-ligature works on the inpatient wards within the Trust. Robert Graves confirmed that Milford Ward would be used as a decant facility whilst this work was undertaken. In response to a question from Martin Gower, Neil Carr advised that the intention was to ensure a balance between a safe but healing environment and that patient safety was best maintained through relationship building and robust risk assessment. He advised that it was also important for Heads of Departments to take ownership of managing a safe environment.

16/217 Annual Report and Thematic Review of the Customer Services and Patient

Advice and Liaison Service 2015/16 Fiona Moore attended the meeting and pr esented the report. S he referred to the

category changes implemented by NHS Digital, which made comparisons with previous years less straightforward and highlighted a number of areas including the continued emphasis on local resolution of complaints and concerns, the intention to focus on t he alignment of feedback from patient experience working with Kath Chambers and t he Involvement and E xperience Team and w ith the Quality Improvement (QI) Team on l earning lessons and ac tion planning, which was currently the subject of a QI project. Fiona summarised the priorities for the current year including the intention to correlate numbers of complaints, compliments and concerns with activity levels. Martin Gower commended Fiona’s remarkable handle on the issues and pr iorities having only taken up post in August. David Matthews also commented an excellent and comprehensive report. In response to a question from Megan Nurse about the apparent discrepancy surrounding the percentage of complaints from the BME community, Neil Carr advised that this was likely to reflect the numbers where the ethnicity was “not known” which would increase the numbers in the “white” category. In response to a q uestion from Sue Nixon, Fiona Moore summarised her plans to monitor and address satisfaction with complaints handling and outcomes through a redesigned survey and that she would be working with Jas Kaur regarding this in the coming months and exploring options such as the use of Meridian. She advised that she anticipated that future reports would include data on satisfaction levels. T he Board formally approved the action plan for 2016/17 and agreed to refer more detailed discussion on t he report at the Quality Governance Committee (QGC) in December 2016, with any further actions/recommendations reported back to the Board through the QGC summary report.

16/218 Trust Assurance Report: Workforce and Development and Safer Staffing Greg Moores presented the report and summarised the current rates and hotspots



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around sickness, turnover, vacancies and appraisal rates. He advised that a return to work date had been confirmed for the long term sickness. The inclusion of a section of the report on agency usage was noted and as per minute 16/203 it was noted that the target spend reduction would be included in future reports. David Matthews commented on the safer staffing report and whether it was possible to be ‘too green’ in terms of over-fill rate. Alison Bussey advised that the factors impacting on this were complex and the fill rates were a matter of professional judgment on a case by case basis and that he would learn more at the workshop taking place the following week to provide assurance regarding this. Jayne Deaville advised that this was also something she continued to challenge and seek assurance on. In response to a question from Megan Nurse about forensic staff turnover, Greg Moores advised that the percentage was an annualised figure reflecting the impact of a management of change process earlier in the year, which was now stabilising.

16/219 Trust Assurance Report: Infection Prevention and Control Dr Abid Khan presented the report which was received and noted. With respect to

the flu vaccination uptake, it was acknowledged that it was unlikely that the CQUIN target of 75% of clinical staff would be achieved. Jayne Deaville confirmed that there would therefore be a financial penalty imposed, but that provision had been made for this in the accounts.

16/220 Trust Assurance Report: Research and Innovation Dr Abid Khan presented an update on activity within the Research and Innovation

Team and highlighted the extent to which the Trust had demonstrated a high level of research activity in comparison with other mental health trusts within the West Midlands and building a strong reputation and profile, which was commended by the Board.

16/221 Service User and Carer Involvement and Experience Strategy Update Report Therèsa Moyes reminded Board members that in February 2016, members of the

Service Users and Carers Involvement Committee began to review the Trust’s 2011-16 strategy and started to generate new ideas for how members wanted to influence Trust strategy with respect to involvement over the next 5 years. She advised that further consultation processes included survey feedback; a mini workshop using national standards and local research; feedback from local service user forums on their own changes and aims; as well as consensus gathering using those ideas prioritised by members during the October committee meeting. Responses to the final feedback has been circulated to local involvement forums and it was anticipated that this will included in a new strategic framework to be presented to the Board in January 2017. Therèsa Moyes advised that the paper represented a highlight update report in advance of finalising the new framework for 2017-2022 as part of the 2016 consultation, with Board members being identified as co-stakeholders. The Board confirmed its support for the direction of travel outlined in the paper and agreed to receive the finalized involvement framework in January 2017.

16/222 Annual Board Committee Governance Review Jane Landick summarised the new format for the presentation of the Board

Committee terms of reference which enabled the completion of a self-assessment against the defined duties of each committee as part of the annual processes of review, focused on the inputs required and the outcomes delivered. David Matthews



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commented that he found the approach provided greater clarity and an effective review process. Jane Landick outlined the rationale for the recommendation to remove the Policies and Procedures Committee (PPC) from the list of Board committees and thanked Ian Wilson for his role in steering the Committee through its work programme over the past 12 months. It was agreed that the policy governance framework was robust and that whilst policies would still be referred to the Board for ratification, the PPC would no longer be a formal Board committee. Further minor amendments were noted as requiring to be made to both the Business Development and Investment Committee and the Workforce and Development Committee terms of reference, subject to which the terms of reference were approved.

16/223 Progress update on the action plans put in place to address the improvements

identified by CQC following their Comprehensive Inspection of the Trust in March 2016

Therèsa Moyes presented the report which confirmed that the action plan was on

track and the Project Board continue to meet to monitor and track progress and report monthly to the Quality Governance Committee.

16/224 Freedom to Speak Up Thematic Review 2015/16 Jane Landick presented the second annual thematic review of the work completed in

2015/16. She also summarised the significant progress made since the appointment of Paula Johnson as the Trust’s first Freedom to Speak Up Guardian, in July 2017. In particular she highlighted Paula’s involvement regionally and nationally, having been approached, informally to join a Marketing Committee at national office, having organised the first Regional Network Meeting for FTSU Guardians held earlier in November which was attended by the National Guardian and which will meet quarterly, not only as a support mechanism, but to promote learning and best practice. Paula is currently looking at the possibility of introducing some local “champions” particularly to support services at a distance and is presently gaining further information from some Trusts which have gone down this route. It was noted that a programme of awareness sessions will commence in January, targeting inpatient areas in the first instance and will be led by Paula in conjunction with a staff representative. In the meantime Paula has attended the first conference hosted by the National Guardian at which Sir Robert Francis also spoke and has completed her official training delivered by Public Concern at Work and a representative from the National Guardian’s Office. The Board commended the significant progress made in a very short time and formally approved the action plan and objectives for2016/17.

16/225 Questions from the Floor In response to a question from Peter Jetson about the use of open days and

promotional events to support recruitment, Greg Moores confirmed that a wide range of different approaches had and were being taken to boost the recruitment of hard to fill posts despite the national shortages, including a focus on recruitment from outside of Staffordshire and Shropshire to broaden the pool of potential applicants.

16/226 Summary of Decisions Decisions made were summarised by the Company Secretary as follows:

• The MHA Section 117 Aftercare Policy was ratified. • The Board ratified the capital projects relating to the award of the tenders for the



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Section 136 facilities and the anti-ligature work as per minutes 16/215 and 16/217.

• The complaints/PALS/compliments thematic review action plan for 2016/17 was agreed.

• The Freedom to Speak Up Thematic Review objectives for 2016/17 were agreed. • The Board committee terms of reference were agreed • The Board agreed to dis-establish the Policies and Procedures Committee as a

Board Committee. 16/227 Agenda Items for Future Meetings • Service User and Carer Involvement Framework (January 2017) 16/228 Any Other Business There were no matters arising. 16/229 Date of Next Meeting The next public Board meeting will take place on Thursday 26th January 2017

at 0930 at St George’s Hospital, Stafford.

Board of Directors: 26 January 2017 1

Board of Directors Agenda Item 5 Enc B

Document Title: Chief Executive’s Report and Environmental Scan

Sponsoring Director: Neil Carr, Chief Executive

Author(s): Neil Carr, Jane Landick, Steve Grange

Date of Meeting: 26 January 2017

Executive Summary The objectives of the report are to:- • Scan the fast changing environment in which our NHS Foundation Trust operates • Consider this from a range of perspectives • Focus on new vital issues and encourage focussed and strategic discussion • Help stimulate all Board members to raise issues • Encourage the Board to share intelligence, place action or seek assurance • Ensure effective internal governance of issues discussed through committees • List policies for ratification by the Board and provide assurance of a robust

consultation and approval process.

Recommendations The Board of Directors is asked to: • Receive and note the report and recommend any further action required. • Agree Trust Leads for decisions on action • Note the summary reports from Board committees and review key issues and

decisions made to ensure that issues are appropriately cross referenced between committees of the Board

Monitoring Details Care Quality Commission Compliance

Safe Caring Responsive Effective Well Led

NHSI Compliance Other (add details) As identified

Assurance Ref Details Risk Register All Assurance Framework All Link to Strategic Aims All


Board Committee As appropriate

1.0 Committee Reports

1.1 Quality Governance 8 December 2016 1.2 Business Development and Investment 28 November 2016 1.3 Workforce and Development 30 November 2016 1.4 Service User and Carer 14 December 2016 1.5 Finance and Performance 22 December 2016

2.0 Policies – approved at PPC – 19 January 2016

2.1 Spirituality, Religion and Pastoral Care Policy 2.2 Social Networking Policy


2.1

Chief Executive’s Report January 2017 Neil Carr Chief Executive


OVERVIEW OF THE REPORT The objectives of the report are to: • Scan the fast changing environment in which our NHS Foundation Trust

operates • Focus on new vital issues and encourage focussed and strategic

discussion • Encourage the Board to share intelligence, place action or seek assurance • Ensure effective internal governance of issues discussed through Board

committees • List policies for ratification by the Board and provide assurance of a robust

consultation and approval process. CONTENTS 1. Our strategy 2. New national guidance and reports 3. Our current priorities 4. Horizon scan - Quality - Staff, teams and culture - Partnerships - Commercial Development - Regulation 5. Key Opportunities / Risks - Strategic opportunities - Political issues of direct relevance - Area of particular success 6. Strategic Projects and key dates and events


1. OUR STRATEGY

Board of Directors: 26 January 2017

Page 6 of 20

1.0 Projects Overview

1.1 The PMO are currently reporting on 88 projects which includes 6 Business Critical projects. 7 of the projects are rated red, 23 rated amber, 30 rated green, 5 are on hold, 16 are in the initiation stage and 7 projects are in closure. 6 of these projects are related to the delivery of a CQUIN target. 10 projects are related to the delivery of a Cost Improvement Plan.

1.2 The below chart shows the RAG Status for these projects as at end of December 2016. Overall, the performance of Trust projects has slightly declined on the previous month as more projects have been rated red than in the previous month. In November, performance is expected to be maintained across all projects.


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2.0 Business Critical Projects and Red Rated Projects

2.1 The below table shows the status of the 6 Business Critical projects and any

project rated Red in progress in December:

Project Title

Directorate

Expected Key Benefits

Priority

RAG Status

Risk No, Description and (score)

RAG status comments/Risk mitigations

Community Service Re-Modelling Programme

Mental Health

Improved service user experience Improved partnership working Greater consistency of service Improved productivity/quality Overall improvement in treatment outcomes

BUSINESS CRITICAL

Red N/A There is a risk associated with sufficient resources to complete the configuration changes to RiO by 1st April 2017. Potential delays to procurement of Mobile Voice Dictation. Possibility that accommodation requirements will not be ready by 1st April. There is a risk relating to provision of the disaster recovery solution for Access which may not be supported by HIS.

EPMA Medical Directorate

Reduction in medicines errors Significant positive effect on patient safety Prescribed medicines information available to SSSFT healthcare professionals at all times

BUSINESS CRITICAL

Red 438 – roll out requires re-planning (8) 357 – additional equipment may be required (6)

Problems with Rio environment mean E-prescribing is still not testable

St George’s Re-Development

Facilities & Estates

Improved service user/staff safety and experience through development of modern, fit for purpose

BUSINESS CRITICAL

Green

N/A Demolition work is progressing on schedule. Business Case for further work is due in March.


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Project Title

Directorate


Priority

RAG Status



accommodation at St George’s site.

Section 136 Re-provision

Operational Cross-Cutting

To enable the Trust to deliver Section 136 Place of Safety Suites in line with best practice. To fully meet demand in South Staffordshire and Shropshire for Health Based Place of Safety. Effective child-friendly facility in place. Increased capacity within Shropshire, Telford & Wrekin localities thereby reducing out-of-area placements.

BUSINESS CRITICAL

Green

N/A Building works at Haywood Lodge completed (23/12/16) and planning application for Redwoods suite submitted.

Fuller House, Hall Court Telford Team Move

Facilities & Estates

Improved service user and staff experience through new accommodation.

BUSINESS CRITICAL

Green

903 - Current IT suppliers may not be able to install IT networks in time for service commencements (8)

Construction works commenced

RiO Development & RiO 7.5.2 Upgrade

IM&T Increased user functionality and content tailored to individual user Speed up use of RiO and reduce clinical input overhead by reduction in forms Better support for end of bed care Improved technical integration ability Enables EPMA to

BUSINESS CRITICAL

In Closure

914 – risk of non-compliance with MHA due to RiO configuration (15) 549 – issues with

Project in closure


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Project Title

Directorate


Priority

RAG Status



be implemented connectivity and assessments (15)

Flu Vaccinations


CQUIN achievement of % uptake of the flu vaccination by frontline clinical staff will have a positive impact on the health of the workforce and in the prevention of flu being contracted by patients and the wider public.

HIGH RED 997 – There is a risk that the CQUIN for Flu Vaccinations will not be achieved due to the high target set of 75% (financial risk -£251.5K) (16)

The Trust is not going to meet the 75% target and is unlikely to meet 65% target by December 31st as many staff are unwilling to take up the offer of flu vaccination.

SharePoint 2013/New Intranet

IM&T Centralised storage area for Trust documents allowing collaborative working on documents and access permissions.

MEDIUM

RED Exception Plan: Risual have failed to meet the requirements of the project’s original delivery date of October 2015, their subsequent Exception Plan delivery dates of January 2016, August 2016 and the end of October 2016. SharePoint intranet site is ready for go-live (since August), however, requires IM&T Application Development team to review, document and confirm the configuration prior to going live as the default intranet for the Trust to ensure safe, ongoing support of the


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Project Title

Directorate


Priority

RAG Status



system.

Clinical Coding


Improvement to quality of future care delivery; avoidance of penalties in existing contracts, increased success in bids for new/existing business; richer data to inform organisational decision making.

HIGH RED 920 – There is a risk that the Trust will remain ‘unsatisfactory’ on the Information Governance toolkit for 2016/2017 (12)

Coding commenced week of 12/12/16, however red RAG status remains as too early to see significant improvement in coding compliance.

Gosport New Site Setup


Meet expectations of existing contracts; access to services will be increased for service users.

HIGH RED 646 – Still awaiting formal leases for buildings at increased cost to service (6)

Not financially and physically possible to make the building DDA compliant.

Winchester Reconfiguration


Release of savings on current spend of £120,000 per annum. Improvement of service user experience and ability of the service to create an environment that is recovery focussed.

MEDIUM

RED 646 – Still awaiting formal leases for buildings at increased cost to service (6)

Project cannot move forward with IM&T elements until the F&E works have been completed. GVA do not think the building contractor will complete the works by 31st March 2017. Danny Hames has suggested this will be completed in April 2017.


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2. NEW NATIONAL GUIDANCE, REPORTS The following documents and reports are placed with Executive Leads for decisions on whether any actions are required for follow up or consideration by Board Committees. 2.1 Guidance and Reports No. Document Hyperlink Lead 2.1.1 NHS Employers - Improving staff engagement through

the workforce development strategy. This case study from Kettering General Hospitals shares their experiences of how they've improved their staff engagement levels through the implementation of a workforce development strategy. The strategy focuses on eight key objectives and is based on findings from the NHS Staff Survey and is aligned to the trust's wider five year organisational strategy.

Case Study Greg Moores

2.1.2 Commission on Children and Young People's Mental Health - Children and young people's mental health: time to deliver. This is the final report from an independent commission that was tasked to reflect on the progress made in transforming children and young people's (CYP) mental health services following the government's promised investment of £1.4bn. The report highlights that the government decision not to ring fence the CYP funding is putting the transformation process at risk. The commission also found that there is little clarity around whether the CYP funding is reaching frontline services, and with increasing pressures on the NHS, there is a risk that the investment may be spent on other priorities.

Report Alison Bussey

2.1.3 Personal Social Services Research Unit (PSSRU) - Best practice for perinatal mental health care: the economic case. This report examines the economic case for investing in early interventions that reflect best practice in England. Commissioned by NHS England, the study included a comparison of the potential costs and consequences associated with such interventions compared with one or more alternative course of action (operationally defined as current practice, and sometimes referred to in studies as the ‘do nothing’ option).


2.1.4 Care Quality Commission (CQC) - 2016 community mental health survey: statistical release. This report outlines the findings of a patient experience survey of people who have received community mental health services. It found that overall the majority of respondents reported a positive experience of care, but that areas for improvement include patient involvement in their care decisions, provision of crisis care, named contacts for care planning and regularity of care reviews.


2.1.5 Centre for Mental Health - Meeting the need: what makes a 'good' joint strategic needs assessm ent (JSNA) for mental health or dementia?. This research outlines how mental health needs assessments can prompt concerted action to improve wellbeing and life chances in local communities. It explores how five local councils across England went about understanding the mental health needs

Report

Alison Bussey

http://kingsfundmail.org.uk/21A8-4LQMQ-FLWPIM-2D6M5J-1/c.aspx

http://kingsfundmail.org.uk/21A8-4LW7K-FLWPIM-2DEY9Z-1/c.aspx

http://kingsfundmail.org.uk/21A8-4LW7K-FLWPIM-2DF5M7-1/c.aspx

http://kingsfundmail.org.uk/21A8-4LW7K-FLWPIM-2DF3IW-1/c.aspx


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of their communities and taking action to meet them more effectively. It finds that JSNAs for mental health and dementia can help to direct investment, to improve services and to help local agencies work together more effectively.

2.1.6 NHS Providers - The state of the NHS provider sector: November 2016.This survey of NHS trust chairs and chief executives has revealed rising concerns over the growing NHS workforce gap. 172 NHS leaders responded to the survey and only 27 per cent of these respondents reported confidence in having the right staff numbers, quality and skill mix to deliver high-quality care. The report provides examples of where trusts are improving quality of care and increasing productivity despite financial constraints and growing demand. The report highlights that trusts are able to deliver when given achievable tasks, but warns that the sustainability of services is at risk.

Report Greg Moores

2.1.7 Royal Pharmaceutical Society (RPS) - Frontline pharmacists: making a difference for people with long term conditions. This report argues the case for community pharmacists being able to routinely prescribe medicines for people with long term conditions and refer them directly to other healthcare professionals to ease the overwhelming demand facing the NHS. Currently, the care of people with long term conditions accounts for half of all GP appointments, 64 per cent of outpatient appointments and 70 per cent of all health and social care spending. The report estimates that up to £500 million of extra value could be generated if medicines were used in a more optimal manner in five therapeutic areas: asthma, diabetes, high blood pressure, vascular disease and schizophrenia

Report Abid Khan

2.1.8 Howard League for Penal Reform - Preventing prison suicide. This report, written in conjunction with the Centre for Mental Health, reveals that 2016 has been the worst year on record for prison suicides with 102 suicides recorded since the beginning of the year. The report highlights the action that needs to be taken to improve the safety and mental health of prisoners in England and Wales. It calls for a reduction in the use of solitary confinement and an increase in investment in staffing.

Report

Alison Bussey

2.1.9 Care Quality Commission (CQC) - Monitoring the Mental Health Act in 2015/16. This annual report on the use of the Mental Health Act looks at how providers are caring for patients, and whether patient’s rights are being protected. The report found many examples of good practice but also discovered that good care is not consistent across the country. The priorities for change highlighted include stronger leadership from providers; a more local and needs-based approach from commissioners; and greater collaboration between the Department of Health and national agencies on early intervention to reduce detention rates

Report Therèsa Moyes

2.1.10 Public Health England (PHE) - The mental health of children and y oung people in England. These reports describe the importance of mental health and wellbeing among children and young people and the case for investment in mental health. They also summarise the evidence of what works to improve mental health among children and young people in order to inform local

Report for England

Alison Bussey

http://kingsfundmail.org.uk/21A8-4MOOK-FLWPIM-2E3D84-1/c.aspx

http://kingsfundmail.org.uk/21A8-4MOOK-FLWPIM-2E3J7M-1/c.aspx

http://kingsfundmail.org.uk/21A8-4MOOK-FLWPIM-2E0OO4-1/c.aspx

http://kingsfundmail.org.uk/21A8-4MZ3M-FLWPIM-2E8X82-1/c.aspx

http://kingsfundmail.org.uk/21A8-4NI6M-FLWPIM-2EJHL5-1/c.aspx

http://kingsfundmail.org.uk/21A8-4NI6M-FLWPIM-2EJHL5-1/c.aspx


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transformation of services.

2.1.11 Care Quality Commission (CQC) - Learning, candour and accountability: a r eview of the way NHS trusts review and investigate the deaths of patients in England. This national review has found that the NHS is missing opportunities to learn from patient deaths and that too many families are not being included or listened to when an investigation happens. The report looked at how NHS trusts across the country identify, report, investigate and learn from the deaths of people using their services. The report calls for the development of a national framework so that NHS trusts have clarity on the actions required when someone in their care dies.

Report Therèsa Moyes

2.1.12 Institute for Employment Studies (IES) - Beyond Brexit: assessing key risks to the nursing workforce in England. This paper analyses data at national and trust level to map the regions and NHS trusts in England who may be most vulnerable to the associated risks of Brexit and population growth. The analysis forecasts that areas with a high projected rate of population growth of over-85s and above average employment of nurses from the European Economic Area are most at risk of facing greater pressures in those health economies.

Report Greg Moores

2.1.13 House of Commons Health Select Committee - Suicide prevention: interim report. This report presents interim findings from an inquiry that will go on to inform the updated suicide prevention strategy. It argues that the government should prioritise a clear implementation strategy and increase support for public mental health and early intervention services if it is to bring down the suicide rate. Ahead of the final report, the interim report highlights areas for action: a clear implementation strategy; improving services for those who are vulnerable to suicide; developing a consensus statement on sharing information with families; the need for more timely and consistent data to help prevent suicides; and greater adherence to media guidelines for the reporting of suicides


http://kingsfundmail.org.uk/21A8-4NNN0-FLWQ0M-2EUE8U-1/c.aspx

http://kingsfundmail.org.uk/21A8-4O80N-FLWQ0M-2F8ALC-1/c.aspx

http://kingsfundmail.org.uk/21A8-4O80N-FLWQ0M-2F5SHT-1/c.aspx


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3. OUR AIMS


Page 15 of 20


Page 16 of 20

4. HORIZON SCAN

Monitor Compliance ratings Gov: GREEN - Finance: 4 CQC compliance positions and rating

Contract targets Performance against activity - overall on target CIP position On target Membership The Trust has 14572 members

Ratings at a glance

Continuity of services rating

No evident financial concerns

Governance rating

Green: No evident concerns

PERFORMANCE ON A PAGE


Page 17 of 20

Quality • CQC outcome (Good, Good, Good, Good,

Good) • Progress Towards Outstanding : Work

programme progress • Quality Plan: delivery of the clinical strategy • Deployment of Listening into Action • Thematic Reviews • NHSI contractual performance and

Performance indicators • CQUIN development linked to STP • Continued modernisation of inpatient and

community estate – key dates including 136 • Clincial Dashboard development and

impacts • SSSFT Operational plan 2016/17 and

Strategic Plan 2016/21 submitted • Deployment and use of data within clinical

teams • Development of partnership work with

Primary Care linked to emerging new models of care

• Service User Carer feedback and Board stories

Staff, Teams and Culture • Staff training and development –

leadership development and staff team development – progress

• OD and System Change agenda • STP focus on workforce and workforce

redesign including key vacancies • Staff satisfaction survey • Workforce and agency spend –

guidance and control totals • Living our values & Listening into Action

(LiA) – next steps and impacts on staff satisfaction and culture

• Deployment of new performance conversations

• Safe staffing levels compliance • Sickness absence and mandatory

training performance – impacts in service and contractual compliance

• Staff Awards • LOV Awards

Partnerships • Service user, carer and governor

involvement in recruitment, service modernisation and strategic development

• Partnership with educational bodies to enhance staff training and development

• Deployment of new contracts including new partnerships across multiple sectors

• Prime provider models being explored for clinical and non-clinical services

• Active participation in transformation board and local economy redesign

• Wagner College: PA partnership with American Students – opportunities increased to 40 student placements

• Contracting/sub-contracting arrangements deployed locally and nationally

• NHS Vanguard schemes – deployment and local integration agenda

• Emerging partnerships with Local Enterprise Partnerships (LEP)

• Future Fit and Community Fit: Shropshire and Telford and Wrekin

• Federation models – links to GP communities and commissioning fora

Commercial Development • STP emerging models and national

impacts • MCP contract guidance including national

contracting changes • NHS E Perinatal Development fund linked

to emerging models of alternative to T4 CAMHS

• NHS operating plan 17/18 – links to STPs and impacts on planning assumptions

• Development of PA roles within primary care and General Practice

• Continuing Care : development of project outline and new models of delivery

• Section 75 development • Operational delivery plans: one year

business plans and key objectives 16/17 • Managed clinical networks and links to

Vanguard schemes and MCP Schemes • C10 tenders within the system linked to

commercial strategy • Secure service model based on new

models of care and development of an MCP

QUALITY, PARTNERSHIPS, STAFF TEAM AND CULTURE AND COMMERCIAL SCAN


Page 18 of 20

Strategic Opportunities Alignment of the Divisional Business plans to include: • MCP and NMC opportunities • Secure review and prime provider

services linked to MCPs/ACO • Continuing care market • Public health market • Child and Adolescent mental

healthcare – T2/3/3+/4 • Children and Young People Eating

Disorders • Talking therapy training • Eating disorders in young people • Step down care and supporting care

in the community • Probation & Forensic Services • Community service partnerships • Independent sector partnerships • Secondary care partnerships • Older age services including

Dementia • Healthy lifestyle choices and services • Charitable sector partnerships • New GP partnerships

Political issues of relevance • Ministerial changes : New Health Advisor (Dr.

James Kent appointed) • New MH policies launched • A&E performance and impacts on local national

targets • Digital funding : national programme • Sustainability Transformation Fund – local

leadership changes and impacts • NHS STPs : publication and engagement

processes • New Models of care MCP contract developed in

first draft • PACS implementation linked to MCP

development and new GP contracting arrangements

• CQC re-reviews of hospitals in special measures • Implementation of the NHSGP5YFV, linked to

the NHSMH5YFV • Taskforce implementation progress • Local system architecture linked to changes to

commissioning and provision • Local MCP models emerging including pilots

with integrated mental health and IAPT models

KEY DATES / EVENTS

• 7th to 10th March 2017 - Cohort 1, Wagner College (approximately 20 Students)

• 28th To 31st March 2017 - Cohort 2, Wagner College (approximately 20 Students)

• 14th June 2017 - Service User & Carer Celebration Day

• 21st June 2017 - Motherhood & Mental Health Conference

• 13th September 2017 – Annual Members Meeting & Annual General Meeting

• 31st October 2017 - Research MH Forum

• 22nd November 2017 - Psychological Services Conference

• 28th November 2017 – NFAO National Meeting

• 5th December 2017 – AHP Best Practice Day

STRATEGY, POLITICAL AREAS OF INTEREST AND KEY DATES SCAN

Multi-Specialty Providers (MCPs) The service specification, outcome measures, and implications for contract management and assurance

There are three broad ways in which NHS England and commissioners could contract for an MCP with the intention of ensuring the delivery of high quality services by an MCP provider:

a) contracting for the core elements of the MCP care model itself;

b) contracting for high-level population health outcomes;

c) contracting by defining local service specifications and/or desired clinical outcomes.

The balance of these in existing commissioning arrangements differs by area and setting. Alone, none of them would sufficiently capture the requirements of an MCP and provide assurance of delivery. The way in which the three are balanced to do so will need to be considered by commissioners, and evaluated by the integrated support and assurance process (ISAP).

The MCP care model

For an MCP to be recognisable, the contract must capture the essence of the care model, as expressed in the MCP framework, published in July 2016. The requirements of the MCP care model are described in the Service Conditions in the MCP Contract – particularly in service condition 3 and 4, for instance. All MCP Contracts must include these requirements. The Service Conditions list requirements for how the set of MCP services will need to be delivered, for example by requiring population health management, the use of information systems supported by risk stratification tools, or recording levels of patient activation.

It ensures that providers are fully aware of the commissioner’s minimum expectations of delivery for an MCP. But the wording of the Service Conditions deliberately operates at a high level and does not describe the model of care in such a degree of depth as to prevent its evolution through learning or render it obsolete over the contract term.

The MCP Health and Care Framework

The MCP Health and Care Framework (HCF) is a corner stone of the contract. It will provide a view of the:

• The overall performance of the MCP itself

• The contribution that the MCP is making to the wider health economy

The HCF is made up of a set of core performance indicators. There are two components within the HCF. The first component is the Health and Care Dashboard (HCD), which will include a wide set of indicators on which data is collected and regularly reported. The HCF is intended to be a live and dynamic product providing the latest information and enabling benchmarking.

SIGNIFICANT AREAS OF POTENTIAL IMPACT

The second component is the improvement payment scheme (IPS). The IPS scheme is a top slice of the contracted whole population budget (WPB) value, which is paid out upon MCP delivery against targets for agreed care quality, outcomes and transformation metrics. This will replace the existing commissioning for quality and innovation (CQUIN) scheme and, for fully integrated MCPs, quality and outcomes framework (QOF). The quantum for the national element of the scheme will be designed to replicate the balance of financial risk and incentives that exist in the current national performance pay schemes (CQUIN and, where relevant, QOF). The implication of this is that national IPS will be worth c2.5-4% of MCP Contract value.

Commissioners will have the opportunity to supplement the indicators in the scheme with their own indicators and, in doing so increase the quantum assigned to the scheme. The

Multispecialty community providers

Additional financial risk borne by MCPs whose commissioners choose to include local metrics and assign additional contract value to them will be assessed through the integrated support and assurance process (ISAP) run by NHS England and NHS Improvement.

Local commissioners can add indicators, beyond the core set, to the HCD and the IPS. Additions to the IPS will be considered in the round with other financial risk in the contract, and would be subject to an assessment through the ISAP. Please see the ISAP guidance (https://www.england.nhs.uk/resources/resources-for-ccgs/#isap) for more detail.

The MCP Health and Care Framework (HCF)

Local measures can be included into any of these categories, but would be subject to review through ISAP, where they form additions to the payment scheme and therefore impact financial risk.

The MCP HCF will report on these different types of outcome indicators:

• Health and wellbeing outcomes – changes in life expectancy, years of healthy life, and reductions in health inequality;

• Care quality and experience – the impact of services on patients, including for specific disease groups;

• Sustainability – the impact of the MCP on sustainability of services, for example through reducing delayed discharges and delivering additional activity in the community. (Note that the incentives to improve sustainability are largely within the whole population budget and gain/loss mechanism; please see the MCP financial strategy for more detail.)

• Transformation drivers – the progress of the MCP in delivering the key enablers to improving the care quality, sustainability and health and wellbeing outcomes of the MCP population.

• The intention is to publish the MCP HCD and IPS scheme in early 2017 alongside the next version of the MCP Contract.

SOUTH STAFFORDSHIRE AND SHROPSHIRE HEALTHCARE NHS FOUNDATION TRUST BOARD OF DIRECTORS: Committee Summary Report

Report of: Quality Governance Committee Date 8th December 2016

Chair: Paul Bunting Executive Lead: Therèsa Moyes

Summary: The Quality Governance Committee continues to receive reports and provide assurance to the Trust Board against its work programme via a summary report submitted to the Trust Board after each meeting. Key Discussion Topics Outcomes and further assurances identified Action including referral to other

committees Internal Audit SI Action Plan and SOP The committee reviewed and agreed the action plan. Action Plan and SOP to go to the PPC. Quality Framework Goals Update The committee discussed and approved the contents

of this report. Review progress against actions for the board in 2017.

Community Complex Care Team Report on Reduction in Relief

The report described the effects of reduction in relief primarily on the families for the committee to reflect on.

Update to be provided to the committee in 6 months time, June 2017.

Quality Standards Assurance Quarterly Update

The report provides a summary of findings and key themes arising from the nine Quality Standards Assurance Visits in Quarter 1 and 2.

Review progress against actions for the Board in 2017.

Deep Dive into Restrictive Practices The report outlined the use of restrictive practices across the Trust.

Thematic Review due to the committee in 6 months, June 2017.

Serious Incident Summary Report The report presented was the monthly summary report for Serious Incidents and relates to activity during November 2016.

The Committee is to receive a Deep Dive into the SI Process and the resources used in carrying out investigations for January’s meeting.

Assurance Plan and Risk Register Update The report presented no new risks this month added to the Assurance Plan that are assigned to the Quality Governance Committee. 1 risk on the register has been downgraded to divisional risk register.

Committees BDISC and HRODE need updating to the correct names BDIC and WDC respectively.

Annual Quality Network Report for Hatherton Centre

The Committee heard the Summary of Quality Network visit to Forensic Services.

No actions for QGC

Security Management Standards - Self-Assessment

The report detailed the regular summary of activity over the last 6 months.

To be referred to Audit Committee

Quarter 2 C ombined Risk Management Report

The Committee received the report which entailed a summary of the Quarter 2 requirements and achievements.

Directorates to feedback on individual areas in January’s meeting.

Service User Experience Group Quarterly Report

The Committee received the Quarterly report for information.

No actions for QGC

Annual Report and Thematic Review of the Customer Services and Patient Advice and Liaison Service 2015/16

The report received was the annual report for information.

No actions for QGC

CQC Project Board High Level Action Plan Update

The report gave an overview of ongoing and completed actions and highlighted 1 action showing as amber.

No actions for QGC

Update on Version 7 of RiO The Committee was presented with a high level road map for RiO 7.5 and introduced to the Change Control Process.

No actions for QGC

Recommendations: The Board is asked to:

Accept and review the Quality Governance Committee summary

SOUTH STAFFORDSHIRE AND SHROPSHIRE HEALTHCARE NHS FOUNDATION TRUST BOARD OF DIRECTORS: Board Committee Summary Report

Report of: Business Development & Investment Committee Date 28th November 2016

Chair: Dr Ian Wilson Executive Lead: Steve Grange

Summary: The Business Development and Investment Committee provide assurance to the Trust Board against its terms of reference via a summary report submitted to the Board after each meeting. Key Discussion Topics Outcomes and further assurances identified Action including referral to other

committees Tenders and business development opportunities

The Committee received the following tender for approval:

• Shropshire and Telford & Wrekin – Emotional Health & Wellbeing services (0-25)

The Committee approved the tender.

Post Tender Evaluations The Committee received the following Post Tender Evaluations

• Wirral IAPT Services • Hampshire Community SMS • Telford & Wrekin SMS

The Committee agreed to discuss the Post Tender Evaluation process and reporting at a separate meeting.

Updates/Reviews The Committee received a 6 month update regarding the Community Managed Libraries, which was well received. The Committee received a review of the Prison and IAPT Implementation.

A further update will be received in March 2017. The Committee discussed capacity and future opportunities.

STPs

Trust Strategy The Committee received a report outlining an overview of progress made at a six month position of the Monitor Operational Plan 16/17, and an update on the revised business planning cycle.

MCP Development Steve Grange updated the Committee on the MCP Development and Mental Health Involvement in Enhanced Primary Care.

Recommendations: The Board is asked to: • Receive and note the report for information.


Report of: Workforce and Development Committee Date 30 November 2016

Chair: Sue Nixon, Non-Executive Director Executive Lead: Greg Moores, Director of Workforce and Development

Summary: The Workforce and Development Committee met in November; key areas and actions are highlighted below.

Key Discussion Topics Outcomes and further assurances identified Action including referral to other Board Committees

Local Workforce Action Board

The committee was advised that agreement had been reached to stand down the Staffordshire and Shropshire LWAB to be replaced with an LWAB focused solely on Staffordshire.

Detailed discussions about future LWAB arrangements to take place with HEE and be reported back to WDC.

Workforce and Development Strategy

Agreement to halt work on the new W&D Strategy pending clarity of changes within the local health economy, linked to the STP.

2017/18 W&D Delivery Plan to be presented to March WDC.

Discrimination Incidents

Analysis of reported discrimination incidents involving staff and service users, confirmed no areas of significant risk but ongoing work with/through directorate management teams is required.

First time incidents have been analysed and reported in this manner and agreement that this work should be reviewed at WDC in 6 months.

Census Report

Analysis of workforce and service user data compared to census data was presented to the committee.

To be reviewed annually and reported to WDC.

Apprenticeship Levy

Assurance provided in relation to plans to maximise the Trust’s contribution to the levy.

To be monitored through WDC leading up to and following the introduction of the levy.

Agency Spending

Data, analysis and actions being taken in relation to agency spending were presented and discussed in detail. Confirmation that spend is reducing but still ahead of required run-rate.

To be monitored monthly through Trust Board and in detail at WDC.

Savile Report – progress update

Detailed discussion of actions being taken and in progress to meet Savile requirements.

Further progress to be monitored through WDC and reported to Audit Cttee.

Recommendations: The Board is asked to:

• Note the report


Report of: Service User and Carer Involvement Committee Date December 2016

Chair: Megan Nurse, Non-Executive Director Executive Lead: Therèsa Moyes

Summary: The Service User and Carer Involvement Committee provides assurance to the Board against its terms of reference via a summary report submitted to the Board after each bi-monthly meeting. The Committee also reports to the Council of Governors. Key Discussion Topics Outcomes

Involvement for Impact. In completion of the Committee’s review of the Involvement Strategy, plans for going forward were outlined with impact workshops replacing the regular committee meetings. Milestones to mark the development of the new programme for involvement were agreed with progress to be reviewed at the end of the year.

The bi-monthly committee meetings previously scheduled will not continue into 2017.

AGM. We will be asking the directorates to report on what is happening in involvement in their services for an annual report so we can measure the impact and sustain it.

Aiming for improved monitoring of involvement activity in the Trust

Celebration Day. The annual Celebration Day event will continue to promote and celebrate the successes of involving service users and carers

Celebration Day remains a feature of the involvement calendar following the review

• Impact Workshops. Three proposals for Impact Workshops were suggested to begin the transition in 2017:

1. Involving service users and carers in research 2. Listening into Action (LiA) with service users and carers 3. Creating a carer awareness training video

Outcomes from the impact workshops will be reported to the Board

M Nurse/HKlich 14/12/2016

National Documents The scan of national papers relevant to members of the committee included the National Voices guidance for involving patients in research and innovation and the House of Commons Library briefing paper about carers and the issues they face.

The scan will continue if there is demand from service users and carers

Recommendations: The Board is asked to: • Be advised of the issues, actions and decisions taken. • Identify issues for additional assurance to the Board through summary reports or other reporting processes.


