Becoming a Community Foundation Trust Assurance and Evidence · Strategic Plan and TCS. A capability to deliver can be demonstrated through the following examples: • DCHS role in

Becoming a Community Foundation Trust

Assurance and Evidence

Contents.

1. NHS East Midlands Assurance Template 2. DCHS Community Foundation Trust Cover Paper 3. Letter of Support from Primary Care/PEC 4. Letter of Support from Derbyshire County Council 5. Letter of Support from Partnership 6. DCHS Staff Engagement Summary

Better Health Better Care

Safer, high quality care

Better patient experience

Improved health Value for money

Real influence More accessible services

Enclosure C

PCT Name:

Pathway/Segment

Proposed Option for Organisational Form:

Submission Date: 30 July 2010

Transforming Community Services

Assurance Process for PCT Proposals on Community Services


Overview: brief description:

What tests the SHA is looking for:

The three crucial tests to be applied by the SHA on each submission will be:

• delivery of quality improvement and service integration

• increased efficiency

• sustainability of solution

Any proposal on provider form will be tested against the criteria below, (set out in the Operating Framework

2010/11)

•are needs and pathway-driven;

•provide more integrated and sustainable primary, community and secondary care services, which have the support

of primary and social care;

•deliver improved quality, including better patient experience as well as increased productivity;

•are affordable, reducing management costs and transaction costs;

•help to manage the demand for services more effectively (for example, reducing acute admissions and lengths of

stay);

•demonstrate that potential providers have a track record of leadership capability, governance structures and culture

to engage and empower staff to lead service transformation;

•support a viable provider market across the local health economy in light of the drive for greater quality and

productivity;

•represent an appropriate level of contestability.


Timescales:

All returns to [email protected]

12 July 2010 SHA Feedback to PCTs on Trajectories and Subject Matter Expert Comments

30 July 2010 PCTs to submit revised Organisational Form Summary Sheets, Assurance Templates and respond to Public Health and Children’s questions

13 August 2010 SHA Feedback to PCTs

17 August 2010 PCTs submit Business Cases to SHA

23 August 2010 SHA feedback to PCTs

25 August – 2 September 2010 SHA Final Confirm and Challenge Discussion with PCTs

6 September 2010 SHA approval of PCT Plans

30 September 2010 SHA to submit PCT Plans to DH for approval

October Onwards CCP and Monitor Review

mailto:[email protected]


Quality Improvement

Increased Efficiency of Solution

Sustainability of Solution


Quality ImprovementEvidence offered by the PCT to support the proposal

Test Q1 Improving Outcomes

The fit with the PCT Commissioning Strategy and priority outcomes as identified in World Class Commissioning, including joint commissioning plans;

That Choice is safeguarded by the proposals;

That there are robust plans which show how patient experience for all groups will be significantly improved, and assess the impact on inequalities.


Will it meet patient needs and deliver improved local health outcomes as identified in the PCT strategic commissioning plan and Local Area Agreement (LAA), and significantly better patient experience (including Choice)?

Rationale for Proposal

As a CFT and a strong independent community services provider, DCHS is best placed to deliver improved health outcomes.

As is described later, DCHS’ development as a CFT fits the PCT’s strategy for choice, competition and market management.

Local authority and primary care partners have confirmed their support for DCHS as a CFT in terms of delivering LAA requirements.

• PCT strategic priorities are to:

• Tackle the leading causes of health inequalities to improve life expectancy and reduce premature mortality.

• Make substantial improvements to the three pathways in greatest need of further development – Stroke, Primary mental health services and Mental health for older people

• Become a national leader and beacon for the rest of the NHS for the historically neglected areas of End of Life Care and support for carers.

• DCHS is a key contributor to these aims from input into children’s health, a key determinant of life expectancy, to the delivery of major parts of the OPMH, stroke and end of life pathways, where they have developed integrated partnership models of care with acute and primary care providers.

Evidenced By:-

Evidence continued over page…


• The DCHS Integrated Business Plan describes the contribution to transforming services in these priority areas and improving outcomes that DCHS will make.

• The service transformation plans are consistent with the LAA and informed by the JSNA and include significant further integration with LA services for children, older people and people with disabilities.

• In terms of improving patient experience and quality DCHS has well developed plans organised around transforming the patient experience (described in the IBP) and a good track record of delivering high quality services for patients, outlined in the Quality Account attached.

• DCHS’ newly established NED led Patient Experience Committee and dedicated quality and patient experience report taken to Board along with the discussion of individual patient stories.

• DCHS was first organisation to be registered with the Care Quality Commission and has just had a positive unannounced visit, with no concerns raised by the CQC.

Evidenced By:-

Will it meet patient needs and deliver improved local health outcomes as identified in the PCT strategic commissioning plan and Local Area Agreement (LAA), and significantly better patient experience (including Choice)?

• DCHS and its lead commissioner have developed detailed service specifications including clear outcomes to measure the health gain from service investment and interventions.

• Contract includes comprehensive CQUINN requirements, with DCHS successfully delivering the required improvements.

• DCHS is also working towards being a ‘health-promoting organisation’ by developing the capability and confidence of community staff to use their interactions with patients to talk about and support improvements in the wider determinants of health. This will support the PCT’s overall strategic aim of reducing health inequalities.

• Establishment of DCHS as an NHS Trust extends commissioners choice of provider services in the market and extends the opportunities for innovative partnership arrangements.

• DCHS is developing an integrated, locality based devolved model for delivering services around the particular needs of individual communities (DCHS Local) which will extend the choice provided to patients about how services are delivered to them as individuals.


Quality Improvement

Evidence offered by the PCT to support the proposal

Test Q.2 Improving Quality

• That there are identified improvements in quality of service outcomes to be delivered;

• That there is a clear plan and capability to shift from acute to out of hospital care;

• That the improvements in quality will be sustained.


Options appraisal work undertaken with McKinsey and through Board discussions, and development of the IBP, indicate that as an effective and independent CFT focused on service provision and adopting rigorous Monitor business processes, DCHS is best placed to deliver improvements in quality of service and outcomes.

Membership strategy as a CFT will enable us to work with members who will hold us to account for ongoing quality improvements.

2. How would the proposed changes improve Quality?

Will it deliver significant improvements in quality of service and outcomes delivered?

Rationale for Proposal

• DCHS is committed to the demonstration and delivery of high quality services through:

• The development of a clear plan for transforming service quality summarised in the Integrated Business Plan.

• The development of service specifications for all services with measurable outcomes.

• The development and implementation of CQUIN a year in advance of national requirement to do so.

• The public reporting of a detailed monthly quality dashboard.

• The publication of an annual Quality Account (attached – highly commended by SHA)

• Held to account for service quality by a formal commissioning Quality Management Group.

Evidenced By:-



• DCHS’s quality and service development plans are aligned to the delivery of the requirements of the PCT Strategic Plan and TCS. A capability to deliver can be demonstrated through the following examples:

• DCHS role in delivering the PCT’s urgent care and long term condition strategies where the role of community hospitals has been reviewed with a consequent reduction in length of stay from 31 to 22 days

• Partnership working with Derbyshire Health United to develop integrated services to provide high quality accessible urgent care.

• Joint provider of integrated stroke pathways with local acute trusts to reduce length of stay and improve functional outcomes

• Preferred provider of end of life care pathway to increase deaths in preferred place

• Awarded service tenders for pulmonary rehabilitation and cardiac rehabilitation having demonstrated clear positive outcomes for patients and commissioners

Evidenced By:-

• DCHS has worked to develop and sustain the capability to transform services through a major OD programme including:

• Implementation of Productive Series – delivering demonstrable improvements in quality and productivity across wards, MIUs and community services

• Development and implementation of Service Improvement Leadership Programme – training over 100 improvement leaders in key QUIPP tools and delivering a wide range of bottom up quality and productivity improvements

• Development and delivery of a range of professional development programmes in conjunction with higher education organisations to advance community services practice.