Report of: Finance and Performance Committee Date 22 December 2016

Chair: Richard Cotterell, Non-Executive Director Executive Lead: Jayne Deaville, Director of Finance & Performance

Summary: The Finance and Performance Committee continues to receive reports and provide assurance to the Board against its work programme via a summary report submitted to the Board after each meeting. Key Discussion Topics Outcomes and further assurances identified Action including referral to other

committees Operational Plan 2017-19 – Final Submission

Final Plan approved for submission to NHSI. The need to maintain an open dialogue, understand the direction of travel and enable a clear view on required focus was acknowledged.

Copy of the Financial Plan together with the M8 Narrative which accompanied the M8 return to NHSI to be forwarded to Board Members. Deep dive to be undertaken where significant risk perceived.

Recommendations: The Board is asked to: • Be advised of the issues, actions and decisions taken • Identify issues for additional assurance to the board through summary reports or other reporting processes.

Reference Checks SoP October 2016

PPC Approval and Board Ratification Form

New Document Review of Existing Document X

Summary of changes where an existing document has been revised/amended:

• List of social media updated to include Instagram and snapchat and removing ‘Flickr’ and ‘MySpace’.

• ‘…and this is likely to continue’ added to the sentence regarding the rise of social media

• Web address of the social media toolkit updated and a reference added to the introduction

• Lync and skype added to list • HRODE Sub-committee and HR Team

removed from responsibilities and replaced with a general ‘Workforce and Development’ section.

• 4.1.1 Changed to Acceptable Use of IT SOP

• ‘Post pictures of patients and people receiving care’ added to 4.1

• ‘Share, re-post or ‘re-tweet’ etc. any content which may demonstrate or support any behaviour detailed above’ added to 4.1

• ‘Steal personal information or use someone else’s identity’ added to 4.1

• ‘Partners’ added to second point on 4.1 • ‘Demonstrate behaviour which is not in

line with the Trust values’ added to 4.1 • ‘Employees are permitted reasonable

Document Title: Social Networking Policy

Document Author: Kelly McPeake, Workforce and Development Manager

Responsible Directorate: Workforce and Development

Justification of need for Document:

The purpose of the policy is to set out the clear expectation that if an employee identifies an association with the Trust, discusses their work and/or colleagues or comes into contact with or is likely to come in to contact with service users, carers and families on any social media sites, he/she will behave appropriately and in a way which is consistent with the Trust’s values and where relevant his/her professional code of conduct.


personal use of Internet facilities as long as this does not impact on normal working duties’. Removed from 4.1.2 to ensure consistency with Trust’s Acceptable Use of Information and IT Systems Standard Operating Procedure.

• ‘The Trust recommends that employees utilise advanced privacy settings so that service users and colleagues who ‘search’ for them are unable to see the content of their profile/account’ added to 4.1.3

• ‘It is also advisable that the employee alters the settings of their account so that they have to ‘accept’ any requests from new friends/followers/connections to avoid any unwanted or inappropriate social media relationships’ added to 4.1.13.

• 4.2 now called ‘Social Networking in a Trust Capacity’ (was ‘Professional Capacity) as individuals may have their own professional accounts for private work etc.

• ‘All employees should be mindful that when using Social Media in a professional capacity, they are representing the Trust and therefore greater care should be taken when posting material. Personal views should be avoided unless it is relevant or part of the role of the employee’ added to 4.2.

• ‘Material containing information about a service user or carer such as photographs taken at Trust events for example, should not be published on social media without the written consent of the service user or carer’ added to 4.2.

• The previous policy set out that the Comms Team would monitor all Trust social media accounts, this has been changed to ‘may’ monitor social media accounts as the number of accounts has now grown significantly and this would be unmanageable.

• Section 4.3 regarding private/direct messaging- this is now clear that the guidance applies to personal accounts and that contact in this way is acceptable


when using a Trust account

Key Document Issues:

Summary of Content:

Sets out clear expectations that if an employee identifies an association with the Trust, discusses their work and/or colleagues or comes into contact with or is likely to come in to contact with service users, carers and families on any social media sites, he/she will behave appropriately and in a way which is consistent with the Trust’s values and where relevant his/her professional code of conduct. Encourages the safe and effective use of Social Media in a professional capacity for both service promotion and communication with service users where deemed appropriate. Recognises the right of its employees to use Social Media and Social Networking in their private lives and encourages its use in a responsible and appropriate way.

Is there a fit with National Policy or supports legislation? If so please state:

The Equality Act 2010; Human Rights Act

Link to Trust Objective Aims 1, 2; Core Values 1 & 2

Link to CQC Fundamental Standards & NHSLA

Dignity and Respect, Consent, Safety

Impact on Service Users/Staff Positive impact

Sub Committee and Board Assurance:

Service Implications None, unless policy is not followed.

Financial Implications None, unless policy is not followed

Legal Implications Failure to follow policy could result in costly Employment Tribunals

What training and other resources have been identified necessary to implement the document?

Raise awareness of the updated policy and support Line Managers when dealing with issues surrounding a breach of the policy.

Summary of the key actions from the equality impact assessment

Some gaps in data around some of the protected characteristics however mainly impact is positive

Are all elements of the document in place to ensure it is fully Yes No


operational? X

Action still required to ensure fully operational None

Action Lead Timescale

What measurable standards or Key Performance Indicators have been identified to support monitoring compliance of the document?

Number of employee relations cases relating to inappropriate usage / excessive usage

Number of issues flagged to or by the Communications Team

What arrangements are in place to review or audit compliance with the document?

Annual review as part of the Workforce Assurance Report.

Consultation Route:

Identify groups, committees, patients, service users consulted in the development of the policy with dates of meeting when consulted

Group/Committee Consulted Date

HR Team; Comms Team, IG Lead

JSP

W and D Committee

September 2016

December 2016

Where service users/carers have not been consulted, please state the rationale for this decision.

Policy is relevant to staff T&C’s

Policy & Procedures Committee Date 19/01/2017

PPC Approval and Board Ratification Form

New Document Review of Existing Document

Summary of changes where an existing document has been revised/amended:

No material changes from previous policy. The policy has been changed to the new format with most recent details for chaplaincy

Key Document Issues:

Summary of Content: The document provides a rationale for the policy, how spirituality, religion and pastoral care fits with the Trust vision and values

Is there a fit with National Policy or supports legislation? If so please state:

No

Link to Trust Objective Aligns with the Trust aim of providing high quality, recovery focused services

Link to CQC Standards & NHSLA Aligns with CQC effective domain

Impact on Service Users/Staff Enables positive support with spirituality, religion and pastoral care

Committee and Board Assurance:

Service Implications Meets the requirement to provide person centered care

Financial Implications No increase

Legal Implications None

Document Title: Spirituality, Religion and Pastoral Care Policy & SOP

Document Author/Title:

Document Owner/Title:

Keith Shaw, Hospital Chaplain

Kenny Laing, Deputy Director of Nursing

Responsible Directorate: Chief Operating Officer

Justification of need for Document:

Spirituality, Religion and Pastoral care is a crucial aspect of recovery and this document provides the details of how this can be accessed in the Trust.

Header – include title of policy here/reference number Add date

Page 2 of 2

What training and other resources have been identified necessary to implement the document?

None

Summary of the key actions from the equality impact assessment None required

Are all elements of the document in place to ensure it is fully operational?

Yes No

Action still required to ensure fully operational None

Action Lead Timescale

What measurable standards or Key Performance Indicators have been identified to support monitoring compliance of the document?

Audit of uptake of service

What arrangements are in place to review or audit compliance with the document?

None at present.

Consultation Route:

Identify groups, committees, patients, service users consulted in the development of the policy with dates of meeting when consulted

Group/Committee Consulted Date

Where service users/carers have not been consulted, please state the rationale for this decision.

Policy & Procedures Committee Date 19/01/2017

Trust Assurance Report: Summary Page 1 of 2

Board of Directors Meeting Enc C

Document Title: Trust Assurance Report Sponsoring Directors: Executive Directors

Authors(s): Various

Date of Meeting: 26th January 2017 Contents Section 1 Quality & Clinical Performance Therèsa Moyes Section 2 Finance and Performance Jayne Deaville Section 3 Business Development Steve Grange Section 4 Workforce and Development Greg Moores Section 5 Medical Director Abid Khan Executive Summary The Trust Assurance Report contains reports from each Executive aligned to the key delivery areas as set out in the Trust’s Strategy 2009-14. The table below summarises the performance/assurance highlights and any notable strategic delivery risks. Key delivery area Exception Reports/Items for Action/Decision

1. Quality health and social care

• There are no exceptions to report on the safety dashboard for October 2016.

• CQC action plans to address issues raised during the Comprehensive Inspection of the Trust are on track

2. Sound financial management and commercial achievements

• At month eight the income and expenditure position shows a year-to-date surplus position of £3.8m, which represents a favourable variance of £1.2m against the ‘flexed’ budget of £2.6m.

• The year to date surplus margin (3.0%) and EBITDA margin (5.8%) are currently ahead of the annual planned levels of 1.7% and 4.4%.

• The Trust’s CIP target is £7.76m for the financial year 2016/17. The Trust is currently forecasting to deliver £6.3m (82%) of its CIP target resulting in an in-year CIP shortfall of £1.4m.

• The Month 8 financial forecast outturn position for the financial year shows a surplus of £3.13m which represents a small unfavourable variance of £0.04 against the trust’s flexed annual budget of £3.17m.

• A review of the forecast for the month 9 submission to NHS Improvement includes an underlying improvement of £1m which together with the STF

Trust Assurance Report: Summary Page 2 of 2

Incentive of £1m takes the forecast surplus to £5.13m.

3. Internal processes to deliver on strategy

• Members are asked to note that all Performance targets have been met on a year-to-date basis.

4. Knowledge; culture and staff development

• Members are asked to note that there was one information governance incident classified as a Serious Incident during November which has now been downgraded and closed.

Recommendations Directors are recommended to:

• Receive and note the report • Note or place responsibility for action/monitoring as required with Board Sub

Committees Monitoring Information Brief Summary Care Quality Commission Compliance • Fundamental standards

• National priorities updates • Mental Health Act

Monitor Compliance • Financial risk ratings • High level financial summary • Key performance indicators

Other • Activity and other targets • Quality monitoring • CQUINs • Information Governance • Libraries and knowledge • Risk management • Overall Sickness Absence • Staff Turnover • Legal Updates (by exception)

Assurance Framework Ref: ******************** Link to Strategic Objectives

Ref: “Provide” and “Deliver”

Board Sub Committee All

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Board of Directors Agenda Item Enc C

Document Title: Trust Assurance Report Section 3: Quality and Clinical Performance

Sponsoring Director: Therèsa Moyes, Director of Quality and Clinical Performance

Author(s): Liz Lockett, Associate Director of Quality & Risk Sara Reeve, Associate Director of Performance

Date of Meeting: 26th January 2017

Executive Summary The Trust Assurance Report contains reports from each Executive aligned to the key delivery areas as set out in the Trust’s Strategy 2009-14. The report contains updates on the following:

• Care Quality Commission Assurance of Compliance • Safety Dashboard – December 2016

Recommendations The Board of Directors is asked to:

• Receive and note the report • Note or place responsibility for action/monitoring as required with Board Sub

Committees Monitoring Details Care Quality Commission Compliance


Monitor Compliance Other (add details) Contracts (CQUINs) and Quality Accounts Assurance Ref Details Risk Register 798,

818, 782, 572, 12

Assurance Framework P1, P3, P5, P8, P10

Link to Strategic Aims P, D Board Committees QGC and F&P

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CONTENTS Paragraph Item Key Delivery

Area Attachment Reference

1. CQC Assurance of Compliance 3 2. Safety Dashboard 1 1. Care Quality Commission Assurance of Compliance ................................................ 3

1.1 Progress update on the action plans put in place to address the improvements identified by the CQC following their Comprehensive Inspection of the Trust in March 2016 ...................................................................................................... 3 1.2 Care Quality Commission Greater Provider Engagement ................................. 3 1.3 2016 CQC Community Mental Health Survey Results ....................................... 4

2 Safety Dashboard – December 2016 ........................................................................... 5 2.1 Introduction ................................................................................................................ 5 2.2 Safety Dashboard – December 2016 .................................................................... 6

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QUALITY PERFORMANCE REPORT 1. Care Quality Commission Assurance of Compliance

1.1 Progress update on the action plans put in place to address the improvements identified by the CQC following their Comprehensive Inspection of the Trust in March 2016 Progress Updates – Regulatory ‘Must Do’ Actions Five regulatory “Must Do” actions were identified and each was assigned to an Executive Director sponsor who oversaw the delivery of these actions. They were managed as individual projects through the PMO (Programme Management Office) with progress being reported to QGC, Trust Board, TMT and CQC Project Board. A risk for each of these five areas was added to the Trust Risk Register (numbers 933 – 937). The Trust submitted a copy of the completed action plan and associated evidence to CQC on the 23rd December 2016 and is now waiting for formal feedback. The CQC has indicated that they will discuss the action plan as part of an engagement meeting, scheduled with the Trust Executive Team, on 14th February. The action plan is available on the Trust website at http://sssft.nhs.uk/images/Corporate/Quality/20161223_Final_High_Level_Action_Plan_-_Update_and_Evidence.pdf

Progress Updates – ‘Should Do’ Actions An overarching project has been set up to manage these actions and will be managed through the PMO. The clinical directorates have led on the development of the detailed action plans identified in each of their core service area reports. Action plans for all the core service areas have been uploaded to the Performance Plus system to monitor progress. Progress is being reported to the QGC, Trust Board, TMT, CQC Project Board and Directorate senior management forums. Overall progress was reviewed at the CQC Project Board on the 16th December and directorates confirmed that they were currently on track to deliver the actions by the required timelines. As at the 3rd January 2017, 125 (91%) of the ‘Should Do’ actions on Performance Plus have been completed. A detailed review of all the completed ‘Should Do’ actions is now underway to ensure that the associated evidence provides satisfactory assurance. The Trust is not expecting to formally submit the ‘Should Do’ action plan to the CQC, however, progress will be reviewed and discussed with the CQC through the monthly Relationship Manager Meetings held with operational managers and the Performance Development Team. 1.2 Care Quality Commission Greater Provider Engagement CQC’s strategy “Shaping the future – CQCs strategy for 2016 – 2012” sets out their revised approach to the regulation of Trusts from 2016 to 2021.

http://sssft.nhs.uk/images/Corporate/Quality/20161223_Final_High_Level_Action_Plan_-_Update_and_Evidence.pdf

http://sssft.nhs.uk/images/Corporate/Quality/20161223_Final_High_Level_Action_Plan_-_Update_and_Evidence.pdf

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The first engagement meeting was held on 28 November with CQC Raphael Chichera, lead inspector for our Staffordshire services. It involved Trust Operational Managers and the Performance Development Team.

The meeting went well and set the scene for future sessions, to be held in January and in February 2017. The lead inspector for our Shropshire services Michael Fenwick, will also be present at these meetings.

1.3 2016 CQC Community Mental Health Survey Results The CQC has published the 2016 survey of people who use community mental health services. The 2016 survey of people who use community mental health services involved 58 providers of NHS mental health services in England (including combined mental health and social care trusts, Foundation Trusts and community healthcare social enterprises that provide mental health services). The CQC received responses from more than 13,000 people, a response rate of 28%. People aged 18 and over were eligible for the survey if they were receiving specialist care or treatment for a mental health condition and had been seen by the trust between 1 September 2015 and 30 November 2015. A questionnaire was sent to 830 people receiving community mental health services from the Trust. 274 people responded, a response rate of 33%.

The survey covered 10 areas including; organising, planning and receiving of care, treatments, views of care and services and the overall experience. The survey results show that the Trust scored ‘about the same’ as other Trusts in every area, except for the health and social care workers category, where the results were ‘better’ than other trusts. CQC will use the results from the survey in the regulation, monitoring and inspection of NHS trusts in England. Survey data will be used in CQC’s Insight, an intelligence tool which indicates potential changes in quality of care to support decision making about their regulatory response. Survey data will also form a key source of evidence to support the judgements and inspection ratings published for trusts. NHS England will use the results to check progress and improvement against the objectives set out in the NHS mandate, and the Department of Health will hold them to account for the outcomes they achieve. NHS Improvement will use the results to inform their Single Oversight Framework model for NHS. The Performance Development Team will be working with the Trust Service User and Carer Lead to include a more detailed analysis of the results from the 2016 Community Mental Health Survey as part of the quarter three Patient Experience Report which will go to the Quality Governance Committee in March 2017. The Trust’s full results can be found at: http://www.cqc.org.uk/provider/RRE/survey/6

http://www.cqc.org.uk/provider/RRE/survey/6

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2 Safety Dashboard – December 2016

2.1 Introduction The Safety Dashboard provides an overview of the Trust’s delivery against key national and local indicators of safety over the previous 12 months. This dashboard provides the Board with an overview of the Trust’s current safety status, with a more detailed analysis being presented to and monitored by The Quality Governance Committee. The Quality Governance Committee reviews compliance against these indicators and will provide the Board with an exception report where any trends or variances are identified. The report provides a definition of each element in the “comments” column as well as an explanation of any significant variations.

The colour coding of the performance is:

Above control limit – performance is worse than expected Within control limits – performance is acceptable Below control limit – performance is good/better than expected

Where there is a known target to be achieved this has been included in the run chart denoted as a red line. However there are few current defined targets for these elements.

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2.2 Safety Dashboard – December 2016 Indicator ------------- Trust Performance

------------- Target (where applicable)

Above control limit Within control limits

Description

Pattern of Occurrence Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Number of serious

incidents - Level 1

9 15 17 21 17 18 13 19 11 9 19 17

Number of incidents warranting internal (trust) investigation by incident date

Number of serious

incidents - Level 2

0 1 0 0 0 0 0 0 0 0 0 0

Number of incidents warranting external (commissioner) investigation by incident date

Serious Incident

Investigations completed

within timescale

15 12 18 13 9 29 32 13 15 20 10 14

Timescale is 60 working days for investigations. Trust should complete between 8-15 per month to maintain achievement

Number of overdue contract

serious incident investigations

0 0 0 0 0 0 0 0 0 0 0 0

Serious incident investigations which are exceeding the agreed timeframe. Improvement is due to implementation of revised SI process

Incidents which trigger Duty of

Candour

5 10 16 22 12 26 18 27 28 22 27 19

Duty to apologise for and review if necessary all “moderate” patient safety incidents. All Duty of Candour incidents responded to within the agreed process

Below Control

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Indicator ------------- Trust Performance

------------- Target (where applicable)

Above control limit Within control limits Below Control Limits

Description


Falls resulting in harm

6 2 2 2 4 11 5 5 2 3 4 4

Number of falls which have caused injury. Actual harm scoring 2 or more

Incidents of Violence and Aggression

patient to staff

85 100 113 130 159 145 98 150 115 107 106 103

Number of incidents reports where staff have experienced acts of violence or aggression at work

Incidents of violence and aggression patient to patient

40 21 49 48 52 22 44 73 35 34 46 35

Number of incidents reports where service users have experienced acts of violence or aggression by other service users

Number of medication

errors causing harm

1 1 4 5 1 4 5 2 1 2 2 0

Number of reported incidents of medication errors which have resulted in harm to the service user

Number of unexpected

deaths (community)

9 14 11 3 4 7 4 9 10 9 18 11

Number of community service users not on an end of life pathway who are reported to have died

Number of unexpected

deaths (inpatient)

0 1 2 0 0 0 1 2 1 0 0 1

Number of inpatient service users not on an end of life pathway who are reported to have died

Number of incidents

reported to NRLS

265

258

340

347

352

303

420

384

292

335

392

400

Number of patient safety incidents which have been reported to NRLS. (High number of reports indicates good safety culture)

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Indicator ------------- Trust Performance ------------- Target (where applicable)

Above control limit Within control limits Below Control Limits


Number of Never Events

0 0 0 0 0 0 0 0 0 0 0 0

A number of specified significant events that have been identified nationally should never occur

Mental Health Safety

Thermometer - % Harm free care provided

88.5 88.4 91.2 90.8 90.7 87.7 91.6 93.9 92.7 89.6 82.7 TBA

Measures Include: • Self-Harm • Assault • Medication

Omissions • Restraint

Number of new claims

0 1 1 1 1 2 1 0 0 2 1 1

Total of claims against the organisation received per month

Number of open claims

54 52 51 48 48 49 50 51 50 51 54 52

Total number of claims against the organisation which are currently being processed / investigated

Further Information Duty of Candour – of the 19 Duty of Candour incidents 16 are being managed through the Serious Incident Process. One Serious Incident regarding an Under 18 Admission is classed as No Harm therefore does not fall under Duty of Candour.

of 12 G:\Finance\Director of Finance\2016-17\BOARD AND TMT\TRUST BOARD\January 2017\Enc C - Finance and Performance.doc

Document Title: Trust Assurance Report Section 2: Finance and Performance

Sponsoring Director: Jayne Deaville, Director of Finance & Performance

Authors: Jayne Deaville, Marianne Cleeve, Jon Shaw, Peter Kendal


CONTENTS Paragraph Item Key

Delivery Area

Attachment Reference

1 High level summary of key financial indicators (see overleaf).

2

Summary Trust Income and Expenditure results for the period ending 30 November 2016 (Attachment 1).

1

Balance sheet at 30 November 2016 (Attachment 2).

2

Financial performance by clinical directorate for the period ended 30 November 2016 (Attachment 3).

3

Charitable Funds 30 November 2016 (Attachment 4).

4

2 Key Points From Financial Summary 2 3 Charitable Funds 4 Information Governance December 2015 -

November 2016 4

5 Freedom of Information December 2015 - November 2016

4

6 Access To Records December 2015 – November 2016

4

7 – 9 Contract Activity & Targets November 2016 3

ENCLOSURE C


KEY POINTS FROM FINANCIAL SUMMARY 1. The table below summarises the April – November 2016 financial performance.

Performance has improved, On target

performance has improved, not on target

Performance maintained

Performance Declined

£m % £m % £m %Month

PerformanceTravel (Since Last Report)

EBITDA 5.50 4.5% 6.08 4.7% 7.29 5.8% Net Surplus/(Deficit) 2.01 1.7% 2.60 2.0% 3.77 3.0%

£m % £m % £m %Month


EBITDA 8.36 4.5% 8.40 4.4% 8.34 4.4% XNet Surplus/(Deficit) 3.13 1.7% 3.17 1.7% 3.13 1.7%

Actual £mMonth


Actual £m

Month Performance

Travel (Since Last Report)

Cash at bank 50.36 (2.41) XPDC/Loans taken out 30.00 1.97

Working capital facility £0m - Used = 0.00 1.65 Current assets variance 5.41 (0.03) X

Current liabilities variance -1.31 1.17 PSPP compliance Target 95% 88.70% X

NHS Debtor days 16 Actual

£mMonth


Non NHS Debtor days 102 X (4.456)

Creditor days 15 (5.680) XCapital expenditure 1.27 (1.224) X

Aged NHS Debtors over 90 days 2.36 X (8.782) XAged Non NHS Debtors over 90 days 2.04 X

Forecast £m

Month Performance


METRICS M8Month

PerformanceTravel (Since Last Report) South Staffordshire CCGs 0.49

Capital Service Capacity 1 Shropshire County CCG (1.00) XLiquidity 1 Telford & Wrekin CCG (0.22) X

I&E Margin 1

Distance From Financial Plan 1 Actual £m

Month Performance


Agency Spend 3 X 0.05 Financial Risk Rating 1 (0.09)

FINANCE AND USE OF RESOURCES METRICS

Income

Pay

Non Pay

Other

Total

Variance from Ceiling

CONTRACTUAL PERFORMANCE

Block Contracts

Income

Expenditure

X

Month Performance

CHARITABLE FUNDS

Total Agency, Bank & Overtime Costs

EBITDA AND SURPLUS

YTD YTD

Agency Costs

NON SUBSTANTIVE STAFFING COSTS (YTD)

Agency Ceiling (pro rata £5.845m)

Plan Plan

WORKING CAPITAL AND BALANCE SHEET (YTD) BUDGET VARIANCES (YTD)

Actuals Against NHSI Control Total

NHSI ForecastRevised Forecast Variance

Revised Plan Actuals Actuals v Revised Plan

Performance is not meeting

target

Performance is on or above

target

Monitor Plan

YTDYTD


2. Key points to note from the summary are:

INCOME & EXPENDITURE POSITION a. At month eight the income and expenditure position shows a year-to-date surplus position of £3.8m, which represents a favourable variance of £1.2m against the ‘flexed’ budget of £2.6m (attachment 1). Table one below shows a summary of the income and expenditure position. b. The year to date Surplus margin (3.0%) and EBITDA margin (5.8%) are ahead of the annual planned levels of 1.7% and 4.4%.

Table 1: Income & Expenditure Position for the period ending 30th November 2016 (Month 08)Original (Monitor)

Plan £ms

NHSI Control

Plan£000s

Flexed Annual Budget

£ms

YTD Budget

£ms

YTD Actuals

£ms

YTD Variance

£ms

Forecast Outturn

£ms

Forecast Outturn

Variance £ms

Income 185.877 187.007 191.959 128.441 126.029 (2.411) 189.334 (2.625)Pay Expenditure (131.984) (131.985) (136.613) (90.949) (88.984) 1.965 (134.457) 2.156Non Pay Expenditure (46.631) (46.662) (46.946) (31.410) (29.758) 1.652 (46.539) 0.406EBITDA 7.262 8.361 8.400 6.083 7.288 1.205 8.338 (0.063)Depreciation (2.600) (2.600) (2.600) (1.733) (1.786) (0.052) (2.744) (0.144)Non Operating Income 0.080 0.080 0.080 0.053 0.077 0.024 0.104 0.024Non Operating Expenses (2.711) (2.711) (2.711) (1.807) (1.813) (0.006) (2.567) 0.144SURPLUS/(DEFICIT) 2.031 3.130 3.169 2.595 3.766 1.171 3.130 (0.039)EBITDA Margin 3.9% 4.5% 4.4% 4.7% 5.8% 1.0% 4.4% 0.0%Surplus Margin 1.1% 1.7% 1.7% 2.0% 3.0% 1.0% 1.7% 0.0%see attachment 1 for further detail

c. The year to date favourable variance is mainly driven by operating expenditure being £3.6m lower than plan off-set by a net £2.4m unfavourable variance against operating income. d. The improvement in the in-month position is due to the non-recurrent release of prior year accruals and rates rebates, and reduced staffing levels within the HMP Prison services.


Income e. There is a year-to-date income under-performance of £2.4m. Clinical income is below budget by £1.9m which is mainly due t o activity underperformances within EDO, PICU and Mental Health Rehab High Cost Low Volume service lines (£0.8m), GUM activity shortfalls (£0.1m), Powys LHB cost & volume activity underperformance (£0.24m), and the deferral of income relating to a number of vacant posts and Prisons start-up funding (£0.45m), and penalty provisions for Hampshire SMS (£0.25m) and CQUIN funding (£0.2m). These unfavourable variances are partially off-set by income from non contracted activity (£0.12m) and a non recurrent credit from Worcestershire local authority (£0.08m).

f. Non clinical income is below budget by £0.5m. This is mainly due to the deferral of HIS project funding and income from the recharging of ‘pass through’ expenditure not being as high as anticipated (£0.6m), partially off-set by additional Training & Education project funding and Facilities & Estates variable income. Pay & Non Pay g. There are year to date underspends against the pay expenditure budget (£2.0m) and the non-pay expenditure budget (£1.6m). h. There are non-recurrent pay underspends due to vacancies – especially within Forensic and Learning Disability services. These underspends are partially off-set by an overspend against supplementary staffing costs and CIP shortfalls. There are also pay underspends showing within the Trust’s central reserves due to slippage in anticipated pay protection costs (£0.17m).

i. Non pay underspends include lease cars (£0.3m), travel costs (£0.23m), telephones and data lines (£0.12m), energy & utilities (£0.19m), course fees, delays in expected redundancy costs, the release of Hampshire SMS FP10 (£0.17m) & Detox bed sub contract (£0.19m) accruals, and underspends against inflationary and contingency reserves not being fully utilised (£0.42m).

j. Cost pressures include building & engineering maintenance (£0.38m), Drug & FP10 costs within Shropshire & Telford ISHS and Sandwell SMS, cost of laboratory tests within ISHS (£0.17m), lease cost increases made by PROPCO, furniture expenditure following the CQC visit (£0.1m), patients travel including taxi costs, secure transport costs, legal fees and Wirral IAPT room hire (£0.11m). k. The Income and Expenditure performance by division/directorate can be seen at Attachment 2


Supplementary Staffing Controls l. The agency spend cap is now one of the key financial metrics under the new ‘single oversight framework’ which will be effective from October 2016. NHS Improvement is therefore tightly monitoring Trust expenditure on agency staffing and the action plans being put in place to reduce agency spend. m. The Trust has been set an agency ‘cap’ of £5.8m by NHS Improvement. A t month eight the cumulative expenditure on agency usage was £5.7m which poses a significant challenge to the Trust with regards to remaining within the ‘cap’ during the financial year. The current forecast shows an outturn agency spend of £8.1m. n. If the Trust exceeds the agency spend cap by 50%+ (circa £8.8m) at the financial year end then the agency spend metric becomes a 4 which then restricts the Trust’s overall ‘finance and use of resources’ score to a 3. o. When including expenditure on bank usage and overtime payments the Trust’s total cumulative expenditure on supplementary staffing costs was £8.8m (circa 10% of total employee expenses). p. The majority of the wards providing Mental Health services are showing an overspend due to experiencing high usage of bank and agency mainly as a result of the complexity of clients and staff vacancies. The wards within the Mental Health Division are forecasting a combined outturn overspend of circa £0.5m. q. The year to date expenditure on medical agency is £1.8m and the spend on agency other than medical and nursing staff is circa £2.3m and this mainly relates to non-clinical areas.


r. The Director of Workforce is in the process of enhancing the controls on the use of agency staff and co-ordinating the response on the actions being put in place by the individual directorates to reduce agency spend. s. The graph above shows a gradual reduction in spend on agency staffing over the last four months. Savings Plans t. The Trust’s CIP target is £7.76m for the financial year 2016/17. The Trust is currently forecasting to deliver £6.3m (82%) of its CIP target resulting in an in-year CIP shortfall of £1.4m. u. The Trust holds a CIP Contingency reserve of £1.5m to help off-set any in-year CIP shortfalls. Therefore the forecast ‘net’ CIP position is a favourable £0.1m. v. It is forecast that 64% will be delivered on a recurrent basis carrying forward a recurrent shortfall of £2.8m into 2017/18. w. Contributing towards the recurrent CIP shortfall is a net unidentified CIP balance of £0.6m, non-recurrent saving plans through holding vacant posts, and anticipated delays in the Mental Health community remodelling (£1m) and bed reduction saving plans, the Corporate Support Services Review (£0.5m), the estates rationalisation (£0.3m) and t he reconfiguration of services provided at Oak House (£0.1m). x. There is £0.3m of unidentified CIP currently held centrally. The Executive Team are considering how this is to be addressed along with any other CIP shortfalls. Facilities & Estates have an unidentified CIP balance of £0.8m mainly as a result of the loss of the PROPCO contract. A number of directorates are holding a pos itive CIP balance which partially off-sets these unidentified CIP balances.


Forecast Outturn Position y. The forecast outturn position for the financial year as at Month 8 shows a Surplus of £3.13m, which represents a small unfavourable variance of £0.04m against the Trust’s flexed annual budget of £3.17m. z. The planned Surplus position reflects the control figure of £3.13m set by NHS Improvement which is to be supported by non-recurrent STP funding of £1.13m.

aa. The expected reduction in the Surplus position during quarter four of the current financial year is mainly due to a reduction in Sustain income (£0.1m), non-recurrent expenditure on building demolitions, IT projects, redundancy costs, STP contributions, accommodation and w ard refurbishments, and spend on P aediatric locum and out of hours. These are off-set by further pay vacancies during the management of change in relation to the Mental Health Community Remodelling project. bb. There are a number of key assumptions within the forecast outturn position including:

i. The CQUIN penalty provision of £0.42m will be required, although the

Trust will tightly monitor and mitigate against any in-year risk. ii. The Trust’s General Contingency reserve of £0.5m will be fully utilised

and inflationary reserves will be partly utilised during financial year. iii. A number of pay vacancies within operational services will be appointed

to, although pay vacancies may increase during periods of management of change.

iv. The £0.7m non-recurrent set-up funding for the new Prison contracts will be fully utilised on redundancy costs.

v. The planned savings from the Corporate Support Services review and Mental Health workforce plans will not be del ivered in year, whilst the central unidentified CIP of £0.3m will continue to be unidentified.

vi. Not all movements in balance sheet provisions are known (i.e. aged debt, pension, dilapidations and annual leave provisions etc). These will be reviewed in full during Q4 and the assumption is that any movements will be revenue neutral.

cc. Any changes to the above assumptions are likely to result in an improvement in the Surplus outturn position. dd. Trust at month 8 reported to NHS Improvement that it will achieve its Surplus control total of £3.13m by the financial year-end. The current forecast outturn position assumes that any excess above the control total will be ut ilised on non -recurrent expenditure plans prior to the year-end. The Trust is currently considering if it is in a position to declare a forecast outturn Surplus in excess of its control total to NHS Improvement.


Table 2 : Surplus Outturn Position, 2016-17

£msForecast Outturn Position 3.680Additional Action Plans (0.550)NHS Improvement Control Total 3.130

ee. A review of the forecast for the month 9 submission to NHS Improvement includes an underlying improvement of £1m which together with the STF Incentive of £1m takes the forecast surplus to £5.13m.

Table 3 : Surplus Outturn Position, 2016-17£ms

Detailed Forecast Outturn Positions 3.394Additional STF income 1.000Balance Sheet Flexibility 0.736Surplus Forecast Outturn 5.130

STATEMENT OF POSITION (BALANCE SHEET) ff. Non current assets are under plan by £2m against the month eight plan, due to the revaluation of St Georges site and the Staffs County Council Pension as at 31st March 2016 and slippage on the capital schemes in 2016/17. gg. Current assets (debtors) are higher than the month eight plan by £5.4m due to having higher than planned debtors £3.7m (see debtors report over 90 days), accrued income £2.7m and prepayments £0.4m, offset by lower cash than planned £1.4m.

hh. Current liabilities (creditors) are slightly over £1.3m the month eight plan due to having higher than planned trade and other payables £1.3m.

Capital ii. The capital schemes have no significant variance from plan. jj. There have been no new fast track schemes approved since last month. Cashflow kk. Currently the cash balance is £50.4m which is below the month eight plan by £1.4m. Aged Debts ll. The aged debts have increased from month six when the last papers were presented by £0.3m. This is mainly from increase in the following accounts debts -


Burton Hospitals £0.2m (F&E and HIS recharges), NHS Midlands & Lancashire CCG £0.15m (HIS recharges) and C are UK Clinical Services £0.08m (Prison In-reach services) offset by reductions on other accounts CHARITABLE FUNDS (Attachment 4) 3. Year to date charitable funds have received income of £97k which relates to £60.2k donations, £8.6k investment income and £28.2k revaluation of the investments. Expenditure to date is £100.8k - £11.3k on management costs and £89.4k on grants payable. Available fund balances at the end of November 2016 totalled £428k after commitments INFORMATION GOVERNANCE 4. There were 12 information governance incidents reported during November, one of which was classified as a Serious Incident. However this has now been downgraded and closed. The table below shows the 12 month rolling trend.

Freedom of Information Requests 5. There were 30 requests received in November. There were no requests that breached the statutory deadline during the month. The table below shows the rolling 12 month trend.


Access to Records Requests 6. There were 56 Access to Records Requests received in November. There were no requests that breached the statutory deadline during the month. The table below shows the rolling 12 month trend.

CONTRACT PERFORMANCE ACTIVITY 7. The contract activity report for the period April – November 2016 appears on the following pages.


FMT Currency Contract Va lue YTD Activi ty Target

YTD Activi ty Actuals

YTD Activi ty Variance

YTD Aggregated Variance Value.