• Sustainability is evidenced through plans attached and through 3 year track record of improved patient experience data, external assurances received and contractual performance.

2. How would the proposed changes improve Quality?

Will it deliver significant improvements in quality of service and outcomes delivered?


Quality Improvement

Evidence offered by the PCT in to support the proposal

Test Q.3 Service Integration

• The proposals demonstrate at patient and pathway level how service integration will be enhanced to improve care;

• Show how the proposal supports primary, community, secondary, children’s services and social care partners to increase prevention through more integrated approaches.


3. How would the proposed option deliver service integration?

Will it deliver significant improvements in service integration and quality of health and social care?

Rationale for proposal

We have agreed with the PCT, primary and social care colleagues that as an independent CFT , DCHS is best able to focus on service integration and quality improvements, in contrast to other organisational options.

In particular, DCHS will develop its concept of DCHS Local already being rolled out across the county, continue its agree work programmes with DCC and develop partnerships to deliver current PCT and PbC priorities around stroke, end of life care, urgent care, learning disability and mental health services.

DCHS already has a dedicated health and well being division including health promotion services and our IBP commits us to developing those further.

• Integrated business plan (attached)

• Quality account (attached)

• DCHS Local plans which set out joint development plans with primary and social care for individual localities – based on ‘total place’ concept.

• Work with PCT and other partners on developing a stroke pathway across the county, including management of ‘coordinating hub’ for the management of stroke patients discharged back into the county from surrounding acute hospitals.

• Joint venture agreement for the delivery of diagnostics and outpatient services on an outreach basis with local acute provider

• Successful management of integrated services such as learning disability and intermediate care services with LA.

Evidenced By:-



• Work with DCC around safeguarding – with co-located teams, joint training programmes and the development of integrated 0-19 children's teams linked to secondary schools and ‘total place’ commitments

• Ongoing top team meetings with DCC and agreed work programmes, membership of key partnership forums and governance structures such as Children's’ Trust and Safeguarding Board.

• Ensuring the specialist health promotion/prevention skills and services within DCHS are used to up-skill all community staff in health promotion and prevention – specific development programme currently being developed.

Evidenced By:-

3. How would the proposed option deliver service integration?

Will it deliver significant improvements in service integration and quality of health and social care?


Quality Improvement


Test Q.4 Stakeholder Engagement

• The extent of engagement to date with all key stakeholders including clinicians, workforce, SPF, patients, the public, OSCs, LINKs and local service partners and their relevant partnership Boards;

• Specific plans for workforce engagement to deliver transformed services;

• Specific plans which demonstrate how the proposals will bind in the support of primary and social care and children’s services;

• Evidence of robust planning involving all key stakeholders for:– future engagement and involvement;– any necessary consultation.


4. What stakeholder engagement has been sought for the proposed option?

Has it got engagement and support of key stakeholder groups?Have the proposals been tested with GP commissioners and Local Authorities?Please provide an accompanying statement from staff side relating to the level of engagement of local and staff representatives and advising of any significant unresolved issues that are still the subject of local staff side.


Our stakeholder engagement has heavily influenced our rationale to develop DCHS as a CFT.

Letters of support for DCHS as a CFT from NHS Derbyshire County PCT Board, Professional Executive Committee Chair, Chief Executive of DCC, and from our staff partnership leaders;

DCHS local which is binding in primary, social and children’s services to clear agreed local service development proposals ;

Summary of staff engagement about organisational forms over last year is attached;

DCHS has worked hard to develop staff engagement in the development and delivery of excellent services, evidenced by:

IBP (attached)

People strategy (attached as part of IBP)

Consistently improving staff survey results

Recent success as 7th best employer in Healthcare 100 list, highest placed in the East midlands and second best large employer nationally.

Strong employer relationship structure evidenced by Partnership Agreement, Forum and joint staff engagement process

DCHS is represented on wide range of stakeholder forums including Children's Trust, Safeguarding Board, SHA Towards Excellence Programme

Evidenced By:-


• Quality Improvement

• Increased Efficiency of Solution

• Sustainability of Solution




Test Q.5 Efficiency Improvements

• The proposals will help deliver the efficiency improvements set out in the Operating Framework 2010 / 2011;

• The proposals explain how, and the extent to which, they will deliver technical efficiencies in 2010 / 2011 and 2011 / 2012;

• The proposals set out how allocative efficiencies will be delivered

in 2011 / 2012 and thereafter;• Identified reductions in fixed costs including management and

transaction costs.


5. How would the proposed option deliver efficiency improvements?

Will it delivery substantial improvements in the technical and allocative efficiency of the services being delivered?


The evidence from our development since our inception in 2006, is that working towards FT /Monitor working practices has enabled us to deliver significant improvements in service quality, stakeholder engagement and also efficiency improvements.

DCHS’ IBP sets out a challenging productivity programme and the rigour and freedoms of a CFT are of critical importance to DCHS’ continued ability to deliver its programme of efficiency improvements.

• Historical achievement of financial duties including delivery of CRES programmes and planned surpluses

• IBP (attached) outlines our productivity plans for the next 3 years;

• Schedule of productivity projects exists for the next 3 years which has already realised 60% recurrently of the required savings for 2010 / 11 at quarter 1.

• We have already exceeded our original management cost reduction target for 2010 / 11 and are confident of delivering the remainder over the life time of the plan;

• One of our IBP projects is focused on back office functions. This goes beyond the traditional functions and covers all transactions and processes across DCHS. A value for money assessment process is planned to identify the major improvement areas across the organisation;

• As part of DCHS Local we are working with primary care teams around shared development and running of back office functions.

• The IBP confirms we will continue developing service line reporting and ongoing review of reference costs.

• Demonstrable improvements in productivity through implementation of Productive Services and Service Improvement Leadership Programme.

Evidenced By:-




Test Q.6 Infrastructure Utilisation

• The proposals will identify steps to increase utilisation and efficiency of back office, estate and other infrastructure. Identify scope to share use of assets more efficiently with other partners, including local authorities;

• How will the proposal improve the utilisation of all NHS owned or use estate and infrastructure?

• The proposals will identify any surplus assets and infrastructure that will be released by the proposals.


6. How would the proposed option maximise infrastructure utilisation?

Will it maximise utilisation of own (and any integration partners) estate and infrastructure?


As a CFT, DCHS is best placed to develop rigorous processes, and work in partnership with all relevant organisations, to maximise the use of its infrastructure.

The clarification of national policy on use of assets may affect the delivery of our work streams.

• Track record of working with partners to maximise use of estate and infrastructure e.g. development of satellite renal dialysis unit to improve patient experience and community hospital utilisation, shared facilities with local independent GP provider and Primary Care Out of Hours provider.

• Host of Derbyshire shared service for IM&T to secure efficiencies for all partners.

• Delivery of significant efficiencies for DCHS and partners through implementation of new COIN AND VOIP technologies;

• IBP (attached)

• Back office work stream referred to under test 5

• DCHS Local commitment to sharing back office functions with primary care;

• Estate strategy to reduce the use of our estate by 20% over life time of the IBP;

• Participation in health and social care community wide work to review use of assets collectively and work with DCC looking at co-location options

Evidenced By:-


• Quality Improvement

• Increased Efficiency of Solution

• Sustainability of Solution




Test Q.7 Sustainability

• Show how proposals will be sustainable in the long and short term, clinically, financially and in terms of infrastructure;

• Show how the proposals will give PCTs with LA and PBC partners the leverage in the local health economy to deliver;

– strategic commissioning plans;

– continued service transformation and realignment;

– continuing contestability and service innovation;

• Show how the proposals will ensure that the local health economy has and can retain a sufficiently skilled workforce to lead, develop and deliver new service models.


7. How would the proposed option support sustainability?

Will it be clinically and financially sustainable?