YTD Financia l Adjustments

YTD Tota l Contract Va lue

Learning Disabi l i ty Services

£698,447 1,649 2,439 790 £119,541 £0 £465,632

Menta l Heal th Non PbR £170,174 337 230 (107) (£20,838) £0 £113,449

Menta l Heal th PbR (Admitted Care)

£868,783 5,061 4,533 (528) (£303,684) (£124,218) £579,189

Menta l Heal th PbR (CQUIN)

£174,741 0 0 0 £0 £0 £116,494

Menta l Heal th PbR (Non Admitted Care)

£6,120,854 202,075 287,835 85,760 £548,988 £0 £4,080,569

Other £3,545,367 0 2 2 £0 £0 £2,358,949

Specia l i s t and Fami ly Services

£2,133,385 6,454 6,810 356 £111,668 £0 £1,424,596

Tota l £13,711,751 215,576 301,849 86,273 £455,676 (£124,218) £9,138,878


£531,848 1,169 1,883 714 £137,382 £0 £354,565

Menta l Heal th Non PbR £467,771 1,181 1,090 (91) (£10,689) £0 £311,847


£622,393 4,426 5,110 684 £178,412 £71,306 £414,929


£245,629 0 0 0 £0 £0 £163,753


£9,202,769 458,134 367,099 (91,035) (£1,442,263) £0 £6,135,179

Other (£1,229,331) 0 13 13 £0 £0 (£816,712)


£2,178,241 7,260 8,444 1,184 £224,536 £0 £1,454,297

Tota l £12,019,319 472,170 383,639 (88,531) (£912,621) £71,306 £8,017,858


£983,616 2,429 3,255 826 £142,658 £0 £655,744

Menta l Heal th Non PbR £945,758 817 656 (161) £3,131 £0 £630,505


£723,548 9,253 7,647 (1,606) £56,999 (£3,081) £482,365


£403,686 0 0 0 £0 £0 £269,124


£15,423,874 761,143 749,044 (12,099) (£715,873) £0 £10,282,583

Other (£1,871,765) 0 19 19 £0 £0 (£1,238,552)


£3,759,375 9,546 10,390 844 £214,456 £0 £2,509,607

Tota l £20,368,092 783,188 771,011 (12,177) (£298,629) (£3,081) £13,591,375


£661,993 1,735 2,472 737 £100,242 £0 £441,329

Menta l Heal th Non PbR £165,451 301 227 (74) (£12,447) £0 £110,301


£830,152 5,503 6,128 625 £9,260 (£31,813) £553,434


£199,141 0 0 0 £0 £0 £132,761


£7,135,484 230,001 341,018 111,017 £782,173 £0 £4,756,989

Other £2,245,171 0 6 6 £0 £0 £1,488,549


£2,656,936 7,960 9,094 1,134 £198,517 £0 £1,770,630

Tota l £13,894,327 245,500 358,945 113,445 £1,077,746 (£31,813) £9,253,993

£59,993,489 1,716,433 1,815,444 99,011 £322,172 (£87,806) £40,002,104

Contingency 0 0 0 £0 £0 £0


£2,622,752 6,374 5,566 (808) (£206,524) (£8,204) £1,748,502

Menta l Heal th Non PbR £2,429,353 14,431 16,173 1,742 £104,226 £3,938 £1,619,568


£1,418,500 14,356 15,568 1,212 £35,166 (£5,054) £945,666


£536,916 0 0 0 £0 £0 £357,944


£20,058,135 835,381 812,415 (22,966) (£651,102) (£39,075) £13,372,090

Other (£376,027) 0 0 0 £0 £0 (£250,684)


£503,419 1,241 1,380 139 £25,098 £1,791 £335,612

Tota l £27,193,047 871,783 851,102 (20,681) (£693,136) (£46,602) £18,128,698

Contingency 0 0 0 £0 £0 £0


£1,580,342 4,202 4,121 (81) £31,480 £2,416 £1,053,562

Menta l Heal th Non PbR £2,446,350 13,390 14,136 746 £1,717 £5,257 £1,630,900


£1,116,987 7,614 5,406 (2,208) (£445,977) (£344,169) £744,658


£329,662 0 0 0 £0 £0 £219,775


£12,069,492 496,059 503,061 7,002 £241,631 £18,555 £8,046,328

Other (£2,487,533) 0 0 0 £0 £0 (£1,658,355)


£203,228 418 562 144 £25,898 £698 £135,485

Tota l £15,258,528 521,683 527,286 5,603 (£145,252) (£317,243) £10,172,352

£42,451,575 1,393,466 1,378,388 (15,078) (£838,388) (£363,845) £28,301,050


£58,653 171 170 (1) (£3,210) £4,170 £39,102

Menta l Heal th Non PbR £175,702 631 826 195 £36,979 £9,940 £117,134


£114,248 719 1,184 464 £141,004 £182,209 £76,166


£26,917 0 0 0 £0 £0 £17,945


£962,431 33,401 30,849 (2,552) (£115) £1,803 £641,620

Other £271,840 0 27 27 (£1,105) £0 £181,226


£154,264 638 977 339 £40,499 £14,614 £102,843

Tota l £1,764,055 35,561 34,033 (1,529) £214,054 £212,736 £1,176,036

£1,764,055 35,561 34,033 (1,529) £214,054 £212,736 £1,176,036


£3,916 13 21 8 £6,576 (£767) £2,611

Menta l Heal th Non PbR £12,756 30 49 19 £1,383 £1,353 £8,504


£13,051 50 134 84 £4,860 £3,840 £8,701


£3,392 0 0 0 £0 £0 £2,261


£122,614 4,411 3,274 (1,137) (£32,741) (£26,655) £81,743

Other £1,884 0 0 0 £0 £0 £1,256


£58,679 166 191 25 £5,310 (£5,308) £39,119

Tota l £216,292 4,669 3,669 (1,000) (£14,612) (£27,537) £144,195

£216,292 4,669 3,669 (1,000) (£14,612) (£27,537) £144,195


£9,606 30 18 (12) (£2,562) (£672) £6,404

Menta l Heal th Non PbR £143,430 500 523 23 (£42,460) (£13,255) £95,620


£1,009,637 1,782 1,588 (194) (£76,973) (£76,971) £673,091


£134,995 9,027 9,758 731 £7,815 £7,820 £89,997

Other £39,735 51 75 24 (£18,490) (£18,490) £25,323


£1,117 3 22 19 £3,072 £933 £744

Tota l £1,338,520 11,393 11,984 591 (£129,598) (£100,636) £891,180

£1,338,520 11,393 11,984 591 (£129,598) (£100,636) £891,180

Menta l Heal th Non PbR £0 0 2,355 2,355 £0 £0 £0

Tota l £0 0 2,355 2,355 £0 £0 £0

£0 0 2,355 2,355 £0 £0 £0


£0 0 1 1 £211 £0 £0

Menta l Heal th Non PbR £0 0 18 18 £3,246 £0 £0


0 183 183 £63,108 £0 £0


0 81 81 £2,066 £0 £0


£0 0 8 8 £1,628 £0 £0

Tota l £0 0 291 291 £70,260 £0 £0

£0 0 291 291 £70,260 £0 £0

£127,577,044 3,193,933 3,294,876 100,943 £461,013 (£125,317) £85,136,2784,790,782

Al l 0

0

0

0

Tota l 0

Al l 0

0

Tota l 0

Al l 45

750

2,673

13,541

76

4

17,089

Tota l 17,089

Al l 19

45

75

0

6,616

0

249

7,004

Tota l 7,004

Tota l 2,090,199

Al l 257

947

1,079

50,102

0

957

53,342

Tota l 53,342

NHS CANNOCK CHASE CCG 2,473

505

7,592

0

303,112

0

9,680

323,362

NHS TELFORD AND WREKIN CCG 6,303

20,085

11,421

744,088

0

627

782,524

Tota l 2,574,645

NHS SHROPSHIRE CCG

9,561

21,646

21,534

1,253,072

0

1,862

1,307,675

NHS STAFFORD AND SURROUNDS CCG

2,603

451

8,255

0

345,002

0

11,938

368,249

0

10,889

708,253

NHS SOUTH EAST STAFFORDSHIRE AND SEISDON PENINSULA CCG

3,644

1,225

13,879

0

1,141,715

0

14,318

1,174,781

NHS EAST STAFFORDSHIRE CCG

1,753

1,771

6,639

0

687,201

Commiss ioner YTD Activi ty Target


PERFORMANCE TARGETS 8. Performance Target performance for the period to November 2016 are shown below:

9. All targets have been met on a year-to-date basis but there was a small shortfall in-month on the Early Intervention Target.

ThresholdMonth

Performance Achieved in MonthTravel (since last report) Year to Date Q1 Q2 Q3 Q4

95% 97.66% 97.01% 97.07% 96.31% 97.87%

95% 96.61% 97.94% 97.30% 96.79%

<=7.5% 6.88% 5.59% 3.80% 6.45% 6.98%

95% 100.00% 100.00% 100.00% 100.00% 100.00%

50% X 37.50% 66.67% 58.33% 79.17% 61.11%

50% 53.19% 53.40% 53.49% 52.28% 55.13%

75 percent in six weeks 75% 91.39% 82.65% 77.35% 83.38% 90.26%

95 percent in eighteen weeks. 95% 96.80% 92.40% 89.08% 93.21% 96.56%

97% 99.30% 99.47% 99.45% 99.50% 99.30%

50% 60.90% 67.43% 65.14% 69.43% 63.70%

N/A

95% 97.47% 97.43%

95% 97.04% 97.89%

95% 96.91% 97.80%

95% 100.0% 100.0%

b) Paedatrics 95% 100.0% 100.0%

c) LD 95% 100.0% 100.0%

e) Eating Disorders 95% 100.0% 100.0%

f) Mother and Baby 95% 100.0% 100.0%

g) Adult Mental Health 95% 100.0% 100.0%

h) Older Adult Mental Health 95% 100.0% 100.0%

95% 100.0% 100.0%

c) Eating Disorders 95% 100.0% 100.0%

d) Mother and Baby 95% 100.0% 100.0%

e) Adult Mental Health 95% 100.0% 100.0%

95% 100.0% 100.0%

c) Eating Disorders 95% 100.0% 100.0%

d) Mother and Baby 95% 100.0% 100.0%

e) Adult Mental Health 95% 100.0% 100.0%

Performance is on or above target

Performance has improved, On targetPerformance maintainedPerformance Declined

Month Performance

performance has improved, not on targetperformance maintainedPerformance Declined

Host CCG Contract Targets

IAPT treatment recovery rates

Monitor Submissions

Monitor TargetsCPA 7 Day Follow Up

X Performance is not meeting target

Performance has improved.

CPA Review within 12 months - excludes patients on an el igible care pathway

Minimising Delayed Transfers of Care (YTD)

Target

Inpatient Admissions via Crisis

Early Intervention in Psychosis programmes: the percentage of Service Users experiencing a first episode of psychosis who commenced a NICE-concordant package of care within two weeks of referral

MHMDS Completeness - Outcomes for patients on CPACertification against Compliance with Requirements regarding Access for people with Learning Disability

IAPT treatment waitinmg times

Wait Time - Referral to Treatment within 18 weeks

Compliant

MHMDS Completeness - Identifiers

South Staffordshire CCG

a) South Staffordshire CCGs

b) Shropshire County CCG

c) Telford & Wrek in CCG

CPA Review within 12 months - excludes patients on an eligible care pathway

a) CAMHS

a) LD

Shropshire County CCG

Telford & Wrek in CCG

a) LD

SOUTH STAFFORDSHIRE & SHROPSHIRE HEALTHCARE NHS FOUNDATION TRUST Attachment 1

Financial Management Report

Income & Expenditure Statement for the period ending 30th November 2016 (Month 08)

Opening

Annual

Budget

£000s

NHSI

Control

Plan

£000s

Flexed

Annual

Budget

£000s

Period

Budget

£000s

Period

Actuals

£000s

Period

Variance

£000s

YTD Budget

£000s

YTD

Actuals

£000s

YTD

Variance

£000s

Forecast

Outturn

£000s

Forecast

Outturn

Variance

£000s

Operating Income

NHS Clinical Income

Block Contract income 99,183.7 99,183.7 100,102.8 8,374.8 8,340.4 (34.4) 66,643.5 66,311.1 (332.5) 99,527.8 (575.0)

High Cost Low Volume Activity - Cost & Volume Contract income 23,446.8 23,446.8 23,710.9 1,975.9 1,889.7 (86.2) 15,807.1 15,051.2 (755.9) 22,586.2 (1,124.7)

Short term episodic treatment - Cost & Volume Contract income 5,863.1 5,863.1 6,081.7 492.6 490.6 (2.0) 4,122.4 4,119.7 (2.7) 6,072.6 (9.1)

Other - Cost & Volume Contract income 5,635.5 5,635.5 5,947.0 506.3 529.0 22.8 3,921.8 3,804.4 (117.4) 5,805.6 (141.4)

Clinical Partnerships providing mand svcs (incl S75 agreements) 24,603.5 24,603.5 25,160.2 2,134.2 2,075.8 (58.4) 16,922.9 16,517.6 (405.3) 24,591.7 (568.5)

Clinical income for the Secondary Commissioning of mand svcs 11,060.2 11,060.2 11,634.2 1,001.2 942.9 (58.3) 7,629.3 7,174.7 (454.5) 11,627.1 (7.0)

Other clinical income from mandatory services 837.0 837.0 1,368.5 85.5 93.2 7.7 1,089.4 1,223.4 133.9 1,543.2 174.7

Other clinical income not included above (including STF) - 1,130.0 1,130.0 94.2 94.2 (0.0) 753.3 753.3 (0.0) 1,130.0 -

NHS Clinical Income, total 170,629.9 171,759.9 175,135.1 14,664.6 14,455.8 (208.8) 116,889.8 114,955.5 (1,934.4) 172,884.2 (2,250.9)

Non NHS Clinical Income

Other Non NHS Clinical income - - - - - - - - - - -

Non NHS Clinical Income, total - - - - - - - - - - -

Non Clinical Income

Research and development income 403.6 403.6 461.4 48.9 32.8 (16.1) 252.3 230.6 (21.7) 392.3 (69.1)

Education and training income 4,686.5 4,686.5 4,855.9 394.4 483.6 89.2 3,337.3 3,504.3 166.9 5,122.2 266.2

Parking income - - - - - - - - - - -

Catering income 126.8 126.8 126.8 10.6 13.2 2.6 84.5 91.2 6.7 137.2 10.4

Accommodation income 166.4 166.4 225.4 18.8 27.6 8.9 150.3 224.9 74.6 323.1 97.8

Income from non-patient services to other bodies 9,504.2 9,504.2 10,610.2 852.0 794.4 (57.7) 7,318.6 6,695.9 (622.7) 10,040.6 (569.6)

Misc. other operating income 356.5 356.5 541.2 33.9 27.4 (6.5) 405.7 325.0 (80.7) 431.5 (109.7)

Donations & Grants received of PPE & intangible assets 3.3 3.3 3.3 0.3 0.3 (0.0) 2.2 2.1 (0.1) 3.2 (0.1)

Non Clinical Income, total 15,247.3 15,247.3 16,824.3 1,358.8 1,379.2 20.4 11,550.9 11,074.0 (476.9) 16,450.2 (374.1)

Operating Income, total 185,877.2 187,007.2 191,959.4 16,023.4 15,835.0 (188.5) 128,440.7 126,029.5 (2,411.3) 189,334.4 (2,625.0)

Operating Expenses

Employee Expenses

Medical Employee Expenses, Substantive (17,804.7) (17,508.0) (18,093.7) (1,540.6) (1,308.1) 232.5 (11,923.7) (10,258.5) 1,665.2 (15,743.5) 2,350.1

Nursing Employee Expenses, Substantive (39,299.5) (38,276.0) (40,087.4) (3,305.2) (2,914.5) 390.6 (26,577.3) (23,493.8) 3,083.4 (35,683.3) 4,404.1

Other Employee Expenses, Substantive (71,390.7) (72,295.0) (74,679.8) (6,504.6) (5,863.9) 640.6 (49,305.8) (46,449.7) 2,856.1 (70,538.3) 4,141.6

Substantive Staff, total (128,494.9) (128,079.0) (132,860.9) (11,350.3) (10,086.6) 1,263.7 (87,806.7) (80,202.0) 7,604.8 (121,965.1) 10,895.8

Medical Employee Expenses, Bank & Overtime - - - - - - - - - -

Nursing Employee Expenses, Bank & Overtime (21.0) (24.0) (45.6) (1.8) (136.2) (134.4) (38.6) (938.6) (900.0) (1,365.0) (1,319.4)

Other Employee Expenses, Bank & Overtime (137.6) (132.0) (161.9) (11.5) (275.4) (263.9) (116.0) (2,163.4) (2,047.4) (3,077.2) (2,915.3)

Bank Staff & Overtime, total (158.6) (156.0) (207.5) (13.2) (411.6) (398.3) (154.6) (3,101.9) (2,947.3) (4,442.2) (4,234.7)

Medical Employee Expenses, agency (632.2) (756.0) (465.9) (13.8) (211.3) (197.5) (410.6) (1,801.9) (1,391.3) (2,563.2) (2,097.3)

Nursing Employee Expenses, agency (820.8) (819.0) (836.6) (54.7) (44.6) 10.1 (756.6) (1,066.5) (309.9) (1,608.7) (772.1)

Other Employee Expenses, agency (1,877.9) (2,175.0) (2,242.5) 31.6 (216.0) (247.6) (1,819.9) (2,811.3) (991.4) (3,878.2) (1,635.8)

Agency Staff, total (3,330.9) (3,750.0) (3,545.0) (37.0) (471.9) (434.9) (2,987.2) (5,679.7) (2,692.5) (8,050.1) (4,505.2)

Employee Expenses, total (131,984.5) (131,985.0) (136,613.4) (11,400.5) (10,970.0) 430.5 (90,948.5) (88,983.6) 1,964.9 (134,457.4) 2,156.0

Raw Materials and Consumables Used

Drugs (5,124.9) (5,124.9) (4,776.0) (397.2) (365.8) 31.4 (3,187.0) (2,986.3) 200.7 (4,626.6) 149.5

Supplies and services - clinical (2,417.5) (2,417.5) (2,129.1) (252.6) (326.3) (73.7) (1,339.7) (1,490.7) (151.0) (2,310.0) (181.0)

Supplies and services - general (9,201.9) (9,201.9) (9,485.1) (848.7) (823.9) 24.9 (6,377.3) (6,089.3) 288.0 (9,321.8) 163.3

Raw Materials and Consumables Used, total (16,744.3) (16,744.3) (16,390.2) (1,498.6) (1,515.9) (17.4) (10,903.9) (10,566.3) 337.6 (16,258.4) 131.8

Purchase of healthcare services / secondary commissioning

Purchase of healthcare services from other NHS bodies (2,302.4) (2,302.4) (2,773.0) (352.5) (211.4) 141.1 (1,869.9) (1,874.3) (4.4) (2,753.8) 19.2

Purchase of healthcare services from non-NHS bodies (9,762.4) (9,762.4) (11,110.8) (804.1) (905.5) (101.4) (7,416.6) (7,172.9) 243.6 (10,818.6) 292.2

Purchase of healthcare services/secondary commissioning, total (12,064.8) (12,064.8) (13,883.8) (1,156.6) (1,116.9) 39.7 (9,286.5) (9,047.3) 239.2 (13,572.4) 311.4

Other non-pay expenses (excluding PFI/LIFT)

Research & Development expense - - - - - -

Education and training expense (1,142.6) (1,142.6) (918.8) (73.1) (117.8) (44.7) (626.1) (608.4) 17.8 (975.1) (56.2)

Consultancy costs (103.7) (103.7) (151.4) (12.2) (32.5) (20.4) (102.8) (135.2) (32.4) (185.6) (34.2)

Premises (5,777.2) (5,777.2) (5,432.3) (420.4) (384.2) 36.1 (3,566.2) (3,454.9) 111.3 (4,916.6) 515.7

Clinical negligence (169.5) (169.5) (169.5) (14.1) (14.1) - (113.0) (113.0) 0.0 (169.5) -

Misc. other Operating expenses (10,628.5) (10,659.5) (9,999.7) (794.7) (665.1) 129.5 (6,811.1) (5,832.8) 978.3 (10,461.7) (462.0)

Other non-pay expenses, total (17,821.5) (17,852.5) (16,671.8) (1,314.5) (1,213.9) 100.6 (11,219.3) (10,144.4) 1,074.9 (16,708.5) (36.8)

Operating Expenses, total (178,615.1) (178,646.6) (183,559.1) (15,370.2) (14,816.8) 553.4 (122,358.2) (118,741.6) 3,616.6 (180,996.8) 2,562.4

EBITDA 7,262.2 8,360.6 8,400.3 653.3 1,018.2 364.9 6,082.6 7,287.9 1,205.3 8,337.6 (62.7)

G:\Finance\Accounting & Assurance\Corporate Information\Committee Papers\2016-17\Month 08 - November\F&PC\02 - Attachments 1 & 2 - Income & Expenditure Statement & Directorate Budget Positions M08 - 2016-1702 - Attachments 1 & 2 - Income & Expenditure Sta



Income & Expenditure Statement for the period ending 30th November 2016 (Month 08)

Opening

Annual

Budget

£000s

NHSI

Control

Plan

£000s

Flexed

Annual

Budget

£000s

Period

Budget

£000s

Period

Actuals

£000s

Period

Variance

£000s

YTD Budget

£000s

YTD

Actuals

£000s

YTD

Variance

£000s

Forecast

Outturn

£000s

Forecast

Outturn

Variance

£000s

Non Operating Income

Interest Income 80.0 80.0 80.0 6.7 6.8 0.1 53.3 76.8 23.5 103.5 23.5

Gain/(loss) on asset disposals - - 0.2 0.2 - 0.2 0.2 0.2 0.2

Other Non-Operating income - - - -

Non Operating Expenses

Depreciation and Amortisation (2,600.0) (2,600.0) (2,600.0) (216.7) (225.4) (8.8) (1,733.3) (1,785.5) (52.2) (2,744.1) (144.1)

Impairment Losses - - - - - - - - -

Interest Expense (1,011.0) (1,011.0) (1,011.0) (84.3) (82.1) 2.1 (674.0) (679.9) (5.9) (1,007.1) 3.9

PDC Dividend Expense (1,700.0) (1,700.0) (1,700.0) (141.7) (141.7) (0.0) (1,133.3) (1,133.3) (0.0) (1,560.0) 140.0

Other Non-Operating expenses - - - - - - - - -

SURPLUS/(DEFICIT) 2,031.2 3,129.6 3,169.3 217.3 575.9 358.5 2,595.2 3,766.2 1,171.0 3,130.1 (39.2)

FINANCIAL METRICS

EBITDA Margin 3.9% 4.5% 4.4% 4.1% 6.4% 2.4% 4.7% 5.8% 1.0% 4.4% 0.03%

Surplus Margin 1.1% 1.7% 1.7% 1.4% 3.6% 2.3% 2.0% 3.0% 1.0% 1.7% 0.00%

G:\Finance\Accounting & Assurance\Corporate Information\Committee Papers\2016-17\Month 08 - November\F&PC\02 - Attachments 1 & 2 - Income & Expenditure Statement & Directorate Budget Positions M08 - 2016-1702 - Attachments 1 & 2 - Income & Expenditure Sta

Attachment 2

2015/16 2016/17 2016/17 2016/17As at 31 March Monitor Year to date Year to date

2016 - unaudited Budget Actuals Variance

£000s £000s £000s £000sNon Current AssetsProperty, Plant & EquipmentLand 24,625 91,528 24,625 (2,956)Buildings 61,894 Inc Above 61,068Plant and equipment 2,048 Inc Above 1,629In course of construction 668 Inc Above 1,250In course of construction funded by donations 0 Inc Above 0Intangible fixed assets 34 33 28 (5)Non Current Prepayments Other Debtors due > 1 Year 176 25 285 260Non Current Other AssetsSCC Pension Asset 714 714 714Total Non Current Assets 90,159 91,586 89,599 (1,987)

Current AssetsInventories 171 200 220 20Net Current Trade & Other ReceivablesNHS Trade Receivables 5,089 4,000 7,438 3,438Non NHS Trade Receivables 2,970 5,500 5,129 260Capital ReceiptsProvision for Bad Debts (514) (1,063) (432)Current Other Financial AssetsAccrued Income NHS (DA Control A/c may contain a small element of prepayments) 0 2,500 1,034 2,694Accrued Income Non NHS (DA Control A/c may contain a small element of prepayments) 2,176 Inc Above 4,159Other Debtors 18 17Accrued Dividend 0Current Prepayments 1,656 1,600 1,986 386Cash & Cash EquivalentsCash Invested (Government Banking Services) 0 Inc below 0Cash (Government Banking Services) 56,178 Inc below 50,094Cash (Commercial Banks and in hand) 266 51,752 266 (1,392)Current Other AssetsAssets Held For Sale 3,121 2,000 2,000 0Total Current Assets 71,130 66,489 71,912 5,406

Current LiabilitiesInterest Bearing Borrowings - Loans Non Commercial (1,333) (1,333) (1,333) 0Deferred income (4,947) (4,000) (3,880) 120Provisions (7,350) (7,000) (7,097) (97)Tax Payables (Tax & Social Security Costs) (2,197) (2,700) (2,521) 179Other Payables (1,612) (1,600) (1,740) (140)Trade & Other PayablesTrade Creditors - NHS (4,395) (6,000) (2,181) (1,237)Trade Creditors - Non-NHS (5,721) Inc above (5,073)Other Creditors Inc aboveCapital Creditors (268) (250) (114) 136Current Other Financial LiabilitiesAccruals NHS 0 (11,000) (886) (36)Accruals Non NHS (10,421) 0 (10,151)Payments on Account 0 0 0 0PDC Dividend Creditor (55) (142) (283) (141)Interest Payable on Loans (45) (118) (212) (94)Total Current Liabilities (38,346) (34,143) (35,470) (1,310)

Net Current Assets/(Liabilities) 32,784 32,346 36,442 4,096

Non Current LiabilitiesInterest Bearing Borrowings - Loans Non Current, Non commercial (25,337) (24,670) (24,671) (1)SCC Pension Liability (475) 475Deferred Government Grant Income (66) (66) (64) 2Provisions (208) (218) (208) 10Total Non Current Liabilities (25,611) (25,429) (24,943) 486

TOTAL ASSETS EMPLOYED 97,332 98,503 101,098 2,595

Taxpayers and Others EquityTaxpayers EquityPublic Dividend Capital 75,698 75,698 75,698 (0)Retained Earnings/(Accumulated Loses) (Income and expenditure account) (6,018) (5,013) (2,252) 2,761Pension Reserve (8) (1,348) (8) 1,340Revaluation reserve 27,660 29,166 27,660 (1,506)Other reserves 0 0 0TOTAL ASSETS EMPLOYED 97,332 98,503 101,098 2,595

SOUTH STAFFORDSHIRE & SHROPSHIRE HEALTHCARENHS FOUNDATION TRUST

IFRS FORMAT - STATEMENT OF POSITION AS AT 30th November 2016/17 (MONTH 08)



Directorate Budgetary Positions for the period ending 30th November 2016 (Month 08)

Opening

Annual

Budget

£000s

Flexed

Annual

Budget

£000s

In Month

Variance

£000s

YTD

Budget

£000s

YTD

Actuals

£000s

YTD

Variance

£000s

On

Target Trend

Forecast

Outturn

£000s

Forecast

Outturn

Variance

£000s

On

Target Trend

Devolved Budgets

Mental Health Division

D4MENH Staffordshire Mental Health (24,226) (24,215) 49 (16,139) (16,616) (477) � �� (24,969) (754) � ��

D4MHSH Shropshire Mental Health (26,846) (26,750) 70 (17,747) (17,575) 172 � �� (26,612) 138 � ��

Mental Health Division, total (51,073) (50,965) 119 (33,886) (34,191) (305) � �� (51,581) (616) � ��

Specialist Healthcare Division

D4SPMG Business Management Team (423) (438) 8 (297) (298) (2) � �� (433) 5 � ��

B4FRSC Forensic Services 4,609 4,642 43 3,104 3,329 225 � �� 5,000 358 � ��

D4LRND Learning Disability Services (5,373) (5,434) 40 (3,630) (3,126) 504 � �� (4,813) 621 � ��

B4CHLD Specialist & Family Services (7,183) (7,287) 17 (4,839) (4,720) 119 � ��(7,377) (90) � ��

D4SPIN Inclusion Services 2,715 2,744 37 1,849 1,687 (162) � ��2,285 (460) � ��

D4SPMO Armed Forces 211 211 8 141 162 21 � �� 245 35 � ��

Specialist Healthcare Division, total (5,444) (5,562) 153 (3,672) (2,967) 705 � �� (5,093) 469 � ��

Corporate Support Services

B4TSTW

Trust Board, HR&OD, Professional

Leads & Other Corporate Functions (4,248) (4,416) (44) (2,934) (3,092) (158) � ��(4,653) (236) � ��

D4BDFE Facilities & Estates (9,525) (9,501) (4) (6,168) (6,590) (422)� ��

(9,921) (419)� ��

D4MEDI Medical (2,614) (2,621) 31 (1,741) (1,434) 308 � ��(2,372) 249 � ��

D4COO Nursing (1,189) (1,049) 11 (697) (697) (0) � �� (1,009) 40 � ��

D4QCP Quality & Clinical Performance (1,593) (1,601) 8 (1,067) (983) 84 � �� (1,563) 38 � ��

B4FINF Finance & Performance (7,167) (7,484) (41) (4,992) (4,785) 207 � ��(7,432) 52 � ��

B4FA&E Commercial & Business Development (461) (347) (2) (231) (236) (5) � ��(351) (4) � ��

D4HIS Health Informatics Shared Service (0) 0 (40) 4 179 175 � �� 84 84 � ��

Corporate Support Services, total (26,797) (27,019) (81) (17,827) (17,639) 188 � �� (27,216) (196) � ��

Devolved Budgets, total (83,314) (83,546) 191 (55,384) (54,797) 587 (83,890) (343)

Centrally Held Budgets

B4INCM Central Income 92,795 92,815 11 61,838 61,788 (50) � �� 92,738 (77) � ��

B4RSVE Reserves (2,222) (872) 162 (374) 299 673 � �� (509) 363 � ��

B4FREG

Finance Regime (Items excluded from

EBITDA) (5,228) (5,228) (6) (3,485) (3,524) (39) � ��(5,209) 19 � ��

Centrally Held Budgets, total 85,345 86,716 167 57,979 58,563 584 � �� 87,020 304 � ��

SURPLUS/(DEFICIT) 2,031 3,169 359 2,595 3,766 1,171 3,130 (39)

30 Nov 2016 30 Nov 2016

£ Funds as at Funds as atIncoming Resources: 30 Nov 2016 31st March 201601 / 100 Donations 60,172 £ £01 / 110 Legacies - Fixed Assets:01 / 120,12Grants receivable 02 / 100 Intangible Assets 0 001 / 160 Investment income 8,662 02 / 110 Tangible Assets 0 001 / 450 Profit / (Loss) on disposal of asset 02 / 120 Investments 386,195 357,98601 / 440 Revaluation of asset at quarter end 28,210 Total 386,195 357,986

Total 97,044 Current Assets:

Resources expended: 02 / 200 Stock 0 001 / 200 Year end provision reversed - 02 / 210 Debtors 31 27201 / 200 Grants to other NHS charities - 02 / 220 Short term investments and deposits 0 001 / 440 Revaluation of asset at quarter end 02 / 230 Cash and bank 169,344 184,52001 / 210 Other grants payable 89,431 Total 169,375 184,79201 / 240 Management & administration 11,319

Total 100,750 Liabilities:02 / 300 Creditors 1,727 5,35310 / 130 Commitments 20,124 105,288

Net movement in funds 3,706- Total 21,851 110,641

Net Assets 533,719 432,136

Fund Balances 553,842 537,424Available Fund Balances 428,431 432,136

Statement of Financial Activities for the Period ending Balance sheet as at

South Staffs Community & Mental Health Charity

Attachment 4

Charitable Funds reg no. 1061006

South Staffs Community & Mental Health Charity

Charitable Funds reg no. 1061006

1

Initial Document Title:

Trust Assurance Report Item 6: Business Development

Sponsoring Directors:

Steve Grange, Director of of Strategy and Strategic Transformation

Authors: Steve Grange, Director of of Strategy and Strategic Transformation

Date of Meeting: Thursday 26th January 2017 CONTENTS Paragraph Item Attachment

Reference 1. Business Development & Communications 6.3 Enc C 1.0 Business Development 1.1 Strategic Alignment The Commercial Report, including market intelligence, tender performance, business activity and opportunities, combined with a commercial scan of the commercial market place is discussed with the Business Development and Investment Committee (BDIC). This report demonstrates our alignment to the Trust’s strategy, in particular aims "Innovate" and "Expand".

2

3 Innovate through co-operation and co-production The Trust remains committed to rolling out real engagement with staff and the use of improvement methodologies such as the Virginia Mason LEAN methodologies. These projects focus on local teams being empowered to make and take decisions to improve their working environment and ultimately the care that they deliver. 5 Expand our current service portfolio in order to enrich services The commercial goals are contained within its commercial strategy. They are based around the basic principles of expand and retain our existing market share and continue to develop sophisticated clinical partnerships continuing building speciality brands such as MoD and Wagner College. We will ensure we make considered commercial decisions against a clear appetite for risk whilst using our FT freedoms whilst ensuring that we remain able to compete in the changing healthcare market. The Trust remains committed to only providing new business where we feel that we can make a positive difference and we have the capacity and capability to safely deploy. We will not participate in or continue to pursue opportunities if we feel that it will dilute our existing or future offer, or distract our ability to improve core services. Quality and safety are and will always be our overriding priorities. Strategically, we are currently pursuing a number of commercial opportunities. The market place has changed over the last few months with opportunities appearing in areas that are new to Mental Health and Learning Disabilities. A range of new opportunities are starting to emerge with new ways of commissioning and delivering services. 1.2 Multi-Specialty Providers (MCPs) 1.2.1 Overview There are three options of the draft MCP contracts that were published in December 2016, which are out for consultation until 20th January 2017. The aim is to clarify the contracting, commissioning and funding arrangements required to facilitate the delivery and sustainability of MCPs. Further versions will then be published for comment throughout 2017 before the final versions are published. 1.2.2 The service specification, outcome measures, and implications for contract management and assurance There are three broad ways in which NHS England and commissioners could contract for an MCP with the intention of ensuring the delivery of high quality services by an MCP provider: a) contracting for the core elements of the MCP care model itself; b) contracting for high-level population health outcomes; c) contracting by defining local service specifications and/or desired clinical outcomes. The balance of these in existing commissioning arrangements differs by area and setting.

3

Alone, none of them would sufficiently capture the requirements of an MCP and provide assurance of delivery. The way in which the three are balanced to do so will need to be considered by commissioners, and evaluated by the integrated support and assurance process (ISAP). 1.2.3 The MCP care model For an MCP to be recognisable, the contract must capture the essence of the care model, as expressed in the MCP framework, published in July 2016. The requirements of the MCP care model are described in the Service Conditions in the MCP Contract – particularly in service condition 3 and 4, for instance. All MCP Contracts must include these requirements. The Service Conditions list requirements for how the set of MCP services will need to be delivered, for example by requiring population health management, the use of information systems supported by risk stratification tools, or recording levels of patient activation. It ensures that providers are fully aware of the commissioner’s minimum expectations of delivery for an MCP. But the wording of the Service Conditions deliberately operates at a high level and does not describe the model of care in such a degree of depth as to prevent its evolution through learning or render it obsolete over the contract term. 2.0 Business Planning The directorate business planning cycle is progressing to plan. The key dates and actions are listed below.

Activity Who Date

Submission of joint arbitration paperwork by CCGs, direct commissioners and providers where contracts not signed

TBA By 9 January 2017

Arbitration outcomes notified to CCGs, direct commissioners and providers

TBA Within two working days after panel date

Review of Directorate Business Plans Business Leads 16 January 2017

Contract and schedule revision reflecting arbitration findings completed and signed by both parties

TBA By 31 January 2017

Directorate Business Plans taken through Trust governance structures (Operational Board/TMT etc)

Directorate Leads March 2017

Directorate Business Plans Implemented

Directorate Leads April 2017

6-monthly review of Directorate Business Plans

Business Leads October 2017

4

2.1 Personality Disorder in the Probation Service The projects are all progressing well and are fully staffed. The Staffordshire and West Midlands Project Board took place on the 9th January 2017. The Board has identified an Assistant Psychologist to extend the scope of the community project. The West Mercia Project Board is due to meet on the 9th February 2017 after the National Offender Management Service (NOMS) commissioner meeting. 2.2 Military Mental Health Veterans Projects The League of Friends (LoF) Veterans’ housing project is full and Enable employment staff continue to support the Veterans and have had further success in funding them employment. The Enable service is still carrying waiting lists but bids to a number of charities have been submitted. The LoF has secured funding from the Covenant Fund and the Royal British Legion to support further project staffing. 2.3 Military Mental Health – Veterans’ Service Referrals continue for the service and signposting and c linic activity remain steady at present. 3.0 Communication – Operational and Strategic 3.1 e-PoD The January 2017 issue of e-PoD is now available on the Trust intranet, find it here http://nww.intranet.sssft.nhs.uk/The-Knowledge-Bank/Sections/Newsletters-Briefs.aspx You can also find e-PoD on the Trust website at www.sssft.nhs.uk/about/publications/e-pod In this issue:

• Festive Fun • Victorian Carols • RiO Developments • Learning and Development News

3.2 Presentation Skills Training Package Martin Evans has produced a Presentation Skills training package which he is delivering to a selection of Governor Members. The Learning and Development Team have indicated that there may be a demand for this type of training elsewhere in the Trust. 3.3 Media Coverage Following the interviews for BBC Radio Stoke on our 136 Suite development at St George’s Hospital, a good piece was included on the Breakfast programme on 3rd January 2017. In addition, just after Christmas, a crew from BBC Midlands Today visited the Trust and interviewed Paul Bowers for a TV piece which also aired on 3rd January. We have also received positive coverage for our segmentation from NHS Improvement and, following

http://nww.intranet.sssft.nhs.uk/The-Knowledge-Bank/Sections/Newsletters-Briefs.aspx

5

Theresa May’s speech on improving mental health services for children and young people, we re-issued a press release regarding the WHAM (Wellbeing Health Action Map) developed by CAMHS with local young people for use in schools. This was picked up by Staffordshire Newsletter and the team have received at least one school enquiry from it.

3.4 Let’s Be Outstanding Event 18th Jan The Comms Team are very much involved in arrangements prior to and then during the ‘Let’s Be Outstanding’ Event on 18th January 2017 at the Park Inn, Telford. The Comms

team will be running the social media promotion of this day. #outstanding 3.5 Naloxone Following on from the success for Inclusion Services at the HSJ awards under the patient safety category for the Naloxone project, the Comms Team are coordinating production, by Inspired Video, of a short video to continue to promote this outstanding initiative. Filming is due to take place late January and will include service user and carer voices, as well as that of the staff involved.

Document Title: Trust Assurance Report Section 4: Workforce and Development

Sponsoring Directors: Greg Moores, Director of Workforce and Development Alison Bussey, Director of Nursing / Chief Operating Officer

Authors: Angie Astley, Head of Workforce Planning and Development Alyson Sargeant, Head of Recruitment and Resourcing Suzanne Godwin, E-Rostering/Supplementary Staffing Lead

Date of Meeting: 26 January 2017 Please refer to the Workforce Assurance Headlines at Appendix 1 and the Safe Staffing Data at Appendix 2 Introduction This report combines the Workforce Assurance report and the Safe Staffing report for December 2016. The report triangulates the data showing nursing fill rates for registered and unregistered nurse staffing, by day and night shifts, and the workforce metrics that may impact on safe staffing fill rates. The report also details high level Trust-wide workforce metrics and a ny associated action that is being taken to address hotspot areas. As at 31 December 2016 the Trust employed 3473 staff (headcount), with a full time equivalent of 3107.68 FTE. 1. Annual Staff Sickness Rate The Trust’s annual sickness absence rate as at 31 December 2016 was 4.57% which has increased slightly during the last quarter (4.42% at the end of September). There are four Directorates with sickness rates above this target; Mental Health Shrops (481%), Mental Health Staffs (6.23%), Forensic (4.89%) and Inclusion (4.68%). Oak Ward is reported as a hotspot for vacancies and annual sickness absence rates; safe staffing data shows that they are meeting their required fill rates with the support of supplementary staffing. 2. Annual Staff Turnover Rate The annual turnover rate for the Trust was 15.38% which has increased since the beginning of the year (13.83%) and is now above the upper control limit of 15%. There are two clinical areas that are over the upper control limit of 15%; these are Inclusion (20.86% from 16.24% at the end o f September) and Forensic (15.27% from 16.90% at the end of September). Facilities and Estates are reflecting a turnover of 18.61%; this has increased by more than 6% since the same time last year (12.24%).

3. Percentage of staff employed for more than 12 months with a compliant

appraisal The Trust-wide appraisal rate remained at 90% which has now achieved the Trust’s target of 90% however this will now need to be maintained until the end of March 2017. 4. Mandatory Training Overall Compliance Mandatory training compliance at the end of December 2016 increased to 90% which has achieved the Trust target. Clinical Directorates are generally performing at above 80%, with the exception of Inclusion (78%), where staff transfers in April 2016 are still impacting on compliance. This has however improved from the 53% compliance rate in April 2016. 5. Trust-wide Vacancy Rate The Trust-wide vacancy rate as at 31 December 2016 was 8.95% which has increased slightly since last month’s rate of 8.79%. Vacancy rates are reducing in the main with the vacancy rate in Facilities and Estates having improved significantly; this now stands at 12.43% (from the high of 24.16% in November 2015). Analysis of vacancy rates by staff group identifies that the overall nursing vacancy rate at the end of December was 10.99. The Medical and Dental staff vacancy rate at the end of December was 21.49% which is largely attributable to vacancies in prison services. In terms of safe staffing data; all wards reported as vacancy hotspots are rated green or amber for fill rates and i t would therefore appear that they are consistently meeting their safe staffing requirements with the use of supplementary staffing. 5. Number of staff requiring DBS renewal check. At the end of December there were no members of staff outstanding their 3 yearly DBS renewal. A recent audit of data quality in ESR has shown there are a number of staff and volunteers whose records do not hold DBS information. The majority of these records are linked to those registered on ESR who did not join the Trust through NHS Jobs, such as TUPE transfers or volunteers. Work is ongoing to complete these records and, following the audit, an ESR report has now been identified that will mitigate the risk of this happening in the future. 6. Number of staff absent due to sickness for over 12 months. At the end of December there was 1 member of staff who had been absent owing to sickness for over 12 months.