As a strong and viable CFT, focused on service provision, DCHS will be most able to ensure its ongoing sustainability both financially and clinically, building on a strong track record to date.


• IBP (attached) outlines a sustainable plan over the next 3 years, our People Strategy and our QIPP agenda;

• DCHS already operates autonomously with its own back account, financial management processes and financial leadership;

• DCHS has an outstanding track record of financial and clinical service delivery, meeting all financial and quality targets and productivity programmes worth on average 3.5% of turnover and a surplus of 0.5% of turnover.

• DCHS was accredited as business ready as an APO by Deloittes

• An effective commissioning process is in place and this will be further developed with the PCT and GP commissioners and through DCHS LocalPositive internal and external audit reports over past 2 years demonstrating effective governance arrangements.

• Board development programme to continue to develop Board capabilities

• Medical and Nursing director led clinical development processes including annual conferences, clinical forums, clinically led service divisions and service planning.

Evidenced By:-



• Evidence of being a good employer through staff survey and HC100 success and commitment to working with John Lewis on partnership models.

• Comprehensive People Strategy to ensure DCHS can recruit and retain the people required to deliver excellent services

• Dedicated Training and Development Unit which provides clinical and non-clinical development to DCHS employees and to external organisations demonstrating commitment and capability to advance community service practice.

• Development and implementation of Service Line Reporting to ensure clinical teams have a clear understanding of their income and costs and are empowered and incentivised to introduce QUIPP improvements.

Evidenced By:-

7. How would the proposed option support sustainability?

Will it be clinically and financially sustainable?




Test Q.8 Whole System Fit

• Demonstrate how solution will deliver whole health economy effectiveness and efficiency;

• Show how the proposals will fit into current and future patterns of acute and out of hospital provision;

• Show how the proposals will contribute to delivering significant wider health system improvements in allocative efficiency;

• Have any potential adverse impacts of the proposals elsewhere in the local or wider health economy been identified and are there proposals for the management of those impacts?


8. How would the proposed option deliver whole system fit?

Will it fit into and enable delivery of wider health economy service transformation and shifts in care?


DCHS can be a more effective player in implementing the PCT’s strategies for choice, integration, and pathway development as an effective and strong provider of community services.

Currently, 13 acute providers discharge Derbyshire patients across the County. The local authority, primary care commissioners and providers and PCT all recognise the value DCHS can add in working across the complex acute, community, primary and social care interfaces in supporting joined up care and avoiding admissions and supporting discharge arrangements.

Evidenced By:-

• NHS Trust status will ensure that there is a viable and stable option for community services provision across the county to support delivery of commissioning priorities.

• IBP (attached)

• All stakeholders are agreed that a strong community services provider is the best way of supporting the PCT’s urgent care strategy and DCHS is linked into that

• As an independent provider DCHS is also best able to support emerging pathways of care around stroke, end of life, urgent care, dementia and learning disabilities and develop the necessary partnerships;

• No adverse impacts have been identified since Derbyshire is a strong health and social care community and the PCT supports the development of a strong and independent community services provider as part of its strategy to improve choice, competition, community based care pathways and service integration.


9. Department of Health Supplementary Questions – Children’s Services

DH has asked SHAs to undertake additional assurance on the proposals for Children’s Services.

Q1. Have the proposals for transferring Community Child Health services (CCHS) been discussed with the relevant Children's Trust(s) and LSCB?

Q2. Is there evidenced support for the proposals from the Director of Children's services? How have any concerns been taken into account?

Q3.Can the PCT demonstrate how the proposed partner will promote joined up delivery of services?


1 Yes and it is agreed that DCHS as a strong county wide provider but with a strong locality focus, is best placed to deliver the council’s and PCT’s vision for community child health services;

2. Yes

3. Yes

Evidenced By:-

• IBP attached covers these issues in detail

• Letter of support from DCC Chief Executive attached

• DCHS already works as part of the Children's Trust board, especially around safeguarding services

• Jointly planning integrated 0-19 children's teams and work using Total Place concepts


9. Department of Health Supplementary Questions – Children’s Services Cont..

Q4. Has the patient pathway been considered and can the PCT demonstrate that services will not be fragmented? Q5. Is there a nominated lead within the proposed organisation who will have the overview of the organisation's services for children

and who will be responsible for ensuring these fit with wider local services , covering children’s services for all Local authorities in the catchment population?

Q6. Are the governance arrangements in the proposed provider organisation robust, and do they support the safeguarding agenda?


4. The PCT has chosen the preferred option of DCHS as a CFT so that the benefits of integration, scale, and a balance of county wide working but with flexible and responsive locality working, avoid the potential fragmentation of other organisational options. DCHS expect to compete with other providers for the work it feels it can provide most effectively and to then collaborate with other providers in ensuring an integrated approach to care delivery across pathways

5. Director of Quality and Integrated Governance (Chief Nurse)

6. Yes.

Evidenced By:-

• Letter of support from DCC Chief Executive (attached)

• IBP (attached) outlines how children's services will be developed

• Options appraisal work outlines how the proposed option avoids fragmentation;

• DCHS’ governance arrangements were assessed as robust by Deloittes and have been further strengthened;

• DCHS has clear leadership roles around safeguarding, co-located teams with LA and joint development programmes.


9. Department of Health Supplementary Questions – Children’s Services Cont..

Q7. Are the roles and responsibilities for safeguarding children clearly set out? Q8. Has the PCT Director of Public Health assessed the impact on public health services and agreed the arrangements? Q9. Does the proposed provider have the infrastructure to manage and govern the services it will receive ?


7. Yes, clearly set out

8. Yes, see Section 10

9. Yes.

Evidenced By:-

• DCHS roles and responsibilities are clearly laid out as part of its safeguarding policy and within the Children's Trust policy framework;

• DCHS has a dedicated safeguarding leadership team and governance arrangements

• The response to Section 10 below demonstrates clear support from the PCT DPH

• DCHS was assessed as being business ready by Deloittes and has further developed and reviewed its infrastructure and governance arrangements.


10. Department of Health Supplementary Questions – Public Health and Well Being Services

DH has asked SHAs to undertake additional assurance on the proposals for Public Health Services.

Appendix 1 lists those services that PCTs may be providing under the following headings: - Behaviour risk reduction programmes (tobacco control, healthy eating, health trainers, etc) - Screening and early detection - Settings and client specific services (school nursing, fuel poverty, etc) - Health protection (surge capacity for major incident, immunisations, etc) - Public Health Intelligence (dental epidemiological surveys, etc)

In relation to these services, please provide answers to the following questions. It is acknowledged that the answers to these question will overlap. The Public Health Directorate are therefore content for PCTs to use the most appropriate format to provide the SHA with the information and evidence that would give us confidence in your proposals

Q1 What is your rationale for the proposed future form for public health services?

• DCHS has organised its management structure to include a health and well being division with dedicated senior leadership and has recently taken over the health promotion function from NHS Derbyshire County on the same formal contractual basis as all of the organisations services.

• The DCHS Health and Well being division also has experience of running many of those services identified by Directors of Public Health as population health / prevention services broadly categorised as:

• behaviour risk reduction eg obesity awareness, sexual health promotion, oral health promotion, obesity reduction – adults and children, infant nutrition inc breast feeding uptake, healthy schools

• screening /early detection eg chlamydia screening, dental inspections in schools;

• settings / client specific services eg prison Health services /Offender Health promotion

• healthy workplace/health at work, teenage pregnancy prevention, community dental services, school nursing, falls prevention, health visiting;

• major incidents / health protection eg Major incident preparedness and response including pandemic influenza, immunisation, tuberculosis services, infection control and outbreak control & management.


Q2 Have you considered county and region wide solutions for all or any public health services and what was the outcome?