7. Number of staff suspended for more than 3 months At the end of December there were no staff who had been suspended for over 3 months. 8. Safe Staffing Data

There are no red rated area reported for under fill for December. Two units have an amber rating: Willow ward for registered nurse fill during the day and Brocton for registered nurse fill at night. Both areas are reported red for vacancy and amber for sickness levels Any unit rated red for fill rates for the month is required to complete and return an action plan to the Director of Nursing. Registered Nurse Hours – Substantive v’s Temporary Staff Fill Rates Percentage registered staff hours by ward for the reporting period, split by agency hours, bank hours and substantive hours are presented below:

75 70 72 70 82 82 83 79

95

68 81

69 68 82 80

99

82 85

68

87 94 93

18 19 13

26 11 15 11

7

4

20

11

13 22 9 17

1

16 8

22

9 4 4 7 11 15

4 7 3 6 13

1 13 8

17 10 9 4 0 3 7 11

4 2 3

0

10

20

30

40

50

60

70

80

90

100

New

port

Hou

seAs

hley

Hou

seRa

dfor

d Ho

use

Nor

ton

Hous

eEl

lesm

ere

Hous

eW

illow Ye

wO

ak H

ouse

Broc

king

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IAM

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BTIS

FOP

GBT

% AgencyRegisteredHours

% BankRegisteredHours

% SubstantiveRegisteredHours

Bank and Agency Monthly Fill

The overall demand for temporary staffing fell by 169 shifts in December. Bank and agency fill both reduced due to the Christmas holiday period and unavailability of temporary staff. 9. Agency Cap Breaches For the period 1 December 2016 to 31st December 2016 the Trust has reported the following breaches to NHS Improvement: Reporting Period - Week Commencing 00.00 Monday - 23.59 Sunday

No of shifts Nursing, Midwifery

and Health Visiting

No of shifts Medical

and Dental

No of shifts Administration and Estates

No of shifts AHP, Add, Prof, Tech

05/12/2016 0 38 18 7 12/12/2016 0 26 17 3 17/12/2016 0 26 16 3 26/12/2016 0 20 3 3

The above table shows the higher number of shifts breaching the cap remain within the medical workforce. There remains significant challenges in recruiting to the specialist areas such as Integrated Prison Mental Health and Forensic Mental Health Services. Included in the above breaches are the sessional GP’s engaged directly by the Trust under a C ontract for Services. D ecember has seen an increase in breaches within administration, this is due t o two Consultants working in Finance and Performance who are providing specialist support within the Directorate. The Consultant working in the HIS is due to end their assignment at the end of December, therefore January should see a decrease in breaches within this area. A ll requests for agency must be authorised by either the Director of Workforce and Development or the Medical Director for medical staff.

3119 3130 3253 3758 3889

3544 3373 3229 3060

959 861 926 1083 1129 932 795 672 659

1920 2043 2044 2381 2412 2384 2413 2438 2206

240 226 283 294 348 228 165 119 195 0500

10001500200025003000350040004500

Apr May Jun Jul Aug Sep Oct Nov Dec

Shift

s

Inpatient Bank / Agency Use April 16 - Dec 2016

Demand 16/17

Agency Filled 16/17

Bank Filled 16/17

Unfilled 16/17

10. Agency Spend Work is ongoing to expand the Trust Bank to all professional groups and in line with this an advert has been placed on NHS Jobs for admin and clerical workers to join the Trust Bank. A meeting has been arranged to discuss the current Facilities and E states Bank with the proposal of moving this to the central function and utilising E-Rostering more efficiently. The NHS Improvement Agency has given the Trust a ceiling expenditure of £5.845 million by 16/17 year end, the graph below reflects the Trust’s position against the ceiling at Month 9.

Month 9 h as seen a r eduction in agency spend to £529,830 from the high in Month 3 of £833,525. This represents a reduction of around 36%. 11. Recruitment There remains significant difficulty in recruiting to Band 5 nurses to posts within the In-Patient Services of the Trust. The Trust continues to run the open advert for Band 5 nur ses for In-Patient Wards within Forensic Services and M ental Health Shropshire which is having a slow but positive impact. Forensic Services are trialling a variety of shift patterns as an offering to attract nurses to their Service. We are beginning to work with the student nurses due to qualify in September 2017 from Staffordshire University to ensure, wherever possible, they are retained within the Trust. Student nurse recruitment was targeted at Nottingham University in November, when nurse represenatives from the Trust attended a Jobs Fair at the University aimed at marketing the Trust as an employer of choice and attracting students from outside of Shropshire and Staffordshire. We are due to attend Birmingham University on the 7th February 2017 to talk to students who are due to qualify in September 2017.

0

1,000,000

2,000,000

3,000,000

4,000,000

5,000,000

6,000,000

7,000,000

8,000,000

9,000,000

Month1

Month2

Month3

Month4

Month5

Month6

Month7

Month8

Month9

Month10

Month11

Month12

£

SSSFT Agency Spend, Ceiling and Forecast 2016/17

InMonthSpend

Meetings have taken place with a r ecruitment marketing company ‘Jupiter’ to support the Trust with a nurse recruitment campaign during February/March.

Average Lead in Time for

December

Number of new

staff with start

dates for December

Current vacancies

being managed

Number of new

starters with future start dates

Pre-Employment

Checks (PEC) in Progress

28.5 days 44 124 33 87 The target lead in time is 20 working days. The lead in time has reduced from the baseline of 34 d ays prior to the RPIW in September 2016. The Team continues to monitor the lead in time to bring it in line with the target of 20 working days.

Trust Assurance Headlines - December 2016

Assurance Area Target or Control LimitTrust

Performance December 2015

Trust Performance

November 2016

Trust Performance

December 2016

Business Development

Nursing Directorate

Directorate of Psychological

Services

Finance and Performance Directorate

HIS Directorate Workforce and Development

Medical Directorate

Quality and Clinical

Performance Directorate

Executives, Non-Executives and Executive

Support

Facilities and Estates

1. Annual Sickness Rate %age Target 4.2% 4.61% 4.61% 4.57% 0.69% 1.23% 0.57% 2.07% 2.69% 1.92% 2.46% 4.83% 3.22% 4.63%

2. Annual Staff Turnover %age LCL - 10%, UCL - 15% 13.63% 15.08% 15.38% 11.54% 13.59% 18.18% 12.22% 16.54% 7.82% 16.50% 18.75% 17.65% 18.61%

3. %age of staff employed for more than 12 months who have a compliant appraisal

Target 90% 85% 91% 90% 13% 81% 92% 74% 100% 95% 74% 89% 87% 99%

4. Mandatory Training overall compliance %age Target 90% 85% 89% 90% 97% 96% 91% 96% 98% 98% 87% 96% 92% 92%

5. Trustwide Vacancy Rate Green (below 8%), Amber (between 8.1% & 10%, Red (above 10%) 11.39% 8.79% 8.95% 8.57% -2.32% -40.39% 14.00% 9.19% -7.99% 21.16% 10.28% -6.43% 12.43%

6. No. of staff requiring DBS check/recheck Green (0), Amber (1 - 2), Red (3 or more) 1 0

7. No. of staff absent due to sickness for over 12 months Green (0), Amber (1 - 2), Red (3 or more) 0 1 1 0 0 0 0 0 0 0 0 0 0

8. No. of staff suspended for more than 3 months Green (0), Amber (1 - 2), Red (3 or more) 0 0 0 0 0 0 0 0 0 0 0 0 0

TRUSTWIDE CORPORATE SERVICES DIVISION

Trust Assurance Headlines - December 2016

Assurance Area Target or Control LimitTrust

Performance December 2015

Trust Performance

November 2016

Trust Performance

December 2016

Forensic Directorate

Inclusion Services

Directorate

Specialist and Family Services

Directorate

Specialist Learning

Disabilities Directorate

Mental Health Shropshire Directorate

Mental Health Staffordshire Directorate

1. Annual Sickness Rate %age Target 4.2% 4.61% 4.61% 4.57% 4.89% 4.68% 3.92% 3.84% 4.81% 6.23%

2. Annual Staff Turnover %age LCL - 10%, UCL - 15% 13.63% 15.08% 15.38% 15.27% 20.86% 12.89% 10.64% 12.67% 15.00%

3. %age of staff employed for more than 12 months who have a compliant appraisal

Target 90% 85% 91% 90% 88% 86% 88% 86% 91% 96%

4. Mandatory Training overall compliance %age Target 90% 85% 89% 90% 91% 78% 90% 93% 93% 92%

5. Trustwide Vacancy Rate Green (below 8%), Amber (between 8.1% & 10%, Red (above 10%) 11.39% 8.79% 8.95% 14.91% 8.24% 10.84% 7.98% 9.01% 7.10%

6. No. of staff requiring DBS check/recheck Green (0), Amber (1 - 2), Red (3 or more) 1 0

7. No. of staff absent due to sickness for over 12 months Green (0), Amber (1 - 2), Red (3 or more) 0 1 1 0 1 0 0 0 0

8. No. of staff suspended for more than 3 months Green (0), Amber (1 - 2), Red (3 or more) 0 0 0 0 0 0 0 0 0

TRUSTWIDE SPECIALIST SERVICES DIVISION MENTAL HEALTH DIVISION

December 2016 Data Reporting

Average Fill Rate - Registered N

urses (%)

Average Fill Rate - Care Staff (%

)

Average Fill Rate - Registered N

urses (%)

Average Fill Rate - Care Staff (%

)

Newport House Forensic 109.67 180.25 127.94 180.26 8 64.52 22.15 4.91 10.28

Ashley House Forensic 99.6 160.54 93.65 110.09 13 91.07 10.02 4.09 12.55 Key: -Radford House Forensic 105.91 153.6 100.98 224.2 16 99.6 20.28 8.17 28.50 Vacancy Rate Below 8%Norton House Forensic 95.38 119.62 150.08 157.14 12 91.67 22.61 4.44 25.07 8.1 to 10%Ellesmere House Forensic 91.25 168.71 100.24 203.27 12 97.31 13.64 4.25 17.39 Above 10%IFOR Willow Shrops Forensic 87.79 108.98 100 100 20 96.13 12.56 4.98 6.72 Sickness Rate Below 4.2%IFOR Yew Forensic 100.21 103.47 97.59 98.3 12 99.73 12.41 5.29 13.86 4.21% to 9.99%Oak House LD 110.83 98.84 104.72 119.88 10 41.29 12.92 3.56 16.36 Above 10%Brockington M&B 109.09 136.01 101.17 152.45 8 50 11.44 3.84 9.96 Turnover Rate 10% to 15%Kinver (including HD) ED 108.6 107.69 98.64 100 12 75 17.34 6.80 9.18 5.01 to 9.99% and 15.01 to 24.99%IFNCT Holly Redwoods AMH 97 118.66 97.35 177.42 16 98.39 14.15 7.16 14.71 Below 5% and Above 25%IDEM Oak Redwoods AMH 123.63 138.07 98.62 232.26 16 92.34 19.79 12.49 16.85 Fill Rates Above 90%IFNCT Laurel Redwoods AMH 96.68 121.72 100.23 167.93 16 90.73 17.67 5.93 14.12 80.01% to 89.99%IFNCT Pine Redwoods AMH 103.43 124.49 134.09 213.33 16 89.11 29.38 9.52 10.65 Below 80%IFNCT Birch Redwoods AMH 99.45 114.61 96.63 120 14 94.35 12.03 7.72 21.43

Baswich AMH 124.74 96.87 98.48 147.54 12 78.76 2.80 4.28 17.14

Brocton AMH 101.47 126.5 89.09 164.75 21 85.48 14.01 5.97 23.33

Bromley AMH 108.82 174.77 99.98 231.93 14 90 4.94 8.59 12.97

Chebsey House AMH 91.14 169.79 101.13 224.93 20 83.02 22.44 3.75 26.75

Norbury PICU 105.24 289.94 100.85 204.76 13 81.82 12.36 5.43 12.95

IAMH George Bryan Tamworth AMH 101.96 108.91 101.13 174.19 20 93.71 3.00 8.89 18.23

ISFOP George Bryan Tamworth AMH 94.06 123.46 106.89 99.72 12 94.09 12.58 7.91 18.46

% Bed Occupancy (Excluding

leave)

% Vacancy Rate

% Annual Sickness

Rate

% Turnover

RateWard Speciality

Day Night

Number of Beds per

Ward

Trust Assurance Report: Medical Director

2

Document Title: Trust Assurance Report Section 5: Medical Director

Sponsoring Directors: Dr Abid Khan, Medical Director

Authors: Kenny Laing, Deputy Director of Nursing Judy Carr, Lead Infection Prevention & Control Nurse

Date of Meeting: January 2017 CONTENTS Paragraph Item Key Delivery

Area Attachment Reference

1. Infection Prevention and Control Update 1 Principal Objectives

To manage premises and equipment in order that care and treatment will be provided safely. To prevent avoidable harm/risk of harm from infection. To ensure that staff members are trained to meet the principal objectives.

Impact on Quality A healthcare associated infection (HCAI) can adversely affect and delay a patient’s recovery.

Legal Implications

Patients would have the right to take legal action if a HCAI was diagnosed and also in the event of any failure to make appropriate diagnosis and to provide timely and appropriate treatment.

1. Purpose

The infection prevention and control report (IPC) incorporates the period since the previous Board meeting. The report aims to keep the Board fully apprised of infection prevention and control issues or developments, and also aims to highlight any associated risks. 2. Reportable Infections and Outbreaks Since the last report there have been no new cases of MRSA colonisation or clostridium difficile infection. 3. Audit 3.1 Monthly Observational Hand Hygiene Audit Results Hand hygiene compliance audits are undertaken to ensure that the Trust continually strives to reduce healthcare associated infection. The results, shown in figure 1, are discussed at the IPC Committee and then taken back to the clinical areas for action.


3

Figure 1 Hand Hygiene Compliance

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Inpatient areas

91 93 95 92 99 96 92 96 97 97 98 98

4. Training 4.1 Overall Compliance These figures have been reported from ESR. F&E are still following a mixed approach of moving to core mandatory training – some via eLearning and some via workbooks. The ESR figures have also been reported to include those who have started in the trust from day one. Overall ESR Core compliance for those directorates who undertake infection control training is 84% as at the end of December 16 (Figure 2) which is an improvement on the last reporting period of 82 %. Figure 2 Course Meets

requirement Does not Meet Requirement

Grand Total

% Compliance

Core Mandatory Block Clinical Directorates 2153 392 2545 85% Core Mandatory Block - Non Clinical staff (F&E) 164 61 225 73% Grand Total 2317 453 2770 84% 4.2 Compliance by Directorate - Compliance by each individual Directorate is shown below in figure 3. Figure 3 Directorate Meets

Requirement Does not

Meet Requirement

Grand Total

% Compliance

301 Armed Forces Directorate 4

4 100% 301 Directorate of Psychological Services 20 7 27 74% 301 DMT Shropshire Mental Health 494 61 555 89% 301 Facilities and Estates Directorate 164 61 225 73% 301 Forensic Directorate 207 29 236 88% 301 Inclusion Services Directorate 376 114 490 77% 301 Medical Directorate 50 8 58 86% 301 Mental Health Staffordshire Directorate 576 86 662 87% 301 Occupational Therapy Lead Services 3 1 4 75% 301 Specialist & Family Services Directorate 327 66 393 83% 301 Specialist Learning Disabilities Directorate 96 20 116 83% Grand Total 2317 453 2770 84%


4

4.3 Hotspots Hotspots identified are those teams where compliance is less than 70% and teams consist of more than 10 people these are detailed below in figure 4.

Figure 4 Team Meets

Requirement Does not

meet requirement

Total % compliant

301 F&E Housekeeping Redwoods 4 15 19 21% 301 IAPT North Staffordshire 5 11 16 31% 301 Aldershot Hub 5 6 11 45% 301 Ringwood Hub (New Forest) 5 6 11 45% 301 Cambridge 11 9 20 55% 301 F&E Housekeeping St Georges 22 16 38 58% 301 CMH Stafford 21 14 35 60% 301 HMP Hewell 12 7 19 63% 301 Wisbech and Ely 14 7 21 67% 5. Flu Campaign

Flu vaccination for staff is a CQUIN for 2016/17. Overall the Trust reached the first target of 65% by the end of December. This was achieved by running clinics at St Georges and Redwoods, clinics for community staff and using peer vaccinators. Additional incentives were used to support the campaign including prize draws for both staff and peer vaccinators. The intranet and twitter were used to engage staff with the campaign. Figure 5 below shows the number of staff who have had the vaccine per group and the percentage at 31st December 2016 Figure 5 Total No

of staff % of staff

group Group 1 - Clinical/Doctors 69 48.94 Group 2 – Qualified Nurses 485 56.92 Group 3 - Social Workers/AHP/Psychologists 655 81.37 Group 4 – HCSW/staff directly involved with patients 294 58.57 TOTAL 1503 65.35

6. Recommendation For this Infection Prevention Control update to be accepted by the Trust Board as a briefing on the relevant issues since the previous Board report in November 2016.

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Document Title: Trust Assurance Report

Section 5: Medical Director Research and Innovation

Sponsoring Director: Dr Abid Khan – Medical Director

Author(s): Ruth Lambley-Burke – Head of Research and Innovation


1. Purpose of the Report……………………………………………………………….. 1 2. Research Delivery………………………………………………………….................

2.1 Portfolio National Institute of Health Research…………………...................... 2.1.a Conferences…………………………………………………………………. 2.1.b Study and Recruitment Updates…………………………………………… 2.2 Increasing the number of life-sciences studies (Industry/Commercial)…….. 2.3 Our current/upcoming commercial portfolio……………………………………. 2.4 R&I Governance…………………………………………………………………...

1 1 2 2 4 4 4

3. Research Innovation and Academic updates……………………………................ 3.1 Keele University Partnership ……………………………………………………. 3.1.a Senior Lecturer Posts…………………………..………………………….. 3.1.b Groups and Events…………………………………………………………. 3.2 Worcester University Partnership ………………………………………………. 3.2.a Project 1…………………………………………………………………….. 3.2.b Project 2…………………………………………………………………….. 3.2.c The role of non-medical prescribers…………………………………….. 3.3 Evaluation Update………………………………………………………………..

5 5 5 5 5 5 5 6 6

4. Patient and Public Involvement & Engagement (PPIE) in Research………….... 7 5. Budgets………………………………………………………………………………

1. Purpose of Report

• To provide the Trust Board with an updat e on t he key aspects of progress and

performance of Research and Innovation within the Trust since the last assurance report in November 2016.

• To note the Trust’s current position and pr ogress against National Institute for Health Research (NIHR) and Clinical Research Network West Midlands (CRN WM) Performance Metrics.

• To highlight work and development to ensure the continued increase in research activity and development of a research culture across the organisation.

2. Research Delivery

2.1 Portfolio National Institute of Health Research The Trust recruitment target had been i ncreased to 765 for 2016/2017 by the National Institute of Health Research (NIHR). Currently our recruitment figure stands at 440; this means we are behind target, but this is reflecting a network-wide trend. That said SSSFT is still ranked the highest recruiting for Mental Health and Dementia studies within

7

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the West Midlands within the NIHR league tables. There is a general lack of available studies with potential to recruit high numbers within mental health and dementia. Within SSSFT we continue to implement strategies to address this:

• Targeting team resources into high recruiting studies.

• Establishing research clinics across the Trust to maximise the number of participants we are able to see.

• Using new staff funded via Strategic Funding (see below) to develop and promote research activity with clinical teams across the Trust.

• Identifying new areas of business: in the last Trust report we reported on our engagement with the Shropshire sexual health service; we are due to open our first clinical trial in the next few weeks. We have funding for a Research Champion role within the sexual health team, to work alongside Trust R&I staff, until March 2017, to promote research across the sexual health service and facilitate recruitment onto the new clinical trial. We have now successfully recruited a Band 6 sexual health nurse into this role.

• Considering using NIHR funding to offer a second Research Champion role to the dementia teams.

• Working closely with CRN to identify suitable new studies, and actively searching the national portfolio for new studies.

• Robust use of the Join Dementia Research website; this is a na tional platform through which we are able to recruit participants (people with dementia, their carers and healthy volunteers) onto our studies.

• Collaboration with ENRICH programme to expand our research activity into the care home sector – this has been hampered due to lack of suitable studies, but we continue to explore this option.

• Participation in the Rater Development programme, which aims to ensure research staff are equipped to meet industry benchmarks for dementia studies, thereby making SSSFT a more viable partner for the commercial sector.

2.1.a Conferences Staff from the Learning Disabilities (LD) team and R&I Department attended a conference at Cambridge University in December, where the preliminary results of the EPAID study were shared. This study investigated the nursing management of epilepsy for LD patients, for which our LD nursing staff received specialised training. 2.1.b Study and Recruitment Update The following National Institute of Health (NIHR) studies and s tudent/home grown research projects have been opened/are in set up during December 2016 – January 2017:

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• Mental Health studies 4 (NIHR) 7 - student/local

• Dementia studies 3 (NIHR) 0 - student/local

• Learning disabilities 0 (NIHR) 0 - student/local

• Sexual Health 1 (NIHR) 0 - student/local

• Eating Disorders 2 (NIHR/Industry) 0 - student/local

Figure 1: Year graph comparing NIHR portfolio recruitment against NIHR target

Figure 2: Pro rata monthly target against NIHR year target and comparison to 2014/2015 target set by NIHR

Month Target 2015-

16 2016-17 Apr 64 118 46 May 128 315 92 Jun 191 446 144 Jul 255 501 189 Aug 319 528 252 Sep 383 640 317 Oct 446 871 370 Nov 510 1045 419 Dec 574 1056 Jan 638 1098 Feb 701 1149 Mar 765 1202

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2.2 Increasing the number of life-sciences studies (Industry/Commercial Clinical Trials) A key priority for the DOH, Trusts and R esearch Networks is to engage with the life science industry, and we continue to be actively engaged in increasing the number of Industry studies across the Trust. As noted in the last Trust report, we were successful in our application for additional funds from the NIHR which had been made available for Trusts requiring support to increase capacity development / strengthen their feasibility processes to deliver commercial research. We used this to employ a Clinical Studies Officer who is now in post and w ill be dedi cated to setting up our latest industry study within the Eating Disorders service. Our selection for this study was confirmed in November 2016; the study is now in set-up, with recruitment expected to begin February - March 2017. We continue to examine all feasibility requests from industry partners, and have a robust process in place to ensure all feasibilities are submitted promptly. 2.3 Our current/upcoming Industry portfolio Recruiting:

• 2 Industry sponsored dementia clinical trial In set up / awaiting confirmation of site selection from sponsor:

• 2 Eating Disorders study (1 of which is Industry sponsored) • 1 Substance misuse study • 2 Dementia studies

Feasibilities submitted for industry studies in last 6 months, awaiting responses from sponsors:

• 1 Mental health trial • 3 Dementia trials

2.4 R&I Governance

In the previous report in November we identified, the Health Research Authority (HRA) was causing significant delays; requests for HRA for existing studies and amendments nationally and locally were higher than expected and causing a backlog. This has effected how quickly we are able to open studies at SSSFT and we have communicated this to staff via the web site, twitter and social media. This is improving but delays are expected for all HRA studies to take approximately 8 weeks. We will continue to monitor this situation and ar e working closely with the HRA to minimise delays from a Trust perspective.

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3 Research, Innovation and Academic Updates

3.1 Keele University Partnership 3.1.a Senior Lecturer posts Four senior lecturer posts have been appointed; these posts will initially focus on building research capacity in older adults, children’s and inpatient services. 3.1.b Groups and Events A Dementia Special Interest Group and a Dementia Research Seminar at Keele University has been discussed. This is consistent with the RI/SSSFT joint mental health research strategy, in which Dementia is one of the 4 key themes. A series of meetings have been arranged to establish stronger links between members of the mental health research programme at Keele and SSSFT clinicians engaged with Dementia research and/or clinical work with Dementia patients. Primarily, the aims of these meetings are to discuss current Dementia research activities, engagement with the Dementia Special Interest Group to increase the home-grown research volume, and t he Dementia Research Seminar at Keele (suggested date April/May 2017). 3.2 Worcester University Partnership 3.2.a Project 1: Traversing the services: a gr ounded theory of admission in two adult acute mental health inpatient wards A previous 8000 word paper was submitted to Social Science and Medicine but wasn’t selected for review. It was redrafted (4000 words) and submitted to The Patient – patient centred outcomes research, but was also deemed unsuitable due to its focus on psychiatric services. It was passed over to the Transfer Desk to find a more suitable journal for publication. It is currently at pre-submission enquiry stage with The Journal of Behavioral Health Services & Research and J ournal of Psychosocial Rehabilitation and Mental Health. 3.2.b Project 2: An exploration of forensic mental health nurses attitudes towards risk assessment within a secure service An IRAS application is currently being prepared to obtain permission to undertake this research at the Hatherton Centre, St. Georges hospital. It has been prepared and designed by Rob McGrath who is currently on the research secondment programme under the supervision of Tina Hamilton. This research aims to explore the attitudes of ward based staff in forensic mental health towards formal risk assessments. A further aim is to promote the necessity of formal risk assessments in clinical settings and ens ure that a diverse range of professionals assume the responsibility of this task.

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3.2.c The role of non-medical prescribers with medicines optimisation and information exchange This project is in its very early stages of development and aims to explore the role of non-medical prescribers with medicines optimisation. It will broadly involve the following pieces of work.

1. Scoping Activity

a. literature search to identify new research in this area with the potential for a commentary paper

2. Qualitative Systematic Review

a. Research Question: what is the role of non-medical prescribers in relation to medicines optimisation and i nformation exchange: mental health and learning disability services

b. Boolean Terms: non-medical prescribing, nurse prescribers, pharmacist prescribers, medicines optimisation, medicines management, medicines optimisation, information exchange

3. Scoping Survey

a. To collect data regarding NMP locations and prescribing activity

3.3. Evaluation Update Recent/current projects

• Support to clinical psychology trainees for evaluation of Recovery College Without Walls. Data collection is on-going, and analysis has started.

• Support for pilot project bid: a ne ws group for people with learning disabilities (Community LD, Shropshire) – delays due to staff sickness. Bid due in April 2017. Meetings with Service users groups planned.

• Designing evaluation framework for assistive technology – on-going (being piloted).

• Research training for Recovery College – currently working with someone with lived experience, designing both content and format of the course.

• UpTempo project: this is an ex ternally funded project; the evaluation will look at process issues and overall impact of music interventions in the Redwoods and in several South Staffordshire wards. The project itself is delivered over 2 years by independent sector (Make Some Noise and T he Hive); evaluation is currently at planning stage.

• Equal pay audit: support Equality and C ommunity Engagement Coordinator, working specifically on nursing workforce, pay gap and career progression; report due in July 2017.

• Acute Care Coping skills and Life & social skills groups (Redwoods); support with

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evaluation process (designed online survey for service users).

• Collaboration with the Centre for Health and D evelopment from Staffordshire University (CHAD). Currently considering joint areas of work for research planning and funding bids. We have recently delivered a pr esentation at a seminar organised by CHAD at Staffordshire University (presented a publication about co-produced groups in the Trust); we have been asked to present again in a different venue.

4 Patient and Public Involvement & Engagement (PPIE) in Research

The Patient and Carer Experience: Research (PACE Research) group met at the end of November. Tom Shepherd, Research Associate at Keele University and SSSFT, discussed his background and experience and outlined his current research plans. Opportunities for service user and c arer input to this emerging research agenda were discussed. The meeting also reviewed a draft of the annual “Survey of Research Experience” which is about to be circulated by the Clinical Research Network, West Midlands. The group made various suggestions to improve the wording, format and layout of the document; suggestions since incorporated into the final document. Tim Lewington and Jean Nichols reported to the group on the development of the proposal for Healthwatch Shropshire. This bid is looking at the needs and c hallenges faced by rurally-based service users in Shropshire with severe and enduring mental health issues and their carers. Following submission of the bid on December 5th Healthwatch Shropshire have asked for a couple of minor changes and have requested we resubmit on 23rd January 2017. 5 Budgets

We were successful in securing additional strategic funding from the NIHR in September 2016; this has been used to fund 6 additional posts, fixed term until March 2017. We have used the funding to employ a range of research personnel, including research nurses, clinical studies officers and clinical studies assistants. All are now in post, have completed their induction and are able to recruit. We have submitted a further funding bid to NIHR CRN West Midlands, to secure funding to extend these additional posts for a further 12 months. A response will be provided from the NIHR CRN West Midlands on funding allocations the 30th January 2017. A research capability funding (RCF) award of £20’000 from the Department of Health (DOH) will be awarded to the R&I team the end of April 2017 due to their successful portfolio research activity. As outlined in the DOH funding criteria, this will be reinvested to support academic home grown research going forward into 2018.

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6. Recommendation

The Board of Directors is asked to note the updated report for information purposes.

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Board of Directors Agenda Item 7.1 Enc D

Document Title: ‘Involvement for Impact’ A strategic framework for assuring the Board that people

with lived experience are positively involved in influencing and improving our services

Sponsoring Director: Therèsa Moyes, Director of Quality and Clinical Performance

Author(s): Therèsa Moyes with members of the Service Users and Carers Involvement Committee


Executive Summary In November 2016, the Board received a paper summarising the consultation processes that had taken place throughout the year in order to develop a new framework for the involvement of people with lived experience in shaping our services. The Service Users and Carers Involvement Committee met for their last meeting in the existing format on 14th December where it was agreed to ask the Board to ratify the new model for involvement at its January meeting. This paper outlines the new model, ‘Involvement for Impact,’ and highlights what will happen during 2017 in order for it to become embedded.

Recommendations The Board is are asked to:

• Ratify the model approved by the Service Users and Carers Involvement Committee (SUaC)

• Confirm the recommendation by SUaC members that the new Involvement Annual General Meeting (AGM) should be held as part of the same event as the Trust’s AGM and Annual Members’ Meeting (AMM)

• Require a first year evaluation report to the Board in January 2018



Strategic Aims Provide high quality, recovery focused services Respect, inspire and develop our workforce

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Innovate through co-operation and co-production Delivery regulatory, financial, performance and

quality standards Expand our current service portfolio in order to

enrich services NHSI Compliance Other (add details)

Assurance Ref Details Risk Register Assurance Framework P3 Board Committees • Service Users and Carers Involvement Committee

(SUaC)

Sub-Group All directorate, service and team level involvement forums

Figure 1 - 'Involvement for Impact' summarised (A simple framework built on principles of co-production, our service users’ & carers’ charter & the national model of involvement known as 4Pi1) 1 (Faulkner et al., 2015a)

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Contents What involvement means ................................................................................................ 4

Involvement ......................................................................................................................................... 4 Context for change ........................................................................................................... 4

Personalised care level: ................................................................................................................ 4 Real-time feedback, December 2016 ................................................................................. 4 CQC’s community mental health survey 2016 ............................................................... 5

Directorate level ................................................................................................................................. 6 Staff survey 2015 ......................................................................................................................... 6

Trust level (and all service types) ............................................................................................. 6 CQC’s comprehensive inspection 2016 ............................................................................ 6

Involvement at different levels ........................................................................................ 9

Structures for involvement activity ............................................................................................ 9 Focus of involvement activity ................................................................................................... 10

What will remain and what is new about ‘SUaC’ ....................................................... 11

Draft rules for Impact Workshops .......................................................................................... 11 Evaluating the impact of the workshops ............................................................................. 12

Next steps ........................................................................................................................ 12

Draft milestone plan for 2017 ................................................................................................... 13 Recommendations ......................................................................................................... 14

References ...................................................................................................................... 14

Appendix 1: 2016 Detailed Involvement Governance Structures ................................ 15 Figure 1 - 'Involvement for Impact' summarised ......................................................... 2 Figure 2 - Summary of involvement structures across the Trust .............................. 9 Figure 3 - Summary of involvement focus levels across the Trust ........................ 10

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What involvement means Like many similar organisations, the Trust struggles to identify and use consistent, universally acceptable, terminology relating to people’s involvement in influencing great service delivery. Since this has been addressed by the national report referred to below (Faulkner et al., 2015a) we will accept that different terms will be used and not constrain groups from using them. As a Trust, we will recognise the 4Pi “note on language” and use the term ‘involvement’ for consistency:

Involvement “Different words are used by different organisations at different times; these include: consultation, participation, engagement, co-production. Some terms imply a greater level of influence or power; however, sometimes the language does not reflect the underlying ethos or purpose. Our concern throughout is with meaningful involvement – involvement with influence – and with genuine

partnership working2” (p6)

Context for change Progress over the last five years has led to us now being able to demonstrate tangible improvements to services being made as a result of involvement in Trust determined priorities. When the CQC asked for examples of involvement as part of their data collection processes for our 2016 inspection, the involvement and experience team were able to collate and submit hundreds of examples from across the trust. Clear links could be seen with service improvements, although they were not always tightly linked to people’s own feedback or self-determined priorities. Often they were ad hoc and related to local service or Trust priorities. Very few reliable measures of involvement exist: the following sections include what has been independently assessed over the past year, highlighting both good practice and room for improvement.

Personalised care level:

Real-time feedback, December 2016 Our five ‘Living our Values’ behaviours were defined by staff, partners and people who use our services as being the most important ways to demonstrate we are living our three core values:

• People who use our services are at the centre of everything we do • We value our staff • Our partnerships are important to us

In December 2016, questions embedded within our real-time surveys that relate to how service users perceive staff to be ‘Living our Values’ show there is still room for improvement:

2 Bold type is our emphasis

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CQC’s community mental health survey 20163 In November 2016, the CQC published the results of their national mental health service users’ survey. In the 9 of the 10 question categories our scores were ‘about the same’ as other mental health Trusts; in one our scores were ‘better’. There were 32 questions in total: 5 of them had direct relevance to people’s experiences of being involved in their own care. Our question scores on each of these five were as follows: Key relevant survey questions

SSSFT’s benchmarked scores

‘Involvement in planning care’ (for those who have agreed what care and services they will receive, being involved as much as they would like in agreeing this)

‘Better’ than other Trusts

‘Involvement in care review’ (for those who had had a formal meeting to discuss how their care is working, being involved as much as they wanted to be in this discussion)


‘Involvement in decisions’ (for those receiving medicines, being involved as much as they wanted in decisions about medicines received)


‘Involvement in deciding other treatment or therapies’ (for those who received treatments or therapies other than medicine, being involved as much as they wanted in deciding what treatments or therapies to use)

‘About the same’ as other Trusts

‘Involving family or friends’ (for NHS mental health services involving family or someone else close to them as much as they would like)

‘About the same’ as other Trusts

3 See at: http://www.cqc.org.uk/provider/RRE/survey/6#undefined

http://www.cqc.org.uk/provider/RRE/survey/6#undefined

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Directorate level

Staff survey 2015 Results of the key finding in the 2015 staff survey relating to involvement highlighted that staff in all clinical directorates, in Facilities and Estates (F&E) and in HRODE believed that we were worse than average at using feedback effectively. Our score for ‘Key Finding 32 Effective use of patient / service user feedback’ was one of our worst ranked scores4:

Trust level (and all service types)

CQC’s comprehensive inspection 2016 In their report of our 2016 inspection, the Care Quality Commission rated our services as ‘GOOD’ for the domain of ‘Caring’, which

includes an assessment of people’s involvement. The CQC highlighted many positive examples throughout the individual reports and saw consistently good practice. CQC’s definition of GOOD in this domain is that5:

“People are supported, treated with dignity and respect, and are involved as partners in their care.” (Care Quality Commission, 2015)(p32)

They included the following statements about this domain in our overarching ‘Provider Quality Report’: 4 For each of the 32 Key Findings, the mental health / learning disability trusts in England were placed in order from 1 (the top ranking score) to 30 (the bottom ranking score). Further details about this can be found in the document Making sense of your staff survey data, available [email protected] 5 See at: http://www.cqc.org.uk/sites/default/files/20150327_mental_health_provider_handbook_appendices_march_15_update.pdf

mailto:[email protected]

http://www.cqc.org.uk/sites/default/files/20150327_mental_health_provider_handbook_appendices_march_15_update.pdf

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• The trust was proactive in ensuring that the patient voice was heard through the patient experience team. The trust also engaged with several patient representative groups. Teams within the trust were proactive in involving patients in different aspects of the service including taking part in staff recruitment.

• We consistently observed staff treating with patients’ with kindness, respect, compassion and empathy.

• Carers and former patients we spoke to were positive in their views of staff and stated that they were fully involved in the care of their family member and felt well supported. Most patients we spoke to were also positive in their views of staff and told us that they were involved in their care planning, and staff took time to speak to them about care plans and treatments.

• Information was available to patients on all aspects of their care and staff gave a comprehensive information pack to patients on admission. Carers received information about the service.

• Patients gave regular feedback on the quality of care on the acute wards through surveys and participation in weekly community meetings.

• In 2015, the Patient Led Assessment of the Care Environment (PLACE) awarded the service scores for privacy, dignity and wellbeing above the average result for all NHS trusts.

• Care records demonstrated that staff involved patients in regular discussions about their care.

• Advocacy services were accessible to patients and had a regular presence on the wards.

• The Trust had taken on the running of eight community managed libraries in partnership with Staffordshire County Council to both support the local community and provide voluntary experience for patients of working and interacting with the community.

In order for the Trust to be rated as ‘OUTSTANDING’ in this domain, we would need to demonstrate to the CQC that:

‘People are truly respected and valued as individuals and are empowered as partners in their care.’ (Care Quality Commission, 2015) (p31)

To be able to rate an organisation or service as ‘outstanding’ in this domains, the CQC would need to see five kinds of evidence consistently6:

1. Feedback from people who use the service, those who are close to them and stakeholders is continually positive about the way staff treat people.

6 See CQC Provider Handbooks and Appendices at: http://www.cqc.org.uk/content/provider-handbooks

http://www.cqc.org.uk/content/provider-handbooks

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People think that staff go the extra mile and the care they receive exceeds their expectations.

2. There is a strong, visible person-centred culture. Staff are highly motivated and inspired to offer care that is kind and promotes people’s dignity. Relationships between people who use the service, those close to them and staff are strong, caring and supportive. These relationships are highly valued by staff and promoted by leaders.

3. Staff recognise and respect the totality of people’s needs. They always take people’s personal, cultural, social and religious needs into account.

4. People who use services are active partners in their care. Staff are fully committed to working in partnership with people and making this a reality for each person. Staff always empower people who use the service to have a voice and to realise their potential. They show determination and creativity to overcome obstacles to delivering care. People’s individual preferences and needs are always reflected in how care is delivered.

5. People’s emotional and social needs are highly valued by staff and are embedded in their care and treatment.

Although we can provide evidence against all of these points, the CQC did not find that we do so consistently across our services. Our new model aims to address more than this – over time to embed involvement into the culture of management, as well as clinician, thinking.

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Involvement at different levels During the consultation period, we identified broad consistencies in levels of involvement as well as wide variations in involvement activities and processes, yet with related focus points. This framework will not impose models of how involvement will take place at levels below the Board committee level: this needs to be determined according to local need and service type, in co-produced partnerships between people with lived experience and officers of the trust7. There were two types of consistency levels we found:

1. Structures for involvement activity 2. Focus of involvement activity

Structures for involvement activity The consistencies we found in structures across the trust (between the Board and people’s lived experiences of our services through personalised care) are shown in the diagram below:

Figure 2 - Summary of involvement structures across the Trust8

7 The Involvement AGM will be a catalyst for ensuring such partnership working. 8 A more detailed structure chart of 2016 levels is attached as appendix 1

Trust Board •Oversight •Assurance •Organisational

conscience

Cross-directorate • 'Committee'

activities • Support structures

(eg Involvement & Experience Team; Wellbeing & Recovery College; Service Users' & Carers' Research Group)

Clinical strategy influence •Directorate level

forums •Consultations •Culture influence

Local service planning level • Service delivery

influence • Local meaning •Change agents • (Examples include:

children & young people's participation groups; Inclusion's level 4 involvement; SURF ...)

Local feedback & Delivery changes •Responsivity to

local feedback • (Examples include:

ward community meetings; one-off events; team survey feedback; co-produced therapeutic groups ...)

Active involvement in personalised care

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Focus of involvement activity The consistencies we found in the focus of involvement work also can be categorised into different types of levels. These are summarised below:

Figure 3 - Summary of involvement focus levels across the Trust

People who use our services are at the centre of everything we do

Involvement impact

Strategic

Trust & clinical strategies

Operational

Business plans & day-to-day

services

Personal

Motivations & impact on wellness

Person centred care and recovery

Personalised care plans

Outstanding care,

demonstrating our 5 LoV

behaviours

Co-produced recovery &

services

Recovery college

through co-partnership

Delivering on standards

4Pi

Planning, delivery & evaluation

Triangle of Care

Achieving 2nd 'gold star'

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What will remain and what is new about ‘SUaC’ SUaC members were promised that, although bi-monthly committee meetings would cease, there would be more, but different, involvement activities at this level: the overarching aim being to create more impact. The changes are shown in the diagram below:

Draft rules for Impact Workshops To make sure the new Impact Workshops could be evaluated as making a positive difference, SUaC agreed draft rules which will be tested out and refined throughout 2017. They included that the workshops must:

• Be co-produced, including at least one service user or carer and at least one staff member or manager

• Be relevant to more than one directorate or service type • Have goals that can be measured for impact over time • ‘Live our Values’ through our service users and carers charter and include

4Pi principles9

9 Principles, Purpose, Presence, Process, Impact (Faulkner et al., 2015b)

AGM

Annual celebration day

Minimum of 4 x co-produced, cross

directorate ‘Impact Workshops’

Directorate & service level involvement forums plus local

improvement events

New – ‘holding to account’ – demonstrating how involvement has impacted on service changes

Same – Already co-produced & positive feedback about it

New – aimed at direct involvement & real impact

Same – focus on specific service

issues

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• Be representative. Size of group will depend on the theme, but participants (both staff and people with lived experience) must have experience of what’s being explored and commit to sharing the outcomes with others

Evaluating the impact of the workshops • We will ask the impact questions from the 4Pi model:

– What were the intended outcomes? – What actual differences have been made? – How did everyone feel about the process? – Did involvement make a difference to the end

result? – Did involvement make a difference beyond

the activity itself • We will adapt methods used in our Quality Improvement model to

measure impact and make sure there are lasting effects • We will use the local model of motivations for (and benefits of)

involvement to understand how involvement has made a difference to those involved (Neech, 2015)10

Next steps There is a considerable amount of work to be done in 2017 in order to deliver the backbone of the new model and the Involvement and Experience Team will be leading on this to make sure we get it right. Much of the detail has yet to be worked through and there will be iterations based on following core Lean methodology of using the ‘Plan-Do-Study-Act’ cycle. A high draft level milestone plan follows

10 Derived from a piece of research that our service users and carers were involved in designing, contributing to and interpreting – it led to a new model of understanding why people get involved and what the benefits are.

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Draft milestone plan for 2017 (Subject to change depending on unforeseeable co-production constraints) When What Milestones January Trust Board meeting

(26-01-17) Approve ‘Involvement for Impact’ framework

February Communications planning to raise awareness of expectations of directorates

• Draft standard design processes for workshops

• First ePod article

February/ March

Subject to agreement with current SUAC members. One to be a ‘Listening into Action’ style launch event and two to be evaluated using Plan-Do-Study-Act (PDSA) cycle to test concept

Launch event (an ideas gathering impact event)

March/ April First Impact Workshop (testing concept and standard design processes)

Second Impact Workshop (testing concept and standard design processes) April/ May

June Co-produced celebration event as per current format. Planning for this may be done as an Impact Workshop The day may include various mini impact workshops

• Service Users & Carers Celebration Day, including:

• Mini impact workshop to co-design format for AGM reporting by directorates

July/ August TBC Third Impact Workshop

September New – all directorates to co-present their year’s involvement activity that has led to real impact. To coincide with the Trust AGM

Involvement AGM

October/ November

TBC Fourth Impact Workshop

December Review progress ready for reporting to Board in January

(Draft Board paper ready for January)

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Recommendations The Board is asked to:

• Ratify the model approved by the Service Users and Carers Involvement Committee (SUaC)

• Confirm the recommendation by SUaC members that the new Involvement Annual General Meeting (AGM) should be held as part of the same event as the Trust’s AGM and Annual Members’ Meeting (AMM)

• Require a first year evaluation report to the Board in January 2018

References Care Quality Commission (2015) How CQC regulates: Specialist mental health

services. Appendices to the provider handbook: Care Quality Commission. Faulkner, A., Crepaz-Keay, D., Kalathil, J., Griffiths, R., James, N., Perry, E.,

Singer, F. and Yiannoullou, S. (2015a) 4Pi National Involvement Standards, London. Available at: http://www.nsun.org.uk/assets/downloadableFiles/4PiNationalInvolvementStandardsExecutiveSummary20152.pdf.

Faulkner, A., Yiannoullou, S., Kalathil, J., Crepaz-Keay, D., Singer, F., James, N., Griffiths, R., Perry, E., Forde, D. and Kallevik, J. (2015b) Involvement for influence, London. Available at: http://www.nsun.org.uk/assets/downloadableFiles/4PiNationalInvolvementStandardsFullReport20152.pdf.

Neech, S. (2015) User Involvement in Adult Mental Health Settings: User Motivations and Benefits. DClinPsych, Staffordshire & Keele, Unpublished.

http://www.nsun.org.uk/assets/downloadableFiles/4PiNationalInvolvementStandardsExecutiveSummary20152.pdf

http://www.nsun.org.uk/assets/downloadableFiles/4PiNationalInvolvementStandardsExecutiveSummary20152.pdf

http://www.nsun.org.uk/assets/downloadableFiles/4PiNationalInvolvementStandardsFullReport20152.pdf

http://www.nsun.org.uk/assets/downloadableFiles/4PiNationalInvolvementStandardsFullReport20152.pdf

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Appendix 1: 2016 Detailed Involvement Governance Structures

Service Users & Carers

Involvement Committee

(SUaC)

Mental health - South Staffordshire Service User Reference Forum (SURF)

Locality SURF forums

Ward community meetings

Peer support workers

Mental health - Shropshire, Telford & Wrekin

Chorus/operational forum, away-days, task & finish groups, learning

lessons

Locality involvement groups, in-patient involvement group, inc CRHT

Learning disabilities

Transforming Care involvement Family & carer group involvement in planning care delivery; complaints

support

Service User and Carer Support Co-ordinator

One off events, celebration days, procedural changes, assisiting at

interviews

Community based service user and carer events

Forensic

Hatherton User involvement group

Clee User involvement group

Specialist & family

In-patient & other

Ward community meetings

Carers groups

Young people's forum

Consultations, KPIs, recruitment, leaflets, appraisal feedback, regional

presentations

Co-produced step down group post discharge

Children & Young People's Participation

Inclusion Level 4 , cross directorate involvement & consultation

Level 3 (area & regional groups)

Level 2 (project level involvement & consultation)

Involvement & Experience Team (IET)

Wellbeing & Recovery college

Service User & Carer Research Group

All below Board structures are subject to regular review and change as services change

Active involvem

ent in personalised care

National policy & strategy sharing,

influencing common themes

across directorates

Clinical strategy i fl

Local service planning i fl

Local feedback & delivery

h

Cross directorate themes & support

Trus

t Boa

rd –

ove

rsig

ht a

nd a

ssur

ance

Operational Plan 2017-19 apr Final – 26.01.17 Board Mtg Page 1 of 35

Board of Directors Agenda Item 7.2 Enc E

Document Title: Operational Plan 2017-19

Sponsoring Directors: Steve Grange, Director of Strategy & Strategic Transformation Jayne Deaville, Director of Finance and Performance

Author(s): Steve Grange, Director of Strategy & Strategic Transformation Jayne Deaville, Director of Finance and Performance

Date of Meeting: Thursday 26th January 2017

Executive Summary As reported to the November 2016 Board at which the draft plan was received and approved, NHS England and N HS Improvement required the operational plans to cover two financial years, to provide greater stability and support transformation. This has been underpinned by a two-year tariff and two-year NHS Standard Contract. The Trust’s plan was submitted by the 23rd December 2016 following approval by the Finance and Performance Committee based on the Board’s delegated authority.

Recommendations The Committee is asked to:

• Receive and note the final Operational Plan 2017-19 which was submitted to NHS Improvement.



Monitor Compliance Other (add details) Trust Board

Assurance Ref Details Risk Register Assurance Framework Link to Strategic Aims Board Committee All


Operational Plan 2017-19

(Years ending 31st March 2018 and 31st March 2019)


Contents

SECTION ONE: Our approach to National Drivers and their impacts on activity

SECTION TWO: Our approach to Quality Planning

SECTION THREE: Our approach to Workforce Planning

SECTION FOUR: Supporting our STP

SECTION FIVE: Our Activity, Assumptions and Delivery Plans

SECTION SIX: Supporting New Models of Care

SECTION SEVEN: Our Membership and Elections


SECTION ONE: Our approach to National Drivers and their impacts on activity

1.1 The NHS Five Year Forward View (NHS5YFV) The NHS5YFV, published in October 2014 by NHS England, sets out a positive vision for the future based around seven new models of care. Mental Health and Learning Disabilities was featured and included within the nine NHS Must Do’s. The development of the NHS5YFV demonstrated the system priorities with a particular emphasis on mental health and learning disabilities. The Trust is currently working in two STP footprints (Staffordshire and Shropshire). These two footprints have deployed transformation programmes that include mental health and learning disabilities. The Trust Board is fully committed to ensuring that we represent our service users and carers and that service transformation takes into account our objectives.

o Multi-Specialty Community Providers: NHS Five Year Forward View. The Trust is working in partnership with general practice to support the development of new ways of working and integrated care. Many of the practices locally struggling with capacity and sustainability. The Trust is fully engaged in the development of transformation programmes with general practice and i s supporting the system architecture within the STPs.

o Urgent and emergency care transformation: The STP has a s ignificant priority to redesign urgent care and develop new care models that are outlined in the NHS5YFV. Changes include the development of hospital networks with access to locality hubs, specialist centres, redesigned community services and the greater use of pharmacists and out-of-hours GP services.

o Acute care collaborations: The NHS5YFV proposes a new care model for smaller acute hospitals. These may include the formation of ‘hospital chains’ as operated internationally. A number of these options have been included within our STPs and are linked to the transformation agenda needed to enhance our local offer.

o Enhanced health in care homes: The Trust is working with partners within our STP footprint to support care homes and the care that they provide. A particular emphasis for the Trust is a round frailty and dementia. The Trust has successfully deployed a number of services into care homes that enable advice and care to be provided at an early stage reducing the need for patients to come into hospital.

1.2 National Drivers The Trust recognises that there has been a transformation in mental health over the last 50 years including advances in care and the development of anti-psychotic and mood stabilising drugs. There was a new emphasis on promoting public mental health and developing services for children and homeless people. In 1999, the National Service Framework for Mental Health was launched to establish a comprehensive evidence based service. This was followed by the NHS Plan in 2000 which set targets and p rovided funding to make the Framework a reality. In 2011, the Coalition government published a mental health strategy setting six objectives, including improvement in the outcomes, physical health and e xperience of care of people with mental health problems, and a reduction in avoidable harm and stigma. It is widely recognised that there is now a need to re-energise and improve mental health care across the NHS to meet increased demand and improve outcomes.

http://www.kingsfund.org.uk/projects/nhs-five-year-forward-view


1.3 Understanding the needs of our population Epidemiological data demonstrates that half of all mental health problems have been established by the age of 14, rising to 75 per cent by age 24. One in ten children aged 5 – 16 has a diagnosable problem. Children from low income families are at highest risk, three times that of those from the highest. Those with conduct disorder - persistent, disobedient, disruptive and aggr essive behaviour - are twice as likely to leave school without any qualifications, three times more likely to become a teenage parent, four times more likely to become dependent on drugs and 20 times more likely to end up i n prison. The Trust has a number of family services and continues to work with commissioner on providing alternatives to admission to traditional service models such as Tier 4. One in five mothers suffers from depression, anxiety or in some cases psychosis during pregnancy or in the first year after childbirth. Suicide is the second leading cause of maternal death, after cardiovascular disease. The Trust continues to provide services supporting mothers suffering from perinatal mental health issues and w ork with commissioners on extending the service and ensuring that the outcomes are clearly understood. People with severe and prolonged mental illness are at risk of dying on average 15 to 20 years earlier than other people – Two thirds of these deaths are from avoidable physical illnesses, including heart disease and cancer, many caused by smoking. Ensuring that staff are fully aware of the linkages between physical and mental health are one the Trust’s top priorities. The Trust has a number of partnerships with GPs locally; many of these are being built on significantly through the work of the STP and the new models of care. People with long term physical illnesses suffer more complications if they also develop mental health problems, increasing the cost of care by an average of 45 per cent. There is good evidence that dedicated mental health provision as part of an integrated service can substantially reduce these poor outcomes. For example, in the case of Type 2 diabetes, £1.8 billion of additional costs can be at tributed to poor mental health. This is particularly important in areas where the Trust cares for people over a longer period of times such as forensic style services. All of our staff are aware of the needs of patients during their care with us and pr evention is encouraged as part of living well models and the care package they take back into the community. Stable employment and housing are both factors contributing to someone being able to maintain good mental health and a re important outcomes for their recovery if they have developed a mental health problem. Between 60–70 per cent of people with common mental health problems are in work, yet few employees have access to specialist occupational health services. The Trust continues to work with local employers to support service users back into work. The Trust also has a number of successful partnerships with the third sector where social inclusion and enablement are key areas of focus. These partnerships ensure that service users have access to other services that build confidence and pr ovide new skills. Only half of veterans of the armed forces experiencing mental health problems seek help from the NHS and t hose that do ar e rarely referred to the right specialist care. The Trust supports both serving and ex armed forces personnel through a network of providers. Serving personnel are supported via the Trust’s national and international contracts with the Ministry of Defence (MOD) where we place patients often from war zone environments into a network of NHS providers that span the UK. We have developed a t ransitional living unit where sailors, soldiers and airmen that may leave the forces are supported through a step down process. The Trust also supports ex armed forces within the community and have trained all community staff in veterans’ awareness.


One in five older people living in the community and 40 per cent of older people living in care homes are affected by depression. The Trust is working with a num ber of nursing homes and GPs to support people in the community and provide training and education to care home staff in order to provide alternatives to hospital admission. People in marginalised groups are at greater risk, including black, Asian and minority ethnic (BAME) people, lesbian, gay, bisexual and transgender people, disabled people, and people who have had contact with the criminal justice system, among others. As many as nine out of ten people in prison have a mental health, drug or alcohol problem. The Trust works in partnership with a r ange of agencies as prime and s ub contractor to deliver services into prisons. A particular area of our expertise for many years has been to support the prison system providing mental health and s ubstance misuse care into these establishments. Currently the Trust works in 23 prisons. The Trust is fully committed to delivering the NHS5YFV and its “Must Do’s”. The Trust also celebrates the development of the NHS Mental health Five Year Forward View (NHSMH5YFV), this document contains a significant number of the challenges that we face as providers on a daily basis and forms the basis of our strategies to support tour populations into the future. The ambition of the NHSMH5YFV is to deliver rapid improvements in outcomes by 2020//21 through ensuring that one million more people with mental health problems are accessing high quality care. In the context of a challenging Spending Review, it has been identified that there is a need to invest an additional £1 billion in 2020/21, which will generate significant savings. It builds on t he £280 m illion investment each year already committed to drive improvements in children and young people’s mental health, and perinatal care.


SECTION TWO: Our approach to Quality Planning

2.1 Approach to Quality Planning The quality standards for patient services as set out in the NHS Constitution and in the fundamental standards of quality and s afety published by the Care Quality Commission (CQC) provide the framework by which the Trust defines its quality priorities and goals. Each year within the Quality Accounts we set out our quality priorities ensuring that we maintain a balanced focus on patient safety, clinical effectiveness and patient experience. Our priorities are developed and agreed following a process of review and consultation with key stakeholders and through listening to the views of service users and carers. In addition our quality improvement goals also consider both national and local commissioning priorities and recommendations from key national and local reviews. These are also aligned to the areas of the NHS five Year Forward View, the NHS Mental Health Five Year Forward View and the emerging STP plans. The Trust also has a fully deployed Quality Framework. This framework supports the delivery of the Trust Strategic Aim “Provide high quality recovery focused services”. Any key risks that may have an impact on the delivery of our quality goals are detailed within the Board Assurance Framework. The process for the management of these risks is laid out within the Risk Strategy as summarised in the figure below. Like all mental health trusts, we are regulated by the Care Quality Commission (CQC) and are registered with them for the services we provide to patients. The CQC conduct both unannounced and announced inspections and review the quality of care we provide to patients. Our Trust received a CQC inspection in March 2016 and in July 2016 they rated us as Good, meaning we are performing well and meeting our expectations. Our CQC inspection reports are on their website. The reports also raised some areas for improvement, and as a Trust we are working hard to address these areas and make improvements to our services. Details for these can be found on our website (http://www.sssft.nhs.uk/about/quality/cqc).

Communicate and Consult

Establish Context

Objectives

Stakeholders

Criteria Define key elements

Monitor and Review

Identify Risks

What can happen?

How can it happen?

Analyse Risks

Review controls

Likelihood

Consequence

Level of risk

Evaluate Risks

Evaluate risks

Rank risks

Treat Risks

Identify options

Select best responses

Develop plan

Implement

http://www.cqc.org.uk/provider/RRE


2.2 Approach to Quality Improvement Our Quality Improvement priorities are chosen following a r eview of our current services, consulting with our key stakeholders and feedback from our Quality Improvement (QI) approach that utilises the Virginia Mason Production System1 (VMPS). Our QI framework is aligned to our values and s trategic direction; this in turn is aligned to our commissioning intentions and CQIN initiatives and ultimately our contribution to local STPs. A large proportion of our QI work is in delivering Rapid Process Improvement Workshops (RPIWs) and in delivering these with teams where opportunities for improving services have been identified within directorate business plans. Our QI team continues to provide resources, bespoke training, tools and the knowledge to enable teams to expedite changes to add value and remove waste, thereby creating capacity to provide a high-quality, recovery-focused environment for our service users. Our long term aim remains that decisions and responsibilities for improvement are handed to those best equipped for the task – the staff themselves. Key to the Virginia Mason Approach is the development of our Staff Charter which is an agreement between staff and the Trust on how we will ensure quality is central to service delivery. Staff need to believe that they will be aut horised to make changes and i t needs to be c lear that senior staff will take a clearly structured and actively facilitative role to enable them to do so, breaking down any corporate barriers to change. Our Charter, highlighting five key behaviours (below) needed to demonstrate we live our values2, was launched in 2014 and continues to shape our culture.

The Framework will form part of our Appraisal process and going forward, how we Live our Values will be as important as how we deliver our other objectives. The appraisal process will be reviewed to incorporate the Behaviours to ensure that everything is aligned for us to truly Live our Values in every element of our service and at all levels of the organisation. 2.3 Listening into Action (LiA) The Trust has deployed a number of schemes to support staff culture and encourage engagement. A significant area of this development is our use of the Listening into Action programme. Since the start of LiA in April 2015 we have held nine ‘big conversations’, therefore listening to the concerns and ideas from over around 1,500 staff (this includes LiA clinical teams, Enabler Teams, Staff having attended the big conversations and pass it on event. 1539 staff have completed a pulse check throughout our LiA Journey to date, each of the 15 questions asked to staff showing an increase, particularly around Q2) the organisation’s culture encouraging staff to contribute to changes that affect their teams/departments and services, Q9) that their role contributes to the wider organisation vision and Q11) that the quality and safety of patient care is our organisation’s top priority. Over highest scoring area being around staff believing they provide a high quality service to our patients / service users 67.05%. The last time staff were pulse checked was in March 2016. 1 https://www.virginiamason.org/VMPS 2 http://www.sssft.nhs.uk/images/LOV/LivingOurValuesCharterA4.pdf

https://www.virginiamason.org/VMPS

http://www.sssft.nhs.uk/images/LOV/LivingOurValuesCharterA4.pdf


20 teams have signed up to the LiA way seven steps of working and being an ‘LiA team’, a total of 18 missions between all teams (around 260 staff). We’ve announced 53 quick wins – simple changes and solutions in response to concerns raised at each of the big conversations, each linked directly to ‘what gets in the way for staff’ and ‘what can be done differently’

2.4 Our approach to Risk The Trust continues to promote and deploy a positive risk culture. This encourages its staff to consistently use risk management policies, Assurance Plans and Risk Registers. These help us to identify and control risks which may adversely affect the Trust’s operational ability to meet its principle objectives and where possible, eliminate or transfer risks or reduce them to an acceptable and cost effective level. The Trust Board has identified four strategic risks that are monitored and reviewed by a lead Executive Director and the appropriate Trust Board committee. Additionally these strategic risks are also reviewed by the Trust Board and Audit Committee. The four strategic risks and key controls are detailed below: Risk Number

Trust Objective Principal Risk Key Controls Lead Responsible Committee

E18 Expand our current service portfolio in order to enrich services

The tightened economic environment has the potential to affect our ability to remain competitive when local economies require greater efficiencies

• Competitive tendering processes in lace that are monitored through Business Development & Investment Committee (BDIC)

Steve Grange

Business Development & Investment Committee


Reform and structural changes to the NHS creates a changing systems and political environment which creates the risk of not being able to effectively plan strategically with our partners over a longer period of time

• Engagement in national forums such as Chief Executives and Monitor

• Horizon scanning at Trust Board

Steve Grange



Increase in local and national competition, including a significant change in commissioning processes and scoring affects our ability to pursue new contracts

• Co-ordinated robust approach to competitive tendering

Steve Grange


R16 Respect inspire and develop our workforce

Failure to maintain and improve the morale of the Trust workforce. The risks include: • Increased sickness • Reduced productivity • Increased turnover • Challenges in recruiting

• Monthly HR Reports • Vacancy Rates

Neil Carr Human Resources, Organisational Development & Equality Committee


2.5 Sign up to Safety priorities The Trust Board has formally signed up t o the five safety pledges. Thes e pledges are reviewed through our Quality Governance Committee. The Trust continues to strive towards the provision of harm free care by delivering on our action plan against the following priorities:

I. Put safety first. Commit to reduce avoidable harm in the NHS by half and m ake public our goals and plans developed locally. We will:

• Publish our Safety Dashboard monthly on our website. • In consultation with stakeholders we will specifically (but not solely) focus on three indicators identified within our Quality Accounts. • Adopt the Medication Safety Thermometer in specific clinical areas to identify areas for focussed improvement. • Further reduce the impact of falls. • Build practice improvements in our services using RPIWs and Kaizen improvement events. • Using the Safety Thermometer maintain our “harm-free care” above 95% • Review the ways in which we engage with our service users.

II. Continually learn. Make our organisation more resilient to risks, by acting on the

feedback from service users and carers and by constantly measuring and monitoring how safe our services are. We will:

• Participate in patient safety research in conjunction with our research and development network.

• Embed best practice in learning lessons from patient safety incidents. • Publish a regular learning lessons bulletin and make it available to all our

staff. • Use feedback from our service users and carers to continually develop and

improve services, using a r ange of sources including the Meridian patient experience real-time feedback tool, feedback and learning from PALS and complaints and the Service User and Carer Committee and its directorate and divisional sub groups.

• Continue to review our incidents identifying recurring themes and share the learning through Thematic Reviews.

• Share and s pread the learning from improvement events via briefings, e- bulletins and websites.

III. Honesty. Be transparent with people about our progress to tackle patient safety issues and s upport staff to be c andid with patients and t heir families if something goes wrong. We will:

• Ensure Duty of Candour is effectively implemented. • Continue to develop the use of Patient Stories at Trust Board and throughout

the organisation. • Share the findings of our serious incident investigations with our service

users, their families and our commissioners. • Actively involve our commissioners and member governors in our regular

service reviews. • Involve service users, carers and partners in improvement events, sharing

with them the observations and data gathered from services looking to improve.

IV. Collaborate. Take a leading role in supporting local collaborative learning, so that improvements are made across all of the local services that patients use. We will:


• Collaborate with Clinical Commissioning Groups (CCGs) to identified shared learning opportunities across the health economy (ie the collaborative learning forums)

• Continue to engage with our local communities through groups such as Healthwatch and Overview and Scrutiny Committees to review the quality of our services

• Work with our partners in primary care and other secondary care services to reduce harm.

V. Support. Help people understand why things go wrong and how to put them right. Give staff the time and support to improve and celebrate the progress. We will

• Train our staff to ensure they are equipped to identify and manage risks. • Support staff to review incidents when they occur and l ook for ways to

prevent re-occurrence. • Provide support to our staff to implement best practice in reducing incidents

of absconding. • Support our staff to implement best practice in reducing harm from falls. • Provide our staff with training, resources, tools and s upport to undertake

RPIWs and K aizen events, and t o sustain the improvements from such events in the long term. Our Medical Director is the lead officer for the assurance required within the Association of Medical Royal Colleges’ guidance on the responsible consultant. The Trust can confirm that this has been fully taken into account. We are also conscious of the need to work closely with commissioners on deploying seven day services including a primary focus on their need to increase the level of consultant cover and diagnostic services available in hospitals at weekends and improving access to out-of-hours care, by achieving better integration and redesign of 111/walk-in clinics/urgent care to enhance the patient offer. Progress towards the delivery of the above will be included within the economy Sustainability & Transformation Plan (STP) and organisational plans. 2.6 Quality Impact Assessment process (QIA) The Trust has a well embedded QIA process and tool for identifying Cost Improvement Programme (CIP) schemes and as sessing for their impact on pat ient safety, clinical outcomes and patient experience. All schemes subject to this process are approved by the Director of Quality and Clinical Performance, the Medical Director and D irector of Nursing/Chief Operating Officer. Divisions are required to regularly monitor the impact of the schemes on quality and safety of care through collecting and reviewing the performance of these agreed measures at appropriate management meetings. If a scheme is identified as having an adv erse risk to the quality and s afety of care, then specific measures for monitoring the potential impact of a scheme should be identified and documented as part of the QIA process. 2.7 Triangulation of Indicators The Trust undertakes a series of performance reviews. Performance reviews provide the Board with assurance that directorates and corporate areas are assessed and challenged against key delivery areas and any other appropriate crosscutting issues.


2.8 Our approach to assessing quality impacts of Cost Improvement Programmes

Note: All Schemes = Any CIP/QIPP/Other Scheme where money is being withdrawn from service and which may have a significant adverse impact on quality covering; safety, clinical outcomes & patient experience (see guidance below for further detail) All CIP Schemes – Where the proposed scheme(s) meets one or more of the following criteria:

• Whole scale changes to service configuration including the closure of beds • Fundamental changes to the clinical model • Clinical posts removed or changed i.e. bandings or professional group

Schemes Included All Schemes

Schemes considered at Divisional

Challenge Forum

• Heads of Service

• Clinical Directors

• Clinical Leads • Service

Managers • Prof Leads • Corporate

Services (inc Finance, HR & Performance)

• Director of Finance & Performance

• Director of Operations

• Heads of Service • Operational

Project Leads • Head of Financial

Planning & Finance Business Advisor

• PMO • HR Business

Partner • PDT

• Heads of Service • Clinical Leads • Service Managers • Prof Leads • Corporate Services • PMO

• Clinical Directors • Heads of Service • Clinical Directors • Exec Directors • Finance Business

Advisor • PDT

• Service Manager – On-going • DMT/SMT –

Monthly /Quarterly • F&P -

Monthly • QGC – 6

Monthly • PMO / TMT

Monthly

Responsibility

Directorates Develop Ideas –

Business Planning

Undertake and complete

QIA Tool & scheme

logged with PMO

Scheme & Considered at

Directorate Challenge

Forum & QIA ‘Signed Off’

Do Not Proceed

Implement Schemes - Monitoring of Schemes via PMO &

Finance STAR

Chamber

Proceed

Proceed

Proceed

Directorates to complete ‘Saving Plan Templates’. Identify CIPs

requiring QIAs, MoC &

PMO

Do Not Proceed

CIP schemes considered at Finance STAR

Chamber

Schemes considered at

Exec CIP Challenge

Session

Do Not Proceed Do Not Proceed


• Admin or other support services posts that could impact on front line delivery

QIPP/Other Schemes – Where the proposed scheme(s) meets the CIP criteria above, but also the following criteria needs to be considered:

• If the Trust is not involved with the decision to withdraw funding/ or the service i.e. it was made solely by the commissioner then the Trust is not required to complete a QIA, it is the commissioning bodies responsibility to complete a QIA and ensure any risks associated with the changes are mitigated

• If it is a jointly made decision to withdraw funding/ or the service and t he Trust is involved in this decision making process with the commissioners, then a QIA should be completed by the Trust

• If it the decision to withdraw funding/ or the service is solely made by the Trust then a QIA should be completed by the Trust

Removal of CIP Schemes

• Proposed CIP schemes cannot be removed from the spreadsheet maintained by Finance unless first agreed at STAR Chamber

Timescales for production of QIAs

• Vacancy or small scheme - 1 month from the scheme being approved at STAR Chamber

• Larger project or wholescale changes - 2 months from the scheme being approved at STAR Chamber

If the QIA tool is required to be completed for a scheme, then that proposal and associated QIA will also be subject to a Challenge Session.

A QIA will be triggered when the Performance Development Team receives a spreadsheet from the Finance Department which indicates that a QIA is required and that the scheme has been ‘signed off’ by the Finance Department. Spreadsheets will be circulated following each STAR Chamber until such time as a “ live” version of the spreadsheets is available on Sharepoint. If a CIP scheme is low risk and the risks of the potential delays in organising a CIP Challenge Session outweigh the risks of proceeding with the scheme, electronic approval of the scheme may be an option. This process can be beneficial in avoiding delays if the CIP scheme needs to commence in a short period of time. P rocess - The Performance Development Manager will circulate the completed QIA with any associated documents for the proposal v ia email to the Director of Quality and C linical Performance, the Medical Director and Director of Nursing/Chief Operating Officer for electronic approval with a deadline to respond. The email should describe reasons behind seeking electronic ‘sign off’ and anticipated start date for the scheme. When considering and assessing the risk of the schemes on the quality and safety of care. Please ensure the thinking and rationale when arriving at the risk score is transparent and clearly documented, as this will be the key focus of challenge from the Executive Directors. Executive Director Scrutiny will need to take place for all schemes meeting the criteria, which may take place through one of the following forms;

• Formal Challenge Session • Attendance at appropriate Divisional forums where schemes are discussed and

approved


Monitoring of Schemes Divisions are required to regularly monitor the impact of the schemes on quality and safety of care through collecting and reviewing the performance of these agreed measures at appropriate management meetings. If a scheme is identified as having an adverse risk to the quality and safety of care, then specific measures for monitoring the potential impact of a scheme should be identified and documented as part of the QIA process.

• Final approval of which schemes require; specific monitoring, the measures and frequency of monitoring are subject to agreement at both Divisional and Executive Challenge Forums/Sessions

• As a minimum, quarterly progress updates on the impacts and monitoring of specific schemes are required to go through the Trust’s established governance structures

The Quality Governance Committee agreed the following assumptions and r ules to be applied to schemes in terms of ‘closing down’ schemes and moving specific monitoring of schemes through QGC to ‘business as usual’ monitoring through DMTs:

• Monitoring to be under taken in accordance with specified rules or if no specific

follow up is agreed, monitoring to be conducted for one year and if monitoring has shown no impacts on quality, specific monitoring can cease and the scheme can be ‘closed’.

• If the risk has reduced from the baseline score and if monitoring has shown no impacts on quality, specific monitoring can cease and the scheme can be ‘closed’.

• If the risk remains but monitoring of a scheme continues as ‘business as usual’, specific monitoring by QGC can cease.

• If the risk remains at the baseline score and m onitoring has revealed quality impacts, monitoring is to continue.

2.9 Our capacity and capability within the Trust to deliver the quality improvement plans Each Directorate has a range of quality improvement plans, developed alongside their business plans and enh anced throughout the year. These quality improvement plans are shared with the Quality Improvement Team and capacity to support the Directorates to deliver these plans forms the Trust Quality Improvement Programme (QIP). The QIP is a rolling programme tailored to support the Directorates’ plans depending on t he level of involvement required from the Quality Improvement Team and t he range of QI tools and methodologies considered to be required to deliver the plans. The QIP is reported on to Trust Management Team and the Quality Governance Committee. The capacity to deliver the plans includes, not exhaustively:

• Rapid Process Improvement Workshops – week-long events, preceded by twelve weeks of data gathering and staff and service user/ carer engagement, designed to analyse and improve clinical and corporate processes. There is capacity to support over ten such events per year, across all Directorates, with an ongoing annual training programme to ensure facilitators and sponsors of such events are available on a continuous basis.

• Kaizen workshops – two-three day events for teams to work on elements of QI plans using a range of Lean tools, supported by the corporate QI Team. There is capacity within the organisation for there to be a constant rolling programme of kaizen activity.

• Leading Quality Improvement Projects – the Directorates’ Quality forums have oversight of the range of QI projects being undertaken by clinicians and managers across their Directorates to ensure these Lean projects add to and del iver towards


their QI plans. There is capacity within the Trust for ten projects to be delivered per quarter.

• Team-level QI activity – the degree of engagement with the QI programme across the organisation allows for all team members to be working towards delivering the QI plans, with bespoke, at-base QI training being delivered across the Trust, to ensure all team members are cognisant of the QI/Lean methodology and i ts potential application. There are currently over 500 m embers of staff within the organisation trained in some aspects of our Lean methodology (VMPS).

• The corporate QI Team also adds to the delivery of the QI plans through a r olling programme of bespoke events and t raining, such as Value Stream Mapping, Information Flow Mapping, Creation of Standard Work, Waste Analysis and Experienced-based Design.

The Quality Improvement (QI) Team The Trust has an exciting and ambitious programme of further improving quality which puts service users and carers right at the centre and staff in the driving seat of change. It is based on the principle that staff will develop their own effective solutions to improving the processes of delivering high quality services and care. A large proportion of our work is in managing the Rapid Process Improvement Workshop Programme and in delivering RPIWs in the areas in which had been i dentified as having opportunities for improving services. We have established a comprehensive rolling programme of both RPIWs and Kaizen Events. Our team provides inspirational resources, bespoke training, tools and the knowledge to enable teams to expedite changes to add value and remove waste, thereby creating capacity to provide a high-quality, recovery-focused environment for our service users. We will continue to deploy bespoke, innovative training; 'Leading Quality Improvement', and 'First Steps in Quality Improvement'. This will enable teams to produce their own improvement ideas, and continuously improve the quality of the services which they provide. We will continue to support and deliver the Certified Leaders Training, which provides staff with the knowledge and tools to facilitate RPIWs across the organisation. We have also developed a coaching programme, so we can provide in-house coaching and mentoring to Certified Leaders in training. The Quality Improvement Team is drawn from a variety of professional backgrounds; from clinical and managerial experience in the NHS, public and private sector and academia. Process Owner Support Group These support groups allow previous process owners to give their feedback and views on their role as process owners, and for future process owners to ask questions and learn from others. Certified Leader Training The Certified Leader Training provides coached training to enable senior leaders within the organisation to facilitate quality improvement events. All trainee certified leaders will undertake two RPIWs to obtain certified leader status, followed by one RPIW per year to maintain this status. All Executive Directors, Professional Leads, Directors of Services, Clinical Directors, Service Leads and Operational Heads will be trained to become Certified Leaders.


Kaizen Events A Kaizen event is a shorter piece of work and can take two to three days, sometimes just one. A Kaizen event can use one or more of the tools which are all available on an RPIW Teams involved in Kaizen events this year include Kinver and t he Assisted Technology Project Team. Leading Quality Improvement The Leading Quality Improvement training series supports staff to deliver safe, high quality, efficient and compassionate care by promoting engagement and empowerment so people can make significant service improvements using evidence based lean tools and techniques. Leaders who attend the 'Leading Quality Improvement' series course will:

• explore the context and influences upon the changing health and social care environment and the importance of efficiency and quality improvements

• gain appreciation of the future leadership challenges and a better sense of what this means to their role

• have opportunity to further develop their Leadership/Management style • gain techniques to influence and deliver convincing communications • gain an appreciation of the key principles of team based working • analyse and evaluate lean production and improvement methods • create a project proposal using lean methods to improve their service, implement the

service improvement project, and evaluate and report on the success of the project, ensuring continued sustainability

• benefit from the support of a Certified Leader mentor within their own Directorate or service

• have space to think and reflect about personal impact as a leader Every Day Lean Ideas To ensure our improvement programme is focused wisely and programmatically, the 'topics' for potential RPIWs come from a variety of sources, all scoped by the QI Team. One such source is the 'Everyday Lean Ideas' (ELIs). The ELIs initiative provides an oppor tunity for anyone to identify and suggest a quality improvement idea. We will soon be piloting 'ideas boards', that is, a dedicated space in your team, where people can post ideas and the team can discuss and work on these ideas.


SECTION THREE: Our approach to Workforce Planning

3.1 Workforce Planning We have aligned our workforce planning with that of our partners and will continue to work through development plans and t he sustainability transformation plans (STPs) to ensure longer term alignment. Our plans are mapped against staff and dem and profiles outlined through patient need, commissioning intentions and contract monitors. We will continue to reduce our vacancy rates and the use of bank and agency by utilising our Nurse Bank.

We will continue to redesign our workforce, looking to develop new roles, broaden skills and competencies, as well as providing development opportunities. We are keen to promote Mental Health and Lear ning Disabilities as an ex cellent sector to work in as well as demonstrating with our partners that Staffordshire, as a heal th economy, has a lot of opportunities. We have been s uccessful in our commitment to involve service users and carers in workforce development and recruitment.

We are also keen to explore new workforce opportunities to grow new roles and also provide opportunities through talent management. Some examples of this include:

• A real commitment to the employment of apprenticeships - with over 60 apprentices currently working within the sector. The introduction of the Apprenticeship Levy in May 2017 will enable us to further develop the range of apprenticeship opportunities available including pre-registration nursing and occupational health apprenticeships.

• A real commitment to learning and development, from vocational places through to higher degree level opportunities.

• A real commitment to developing staff and living our values so that the organisation is a good place to work.

The Trust is actively involved in an ec onomy workforce transformation programme that includes productivity schemes, leadership development and new ways to attract and retain staff. The development of STPs will also support joint planning for any new workforce initiatives, agreed with partners and funded specifically as part of the Five Year Forward View. Any economy wide remodelling within clinical services that form part of these programmes will be integrated into our internal business plans and ensure the involvement of clinicians as well as corporate support services.

A key element of this programme of transformation is the development of a new model of care underpinned by re-developed patient pathways. The approach has ensured involvement of clinical staff with specialist workforce planning support from corporate services. The next phase of this programme is the development of a 5 year workforce plan and the skill mix within teams to align patient need by care cluster with staffing requirements. This work will see an increase in the deployment of new roles such as assistant and adv anced practice as a s olution to national shortages within nursing and middle grade medical staff. It is also likely that there will be training needs identified to further upskill existing staff.

The Trust also ensures that it effectively uses e-rostering. This has been effectively deployed and the monthly safe staffing metrics are analysed and triangulated with workforce indicators to identify areas of risk. This is reported monthly through our governance structures both internally to senior management and ex ternally to commissioners. Action plans are developed to minimise any impact on safe staffing levels and these are monitored through Ward Managers’ meetings. Six monthly establishment reviews are also undertaken.


3.2 Working with Partners The Trust is engaged with the Health Education England (HEE) workforce planning process and submits an Annual Workforce Plan that identifies the likely future supply requirements by professional group. The Trust is represented at Mental Health Transformation Theme (MHTT) meetings where supply issues are debated and educ ation commissions agreed. Moving forward with the removal of the nursing bursary, the Trust is exploring opportunities with local Higher Education Institutions to develop a par t time route into mental health nursing as a du al award (academic and v ocational award) to overcome further nursing supply challenges. The Trust has developed a range of recruitment and retention projects including an in-house nurse bank which has impacted positively with a r eduction in the reliance and us age of agency staff. The Trust will continue to look at innovative ways to reduce spend in this area whilst ensuring that the quality of the workforce is improved. This is demonstrated within our workforce plan. 3.3 Establishment of Trust Bank The Trust has expanded the Nurse Bank to a Trust Bank which now covers a much wider range of staff groups. In addition, the Trust Bank has been es tablished as a c entralised point for all temporary staffing requests including bank, agency and individual contractors. The master vend arrangement with Medacs has been ex panded to include other professional groups providing much better governance, the Trust is not using off framework agencies. To reduce reliance on medical locums the Trust has adopted the NHS Improvement guidance on reducing locum agency spend and is taking a hard line with agencies when negotiating rates; agencies have been advised more recently that the Trust will only be engaging locums within the 1st April capped rates. The length of both nursing and locum bookings are being kept to a minimum to ensure placements are being constantly reviewed. E-Rostering is fully implemented across all In-Patient Wards and we are looking to widen this to the Junior Doctors On-Call Rota to manage and improve rostering. The Trust is looking at alternative roles in order to fill vacancies such as Physician Assistants/Associates, nurse practitioners and two Trust Doctors have recently been employed. Through career fairs, relationships are being developed with Universities across the Trust’s geography to boost recruitment and encourage student nurses to take a career with the Trust. The Trust has robust systems in place to regularly review and address workforce risk areas. Areas of risk are reported monthly through the Trust Assurance Report to Trust Board. In addition, any areas of risk are highlighted through the Trust’s Risk Register which is reviewed regularly. This is reported and m anaged through the Trust’s governance and committee structures.


SECTION FOUR: Supporting our STP

4.1 Staffordshire STP The Staffordshire STP has made significant strides to align the healthcare system and provide strategic and o perational context to working as a system to bridge the gap and improve the offer to our local populations. There was a c lear recognition that the current model of service did not provide a s ustainable future and that changes to the whole healthcare system were needed based on a model of "Shift left". This is reinforced by our commitment to the deployment of place based care ensuring our focus remains both strategic and local. Our STP articulates clear priorities. These include transforming primary care, sustaining general practice and redesigning our approach to supporting patients with long term conditions. Our system recognises that primary care and the effective management of patients with long term conditions are pivotal to supporting change in the system and in many cases provide the catalyst to change. Evidence indicates that our community and primary care interfaces need alignment including the most effective use of our more fixed assets such as the community hospitals. We also recognise that GPs and practice teams provide vital services for patients. They are at the heart of our communities, the foundation of the NHS and i nternationally renowned. Their services are now under unprecedented pressure and, as set out in the NHS Five Year Forward View; it has become clear that action is needed so we have a responsive NHS, fit for the future. Actions to address this issue include the development of new models of care and the deployment of the multispecialty community provider (MCP) emerging care models and new contracting frameworks. Many of the areas above are interdependent and inextricably linked in terms of drivers and outcome dependencies. In recognition of this, the priorities of transforming primary care (including new models of care and MCP), sustaining general practice and redesigning our approach to supporting patients with long term conditions and the community hospital programme have been aligned into a s ingle STP portfolio now named Enhanced Primary and Community Care (EPCC). The focus of the Staffordshire STP is “better health, better care, and affordable services”. This will be delivered through five aims:

• Focused prevention – identify where upstream investment in prevention and early intervention will have a positive impact on bo th the health of the population and reduce high cost care

• Enhanced primary and community care – Enhance and i ntegrate primary and community care to enable frail elderly and those with LTCs to live independent lives and avoid unnecessary, costly and upsetting emergency episodes

• Effective and efficient planned care – Reconfigure planned care services to meet patient needs, improve productivity and remove duplication and over capacity

• Simplify urgent and emergency care system – Simplify emergency and urgent care services across the system to reduce avoidable A&E attendances and N EL admissions

https://www.england.nhs.uk/futurenhs/


• Reduce cost of services – Accelerate the delivery of productivity and efficiency plans. Reduce total bed capacity and rationalise estates. Provider collaboration to reduce management costs

The Enhanced Primary Community Care work stream has established a work programme for the development of the priorities contained within our STP and focussed on t he areas of transforming primary care (including new models of care and M CP), sustaining general practice and redesigning our approach to supporting patients with long term conditions and the community hospital programme. 4.2 Shropshire and Telford and Wrekin STP Shropshire and Telford and Wrekin have two programmes “Future Fit” (acute care modernisation) and “Community Fit” (community modernisation). The two plans are linked and are aimed at supporting a significant shift from the acute sector to enhanced community provision. The Trust is fully participating in this programme and leading on the Mental Health work streams.

Early thinking is that the work already undertaken within the Future Fit programme will underpin the development of the STP. It is key the next steps include the incorporation of the other pieces of work which are at different stages of development. In effect the STP will become an umbrella plan for the several pieces of work:

• Future Fit • Community Future Fit • Deficit Reduction Pan • Primary Care Strategy • Developing Rural Urgent Care services

This economy will produce one S TP with the other pieces of work all feeding into it; Shropshire and Telford and Wrekin have stated that they do not want to lose the Future Fit work or the name, because it is recognised locally. Both of these programmes have timescales that are leading discussions around planned changes in planning assumptions. The two programmes are primarily acute care focussed; however, the Trust is aware that its involvement is key in shaping the local strategy for its local populations. Early strategic thinking includes a review of Psychiatric Intensive Care (PICU) capacity, Low Secure and Child and Adolescent Mental Health Services demand and provision. The Trust is not expecting any major change for 2016/17 to core services but will ensure that the following national drivers are incorporated within our strategy:

• Ensuring that mental health and learning disability retain parity of esteem • The continued embedding of an open, learning and safety cultures • The deployment of all quality standards and greater access to services • The implementation of children and young people mental health strategies • The implementation of local digital roadmaps • The implementation of Multi-Specialism Community provider and Primary and Acute

Care Systems including sustainable general practice solutions • The transformation of urgent and emergency care • The transformation of prevention programmes • The implementation of combinatorial innovation • Plans to reduce costs, improved demand growth and increased efficiency


SECTION FIVE: Our Activity, Assumptions and Delivery Plans

5.1 Activity and Assumptions The Trust bases its planning assumptions on local, regional and na tional trends and intelligence. National information is useful in guiding the Trust and i nfluencing strategy in how it understands data and where the greatest impacts can be m ade. Key assumptions include: • Nearly two million adults were in contact with specialist mental health and learning

disability services at some point in 2014/15. • Nine out of ten adults with mental health problems are supported in primary care.

There has been a significant expansion in access to psychological therapies, following the introduction of the national IAPT programme (Improving Access to Psychological Therapies). However, there is considerable variation in services, with a waiting time of just over six days in the best performing areas and 124 days in the worst performing areas in 2014-15.

• Of those adults with more severe mental health problems 90 per cent are supported by

community services. However, within these services there are very long waits for some of the key interventions recommended by NICE, such as psychological therapy, and many people never have access to these interventions. One-quarter of people using secondary mental health services do not know who is responsible for coordinating their care, and the same number have not agreed what care they would receive with a clinician. Almost one-fifth of people with care coordinated through the Care Programme Approach (for people with more severe or complex needs) have not had a formal meeting to review their care in the previous 12 months.

• In its recent review of crisis care, the Care Quality Commission found that only 14 per

cent of adults surveyed felt they were provided with the right response when in crisis, and that only around half of community teams were able to offer an a dequate 24/7 crisis service.

• Only a minority of hospital Accident & Emergency (A&E) departments has 24/7 cover

from a l iaison mental health service, even though the peak hours for mental health crisis presentations to A&E are between 11pm and 7am. Too often, people in mental health crisis are still accessing mental health care via contact with the police. The inquiry found that while adults were seen promptly where liaison mental health services were available in an A&E department and there were clear pathways through to community services, those aged under 16 were referred directly to children and young people’s services but seen only when services were open during office hours. This could involve waiting a full weekend and l ead to a s ignificant variation in the quality of care on the basis of someone’s age.

• Admissions to inpatient care have remained stable for the past three years for adults

but the severity of need and the number of people being detained under the Mental Health Act continues to increase, suggesting opportunities to intervene earlier are being missed. Men of African and Caribbean heritage are up to 6.6 times more likely to be admitted as inpatients or detained under the Mental Health Act, indicating a systemic failure to provide effective crisis care for these groups.


• The number of adult inpatient psychiatric beds reduced by 39 per cent overall in the years between 1998 and 2012. For children and young people, average admissions per provider increased from 94 in 2013/14 to 106 in 2014/15. Bed occupancy has risen for the fourth consecutive year to 94 per cent. Many acute wards are not always safe, therapeutic or conducive to recovery. Pressure on beds has been exacerbated by a lack of early intervention and c risis care, and the resulting shortage leads to people being transferred long distances outside of their area.

• Mental health accounts for 23 per cent of NHS activity but NHS spending on

secondary mental health services is equivalent to just half of this. Years of low prioritisation have led to Clinical Commissioning Groups (CCGs) underinvesting in mental health services relative to physical health services; however, the degree of the disparity has largely been obscured by the way spending on mental health conditions is grouped together and reported, unlike spend on phy sical health care, which is disaggregated by specific conditions. Spending per capita across CCGs varies almost two-fold in relation to underlying need.

Divisional business plans reflect both current and future demand and needs on the service. The Trust uses qualitative data to forecast demand activity and qualitative data on service fit and this is aligned with commissioner intent and feedback from service users and their carers. A ll of this data is used to evaluate our services. S ervice line reporting and management is effectively deployed throughout the Trust and an overview is maintained through the Finance and Performance committee. Our current activity within our core contracts are reviewed regularly with our commissioners to understand any areas of change including the new increased access targets around Early Intervention, Improving Access to Psychological Therapies (IAPT) and Child Adolescent Mental Health Services (CAMHS) transformation plans. The Trust has also been successful with a num ber of contracts that will start 1st April 2016; these activity assumptions are included within our baseline position. We work in partnership with a number of other providers including the independent sector. We are planning to continue to work as a prime provider to a network of independent providers that support our ability to deliver complex care management such as long stay rehabilitation across our communities. Our plans are sufficient to deliver and ac hieve our recovery milestones and national targets and operational standards. The Trust works closely with local commissioners to understand, plan and r espond to demands and any seasonality on services on a r egular basis. The Trust also, through its Contracting, Operational and Information departments, regularly model against existing and expected capacity and activity of existing contracts and new opportunities. The Trust prides itself on work undertaken prior to committing to the delivery of clinical services or the acquisition of new business by completing assessments or inputs needed against expected activity levels. These assessments include:

• Quality and safety standards and compliance with regulatory standards • Contractual compliance against key targets • Physical capacity to maintain a safe and effective workforce • Workforce and workforce development • Information Technology and assistive technology • Activity and Information requirements • Physical locality including the estate and the operating environment • Contractual and reputational risk


This analysis is also used to inform key operational risks and an ticipated risks in areas of new business or contracts. The Trust has always demonstrated a pos itive appetite to risk including its commercial strategy and approach to growth. All growth in new business is reviewed on its return and impacts on our ability to continue to deliver in line with the above. The commercial strategy is focussed on our ability to develop new services in areas where we feel that we can make a positive difference and provide a high quality offer. The Trust is also conscious that changes to existing services are needed to continue to improve the service offer and be as efficient as possible. This is done i n a number of ways but one ar ea of strength includes our ability to respond to the current economic climate. The Trust is anticipating that there will be on-going pressure on levels of income but believes that changes being worked through based on t he LEAN thinking will enable further cost reductions to be made in 2016/17 and the forthcoming years. Our activity assumptions and returns are underpinned by agreed planning assumptions and are aligned to commissioning intentions. These commissioning intentions form part of the annual contracting rounds which in turn help shape the assumptions within the directorate and divisional business plans. The Trust has aligned these assumptions to the emerging STP plans and has been activity involved in addressing many of the gaps within the system. A priority for SSSFT over the next 12 months will be to continue to emphasise the need to demonstrate mental health and learning disabilities retain parity within these plans and t hat investment is placed where it supports the most impact. Both STP footprints have mental health and learning disability input and have made significant inroads to understanding, recognising and pr ioritising many of the requirements laid out within the NHSMH5YFV. The operational, contracting and finance teams work closely on gathering and analysing qualitative and quantitative evidence on the delivery of contracts and services on an ongoing basis as part of the routine monitoring. This is formalised through regular contract review meetings with commissioners where trends or changes in demand/capacity and resulting activity are reviewed. 5.2 Community Remodelling (Mental Health Services) Community remodelling is the Mental Health Services’ programme responsible for transforming community mental health services. Building on the work undertaken in 2011, the Mental Health Business Plan sets out the strategic direction of the Mental Health Services’ transformation agenda. The pathways have been developed by managers, clinicians, social work and s ocial care staff, service users, carers and our partner organisations. The programme is highly ambitious and sets out to:

- Significantly enhance provision of evidence based treatment packages aligned to service user need (some of which are currently not delivered)

- Instil a recovery approach throughout, putting the service user truly ‘at the centre’ - Up-skill and c hange the shape of the workforce so that it is fit for purpose for the

work it will deliver - Increase clinical contact by releasing staff of the burden of bureaucracy and

inefficient systems - Create new teams with new capability in locations so that they are focused around

the needs of service users and carers - Create standard ways of working that reduce variation, promote safety and improve

efficiency


- Break down barriers and working with partners in a more integrative approach, that not only delivers better outcomes for service users, but sets the tone for further integration over the next 5 years.

The proposals support a cost-reduction and will contribute to the overall sustainability of the Trust and its services. Over 30 workshops involving approximately 250 staff were undertaken to further define the proposed pathways across Staffordshire and Shropshire and develop the standard work and processes that will be r equired to support implementation of the new pathways. E ach pathway of the future model was designed from scratch, from the bottom-up, and w as grounded in our underpinning guiding principles for community remodelling. A number of ‘enabling’ workshops were also held which looked at issues such as IT, administration, estates and skill mix in order to agree how best the model could be delivered within existing resources. Wide engagement and participation was achieved in this process with both SSSFT staff and external partners such as GP’s, Local Authority, voluntary sector and commissioners and most importantly service users and carers. It is proposed that community remodelling will be implemented across teams in South Staffordshire and Shropshire. The service model has been split into 6 pathways which are aligned to care clusters. Within South Staffordshire Mental Health, the s75 specific needs of the ‘s75 partnership agreement’ will be met via the Adult Social Care Pathway which is underpinned by the Social Inclusion and Personalisation agenda. This pathway has been developed over the past 12 – 18 months in response to a number of major changes including the implementation of the Care Act (2014), the Standards for Employers of Social Workers in England (Social Work Reform Board, 2012), as well as the Staffordshire County Council Adult Social Care Transformation Project (2016). This pathway will work alongside the above pathways via the provision of ‘prevention/reduction/delay’ social care support and other statutory social care specialist interventions. 5.2.1 Proposed pathways of Community Remodelling

• Urgent Care: Although urgent care pathways are still in development, Crisis resolution and Home Treatment, RAID and P sychiatric Liaison will eventually be managed within a single Urgent Care pathway to facilitate flexibility. It is recognised that the new pathways also need to work alongside inpatient wards and support an in-reach model to facilitate timely discharge.

The home treatment function will be delivered within all pathways for all service users known to service users; this is key to maintaining people within the community and prevents admission through a t imely and m ore intensive response to reflect the needs of the individual at that time. The urgent care pathway will support services users not known to services.

• Home Treatment: The home treatment function will form an essential part of all the pathways but predominately in the Psychosis pathway by:

- Protecting planned work within the community team from being disrupted by urgent requests.

- Creating a resource that can be rapidly pulled to a service user showing early signs of relapse. This is particularly crucial in psychosis where relapses are difficult to manage in the later stages.


- Managing the care of people who require intensive care packages, who have previously been managed by Assertive Outreach Teams.

- To have a ‘ward facing’ remit to ‘pull’ people out of in-patient beds. - To monitor and review out of area placements and facilitate an early return to the

local area. The new model will offer a more robust service out of hours and will be integrated into the psychosis pathway for high need s ervice users creating a m ore seamless pathway. The increased integration will enable easier flow and minimise transitions for service users.

• Non- Psychosis and Psychosis Pathways: These pathways are needs led and it is envisaged that physically healthy older people with a functional mental health problem will be managed within these pathways. Such management will be supported by staff from Dementia/Older Adults pathway. Support will also be ‘pulled’ into the patient pathway from specialist services as required to meet service user need. The psychosis and non-psychosis pathways will have sub-specialisms within them. Staff working within these functions will have specialist knowledge, experience and skills in working with service users with psychosis and non-psychosis, however, it is expected that staff will also continue to maintain a broader skill base and have some variety in their caseload.

Early Intervention will operate within the psychosis pathway. This is to ensure fidelity with the evidence based EI model and guarantee consistently high clinical care through strong multidisciplinary working and positive risk management.

• Dementia: This pathway will support people of all ages with a cognitive impairment

in Clusters 18-21. In this model, people with a ps ychosis or non- psychosis presentation in Clusters 1-17, but whose physical health impacts on their mental health resulting in increasing complexity of their needs, will pull support from this pathway.

As with all the pathways in Community Remodelling, close integration with primary care, social care and t hird sector organisations will be c rucial to delivering good quality care and good communication and liaison is vital throughout the service user pathway.

The pathway will consist of the following key elements:

- Provide pre-clinic assessment across all localities for those referred to the diagnostic pathway within 2 weeks of referral

- Extend the use of specialist nurse practitioners in memory clinics to support earlier diagnosis and treatment.

- Partnership working with 3rd sector providers with post diagnostic support local to the service user’s home.

- Extend and enhanc e the Home Treatment (SHIELD) service to further support people with dementia and their carers at home, including extended hours of service.

- Provide a br oader spectrum of psychological therapies for older people across all pathways, including within home treatment delivery.

• Complex Care: A specialist personality disorder pathway has been created. Staff

working within this function will have specialist knowledge, experience and skills in working with service users with a personality disorder. These staff will have particular focus on working with service users in cluster 8.


The specialist staff will also continue to maintain their broader skill base and ha ve some variety in their caseload. This will reduce the risk of burnout due to the complexity of this client group. The complex care pathway will also provide support to the other pathways where personality disorders can also be a feature.

• Administration Teams: There will be a f ocus on excellence in customer service at all times, including a focus on dedicated time spent carrying out the ‘meet and greet’ reception function, and i n coordinating the operation of visitor areas within clinical offices.

• South Staffordshire – ‘Section 75 Partnership Agreement’: A specialist social

care pathway (the Personalisation Super Pathway for Adults and Carers) has been developed, and although currently largely operational there will be some further developments particularly around the Social Inclusion and P ersonalisation agenda. This includes the need to enhance the universal offer of ‘Information, Advice and Guidance’, as well as improving the ‘ prevention /reduction /delay’ systems and processes to ensure early help (including self-help) is able to be provided to minimise or prevent deterioration in line with the statutory requirements of the Care Act (2014) and other legislation (as applicable).

5.2.2 Key Milestones (2017/18/19) The community remodelling project will focus on the following strands in the next 2-3 years: • Development and delivery of a comprehensive OD and training plan to support staff in

the new pathways and admin hubs. • Strengthen our relationships with partner and 3rd sector organisations work to ensure

there is joined up working between SSSFT and other partners, including the voluntary sector. In areas in which we hold either Primary or Secondary care contracts will be redefining our relationship with other care providers to ensure the transfer of care is seamless for service users.

• Develop and implement a strategy to reduce the number buildings used for clinical purposes, reducing associated expense and improving space utilisation

• Development of a 5 year workforce plan which delivers year on year CIP savings and increases the skill mix of our workforce

• Develop extended working hours in community services preventing the need f or admission into inpatient beds.

5.3 Implementation of national guidance • Mental Health Services: Commission services in line with the recommendations

of the guidance set out in the Mental Health 5 Year Forward View and Implementation plans, including liaison psychiatry.

The Trust is aware of the importance of the Crisis Services and Liaison Psychiatry Services together with the continuation of the “Community Triage Service” development. Liaison Psychiatry Services should be provided on a 24/7 basis and meet the requirements of the “Core 24” standard. The approximate cost for achieving this important objective is £1.15M in South Staffordshire. Thi s investment was included in the STP, along with resources to provide adequate Crisis Teams across South Staffordshire and enable us to meet the two and four hours waiting times. Both these investments were included in the Staffordshire STP.


The Trust wishes to replicate Crisis Services, Liaison Psychiatry Services, S136 suite and introduce a “Community Triage Service” in Shropshire. This investment was included in the Shropshire STP financial template.

o Simplify Urgent & Emergency Care System : We fully support the need to improve urgent and emergency care pathways to ensure people receive the right care, in the right place, at the right time, and with the right level of clinical expertise to meet their needs. The Trust is keen to work more closely with our Acute Trust colleagues to develop Crisis Services and Li aison Psychiatry Services, which will need to be provided on a 24/7 basis in order to achieve this important objective.

o Re-specification of Primary Care Mental Health Services, including IAPT : The Trust does not provide Primary Care Mental Health Services any longer; these Services were redesigned to meet the new clinical model required to meet the Psychological Therapies Service Specification from 1st April 2016. The Trust is currently working with commissioners on the third “must do” requirement to have more trained IAPT staff working in General Practice. We are aware the Mental Health 5 Y ear Forward View was expecting the prevalence for IAPT Services to increase from 15 per cent to 16.8 per cent in 2017/18 and to 19 per cent in 2018/19. The Trust has built an in investment for IAPT Services into the Staffordshire STP and an investment for IAPT Services into the Shropshire STP.

o Review of the Personality Disorder Pathway: This area remains a strategic objective within the Trust’s strategy. More work is needed with Commissioners to review this clinical pathway in order to develop a pathway that delivers high quality interventions and adds best value.

o PICU : Discussions have started with the commissioner around what PICU activity is planned to be commissioned in 2017/18.

o Dementia Services: Implementing the recommendations of the Prime Minister’s Challenge on D ementia 2020 i ncluding achieving and sustaining high levels of dementia diagnosis. This key deliverable of ensuring at least two thirds of the people with Dementia are diagnosed is well recognised. The Trust will naturally work closely with General Practitioners on t his matter and t he Trust wants to review the Dementia care pathway, so where appropriate, the Service User is transferred back to the GP to provide care after a diagnosis has been made.

• Learning Disabilities Services : Implementation of the Transforming Care

Programme in partnership with Local Authorities, to step down and repatriate patients in Hospital placements

The Trust is working with commissioners on the implementation of this programme locally. Steps have already been taken to transform our existing services including the development of care models within the community and new ways to reduce the need for admission. The Intensive Support Team has radically changed how we care for this group of people.

• Children’s Services: Implementation of the CAMHS Transformation Plan The Trust recognizes that the deployment of this plan involves a significant investment. We have received details of the investment CCGs are expected to make in 2015/16 and 2016/17 from Claire Murdock, National Mental Health Director, which indicated the following amounts for this Trust: Children’s and Young People Services (including C&YPS IAPT): The Trust believes that this area requires greater investment and has started conversations with commissioners on this basis. Shropshire and Telford & Wrekin CCGs have agreed to invest in this Service in 2017/18, which will be used to support their local commissioning intentions.


Eating Disorder Services: The Trust believes that this area requires greater investment and has started conversations with commissioners on this basis. Shropshire and Telford & Wrekin CCGs have agreed to invest in this Service in 2017/18, which will be used to support their local commissioning intentions.

• Case Management Complex Care Placements The Trust is currently working with commissioners on t his service. We had del ivered this service for a number of years in partnership with commissioner and have provided significant quality improvements in the care delivered and financial economies and savings from our approach. South Staffordshire Commissioners issued a notice letter to the Trust and have indicated that they wish to market test this service whilst adding a number of other opportunities. The Trust will work with commissioners on this area and if it goes to market will tender for the retention and development of the service.

• Early Intervention Services (EI) The Trust understands the need to include the requirement to expand EI capacity so more than 50 per cent of people who experience a first episode of psychosis start treatment within two weeks, receive a “NICE recommended package of care”. A provisional financial amount was included in the STP for this investment.

• Digital Roadmap and Other Comments The Trust is fully aware of the significant investment in the STP related to the implementation the digital roadmap, which is estimated to cost over £31M for Staffordshire and over £31M for Shropshire. It is vital that we work in partnership with commissioners to align the phasing of this investment.

• Contracting Currency in 2017/18 and 2018/19 SSSFT intends to continue to use Mental Health Clusters as the contracting currency for 2017/18 and 2018/19 and to use “Cluster Days “as the method of payment. The Trust will continue to use “Contacts” for other Services and Occupied Bed Days for PICU. However, now IAPT Services use Clusters, NHS Improvement and NHS England are recommending providers shadow the use of “Cluster Periods” for IAPT Services from 1st April 2018 with outcome measures and stop using contacts. The Trust is willing to work with Commissioners in future years to review any changes in the contract currency and payment systems, following the outcome of the 2017/18 and 2018/19 National Payment System Consultation Notice. Y ou will be aware one of the key developments SSSFT has wanted to implement relates to Outcome Measures. We need to achieve this important objective in 2017/18. 5.4 Business Plan Objectives 2017/18

• Mental Health (Staffordshire and Shropshire) o Increased productivity of new community pathways including responding to any

challenges or issues encountered robustly including to responding to STP o Review of acute care pathway including reviewing crisis response and liaison

and link to access and ensure restrictive practice is limited and appropriate with accessible options available.

o Provision of sufficient intensive rehab beds to allow repatriation of complex mental health patients from out of area

o Collaboratively with commissioners in relation to Shropshire IAPT and GP counselling, enhancement of IAPT and widen the service user group currently served to include those with long term conditions and comorbidity


o Work collaboratively with commissioners and stakeholders across the health and social care economy to deliver the ambition of the crises care concord act

o Work collaboratively with the LA to extend the current provision of social care to individuals with a mental health problem and ensure it encapsulates all of the care act requirements through the development of a super personalised care pathway

o Working with commissioners to agree the priorities of the 5 year forward view. o To be an Early Implementer Site for North Staffs IAPT expansion to address

Long Term Physical Conditions.

• Learning Disabilities o Development of an intensive community physical health outreach team in

Shropshire o Retendering for the out of area contract (complex care) across all clinical

directorates o Development of emergency respite services linked to the Intensive Support

Team and transforming care o Development of an acute liaison care role in collaboration with Queens Hospital

Birmingham

• Forensic o Development of the new model of care for forensic and forensic LD o Tendering for the step down community services within Staffordshire o Service evaluation of the directorate’s secure care pathway

• Inclusion

o Embed best practice across the prison contracts – These contracts were won in April 2016 and the first year has been focused on changing the staff teams through a management of change process, introducing new ways of working and up skilling the existing staff.

o Expansion and retention of services – Inclusion will be proactively attempting to retain our contracts and continue to look at tenders in IAPT, community substance misuse, prisons and mental health markets of services that we deliver

o Staff Development – Over the last two years we have inherited over 250 new staff through the TUPE process. We will have a comprehensive training programme in place that ensures these staff have the core skills to undertake their roles and also that they understand and incorporate into their practice the Trusts values and behaviours.

• Specialist & Family

o Consolidating and strengthening core services (that would include the CAMHS developments to meet the objectives in Future in Mind and MOC in Shropshire Integrated Sexual Health Services)

o Improving clinical leadership (perinatal – and getting clinical leadership from our senior clinicians as part of the ongoing collective leadership work)

o Expanding our portfolio where we feel it fits with the specialisms within the directorate and where we feel we can make a positive difference to the service.


5.5 Our Estates Strategy The estates strategy and the capital programme are focused on key deliverables.

Compliance Efficiency 1. Statutory 2. Mandatory 3. CQC domains

1. Healing environment 2. Patient pathways 3. Staff pathways 4. Space utilisation 5. Energy 6. Centralising services

The estate must be more efficient, smaller and flexible and ba lance healing and nur turing with the need to be safe without becoming overtly controlling. At all times it is a tool to deliver excellence in care. The developing use of information technology is an i nherent part of estates development as is working with partners, the 5 Y ear Forward Plan, Sustainable Transformation Plans and t he Carter Report. The E states Strategy states that only core infrastructure (inpatient facilities) are a requirement to be an owned Trust assets and other estate should be as sessed as owned, leased or shared based on what fits the corporate agenda, compliance and efficiency. Key project are:

• St George’s redevelopment - Replacement of aging and ol d style building stock consisting of a suburban sprawl across the Trust’s main inpatient site and replace with a cohesive purpose designed development, removing backlog maintenance and reducing on-going maintenance. This project will focus on developing a high quality healing environment and incorporate redesigned patient and staff pathways that support healing and efficient use of resource.

• Section 136 works - Development and expansion of accommodation to upgrade facilities and capacity.

• Adult Community and Learning Disability o Telford centralisation project – Consolidation of services from a number of sites

to a single central location. Focus on high valuing service user floor, and two upper floors of mainly open plan office accommodation.

o Tamworth centralisation project. Consolidation of services from a number of sites to a single central location. Focus on high valuing service user floor and an open plan office accommodation floor in the borough council HQ offices.

o Burton on Trent - Development of existing premises to an ex panded and homogenous development and centralise services.

• Children’s Services East Staffordshire o Tamworth - Consolidation of services from a number of sites to a single

central location o Lichfield – Development of existing premises to an expanded and

homogenous development o Burton on Trent - Consolidation of services from a number of sites to a single

central location • Disposal programme - The capital programme and constant review of space

utilisation will result in the disposal of sites no longer required and in the termination of leases, licences and Tenancy at Wills where they are no longer required.

Timescales and costs are included within our operational plans and project plans. These are also included within our Capital Programme.


SECTION SIX: Supporting New Models of Care

6.1 New Models of Care The vision of our new model of care will localities that offer an al l-encompassing, all age model tailored to the needs of the cohort whether this be younger children and families, frail elderly, or people with enduring conditions who require information and support in adapting lifestyles. Our model combines groups of GPs with nurses, other community health services, the third sector, hospital specialists, mental health and social care to create more integrated out-of-hospital provision at locality level. This has been mapped across all of Staffordshire and a number of models are being tested against the 10 high impact changes and the national new models of care criteria.

All providers and c ommissioners have committed to developing a c omprehensive out of hospital, health and social care service for Staffordshire and Stoke on Trent. To achieve this we intend to place general practice at the centre of the new model of care. Local providers will work jointly with GP leaders to mobilise clinical and corporate assets to deliver services relevant to their local community. Through this we aim to have a model of care in which:

o Individuals and communities are supported to become more resilient and more able to self-care;

o Local people will have access to an enhanced range of high quality services as close to their home as possible with less need to go into hospital;

o GPs will be able to function as part of locality based teams which will bring together professionals from a range of disciplines to facilitate a m ore integrated way of working and circumvent organisational boundaries;

o GPs will be abl e to more readily communicate with and ac cess support from specialist medical, community nursing, therapy and social care staff;

o Locality based teams will cover populations of around 30-70,000 in order to provide sufficient critical mass to build a r esilient professional team and ensure efficient corporate support;

o GPs and other professionals will have the flexibility to determine the way that locality based teams are constituted and function, within a s trategic framework of duties, priorities and outcomes;

o Innovation will be enc ouraged and facilitated in order to improve the quality of services and drive down costs;

o Whilst there is no ex pectation that general practices will unify, there will be a recognition that no practice would be able to deliver everything themselves, so closer working and more shared working will be encouraged, in line with existing and emerging GP federations;

o Locality based teams will have the ability to extend services of special interest or specialism to other localities where needs exist;

o Services are clinically and financially sustainable with the locality based teams supporting the stabilisation of general practices and t he Enhanced Primary & Community Care work stream of the STP.


Through this piece of work our outcomes include: • The creation of sustainable general practice with a t ransformed workforce and

shared back office functions, with GPs working within strong networks • Working within integrated health/mental/social/voluntary sector teams pulling in

specialist help when needed, wrapped around a consistent offer pan-Staffordshire • Implementation of rapid and c ontinuous learning from early implementer and f ast

follower sites and primary care and LMC led initiatives • Delivering a shift of c20-30% of NEL from acute hospital care to community based

services and appropriate out of hospital urgent care services as described by Keogh • Reduction in the dependency of people on domiciliary care services and care homes • Contracts in place that support an outcome/capitated basis in line with the national

NMC/MCP contracting guidance • Development of system wide overarching governance arrangements that support

emerging models of care

Our operating principles set out: • Contextual background to the new models of care frameworks including standard

definitions • Key principles which act as the foundation for the partnership model for practices

including the approach to public and staff engagement and clinical coproduction • What must be delivered in terms of benefits to service users, carers, family, staff and

partners • The core model of care including approach and patient journey • Key outputs of the model including considerations infrastructure and enablers

required to support delivery e.g Workforce, Estates, IM&T, Technology Enabled Care • Approach to continuous improvements and l earning with clear evaluation and

measurement of outcomes • Proposed contractual framework options and considerations and a specific approach

to communications and engagement

The new models of care work will also be supported by the development of a governance framework helping GP practices determine their overall direction of travel whilst understanding the rights and responsibilities of the models that are available to them. 6.2 A focus on Sustaining General Practice Sustaining Primary Care remains a priority and is essential to building any future models of working. This work will be coproduced with NHS England. Our vision is to deliver clinically and f inancially sustainable general practice over the next five years, and to support the development of a new model of integrated care across primary care, community (including mental health), social care and the voluntary sector to meet the needs of our population. This will be achieved through:

• Greater collaboration / networking across practices • Developing a w orkforce strategy to meet current and future needs, including

workforce planning, recruitment, retention and role redesign • Improving the efficiency of general practice through the national 10 hi gh impact

changes • Developing a vision for and implementation of integrated working across community

NHS and social care services and the voluntary sector • Developing estate based on community need to deliver the new model of care and

ensure more self-reliance and resilience across communities


• Using IT to reduce bureaucracy and to support innovation across general practice, including self-care by patients

• Practices working in collaboration with the ‘Supporting Change in General Practice Team’ to develop more sustainable general practice

• Working to develop and change patients’ and t he public’s relationship with NHS services

• Developing the culture of collaborative working across general practice • Developing the leadership and OD skills across general practice

The economy continues to explore the opportunities for optometry, pharmacy and dental contractors to support the new model of care. Each CCG, in partnership with NHS England, is developing local implementation plans to support the delivery of the vision, with clear outcomes and t imescales. CCGs are working collaboratively across the whole of Staffordshire where there is mutual benefit and economies of scale. This will include the development of a p rimary care manifesto that is clinically led and integrated within plans to deliver the NHS GP Five Year Forward View and integral to defining future workforce needs. Work has started on the development of a core workforce offer for GP Practices that link to the new models of care work. This core offer determines what is required to deliver the list based services within the GMS and opportunities around the enhanced offer. 6.3 Pilot Example General practice is increasingly overwhelmed with patient demand and the supply of GP appointments is limited by a national workforce shortage, dwindling primary care investment and growing workload. With up to three in 10 GP consultations being for mental health conditions it seems logical to bring specialists in this field into general practice. Current Situation: Patients with mental health disorders present in the most part to their general practitioner. The patients are managed in primary care or referred onward to a locally commissioned counselling or therapy service. Once referred, patients are electronically or paper triaged by an experienced IAPT worker. The patient is then offered telephone appointments to further evaluate. This then results in face to face therapeutic intervention (group or individual) or telephone therapies. There can sometimes be an extensive wait for triage and therapy. In the meantime, if the patient is started on medication they will often need to see their GP at least 3 and up to 6 more times to monitor response to therapy and to titrate doses. With depression and anxiety being extremely common presentations, mental health disorders can consume very large quantities of general practice resource. New Care Pathway: It is proposed that clinicians such as prescribing CPN’s are bought into GP surgeries where patients can be booked directly to see them or be referred to them by a practice GP. It would be hoped that the CPN would be able to follow up the individual, initiate and titrate medication and possibly offer CBT or other therapies to the patient directly. This will mean that the patient gets first rate care by the right clinician first time and will allow the GP to see more patients that need a doctors input. Pilot Proposal: One or two CPNs with a prescribing diploma will be seconded to two general practice sites in the Lichfield and Burntwood locality. They will do two sessions per week at each site for a pilot period of six weeks. Future Plans: The pilot will provide information on the dynamics of having a CPN as the first point of contact in GP services, with a view to transformational changes in the way patients access mental healthcare and influence how GP services are commissioned.


SECTION SEVEN: Our Membership and Elections

In 2016, the Trust held elections for 4 public/service user/carer and 3 s taff governor seats, using both postal voting and online voting. Some public/service user/carer seats were contested and all seats were filled. Regular communications were made with members in the months preceding the elections to generate interest, answer queries and pr ovide information. One to one and group meetings with the Company Secretary, Chair and Non-Executive Directors were offered to potential governors to initiate engagement and to ensure that potential candidates fully understand the role, its responsibilities and accountabilities. In 2016, the Trust will commence elections for public/service user/carer and staff seats. The election campaign will commence late spring. A particular emphasis will be the use of social media to improve engagement with a wider audience, alongside written communications, invitations to Council of Governors’ meetings, events, workshops and specifically designed “potential governor” workshops and meetings. We will develop a m icrosite, hosted on t he Trust website which will provide members and potential governors with comprehensive information about the role of a governor, expectations and information with regards to the election process. Governor recruitment is mainly focussed on: current membership, volunteers, current governor recommendations and engagement with members and the public and our service users and c arers. At the point of being elected, governors are offered a c omprehensive induction in addition to attending the Trust Induction. All governors are invited to be part of the internal governor development programme, where development sessions are held on a monthly basis. These development sessions are aligned to governors’ statutory duties, in addition to any subjects which will assist in governors carrying out their role. The Trust also facilitates joint meetings/development sessions between governors and t he Trust Board. Governors are also encouraged to attend external development opportunities such as those provided by NHS Providers. Each year Governors complete a s elf-appraisal which also informs the development programme. There are a number of Governor engagement groups to which all Governors are invited to attend alongside working groups and task and finish groups for specific projects. The engagement groups give Governors the opportunity to be assured of the Trust’s performance and to influence and comment on strategic direction. The purpose of The Membership Strategy is to demonstrate how the Trust plans to grow and retain its membership base; but more importantly to plan and e vidence meaningful engagement with a diverse range of members. At the heart of our approach is the need for the Trust to embrace its membership and focus on qualitative rather than quantitative membership levels and engagement. The Trust and its Council of Governors regularly attend public and community events. Governors are encouraged to facilitate constituency meetings (open public meetings) with local communities which have proved to be a successful method of engagement. Governors also attend events at local schools and other educational establishments to engage with the younger people within our communities. The Trust also encourages members and members of the public to attend Trust events such as the Annual Members Meeting, Annual General Meeting, Board Meetings, Council of Governors Meetings and other events such as a Service User and C arer Celebration Day. These engagement activities are planned to continue with additional events in collaboration with our partners, service users and carers and governor members. During the coming year, Governors, via a working group will be particularly focussing on recruiting and engaging members with communities that we have historically found harder to reach.

Trust Board of Directors AGENDA ITEM 7.3 Enc F

Document Title: Workforce Plan Update

Sponsoring Director: Greg Moores, Director of Workforce and Development

Author(s): Angie Astley, Head of Workforce Planning and Development


HRODE Summary Planned changes against budgeted establishment to the Trust Workforce between 2017 and 2019 will see reductions in the workforce equivalent to:

• Overall 5.74% reduction (-191.0 FTE) • Nursing Workforce 2.29% reduction (-21.0 FTE) • Allied Health Professionals 6.56% reduction (-8.0 FTE) • Scientific, Therapeutic and Technical Workforce 4.44 reduction (-14.0 FTE) • Medical and Dental Workforce 5.16% reduction (-8.0 FTE) • Support to Clinical Staff 7.07% reduction (-87.0 FTE) • Infrastructure Support Staff 9.03% reduction (-53.0 FTE)

The plan identifies that a key risk associated with the workforce is continued affordability alongside continued quality and suggests that mitigation of such risks would be brought about from new and different ways of working, increased deployment of apprenticeships and the development of new roles such as advanced and assistant practice and nursing associates. Work is ongoing in conjunction with Directorates to consider opportunities for redesign in the workforce in line with commissioning intentions, business planning priorities, service developments and within the financial envelope available. The workforce plan considers both the budget available to deliver services; the funded establishment, and the total number of staff required to deliver services alongside supply of staff. Overall the Trusts workforce age profile remains broadly in line with the National and Regional picture with the a large proportion of staff falling in the 51 an d over age bracket. The workforce split across professional groups is representative of this. Recommendations The Board of Directors is asked to:

• Receive and note this update. • Actively encourage and support increased utilisation of apprenticeships and role

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development assistant / advanced practice, nursing associate posts to assist in mitigation of risks associated with workforce affordability and recruitment challenges.

Workforce Plan Update 2016/17

Author: Angela Astley

Sponsor: Greg Moores

Version [1]

11 January 2017

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Contents

1.0 Strategic Oversight 3

2.0 Strategic Forces Impacting on Services and Workforce Planning 4

3.0 Service / Workforce Transformation 4

4.0 Trust Workforce Demand 5

5.0 Challenges and Risks 6

6.0 Workforce Development 7

7.0 Next Steps/Recommendations 7

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1.0 Strategic Oversight

This document has been produced to provide the Trust’s Chief Executive, Executive and Non-executive Directors, other staff members and our partners with a c lear description of the South Staffordshire and S hropshire Healthcare NHS Foundation Trust Workforce Plan for 2017-19. The document is intended to provide an update to workforce planning activity within the Trust as part of the annual workforce planning round. This Strategic Workforce Plan, submitted to NHS Improvement (NHSI) and Health Education England (HEE), reflects the Trusts Total WTE and includes those services geographically located externally to the West Midlands Region. This plan is aligned to the Trust’s financial plan submitted to NHSI for 2017/18. The 2017/18 Trust workforce plan has been produced at a time when the 2017/18 NHSI plan has been developed, acknowledging that this is at a point in time. The Trust actively seeks to provide services across the country and those services are in our plan. In addition, the Trust continues to actively seek to grow the organisation through bids and tenders across the country. The impact of our success with regard to securing these is unknown and therefore cannot be factored into this plan in terms of workforce change. This is an ongoing and c hanging workforce picture and is the nature of the type of organisation we are. This document is presented as a detailed workforce plan for years 2017/18 and 2018/19. The challenge for the Trust will be to determine the organisational and workforce changes that will be required to continue to deliver savings whilst maintaining quality of service provision. Changes to the workforce need to reflect the financial envelope available and the projections in the workforce plan to 31 March 2019 are in line with the submission to NHSI. Planned changes against budgeted establishment to the Trust Workforce between 2017 and 2019 on this basis will see reductions in the workforce equivalent to:

• Overall 5.74% reduction (-191.0 FTE) • Nursing Workforce 2.29% reduction (-21.0 FTE) • Allied Health Professionals 6.56% reduction (-8.0 FTE) • Scientific, Therapeutic and Technical Workforce 4.44 reduction (-14.0 FTE) • Medical and Dental Workforce 5.16% reduction (-8.0 FTE) • Support to Clinical Staff 7.07% reduction (-87.0 FTE) • Infrastructure Support Staff 9.03% reduction (-53.0 FTE)

It is important to view these reductions in the context of a workforce that is ever changing. At the end of December 2016 the trust-wide annual workforce turnover was 15.38% - this figure solely reflects movement outside the organisation and does not include education placement rotations and TUPE transfers. Trustwide workforce planning and development capability is improving and workforce development initiatives are responsive to key workforce needs. There are no significant differences overall between the planned position and t he forecast outturn position for March 2017. A s the Trust continues to tender for contracts across the country there are in year workforce fluctuations owing to transfers into and out of the Trust that cannot be predicted or planned for. The Workforce Plan presented in this report is the first cut and should be viewed as a point in time; workforce planning and development is a year round activity and as such the plan is likely to change as learning progresses, more granular detail is uncovered and i n response to the rapidly changing commissioning, political and pol icy landscape.

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2.0 Strategic Forces Impacting on Services and Workforce Planning

A number of strategic factors will impact upon the Trust’s services and will have workforce implications that will need to be considered. However in the main the specific workforce implications of these strategic factors are in development and are not yet fully known. 2.1 Sustainability and Transformation Plans (STPs) Sustainability and T ransformation Plans (STPs) are the vehicle through which local health and s ocial care economies are coming together to meet the challenge of improving quality amid a climate of growing demand and challenging financial settlements. The workforce agenda is seen as critical to the success of both the Staffordshire and S hropshire STPs; workforce makes up appr oximately 70% of all NHS spending, meaning workforce planning and workforce transformation are at the very heart of local health economy planning. 2.2 Five Year Forward View The national context has seen further emphasis on p reventing hospital admissions, breaking down traditional organisational barriers, with care being centred on t he individual. This will see the development of new care models and different types of organisations emerging. In terms of the wider workforce implications of the Forward View, the coming years will require imaginative approaches to workforce solutions and the development of new and di fferent roles rather than traditional approaches to provide greater workforce mobility and flexibility. In addition, there will be a requirement to adopt a more collaborative approach across the local health system to allow providers to deploy staff in different ways, where staff have a more flexible range of transferable skills to work across different care settings.

3.0 Service / Workforce Transformation

In order to better understand the demand for workforce skills throughout the Trust a series of focused discussions with key staff members has taken place and intelligence has been obtained from Directorate Business Plans; the highlights of which are described below: 3.1 Directorate Level Narrative Highlights The priorities and service changes outlined below are presented for years 1 and 2 of the workforce plan and aligned to the NHSI Plan. In Specialist Learning Disabilities there are a number of programmes of work including the Winterbourne Joint Improvement Programme, the NHS 5 year Forward View, the Transforming Care Programme and the STPs that are driving forces in the work of the Learning Disabilities Directorate and reflected in their business plan. The Directorate has considered workforce implications as a r esult of a range of service developments and consideration is being given to the development of new roles including physiotherapy and dietetics, assistant practice, nursing associates and apprenticeships.

In Children’s Services the priorities are to consolidate and enhanc e existing services to improve clinical outcomes and service efficiency. This includes the implementation of clinical pathways which will be supported by training clinical staff in pathways and evidence based practice. There are difficulties recruiting and r etaining paediatricians; a num ber of experienced and skilled Paediatricians are approaching retirement. T he workforce implications include increasing specialist nursing posts to address difficulties in recruitment of Paediatricians. This will include advanced practice and nurse prescribing, to support reduction in medical posts.

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In Forensic Mental Health Services key strands of work include reviewing and r edesigning the inpatient care pathway to ensure efficiency and effectiveness, the development of intensive wrap around support to prevent readmission and the development of a new care model to provide care closer to home in the least restrictive setting. The Directorate continues to experience challenges in recruiting and r etaining staff and is trialling a variety of shift patterns to attract nurses into the service. An open advert for Band 5 nurses is having a slow but positive impact. There is potential to review other specialties within the workforce to enhance skill mix and introduce new and different roles. In the Mental Health Division a key programme of transformation has taken place during 2016 which saw the development of a new model of care underpinned by re-developed patient pathways. The approach has ensured involvement of clinical staff with specialist workforce planning support from corporate services. The next phase of this programme is the development of a 5 year workforce plan and the skill mix within teams to align patient need by care cluster with staffing requirements. This work will see an increase in the deployment of new roles such as assistant and advanced practice as a solution to national shortages within nursing and middle grade medical staff. It is also likely that there will be training needs identified to further upskill existing staff. The deployment of this new model will be a priority during 2017/18. There are a number of other priorities for the Division including a review of the acute care pathway, enhancement of health based place of safety provision and supporting STP plans through enhanced primary care provision and new models of care. The Division has been experiencing difficulties in attracting Band 5 n urses alongside shortages in specialty doctors. I n response to these challenges the Division is seeking to develop new roles including assistant and advanced practice and nursing associates. The Inclusion Directorate continue to deploy their business model and are continuing to expand existing service provision within the community substance misuse field nationally. The Directorate is engaged in the development of apprenticeship roles to support tendering processes and to provide development opportunities for existing staff.

4.0 Trust Workforce Demand Taking into account the context provided by the narrative above the table that follows on the next page provides an overview of the impact of changes on the Trust workforce. The figures presented reflect those that the Trust presented to NHSI in the annual plan. At Division/Directorate level workforce planning is ongoing. At the time of the report planned changes are anticipated to impact on individual staffing groups in the following ways:

The plan for year ending 31 March 2018 takes into account developed cost improvement plans (CIPs) and known service changes. The forecast demand as at 31 March 2019 is subject to change once further detailed work to develop CIP schemes has been undertaken. The forecast demand outlined above is as presented to NHSI and Health Education England in the workforce plan submission in December 2016.

Funded FTE (Projected Out-turn 2017)

Plan Year Ending 31/03/2018

Plan Year Ending 31/03/2019

WTE Change at 31/03/19 (Funded)

% Change at 31/03/19

Nursing & Midwifery Registered 919.00 912.00 898.00 21.00 2.29Allied Health Professionals 122.00 118.00 114.00 8.00 6.56Scientific, Therapeutic and Technical 315.00 307.00 301.00 14.00 4.44Medical and Dental 155.00 150.00 147.00 8.00 5.16Support to Clinical Staff 1231.00 1159.00 1144.00 87.00 7.07Infrastructure Support 587.00 537.00 534.00 53.00 9.03Total 3329.00 3183.00 3138.00 191.00 5.74

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4.1 Trust Workforce Profile

The table above shows the age profile of the Trust’s workforce. The data shows that 32.87% of staff are aged 51 and over, with only 5.30% of the workforce below the age of 25. Analysis of the nursing workforce highlights that 32.38% of staff are aged 51 and over with 39.71% of medical and dental staff falling within this age range. With the opportunity for retirement at 55 with special class status there are potential risks to workforce supply against demand which would further exacerbate the Trust’s challenges around nurse recruitment and middle grade medical shortages. Retention of specialist skills and k nowledge within these key staff groups will be a pr iority moving forwards as well as attracting, developing and retaining the workforce of the future. Workforce development strategies including role redesign, development of new roles and apprenticeships will be critical as an enabler of continued workforce supply to meet demand.

5.0 Challenges and Risks

There remains significant difficulty in recruiting to Band 5 nurses to posts within the In-Patient Services of the Trust with around 57 WTE vacancies at the end of December. The Trust is running an open advert for Band 5 nurses for inpatient wards within Forensic Services and Mental Health Shropshire which is having a s low but positive impact. Forensic Services are trialling a variety of shift patterns as an offering to attract nurses. An advert aimed at attracting student nurses to the Trust who are due to qualify in March 2017 was published in November. Those nurses on s econdment from the Trust due to qualify in March 2017 hav e now been of fered places through a simplified recruitment process. A large proportion of Community Paediatricians are to retire in the next 2 to 5 years. Mitigation is role redesign for medical and nursing posts, exploring training places for Paediatricians to attract medical staff into the service. The shortage of the middle grade medical workforce and di fficulty in recruiting core trainees in psychiatry continue. Regionally there are issues in recruiting higher trainees within the CAMHS speciality which will also need to be considered in terms of role redesign for future service delivery. Mitigation is partly provided by the development of new and different roles such as advanced practice and physician’s associates. At present there are no retention issues however unless job satisfaction and rotation are considered this may become a problem. In the economic climate, workforce affordability and maintaining quality of service provision is a high level risk. Opportunities are available to increase utilisation of new roles, e.g. apprenticeships, assistant practitioner, developmental roles. There is also an opportunity to review skill mixes in line with patient pathways which supports the priorities within Directorate Business Plans. The Trust has developed a range of recruitment and retention projects including an in-house nurse bank which has impacted positively with a reduction in the reliance and usage of agency staff. The Trust will continue to look at innovative ways to reduce spend in this area whilst ensuring that the quality of the workforce is improved. This is demonstrated within our workforce plan and supporting schedules which outline a number of realistic developments and redesign programmes leading to a reduction in spend on bank and agency and a greater utilisation of the substantive workforce. This will support us in effectively reporting and tackling any challenge of performance during the year.

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6.0 Workforce Development

6.1 Assistant Practice and Nurse Associates Assistant Practitioner (AP) roles have been developed and depl oyed in Mental Health, Specialist and Forensic Services provided by the Trust. There is opportunity for expansion of this role as a potential solution to the nursing shortage that the Trust is experiencing. The academic element of this role encompasses a Higher Apprenticeship route as well as a foundation degree, resulting in a dual award. There are many skilled healthcare support staff within the Trust and there is potential to draw supply from within the Trust as part of a c areer development programme. The Trust is part of a pilot across the West Midlands from January 2017 and will host 5 trainee nurse associates on a 2 y ear development programme. There are plans to develop further nurse associate cohorts from October 2017. The development of this role will provide some mitigation in terms of the Band 5 nurse shortage however it is noted that the benefit of this new role will not be fully realised until 2019 once trainees have qualified. 6.2 Advanced Practice Health Education England has provided funding during this financial year for places on the MSc in Advanced Clinical Practice. It is anticipated that the number of funded places for new starts on the programme will continue in 2017/18. This role is key in bringing about workforce change in terms of addressing shortages within the medical workforce. It is suggested that the role is further developed within longer term workforce plans within the Trust. 6.3 Apprenticeships Apprenticeships are an increasingly important part of the long term plan for improved workforce development and enhanced productivity in England. The government’s apprenticeship reform programme is aimed at ensuring apprenticeships in England become more rigorous and more responsive to the needs of employers.

The apprenticeship levy comes into effect from 6 April 2017 with the new funding system coming into effect from May 2017. E mployers will pay 0.5% of each months pay bill to HMRC via PAYE process alongside tax and national insurance contributions. In addition, the Enterprise Bill passed through Parliament in May 2016 and is now the Enterprise Act. Within the Act there is a section that outlines targets for annual apprenticeship starts placed on public sector employers. This target is 2.3% of total headcount. This equates to approximately 80 new apprenticeship starts for the Trust. Our current activity is around 60 new apprenticeship starts per year. There are plans to maximise our contribution to the apprenticeship levy and to increase the offer of higher level apprenticeships within the Trust. A new four year nursing degree apprenticeship standard has been approved for delivery from October 2017 which will support the career development opportunities available and mitigate against the removal of nursing bursaries for seconded students to nurse training. The Trust is also actively involved in an Occupational Therapist trailblazer which will offer similar opportunities to the nurse degree apprenticeship once developed. Opportunities for building apprenticeships into workforce models within bids and tenders with Inclusion are being explored alongside the opportunity to develop expand the apprenticeship offer to existing staff.

7.0 Next Steps/Recommendations

• Continue to embed workforce planning into Directorates through the provision of specialist support and through business planning mechanisms.

• Embed approaches to attracting and retaining staff in professional groups where shortages are highlighted as a risk.

• Continue to develop new and di fferent roles including Assistant and Advanced Practitioner and Nursing Associate roles and evaluate the impact of the roles on the delivery of services.

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• Continue to identify and deploy Apprenticeship opportunities and expand the range of apprenticeships on offer.

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Board of Directors 26/01/17

Enc G

Document Title: Audited Charitable Fund Accounts 2015/16

Sponsoring Director: Jayne Deaville, Director of Finance & Performance

Author(s): Marianne Cleeve


Executive Summary Enclosed is the draft audited Annual Report and Accounts for the South Staffordshire Community and Mental Health Charitable Fund and Other Related Charities for the financial year 2015/16.

Recommendations 1. Note and approve the contents of the annual report and accounts 2. Raise questions and/or clarify report content



Strategic Aims Provide high quality, recovery focused services Respect, inspire and develop our workforce Innovate through co-operation and co-production Delivery regulatory, financial, performance and quality

standards Expand our current service portfolio in order to enrich

services NHSI Licence Compliance Other (add details)

Assurance Ref Details Risk Register Assurance Framework Board Committee Audit Committee

SOUTH STAFFORDSHIRE COMMUNITY & MENTAL HEALTH CHARITABLE FUND AND OTHER RELATED CHARITIES

FINANCIAL STATEMENTS

FOR THE YEAR ENDED 31 MARCH 2016

CHARITY NO. 1061006

South Staffordshire Community & Mental Health Charitable Fund and Other Related Charities Registration Number 1061006

Annual Report 2015/16

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Reference and Administrative Details of the Charity, it’s Trustees and Advisers for the year ended 31 March 2016 Registered Charity No: 1061006 Address of Charity: South Staffordshire and Shropshire Healthcare NHS

Foundation Trust Trust HQ St Georges Hospital Corporation Street Stafford ST16 3SR Tel: 0300 790 7000 Trustee Arrangements: The South Staffordshire and Shropshire Healthcare NHS Foundation Trust is the Corporate Trustee of the Charity. The Directors who served the South Staffordshire and Shropshire Healthcare NHS Foundation Trust during the year to 31st March 2016 were as follows:- M Gower Chairman N Carr Chief Executive A Bussey Chief Operating Officer J Deaville Director of Finance & Performance C Barkley Medical Director (left 5th November 2015) A Khan Medical Director (commenced 8th November 2015) S Grange Director of Commercial Development T Moyes Director of Quality & Clinical Performance M McQuade Non-Executive P Bunting Non-Executive I Wilson Non-Executive E Nicholson Non-Executive R Hilton Non-Executive S Nixon Non-Executive Bankers: HSBC 49 Market Street

Lichfield Staffordshire WS13 6LB Investment Managers: CCLA Investment Management Ltd 80 Cheapside London EC2V 6DZ M&G Investments Lawrence Pountney Hill London EC4R 0HH External Auditors: Dains LLP Suite 2, Albion House 2 Etruria Office Village

Forge Lane Etruria

Stoke On Trent ST1 5RQ



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Solicitors: Capsticks 35 Newhall Street Birmingham B3 3PU Trustees’ Report for the year ended 31st March 2016 The trustees present their annual report together with the audited financial statements of the charity for the year ended 31st March 2016. The Trustees confirm that the Annual report and financial statements comply with the provisions of the Statement of Recommended Practice (SORP), applicable to charities preparing their accounts in accordance with the Financial Reporting Standard applicable in the UK and Republic of Ireland (FRS 102, effective 1 January 2015 as amended by update Bulletin 1 published on 2 February 2016). Objectives and Activities Policies and Objectives In setting objectives and planning activities, the Trustees have given due consideration to general guidance published by the charity commission relating to public benefit. We believe that South Staffordshire Community & Mental Health Charitable Fund and Other Related Charities meets the principles relating to charities and public benefit described in the Charity Commission guidance and that our report demonstrates this. The Charity’s objectives are as follows:- “The trustees shall hold the trust fund upon trust to apply the income, and at their discretion, so far as permissible, the capital, for any charitable purpose or purposes relating to the National Health Service.” Within the main charitable registration, since 31st October 2002 a number of separate special purpose charities have been listed within the group registration. The objects of each listed charity provide for the funds to be applied for any charitable purpose relating to the NHS. The names and objectives are as follows:- South Staffordshire Child Development Fund For any charitable purpose or purposes relating to the NHS wholly or mainly for child development services. Learning Disabilities General Charity For any charitable purpose or purposes relating to the NHS wholly or mainly for the services provided by learning disabilities. South Staffordshire Therapeutic Services Fund For any charitable purpose or purposes relating to the NHS wholly or mainly for therapeutic services. South Staffordshire Homecare Healthcare Fund For any charitable purpose or purposes relating to the NHS wholly or mainly for homecare services.



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South Staffordshire Nursing Services fund For any charitable purpose or purposes relating to the NHS wholly or mainly for nursing services provided by South Staffordshire Healthcare NHS Trust. Community Mental Health General Charity For any charitable purpose or purposes relating to the NHS wholly or mainly for the services provided by the community mental health service. Community General Charity For any charitable purpose or purposes relating to the NHS wholly or mainly provided by the community services St Michaels Hospital General Charity For any charitable purpose or purposes relating to the NHS wholly or mainly for the services provided by St Michaels Hospital. Margaret Stanhope Centre General Charity For any charitable purpose or purposes relating to the NHS wholly or mainly for the services provided by the Margaret Stanhope Centre. Victoria Hospital General Charity For any charitable purpose or purposes relating to the NHS wholly or mainly for the services provided by the Victoria Hospital Fund Sir Robert Peel Hospital General Charity For any charitable purpose or purposes relating to the NHS wholly or mainly for the services provided by Sir Robert Peel. George Bryan Centre General Charity For any charitable purpose or purposes relating to the NHS wholly or mainly for the services provided by George Bryan Centre. Hammerwich Hospital General Charity For any charitable purpose or purposes relating to the NHS wholly or mainly for the services provided by Hammerwich Hospital. Strategic Health Authority Fund For any charitable purpose or purposes relating to the NHS wholly or mainly for the services provided by the Health Authority. During 2015/16 the trustees will again review fund balances and the overall future objectives and direction of the charity. The Trustees can confirm that they have paid due regard to the guidance on public benefit in deciding what activities the charity should undertake. This guidance is based on two principals: 1 – there must be an identifiable benefit or benefits, 2 – benefit must be to the public, or a section of the public, These principals are demonstrated in the charities strategic objectives and activities above. Activities for Achieving Objectives The charity is funded by donations and/or legacies received from patients, their relatives, the general public and other external organisations. The overall strategy of the Charity is to provide support to the above Trusts by the following means:- Patients Expenditure - purchase small equipment, provision of services and the

provision of facilities not normally provided by or in addition to the normal NHS provision.



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Staff Expenditure - a) motivation of staff, by improving staff facilities and by

providing services that improves staff wellbeing.

b) education of staff by providing education over and above what would normally be provided by the NHS.

Capital Equipment - equipment in addition to that normally provided by the NHS. Achievements and Performance of the Charitable Funds During the year, the designated funds continued to support a wide range of charitable and health related activities benefiting both patients and staff. To fulfil the charitable aims and objectives, the strategy of the South Staffs Community and Mental Health Charitable Fund is to support its related constituent bodies by providing funds to benefit patients by purchasing supplementary and complimentary equipment or services for which the related NHS organisation are unable to provide funding through exchequer sources. For example, charitable funds were used to purchase equipment to compliment what had already been provided for at various hospital sites. The charity does not actively fundraise and relies upon the generosity of the patients and their relatives and other donors who are familiar with or have experienced the care of the participating NHS Trusts or who are sympathetic and generous in their support to their local NHS service. Financial Review The net assets of the Charitable Funds as at 31st March 2016 were £433,000 (2015: £471,000) of which £101,000 was restricted (2015 £127,000). Overall net assets reduced by £38,000, with a loss on the valuation of the investments of £11,000 and a deficit of income over expenditure of £27,000. The charity continues to rely on donations and legacies as the main sources of income. Total incoming resources decreased by £25,000 from 2014/15. During the year the Charity paid grants of £63,000 and these are detailed in note 4 of the accounts. The grants relate to patients welfare and amenities, staff education, training and development and the purchase of new furniture and equipment. Included within the total cost of charitable activities of £80,000 shown in the Statement of Financial Activities are the costs of administering grant making of £17,000 detailed in note 3. Patients welfare grants in 2015/16 totalled £14,000 and includes the purchase of various items of equipment to support the patients across the Charity along with various activities for patients. Purchase of new furniture and equipment totalled £17,000 and includes the purchase of furniture and various items of medical equipment across South Staffordshire & Shropshire Healthcare NHS FT and Burton Hospitals. Staff education, training and development totalled £5,000 and relates to items purchased to support the staff in their roles within South Staffordshire & Shropshire Healthcare NHS FT. Individual fund team co-ordinators for each Trust are responsible for the day to day management of charitable funds, and the trustee relies on the fund advisers to ensure the effective use of those charitable funds earmarked for their clinical area or activity, by applying their local or specialist knowledge appropriately.



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Principal Funding The charity is indebted to the generosity of patients, their families and carers, well wishers and friends who have donated so generously to the work of the charity. In 2015/16 the charity received £38,000 of donation income of which £4,000 was restricted. Investment income of £15,000 was also received during the year. The Charity’s total incoming resources for the year are therefore £53,000. The overall financial performance recorded a net decrease in funds of £38,000. Structure, Governance and Management of the Charitable Funds The charity was created by Trust Deed on the 31st October 2002 and was named as the South Staffordshire Community & Mental Health Charitable Fund and Other Related Charities. South Staffordshire Community & Mental Health Charitable Fund and Other Related Charities retains and administers individual funds on behalf of the following related health bodies:- South Staffordshire and Sesidon CCG Staffordshire & Stoke On Trent Partnership NHS Trust Burton Hospitals NHS FT Within the Charity are a number of earmarked (designated) funds relating to particular wards and departments, along with three restricted funds totalling £101k for nursing services, community mental health and other services. The charity manages spending through fund team co-ordinators who are allocated part of the total budget to spend in accordance with agreed authorisation limits. Fund team co-ordinators for each of the designated and restricted funds manage these funds on a day to day basis within the standing financial instructions and standing orders and powers of delegated authority set by the corporate trustee. The trustee overseas the work of the fund team co-ordinator and has the power to revoke a fund team co-ordinator remit or, subject to any specific donor restriction, direct the use to which funds are put. The Corporate Trustee is the South Staffordshire and Shropshire Healthcare NHS Foundation Trust, and the executive directors and non-executive directors of the Trust Board share the responsibility to ensure that the NHS body fulfils its duties as Corporate Trustee when it manages the charitable funds. The Chair and Non-Executive Directors are appointed by the membership council nominations committee. The Chief Executive and executive directors are appointed by the Trust Board. The Director of Finance is responsible for the day-to-day management control of the administration of the charitable funds. The Director of Finance has particular responsibility to ensure that:

- the spending is in accordance with the objects and priorities agreed by the Board

- the criteria for spending charitable monies are fully met - full accounting records are maintained - devolved decision making or delegated arrangements are in accordance with

the policies and procedures set out by the board on behalf of the Corporate Trustee.

Relationships with Related Parties/External Bodies The South Staffs Community & Mental Health Charitable Fund works closely with and provides the majority of grants to its related NHS organisations authorities and to individuals within these organisations. Staff within these organisations identify and advise South Staffs



6

Community & Mental Health Charitable Fund on local priorities and assist the Corporate Trustee in monitoring the use of the charitable funds. Grants are met from within the Special Charity to which the relevant NHS organisation authority relates. The Director of Finance is a member of the Health Financial Management Association and receives regular updates and bulletins on matters affecting NHS charity funds from the HFMA Charitable Funds Special Interest Group. Training and Development The Charity takes an active role in the training and development of Trustees. Where new Trustees are appointed they receive individual induction training and are provided with guidance including the Charity Commissions “Responsibilities of Trustees”. Additionally the Board will arrange further training as appropriate. Investment Policy and Performance The charity’s investment powers are broad but subject to a restriction that no speculative or hazardous investments, specifically futures or traded options, are allowed. The charity’s current investments are managed by an approved investment company and an investment policy is in place with them. The investment objective is long-term capital appreciation and a reasonable level of income. However the charity will not invest in the producers of tobacco or tobacco products, or arms, nor directly invest in the securities of organisations involved in activities incompatible with the objectives and ethos of the National Health Service. Those income funds not required in the coming year are invested in the portfolio. Reserve Policy As at 31st March 2016 reserves held amount to £433,000 of which £101,000 was restricted, which is in line with Trust expectations. The trustees have reviewed the charity’s need for reserves in line with the guidance issued by the Charity Commission and have set aside or designated £110,000 to meet commitments. The trustee requires all fundraising to be spent within a reasonable period of receipt to avoid large reserves building up. All existing funds are reviewed six monthly to identify any fund that has not spent any of its donations within the previous twelve months and considers the merits of merging such funds with other funds to encourage their utilisation. The charity had a deficit of income over expenditure during 2015/16 of £27,000. The value of investments decreased by £11,000 during the year, this decrease is distributed across the designated funds. Grant Making Policy This year the charity made grants of £63,000. In making grants, the trustee requires that the activity falls within the objects of the charity, that the grant request is supported by a partner NHS body and that the funds are available to meet the request. Where funds are under the day to day management of a fund team co-ordinator, the fund team co-ordinator may incur any expenditure, subject to the authorised expenditure limits provided the expenditure falls within the objects of the fund, is a reasonable charge to charitable funds, and is in furtherance of the objects of the charity. Expenditure incurred by fund team co-ordinators under the scheme of delegation is not reported formally as a number of grants but is accounted for as an ongoing activity in furtherance of the objects of the charity. For further information relating to the type of expenditure and the basis for applying for grants included under the above headings refer to the Achievements and Performance of the Charitable Fund sections of this report.



7

Risk Management Policy The Trustees have a Risk Management Policy in place for the Trust. The policy details the process to be used in identifying risks and controls, assessing risks and evaluating the actions required. This information is consolidated onto a risk register. The risk register is reviewed bi-monthly, the Corporate Trustee reviews any new risks identified during the year on an ongoing basis. The most significant risk which the Trust identified was the loss from a fall in the value of the investments. This has been carefully considered and there are procedures in place to review the investment policy and to ensure that both spending and firm financial commitments remain in line with income. Additionally income and expenditure is being monitored in total on a monthly basis to detect trends as part of the risk management process to avoid unforeseen calls on reserves. Events Since the Year End and Future Plans The trustee does not expect any significant changes in the objectives of the charity in the forthcoming year and intends to reduce the reserves where suitable projects or programmes can be identified. The Trustees are mindful of the many changes in the NHS, including efficiency reviews, payment by results. These changes will influence the priorities for spending charitable funds. New requests for support are encouraged from all participating health bodies. The level of activity is dependant on the generosity of donors and the receipt of legacies. During 2016/17 funds held on the behalf of previous organisations where services have now been transferred into Burton Hospitals NHS FT will be transferred to their own charitable fund as of the 1st September 2016 £44k. Signed: Mrs J Deaville, Director of Finance & Performance on behalf of the Corporate Trustee Date:



8

Statement of trustees' responsibilities in respect of the trustees’ annual report and the financial statements The trustees are responsible for preparing the Trustees’ Report and the financial statements in accordance with applicable law and United Kingdom Accounting Standards. The law applicable to charities in England & Wales requires the trustees to prepare financial statements for each financial year which give a true and fair view of the state of affairs of the charity and of the incoming resources and application of resources of the charity for that period. In preparing these financial statements, the trustees are required to:

• select suitable accounting policies and then apply them consistently; • observe the methods and principles in the charities SORP: • make judgements and estimates that are reasonable and prudent; • state whether applicable accounting standards have been followed, subject to any

material departures disclosed and explained in the financial statements: • prepare the financial statements on the going concern basis unless it is

inappropriate to presume that the charity will continue in operation.

The trustees are responsible for keeping accounting records that disclose with reasonable accuracy at any time the financial position of the charity and enable them to ensure that the financial statements comply with the Charities Act 2011 and trust deed. They are also responsible for safeguarding the assets of the charity and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities. The trustees are responsible for the maintenance and integrity of the charity and financial information included on the charity’s website. Legislation in the United Kingdom governing the preparation and dissemination of financial statements may differ from legislation in other jurisdictions. Signed for and on behalf of the Trustees: Mrs J Deaville, Director of Finance & Performance on behalf of the Corporate Trustee Date:



9

Independent Auditor’s Report to the trustees of South Staffordshire Community & Mental Health Charitable Fund and Other Related Charities We have audited the financial statements of South Staffordshire Community & Mental Health Charitable Fund and Other Related Charities for the year ended 31 March 2016 which comprise the Statement of Financial Activities, the Balance Sheet and the related notes. The financial reporting framework that has been applied in their preparation is applicable law and United Kingdom Accounting Standards (United Kingdom Generally Accepted Accounting Practice) including FRS 102 ‘‘The Financial Reporting Standard applicable in the UK and Republic of Ireland’’. This report is made solely to the charity’s trustees, as a body, in accordance with regulations made under section 154 of the Charities Act 2011. Our audit work has been undertaken so that we might state to the charity’s trustees those matters we are required to state to them in an auditor’s report and for no other purpose. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the charity and the charity’s trustees as a body, for our audit work, for this report, or for the opinions we have formed. Respective responsibilities of trustees and auditor As explained more fully in the Trustees’ Responsibilities Statement set out on page 8, the trustees are responsible for the preparation of financial statements which give a true and fair view. We have been appointed as auditor under section 145 of the Charities Act 2011 and report in accordance with regulations made under section 154 of that Act. Our responsibility is to audit and express an opinion on the financial statements in accordance with applicable law and International Standards on Auditing (UK and Ireland). Those standards require us to comply with the Auditing Practices Board’s Ethical Standards for Auditors. Scope of the audit of the financial statements An audit involves obtaining evidence about the amounts and disclosures in the financial statements sufficient to give reasonable assurance that the financial statements are free from material misstatement, whether caused by fraud or error. This includes an assessment of: whether the accounting policies are appropriate to the charity’s circumstances and have been consistently applied and adequately disclosed; the reasonableness of significant accounting estimates made by the trustees; and the overall presentation of the financial statements. In addition, we read all the financial and non-financial information in the Trustees’ Report to identify material inconsistencies with the audited financial statements and to identify any information that is apparently materially incorrect based on, or materially inconsistent with, the knowledge acquired by us in the course of performing the audit. If we become aware of any apparent material misstatements or inconsistencies we consider the implications for our report. Opinion on financial statements In our opinion the financial statements: • give a true and fair view of the state of the charity’s affairs as at (date), and of its

incoming resources and application of resources, for the year then ended; • have been properly prepared in accordance with United Kingdom Generally Accepted

Accounting Practice applicable to Smaller Entities; and • have been prepared in accordance with the requirements of the Charities Act 2011.



10

Independent Auditor’s Report to the trustees of South Staffordshire Community & Mental Health Charitable Fund and Other Related Charities (continued) Matters on which we are required to report by exception We have nothing to report in respect of the following matters where the Charities Act 2011 requires us to report to you if, in our opinion: • the information given in the Trustees’ Report is inconsistent in any material respect with

the financial statements; or • sufficient accounting records have not been kept; or • the financial statements are not in agreement with the accounting records and returns; or • we have not received all the information and explanations we require for our audit. Dains LLP Suite 2, Albion Office Statutory Auditor 2 Etruria Office Village Chartered Accountants Forge Lane Etruria Date: Stoke on Trent ST1 5RQ Dains LLP is eligible to act as an auditor in terms of section 1212 of the Companies Act 2006

South Staffordshire Community Mental Health Charitable Fund and Other Related Charities

Registration Number 1061006

Statement of Financial Activities for the year ended 31 March 2016

2015-16 2014-15

Note Unrestricted Restricted Total Total

Funds Funds Funds Funds

£'000 £'000 £'000 £'000

Income From:Donations & Legacies: 2

Donations 34 4 38 61

Legacies 0 0 0 0

Sub Total 34 4 38 61

Investments 8 11 4 15 17

Total Income 45 8 53 78

Expenditure on:Charitable Activities 4 66 14 80 126

Total Expenditure 66 14 80 126

Net Gains/(Losses) on Investments 7 -11 0 -11 22

Net Expenditure -32 -6 -38 -26

Transfer Between Funds 20 -20 0 0

Net Movement In Funds 12 -12 -26 -38 -26

Reconciliation of Funds

Fund balances brought forward 344 127 471 497Fund balances carried forward 332 101 433 471

The statement of financial activities includes all gains and losses recognised during the year.

All income and expenditure derive from continuing activities.

11



Balance Sheet as at 31 March 2016

Notes Unrestricted Restricted Total at 31 Total at 31

Funds Funds March 2016 March 2015

£'000 £'000 £'000 £'000

Fixed AssetsInvestments 7 358 0 358 369

Total Fixed Assets 358 0 358 369

Current Assets

Debtors 10 0 0 0 1

Cash at bank and in hand 9 84 101 185 245

Total Current Assets 84 101 185 246

Liabilities

Creditors: Amounts falling due within one year 10 110 0 110 144

Net Current Assets -26 101 75 102

Net Assets 332 101 433 471

Funds of the Charity 12

Income Funds:

Unrestricted 332 0 332 344

Restricted 0 101 101 127

Total Funds 332 101 433 471

The notes at pages 13 to 21 form part of this account.

Signed:

Name: Jayne Deaville, Director of Finance & Performance

Date:

12



Notes to the Account

1 Accounting Policies

(a) Basis of Preparation of Financial Statements

South Staffordshire Community Mental Health Charitable Fund and Other Related Charities is an unincorporated charity in England.

The address of the registered office is given in the reference and administrative details on page 1 of these financial statements. The

nature of the charity’s operations and principal activities are detailed on pages 2 - 3.

The charity constitutes a public benefit entity as defined by FRS 102. The financial statements have been prepared in accordance with

Accounting and Reporting by Charities: Statement of Recommended Practice applicable to charities preparing their accounts in

accordance with the Financial Reporting Standard applicable in the UK and Republic of Ireland (FRS 102) issued on 16 July 2014 (as

updated through Update Bulletin 1 published on 2 February 2016) , the Financial Reporting Standard applicable in the United Kingdom

and Republic of Ireland (FRS 102), the Charities Act 2011 and UK Generally Accepted Practice as it applies from 1 January 2015.

The charity has applied Update Bulletin 1 as published on 2 February 2016 and does not include a cash flow statement on the grounds

that it is applying FRS 102 Section 1A.

The financial statements have been prepared to give a ‘true and fair’ view and have departed from the Charities (Accounts and

Reports) Regulations 2008 only to the extent required to provide a ‘true and fair view’. This departure has involved following the

Accounting and Reporting by Charities: Statement of Recommended Practice applicable to charities preparing their accounts in

accordance with the Financial Reporting Standard applicable in the UK and Republic of Ireland (FRS 102) issued on 16 July 2014

rather than the Accounting and Reporting by Charities: Statement of Recommended Practice effective from 1 April 2005 which has

since been withdrawn.

The financial statements are prepared on a going concern basis and are prepared in sterling which is the functional currency of the

charity and rounded to the nearest £1,000.

The significant accounting policies applied in the preparation of these financial statements are set out below. These policies have been

consistently applied to all years presented unless otherwise stated.

(b) Reconciliation with Previous Generally Accepted Accounting Practice

In preparing theses accounts, the Trustees have considered whether in applying the accounting policies required by FRS 102 and the

Charities SORP FRS 102 the restatment of comparative items was required.

See note 15 for details of adjustments made on transition.

(c) Fund Accounting

Where there is a legal restriction on the purpose to which a fund may be put, the fund is classified either as an endowment fund, where

the donor has expressly provided that only the income of the fund may be expended, or as a restricted income fund where the donor

has provided for the donation to be spent in furtherance of a specified charitable purpose.

Unrestricted income funds are sub analysed between designated funds where the trustees have set aside amounts to be used for

specific purposes, often reflecting the non binding wishes of the donors, and unrestricted funds which are applicable for any purpose of

the charity. The Trustee is responsible for administering the funds of six NHS bodies. To clarify the reporting of the funds the trustee

has designated (earmarked) the funds for each of the six named charities within the group registration.

(d) Incoming Resources

Income is recognised once the charity has entitlement to the income. It is probable that the income will be received and the amount of

income receivable can be measured reliably.

(e) Incoming Resources from Legacies

Legacies are accounted for as incoming resources either upon receipt or where the receipt of the legacy is virtually certain: this will be

once confirmation has been received from the representatives of the estate(s) that payment of the legacy will be made or property

transferred and once all conditions attached to the legacy have been fulfilled and it is virtually certain that the amount of incoming

resources is known.

Where legacies have been notified to the charity, or the charity is aware of the granting of probate, and the criteria for income

recognition have not been met, then the legacy is treated as a contingent asset and disclosed if material.

13



(f) Incoming Resources from Investments

The incoming resources receivable from the investments are distributed across the funds,

apportioned on the size of the fund.

(g) Expenditure

All expenditure is accounted for on an accruals basis and has been classified under headings

that aggregate all costs related to the category. All expenditure is recognised once there is a

legal or constructive obligation to make payment to a third party, it is probable that settlement will

be required and the amount of the obligation can be measured reliably.

Grants are only made to related or third party NHS bodies and non NHS bodies in furtherance of

the charitable objectives of the funds. A liability for such grants is recognised when approval has

been given by the Trustee. Those NHS bodies which have nominated representatives have full

knowledge of the plans of the Trustee, therefore a grant approval is taken to constitute a firm

intention of payment which has been communicated to the participating NHS body, and so a

liability is recognised.

Contractual arrangements are recognised as goods or services supplied.

(h) Irrecoverable VAT

Irrecoverable VAT is charged against the category of resources expended for which it was

incurred.

(i) Allocation of Overhead and Support Costs

Overhead and support costs have been allocated between Charitable Activities and Governance

Costs. Costs which are not wholly attributable to an expenditure category have been

apportioned. The analysis of overhead and support costs and the bases of apportionment

applied are shown in note 3. Where costs are shared by two or more charitable activities, support

costs have been apportioned between categories, for example financial administration costs, on

the basis of the fund balance within the accounting period for each category of charitable activity

and this is analysed in note 4.

(j) Charitable Activities

Costs of charitable activities comprise all costs incurred in the pursuit of the charitable objects of

the charity. These costs, where not wholly attributable, are apportioned between categories of

the charitable expenditure in addition to the direct costs. The total costs of each category of

charitable expenditure therefore include support costs and an apportionment of overheads, as

shown in note 4.

(k) Governance Costs

Governance costs comprise all costs attributable to ensuring the public accountability of the

charity and its compliance with regulation and good practice. These costs include costs related to

statutory audit together with an apportionment of overhead and support costs.

14



(m) Gains and Losses

(n) Pensions

(o) Judgements and key sources of estimation uncertainty

2 Income from Donations and Legacies

Unrestricted Restricted 2016 2015

Funds Funds Total Total

£'000 £'000 £'000 £'000

Donations from Individuals 34 4 38 61

Legacies - - - 0Total 34 4 38 61

3 Allocation of Support Costs and Overheads

Governance Support 2016 2015

Costs Costs Total Total

£'000 £'000 £'000 £'000

Financial Administration

(bought in from South

Staffordshire and Shropshire

Healthcare NHS Foundation

Trust) 4 9 13 13

Auditors Remuneration 4 - 4 4 Total 8 9 17 17

The financial administration costs have been allocated between governance and

charitable activity on the basis of time spent. External audit was wholly allocated to

governance. The subsequent apportionment across activity areas is disclosed in note

4.

All gains and losses are taken to the Statement of Financial Activities as they arise.

Realised gains and losses on investments are calculated as the difference between

sales proceeds and opening market value (purchase date if later). Unrealised gains

and losses are calculated as the difference between the carrying value at the end of

the year and opening market value (or purchase date if later).

The charity is a grant making charity and has no employees and any pension

contribution liabilities that may arise are solely the responsibility of the grant recipient.

In 2015, of the total income from donations and legacies £58k was to unrestricted funds and £3k

was to restricted funds.

In the application of the company's accounting policies, which are described in note 2,

the directors are required to make judgments, estimates and assumptions about the

carrying amounts of assets and liabilities that are not readily apparent from other

sources. The estimates and associated assumptions are based on historical

experience and other factors that are considered to be relevant. Actual results may

differ from these estimates.

The estimates and underlying assumptions are reviewed on an ongoing basis.

Revisions to accounting estimates are recognised in the period in which the estimate

is revised.

No significant judgments have had to be made by management in preparing these

financial statements.

15



4 Analysis of Expenditure on Charitable Activities

Grant Funded Allocated 2016 2015

Activity Costs Total Total

£'000 £'000 £'000 £'000

Staff Welfare & Amenities 27 5 32 10

Staff Education, Training & Development 5 0 5 2

Patient Welfare & Amenities 14 8 22 78

Purchase of New Furniture & Equipment 17 4 21 36

Total 63 17 80 126

5 Analysis of Grants

Institution Receiving Grant Support Number of Total Amount

Grants Awarded Paid

£'000

T Fanneran 6 14

D McNally 6 10

Cardiac Services 1 8

G Nicholls 7 7

K Allen 13 4

R Liggitt 3 3

Indalo Marquees 1 3

Medisave 6 2

D Line 1 2

Midwest Decorators 4 1

Arjo 1 1

Patterson Medical 3 1

Momentum 3 1

Knightsbridge Furniture 1 1

Soundstage One 1 1

J Williams 1 1

S Watson 1 1

Various below £1,000 56 15

Total 76

6 Auditors Remuneration

The charity pursued its charitable activities by making grants. Support costs have been

apportioned across the categories of charitable expenditure on the basis of the fund

balance at the end of the period.

Grants to institutions are listed below on a cash basis, this is included within the charitable

expenditure at note 4.

The auditors remuneration of £4,320 (2015: £4,320) is related solely to the audit with no

other additional work undertaken (2015: £0)

In 2015 of the total expenditure £98k was from unrestricted funds and £28k was from restricted funds.

16



7 Fixed Asset Investments

Movement in Fixed Asset Investments 2016 2015

£'000 £'000

Market Value Brought Forward 369 347

Add: Additions to Investment at Cost 0 0

Less: Disposals at Carrying Value 0 0

Less Net(Loss)/Gain on revaluation -11 22

Market Value as at 31 March 358 369

All gains/(losses) on revaluation have been treated as unrestricted (2015 unrestricted).

Analysis of Fixed Asset Investments Market Market

Value Value

2016 2015

£'000 £'000

Listed Equity Investments 75 77

Fixed interest Bonds 283 292

Total 358 369

Holding Market Percentage

Value of Portfolio

£'000

COIF Fixed Interest 89 24.86%

COIF Investment 75 20.95%

M&G Securities Ltd 194 54.19%

8 Gross Income from Investments

Gross Income Earned from all types of Investment Total Income Total Income

from from

Investments Investments

held in the UK held in the UK

2016 2015

£'000 £'000

Listed Equity Investments 14 16

Interest on Cash Held on Deposit 1 1

Total Investment Income 15 17

All investments were listed on a UK stock exchange or in companies incorporated in the UK and therefore

are investment assets in the UK.

The following individual shareholdings or investments are considered individually to be material with the

market values and proportion of the portfolio shown as at 31 March:

In 2015 of the total invetments £9k was allocated to unrestricted funds and £8k was allocated to restricted

funds.

17



9 Cash Held on Deposit

Analysis of Cash at Bank on Current Investments held on Deposit 2016 2015

£'000 £'000

Business Reserve Account 185 245Total 185 245

10 Analysis of Current Assets, Liabilities and Long Term Creditors

Debtors Under One Year 2016 2015

£'000 £'000

Other Debtors 0 1Total 0 1

Creditors Under One Year 2016 2015

£'000 £'000

Other Creditors: Grants Payable to Other NHS Bodies 5 21

Accruals 105 123Total 110 144

11 Provisions for Liabilities and Charges

There were no provisions made in the current or previous year and all the grants payable have been

paid or accrued.

18

South Staffordshire Community Mental Health Charitable and Other Related Charities


12 Analysis of Charitable Funds

Designated (Earmarked) Fund Movements

Balance Incoming Resources Gains / Balance Fund

B/Fwd Resources Expended (Losses) Transfers C/Fwd

£'000 £'000 £'000 £'000 £'000 £'000

Child Development 11 0 0 0 11

Therapeutic Services 14 24 -20 0 18

Nursing Services 117 7 -10 -2 -5 107

Community MH 77 5 -3 0 -18 61

Community General 27 2 -3 -1 25

Victoria Hospital 26 1 -4 -2 21

Sir Robert Peel Hospital 38 1 -19 -5 15

Strategic Health Authority 56 4 -6 -1 53

Other Earmarked Funds -22 1 -1 0 43 21344 45 -66 -11 20 332

Restricted Fund Movements

Balance Incoming Resources Gains / Balance Fund

B/Fwd Resources Expended (Losses) Transfers C/Fwd

£'000 £'000 £'000 £'000 £'000 £'000

Nursing Services 72 3 -10 0 4 69

Community Mental Health 12 5 -4 0 18 31

Other 43 0 0 0 -42 1127 8 -14 0 -20 101

19



12 Analysis of Charitable Funds (continued)

Other Earmarked Funds

Restricted Funds

13 Related Party Transactions

South Staffordshire & Shropshire Healthcare NHS Foundation Trust

14 Control Relationship

The Charity is controlled by the Corporate Trustee, South Staffordshire & Shropshire

Healthcare NHS Foundation Trust.

The corporate trustee did not pay expenses to any member of the South Staffordshire & Shropshire Healthcare

NHS Foundation Trust Board and members did not receive any honoraria or emoluments from charitable funds

in the year.

George Bryan Centre General Charity for any charitable purpose or purposes relating to the NHS wholly or

mainly for the services provided by George Bryan Centre.

Hammerwich Hospital General Charity for any charitable purpose or purposes relating to the NHS wholly or

mainly for the services provided by Hammerwich Hospital.

Margaret Stanhope Centre General Charity for any charitable purpose or purposes relating to the NHS wholly or

mainly for the services provided by the Margaret Stanhope Centre.

Learning Disabilities General Charity for any charitable purpose or purposes relating to the NHS wholly or mainly

for the services provided by learning disabilities.

South Staffordshire Homecare Healthcare Fund or any charitable purpose or purposes relating to the NHS

wholly or mainly for homecare services.

Margaret Stanhope Centre General Charity for any charitable purpose or purposes relating to the NHS wholly or

mainly for the services provided by the Margaret Stanhope Centre.

During the year certain members of the Corporate Trustee were also members of the following authorities:

The charity has made revenue payments to this authority to the value of £16,941 (£16,941 2015). Other than

these payments, there have been no transactions between the charity and the listed NHS body. Board members

of the South Staffordshire & Shropshire Healthcare NHS Foundation Trust, the Corporate Trustee ensure that

the business of the charity is dealt with separately from that associated with exchequer funds for which they are

also responsible. Declarations of personal interest are made, where appropriate, and those declarations

pertaining to the funds held on trust are available for public inspection by application through the South

Staffordshire & Shropshire Healthcare NHS Foundation Trust.

George Bryan Centre General Charity for any charitable purpose or purposes relating to the NHS wholly or

mainly for the services provided by George Bryan Centre.

Community Mental Health General Charity for any charitable purpose or purposes relating to the NHS wholly or

mainly for the services provided by the community mental health service.

South Staffordshire Nursing Services fund for any charitable purpose or purposes relating to the NHS wholly or

mainly for nursing services provided by South Staffordshire Healthcare NHS Trust.

20



15 First-time Adoption of SORP (FRS 102)

16 Post Balance Sheet Event

17 Financial Instruments

The carrying amounts of the charity’s financial instruments are as follows:

2016 2015

£'000 £'000

Financial assets

- Fixed asset listed investments (note 7) 358 369

Debt instruments measured at amortised cost:

- Other debtors (note 10) 0 1

Financial liabilities

Measured at amortised cost

- Other creditors (note 10) -5 -21

353 349

Measured at fair value through net income / expenditure:

The charity has adopted the SORP (FRS 102) for the first time in the year ended 31 March

2016, with date of transition being 1 April 2014. The effect of transition from SORP (2005) to

SORP (FRS 102) is outlined below.

Changes in Accounting Policies

Under SORP (2005) income was recognised when it was received, under SORP (FRS 102)

income is recognised once the charity has entitlement to the income. It is probable that the

income will be received and the amount of income receivable can be measured reliably.

There is no impact on the previously reported net income in the current period or comparative

period following the transition from SORP (2005) to SORP (FRS 102).

During 2016/17 funds held on the behalf of previous organisations where services have now

been transferred into Burton Hopsitals NHS FT will be transferred to their own charitable fund as

of the 1st September 2016 £44k.

21

Board of Directors Agenda Item 8.2 Enc H

Document Title: Board of Directors: Register of Interests

Sponsoring Director: Neil Carr, Chief Executive

Author(s): Jane Landick, Company Secretary

Date of Meeting: 26th January 2017 Executive Summary In accordance with the Constitution and Part 4 of the Health and Social Care Act 2012, the Trust as a publ ic benefit corporation is required to maintain a R egister of Interests of Executive and Non Executive Directors. All Directors must declare any material interest in a matter as defined within the Trust’s Constitution - see extract (Appendix 1). For clarity, a direct interest shall be taken to refer to the individual making the declaration and an i ndirect interest shall be taken to refer to an interest relating to another individual, whether related or not, to the individual making the declaration. This Register of Interests included as appendix 2 to this report comprises the entire register of interests at 26th January 2017 and is available for public inspection on request. The register is updated regularly and at least on an annual basis. Recommendations The Board of Directors is asked to: Confirm the details in the Register Advise of any additions to or deletions from the Register Monitoring Details Care Quality Commission Compliance

Fit and Proper Person Regulations

Monitor Compliance Code of Governance Other (add details) Francis Report Assurance Ref Details Risk Register Assurance Framework IP4 Failure to maintain legality of constitution Link to Strategic Aims Deliver regulatory, financial, performance and quality

standards Board Sub Committee Audit Committee. Nominations Committee.

Appendix 1

Extract from Trust Constitution (April 2013)

Conflicts of Interest of Directors

11.1. The duties that a director of the Foundation Trust has by virtue of being a director in particular –

11.1.1. A duty to avoid a situation in which the director has (or can have) a direct or indirect interest that conflicts (or possibly may conflict) with the interests of the Foundation Trust.

11.1.2. A duty not to accept a benefit from a third party by reason of being a director or doing (or not doing) anything in that capacity.

11.2. The duty referred to in sub-paragraph 11.27.1 is not infringed if –

11.2.1. The situation cannot reasonably be r egarded as likely to give rise to a conflict of interest, or

11.2.2. The matter has been authorised in accordance with the constitution.

11.3. The duty referred to in sub-paragraph 11.27.2 is not infringed if acceptance of the benefit cannot reasonably be regarded as likely to give rise to a conflict of interest.

11.4. If a director of the Foundation Trust has in any way a direct or indirect interest in a proposed transaction or arrangement with the Foundation Trust, the director must declare the nature and extent of that interest to the other directors.

11.5. If a declaration under this paragraph proves to be, or becomes, inaccurate, incomplete, a further declaration must be made.

11.6. Any declaration required by this paragraph must be m ade before the Foundation Trust enters into the transaction or arrangement.

11.7. This paragraph does not require a declaration of an interest of which the director is not aware or where the director is not aware of the transaction or arrangement in question.

11.8. A director need not declare an interest –

11.8.1. If it cannot reasonably be regarded as likely to give rise to a c onflict of interest;

11.8.2. If, or to the extent that, the directors are already aware of it;

11.8.3. If, or to the extent that, it concerns terms of the director’s appointment that have been or are to be considered –

13.8.3.1. By a meeting of the Board of Directors, or

13.8.3.2. By a c ommittee of the directors appointed for the purpose under the constitution.

11.9. A matter shall be authorised for the purposes of paragraph 11.28.2 if:

11.9.1. the Board of Directors by majority disapplies the provision of the constitution which would otherwise prevent a di rector from being counted as participating in the decision-making process;

11.9.2. the director's interest cannot reasonably be regarded as likely to give rise

to a conflict of interest; or

11.9.3. the director's conflict of interest arises from a permitted cause (as determined by the Board of Directors from time to time).

For the purposes of this paragraph, a permitted cause includes (but is not limited to)-

11.9.4. a guarantee given, or to be g iven, by or to a director in respect of an

obligation incurred by or on behal f of the Foundation Trust (or any of its subsidiaries from time to time);

11.9.5. a transaction or arrangement for the benefit of the Foundation Trust’s

employees (or any of its subsidiaries from time to time) which does not award him or her a p rivilege or benefit not generally awarded to the employees to whom it relates; and

11.9.6. a transaction or arrangement concerning the purchase or maintenance of

any insurance policy for the benefit of directors or for the benefit of persons including directors.

SOUTH STAFFORDSHIRE AND SHROPSHIRE HEALTHCARE NHS FOUNDATION TRUST

REGISTER OF INTERESTS OF BOARD MEMBERS AT 26th January 2017

Appendix 2

NAME NATURE OF INTEREST NAME OF ORGANISATON OTHER RELEVANT INFORMATION Chairman Martin Gower Director Foxes Lane Management Company Ltd Added to Register 16/01/17 Chief Executive Neil Carr Doctor Staffordshire University

Fellow Royal College of Nursing Added to Register 01/05/10 Visiting Professor Wagner College, New York Added to Register January 2017

Executive Directors Jayne Deaville Interim Director of

Finance Staffordshire and Stoke on Trent Partnership NHS Trust

Added to Register 01/11/16

Dr Abid Khan Regional Adviser Royal College of Psychiatry Added to Register November 2015 Visiting Professor Wagner College, New York Added to Register December 2015

Alison Bussey Director Chamberlain Place Management Company Added to Register January 2014 Steve Grange Chairman Joining Forces MOD Network Added to Register February 2012

Visiting Professor Wagner College, New York Added to Register January 2014 Inclusion on preferred speaker list (NHS Strategy)

Lundbeck Added to Register July 2015 (12 month appointment

Therèsa Moyes Associate Fellow British Psychological Society Added to Register December 2012 Editorial Board Member The Basil Skyers Myeloma Foundation Added to Register June 2015

Non Executive Directors Megan Nurse No interests to declare David Matthews No interests to declare Richard Cotterell Board Member Stoke & Staffordshire Local Enterprise

Partnership Added to Register – 20 May 2016

Governor Staffordshire University Added to Register – 20 May 2016 Susan Nixon Volunteer Banners Gate Counselling Centre (Sutton

Coldfield) Added to Register December 2011

Voluntary Lay Panellist (MHA Manager)

St Andrew’s Healthcare Added to Register December 2011

Dr Ian Wilson Trustee and Chairman Carers’ Association of South Staffordshire (CASS)

Added to Register October 2014 Updated to Chairman 16/01/17

Director Embrace Qualitycare (part of Katharine House Hospice)

Added to Register December 2012

Trustee Bridgeman Trust (Stafford) Added to Register December 2012 Vice President Osprey Powerboat Rescue Team Added to Register December 2012

Paul Bunting Secretary Rail Europe Group Ltd Added to Register October 2016 Secretary Voyages – SNCF UK Ltd Added to Register October 2016

SOUTH STAFFORDSHIRE AND SHROPSHIRE HEALTHCARE NHS FOUNDATION TRUST

REGISTER OF INTERESTS OF BOARD MEMBERS AT 26th January 2017

Appendix 2

NAME NATURE OF INTEREST NAME OF ORGANISATON OTHER RELEVANT INFORMATION External Advisor University of Wolverhampton Added to Register December 2012

OTHERS Jane Landick Panel Member Monitor Panel for Advising Governors Added to Register April 2013

Panel Member Staffordshire County Council Independent Remuneration Panel

Added to Register December 2013

Panel Member Monitor Independent Election Arbitration Panel (IEAP)

Added to Register November 2014

Greg Moores Director St Giles’ and St George’s Academy Added to Register October 2015 Chartered Fellow Chartered Institute of Personnel and

Development Added to Register 16/01/17

Board of Directors: 26 January 2017 Page 1 of 2

Board of Directors Agenda Item 8.3 Enc I

Document Title: Use of the Common Seal

Sponsoring Director: Neil Carr

Author(s): Jane Landick

Executive Summary Section 10 of the Trust’s Standing Orders requires that an entry of every sealing shall be made and numbered consecutively in a book provided for that purpose, and shall be signed by the persons who shall have approved and authorised the document and those who attested the seal. A report of all sealing shall be made to the Trust Board of Directors at the next meeting. (The report shall contain details of the seal number, the description of the document and date of sealing). To comply with this requirement, this report is presented to the Board. Recommendations The Board of Directors is asked to receive and note the use of the common seal between 18 October 2016 and 18 January 2017. Monitoring Details Care Quality Commission Compliance

Monitor Compliance Trust Constitution/Monitor License Other (add details) Trust Standing Orders Assurance Ref Details Risk Register Assurance Framework Link to Strategic Aims Board Sub Committee As appropriate

Date Description Authorised by 27.10.16 Deed of Easement for the drains relation to the

former Shelton Hospital, Racecourse Lane, Bicton Health, Shrewsbury SY3 8DN between SSSFT and Shropshire Homes Ltd

Jayne Deaville Robert Graves

12.12.16 Lease relating to Holmcroft Library, Holmcroft Road Stafford (x 2) Heath Hayes Library, Hednesford Road, Heath Hayes, Cannock WS12 1AD (x 2) Glascote Library, 80 Caledonian, Tamworth B77 2ED Norton Canes Library, Burntwood Road, North Canes, Cannock WS11 9RS Hednesford Library, Market Street, Hednesford, Cannock. ( x 2) Baswich Library, Lynton Avenue, Stafford ST17 0EA (x2)

Jayne Deaville Robert Graves

Board of Directors: 26 January 2017 Page 2 of 2

Brewood Library, Newport Street, Brewood, Staffs ST19 9AT Between Staffordshire County Council and SSSFT

12.12.16 Staffordshire County Council and SSSFT agreement for the delivery of a community managed library at:- Holmcroft Library, Holmcroft Road Stafford (x 2) Heath Hayes Library, Hednesford Road, Heath Hayes, Cannock WS12 1AD (x 2) Glascote Library, 80 Caledonian, Tamworth B77 2ED Norton Canes Library, Burntwood Road, North Canes, Cannock WS11 9RS Hednesford Library, Market Street, Hednesford, Cannock. ( x 2) Baswich Library, Lynton Avenue, Stafford ST17 0EA (x2) Brewood Library, Newport Street, Brewood, Staffs ST19 9AT Barton under Needwood, Burton on Trent DEB 8AX (x2)

Neil Carr Jayne Deaville

1 Trust Board – 26 January 2017

Board of Directors Agenda Item 9.1 Enc J

Document Title: Safe, Sustainable Staffing Establishment Review and Analysis

Sponsoring Director: Alison Bussey - Director of Nursing/Chief Operating Officer

Author(s): Kenny Laing - Deputy Director of Nursing


Executive Summary Following the publication of the National Quality Board report “Supporting NHS providers to deliver the right staff, with the right skills, in the right place at the right time. Safe, Sustainable and Productive Staffing” in July 2016, all NHS provider trusts are required to conduct a strategic review of clinical team staffing establishments annually. This review was reported to the Trust Board in July 2016 and this report is an update of the actions taken since the last review. All actions agreed by the board in July 2016 have now been completed, with only a slight delay in the timeliness of the implementation of the Allocate SafeCare module. This implementation will enable a more rigorous process for the management of our staff across all hospital sites and improved data with which to base establishment reviews.

Recommendations The Board of Directors is asked to:

• Note progress made against recommendations previously endorsed by the Trust board in July 2016 to deliver safe staffing

• Note the national context in relation to the work being led by NHS Improvement.

• Note the progress made in relation to the use of Safe Care across ward areas.



NHSI Compliance Other (add details)


Assurance Ref Details Risk Register Assurance Framework Link to Strategic Aims Board Committee


Safe, Sustainable Staffing Establishment Review and Analysis January 2017

1. Introduction

1.1 Following the publication of the National Quality Board (NQB)report

“Supporting NHS providers to deliver the right staff, with the right skills, in the right place at the right time. Safe, Sustainable and Productive Staffing” in July 2016, all NHS provider trusts are required to conduct a strategic review of clinical team staffing establishments annually. This review was reported to the Trust Board in July 2016 and this report is an update of the actions taken since the last review.

1.2 In addition to the annual cycle of establishment reviews, reviews should

also take place when services are required to change, such as when new contracts come to the Trust, or as part of planned changes to services, eg Mental health Community re-modelling. This reflects Directorate business and delivery plans and these changes will also be subject to reporting at Trust Board.

1.3 The latest reviews took place during 2016 and are undertaken by the

clinical directorates as part of business as usual. The reviews are overseen by senior clinical and operational staff throughout with support from corporate services where required. The outputs from these reviews are based upon decisions using the NQB’s triangulation model of comparing quality data, workload/ dependency data and professional judgement.

2. Progress against recommendations endorsed by the Trust Board in

July 2016 Safe Staffing Establishment Reviews Recommendation endorsed by

Trust Board Progress Comments

Progress against actions from July 2016 safer staffing report • All ward areas will be using

Allocate SafeCare module which records the dependency of patients and measures against staffing availability. The use of this data will provide an improved validity for future establishment reviews via the analysis of longer term demand data. All

All ward areas now have access to the module and have been trained in its use. The SOP and governance processes will be finalised and all wards will be routinely entering data from 1st February 2017. This delay has been due to unforeseen changes in project management personnel.


Recommendation endorsed by Trust Board

Progress Comments

wards across the Trust should be using SafeCare module by October 2016.

• Norton House will increase the provision of registered nurses on their establishment, which will improve senior nursing leadership on the unit.

New ward manager now appointed and due to start. 3 x band 6 nursing posts in place All nursing vacancies recruited to as planned

• Brockington plan to increase the provision of nursery nurses across 24 hours to ensure adequate care for babies and mothers

All nursery nurse posts have now been recruited to and 24/7 nursery nurse cover now in place.

3. NHS Improvement Safe, Sustainable Staffing Improvement Resources

3.1 NHS Improvement was asked by HM Government to lead the delivery of

sector specific improvement resources following the cessation of the work of safe staffing by NICE in 2016. There are seven national work-streams to develop safe staffing improvement resources for: o mental health o learning disability o community o maternity o acute inpatients o children’s services o urgent and emergency care.

3.2 The first two improvement resources to be published for wider stakeholder

engagement were Learning Disability (Chair – Alison Bussey and Dr Oliver Shanley) and Adult Acute In-Patients (Chair – Hilary Chapman, Chief Nurse, Sheffield Teaching Hospitals NHS FT). The other improvement resources will be published during Q4 2016-17 with community and mental health expected towards the end of February 2017.


4.0 Care Hours per Patient Day (CHPPD) 4.1 CHPPD is a metric which has been designed by NHS Improvement as

part of Lord Carter’s review of productivity in the NHS and the work on the Model Hospital. The use of CHPPD provides a useful metric for making comparisons and benchmarking between NHS providers in the use of staffing. CHPPD is being used across acute hospitals with work to implement in other NHS specialist providers in 2017. CHPPD gives a picture of the total ward care workforce but is split between registered nurses and healthcare support workers (see box below).

Care hours per patient day =

Hours of registered nurses and midwives alongside hours of healthcare support workers Total number of inpatients (midnight census)

While the summary CHPPD measure includes all care staff, the registered nurse hours must always be considered in any benchmarking alongside quality care metrics (Griffiths et al 2016b) in order to assess the impact on patient outcomes.

5.0 Allocate SafeCare Module 5.1 All wards now have had access to the SafeCare module since November

2016. Since this time, ward managers have been trained and have provided cascade training all registered nurses in the use of the module, particularly how to undertake dependency census scoring for all patients following handover.

5.2 Dependency scoring uses the following descriptors which are applied to

each patient on the ward during the census period, as in the table below:

Patients D

ependency-A

cuity Category

Care Level Descriptors 1. Self-caring and able to do most daily living activities unaided.

Patient has capacity to engage with therapeutic interventions. Patient is at pre-discharge state. Risks can be managed by community services.

2. More dependent on ward staff for his/her mental, social or physical health needs. Patient has capacity to engage with therapeutic interventions. May be potential barriers preventing a safe and timely discharge.


3. Heavily reliant on ward team for his/her safety and care. Presents as medium- to high-risk, or fluctuating risk. Has high-level mental, social or physical health needs. Low or inconsistent engagement with therapeutic interventions. There may be potential barriers preventing a safe and timely discharge.

4. Dependent on ward team for his/her safety and care. Requires high engagement and intervention. Major mental, social or physical health needs. Presents as high-level risk to self and/or others. Minimal engagement with therapeutic interventions.

5. Patient requires one-to-one care by one or more staff throughout the day and possibly the night. Major mental, social or physical health needs. Is a significant risk to self and/or others. Leave from the ward isn’t allowed other than planned hospital appointments with escort. May be awaiting step up to PICU or low-secure environment.

5.3 Once the census is completed by the nurse in charge, an algorithm which

is programmed into the tool (care multiplier numbers) results in the number of staff who are required to undertake the care required according to dependency. This provides a real time view of the staffing in attendance vs. staffing needed. This can be seen below:

5.4 Longer term this data will be used to inform establishment reviews through

monitoring trends in patient dependency demands and actual staffing deployed (see chart below)


5.5 The data can also be analysed to more clearly illustratestaffing variance

when staffing has exceeded and dropped below the level required (see chart below)

5.6 The safecare reporting system also allows the analysis of care hours

being used broken down by substantive, bank and agency usage (as in chart below).


5.7 This data will be used to inform future establishment reviews, starting from

the next review due to be submitted to Trust Board in July 2017. Additionally, the real-time reporting from SafeCare will help operational leaders to make informed decisions about resource allocation.

Recommendations The Trust Board is asked to:

• Note progress made against recommendations previously endorsed by the Trust board to deliver safe staffing.

• Note the national context in relation to the work being led by NHS Improvement.

• Note the progress made in relation to the use of Safe Care across ward areas.

Board of Directors Meeting: 26th January 2017 Page 1 of 5

AGENDA PLANNING Board Papers: Item Required and Due Date Item Minute Ref Meeting Required Deadline Lead

Medicines Incident Thematic Review May-16 Jan-17 (deferred to Feb-17)

18.02.17 AK

Service User and Carer Involvement Framework Nov-16 Jan-17 19.01.17 TM

Stafford site redevelopment business case/phasing and resourcing

Oct-16 TBC TBC AB

(C) Confidential Board

TRUST ASSURANCE REPORT

Reports Due Lead

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

Section 1: Quality and Clinical Performance

Patient Experience TM

Friends and Family Test TM

Fundamental Standards TM

Regulator Updates TM

Special Reviews TM

Quality Accounts TM

CQUIN Update TM

Performance Reviews TM V V

Combined Risk Management Report

TM Q4

Q4

2016

Q1

Q2

Q3

Safety Dashboard TM

Section 2: Finance and Performance

High Level Financial Summary

JD

Financial Risk Rating JD

Key Issues JD

Contract Activity and Targets

JD

Enclosure K


TRUST ASSURANCE REPORT

Reports Due Lead

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

Libraries and Knowledge JD

Information Governance JD

Section 3: Business Development

Market Scan SG

Business Development SG

Strategic Communications

SG

Section 4: Director of Human Resources/Organisational Development/Equalities

Sickness Absence GM

Staff Turnover GM

Equality and Diversity GM

Safer Staffing AB Eval Eval

Section 5: Chief Operating Officer/Director of Nursing

Mental Health Act AB

Section 6: Medical Director

Infection Control AK

R&D Programme AK

REGULAR BOARD REPORTS

Reports Due Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

Environmental Scan NC

Quarterly Reports to NHSI (C)

JD Q4 F(Q4)

Q1 F(Q1) Q2 F(Q2) Q3

F(Q3)

Monthly Reports to NHSI (C)

JD

Budget Setting (C) JD Final Plan 1st cut

Research and Dev. Project Reports

AK

Trust Strategy 2011/16 Progress Reports

SG

NHSI Annual Plan (*revised AP submission date)

SG Draft

Final

Annual Report and Accounts

SG




Charitable Funds Annual Report

JD

Risk Appetite Review TM

Risk Register /Assurance Plan

TM

Use of the Seal JL

Register of Interests JL

Eliminating Mixed Sex Accommodation Declaratation

AB

Staff Opinion Survey Results

GM 1st cut

Final

Dignity and Respect Annual Report

GM

Workforce Race Equality Standard

GM

Annual Workforce Plan GM

Workforce and Development Strategy Report

GM

Joint Staff Partnership Annual Report

GM

Board and Committee Governance Review

JL

Estates Strategy Update

AB

Safer Staffing (Ward Establishment Review and Analysis)

AB

Level 2 Serious Incident Summary Report (C) Note: no report required if no incidents in month

TM

Revalidation Report CB

Audit Committee Annual Report

JD

Programme Management Office Update

NC

Strategic Risk Deep Dive Reports

All




Modern Slavery and Human Trafficking Act 2015: Annual Statement

JD

(C) Confidential Board

CARE QUALITY THEMATIC REVIEWS AND ANNUAL REPORTS

Thematic Review / Annual Report Title Author Board Committee Board Date Library Services Annual Review Claire Charnley June 2017 July 2017 Complaints & PALS Annual Report Jane Landick October 2017 November 2017 Serious Incidents Annual Report Sarah Hankey TBC TBC Medicines Optimisation Annual Report Mo Azar TBC TBC Security Management Annual Report Giles Perry TBC TBC Infection Control Annual Report Kenny Laing TBC TBC In-Patient Suicide Review Annual Report Sarah Hankey TBC TBC Community Suicide Review Annual Report Sarah Hankey TBC TBC Dignity and Respect Annual Report Jas Kaur TBC TBC Restrictive Practices Thematic Review Kenny Laing May 2017 May 2017 Medicines Incident Thematic Review Mo Azar January 2017 February 2017

COMMITTEES/ACCOUNTABLE COMMITTEES

Summary Reports Due Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar

Audit

Business Development and Investment

Quality Governance

Finance & Performance

Senior Leadership Forum

HRODE

Council of Governors

Service User and Carer

Note: Completed items have been removed and archived after each month following completion

ITEMS REFERRED TO AND FROM BOARD AND COMMITTEES Minute Ref

Date Item Referred By

Referred To

Reason Response Deadline

Outcome

16/68

14/10/16

Internal Audit Report: Monitor Requirements – The Savile Inquiry (02.16/17)

Audit Committee

Workforce & Development Committee

To provide assurance that recommendations were being addressed and actions evidenced accordingly via P-Plus by the persons responsible

December 2016

Trust Board of Directors – 26 January 2017

Board of Directors Agenda Item 13 Enc L

Document Title: Patient Story

Sponsoring Director: Therèsa Moyes, Director of Quality & Clinical Performance

Author(s): X – Service User Kath Chambers – Service User and C arer Involvement and Experience Lead.


Executive Summary

In this paper X provides the context and background to her story of involvement and provides the reasons why Service Users and C arers will endorse the new Involvement Strategy for 2017 onwards.

Recommendations The Board is asked to • Receive and note the report• Reflect on the key points arising from the story with respect to how involvement could

have a positive impact on services.

Monitoring DetailsCare Quality Commission Compliance

Caring, Effective, Responsive

Monitor Compliance Other (add details)

Assurance Ref Details Risk Register Assurance Framework Link to Strategic Aims Provide high quality, recovery focused services

Deliver (quality standards) Board Sub Committee Service User and Carer and Quality Governance Committees

Trust Board of Directors – 26 January 2017

1. Purpose of the ReportThe purpose of this report is to provide a focus for discussions at the Board Meetingto link directly to the patient experience in the context of the new strategy forinvolvement.

2. Introduction and BackgroundX has been diagnosed with bi-polar disorder; she had her first episode in 2008 and a subsequent episode in 2014. Both episodes required hospital admission and both admissions gave her experience of being a v oluntary patient and a pat ient detained under the MHA. She has also used the CRHT services in the past. Her most recent episode resulted in psychology sessions and she remains under the care of Stafford CMHT. She has also been a carer for her mother and grandfather.

3. The StoryX joined SURF (Service User and Carer Reference Forum) in July 2016 as a representative and has recently taken over the role of the Chair of the Stafford SURF. During that time she has been using her experiences to help service users and carers get their voice heard at the CMHT team meetings. So far she has been trying to raise awareness of the existence of the group with other service users and carers. She has also met with the Communications Team to look at how the Trust website can be made more accessible to service users and carers. She has also recently met with the Quality Improvement team to look at how the discharges processes can be reviewed and improved as well as how to bring about more consistency across the different CMHTs.X attended the Service User and C arer Committee in December 2016 and became interested in how she can help to make Involvement have more of an impact across the Trust. X felt that an example of how she can help to raise awareness of what service users and carers think the Trust needs to do to become and CQC rated Outstanding Trust could be by making this a discussion point at an upcoming Stafford SURF meeting.In X's role as Chair, she feels very much that she is supported by the Involvement and Experience Team and that it is very important to have this support as navigating the Trust and finding the right person to talk to can be extremely difficult without this.She also feels that raising awareness of the SURF groups’ issues and achievements within the Trust is key and a r ecently introduced report to the MH Directorate Management Team has given some confidence that we are being listened to.

4. ConclusionThe new Involvement Strategy makes the point that there needs to be an impact toinvolvement. To achieve this, Service Users and Carers need to feel that the Trust islistening and r esponding to their voice. Staff also need to be c lear about howinvolvement is making an impact and what support they need to be able to do this.