• The majority of functions are already delivered on a countywide basis following the establishment of a single Derbyshire County PCT, though these services are tailored to different localities and delivered on the basis of needs that differ across localities. There are certain functions that span both the county and the city PCT areas. Examples include most of the Screening services, healthy schools, emergency planning and TB services. There is region-wide coordination of some functions, for example emergency planning and some of the screening services and region wide networks in many other areas (eg most of the behaviour change areas) but actual service budgets and targets are the responsibility of individual PCTs and service delivery has followed this pattern.

Q3 Have opportunities to improve integration and co-ordination of services such as smoking, alcohol and weight management or other such combination of services been considered and what was the outcome?

• These services are already integrated as part of the health and well being division of the organisation. Further work is ongoing to look at how these services can be better integrated at the individual client level. A lot of effort has recently gone into coordinating and improving services for the promotion of breastfeeding, reducing teenage pregnancies, and improving sexual health. High level support for integration and coordination is provided by the Derbyshire Partnership forum, The Children’s Trust, the Local Safeguarding children’s board and the Derbyshire Health and Wellbeing partnership. DCHS is a key partner on almost all the bodies mentioned.

Q4 If you have identified a single provider solution, please can you provide evidence that there is sufficient critical mass to enable quality to be maintained and cost effective delivery of the services?

• We do not have a single provider but the great majority of providers are major organisations such as the acute trusts, primary care and DCHS within the health service and the local authority run leisure services and children’s services. DCHS is one of the biggest providers of public health services as it encompasses the health promotion service, the health visiting service and a major part of the school nursing service. DCHS is one of the largest health organisations in the county with an almost county wide footprint, a wide range of locations and detailed business continuity plans. The contract value of the health promotion service within DCHS is around £3.4m. The HPS in Derbyshire is one of the largest in the country and, unlike some other PCTs, the HPS was retained as an integrated service with the PCT and now within DCHS


Q5 Do the proposed provider/s have the infrastructure to ensure good governance of the services? Please provide evidence.

• Similar to the answer to Q4. most public health functions sit with large organisations with well developed structures for assuring good governance. The PCT as a commissioner and the acute trusts and DCHS as well as the Local Authority all have records of high achievement as measured by the various different inspection and audit processes. Where smaller organisations are used to supplement the activities of larger ones a careful process is gone through by commissioners to ensure that standards are high. In Derbyshire there are good working relations between the PCT and primary care that assure good performance. One example is the area of Immunisation and vaccination where high commitment from practices and excellent support from the PCT and the local HPA have led to the highest overall vaccination levels in the region and even some of the best in the country.

Q6 Given the current financial and political constraints applied to the NHS, is the DPH confident that the Board has undertaken the necessary work to future proof the public health services?

• The DPH has provided a letter of support for this proposal and is confident that the public health services provided by DCHS face the future with confidence and the support of the public health commissioning function. The board has consistently expressed the strongest support for the importance of public health in its various forms and of the services that promote it. It has manifest this support through enabling the development of one of the largest PCT public health teams in any PCT in the region, and through putting aside significant PCT funds for health improvement and health protection. It has also made strong efforts to be a major partner in all county partnerships. For example non executive and executive directors sit on all the main county partnership boards (Children’s Trust, Derbyshire Partnership Forum etc.). It is difficult to guarantee that anything at all is “future proof” but we start from a position of considerable strength in the capacity of our services, in the degree to which they are linked with all the main players in the county and in a proven record of achievement.


12. Approval of Proposals

PCTs should ensure that proposals have been agreed across the whole local health community including Provider Chief Executives. Is the Board of the proposed provider in agreement with the proposals. Please provide evidence.


As this is a proposal for a CFT, the issues around integration with a single provider do not arise. As a CFT we would expect to be in a robust collaborative but competitive relationship with other providers. The PCT Board are fully supportive of this proposal as are the other key players in the health and social care community

Evidenced By:-

Letters of support included from:

PCT Chief Executive

PCT DPH

DCC Chief Executive

PCT PEC Chair

11. Capacity and Capability

Does the proposed provider have the infrastructure to manage and govern the services it will receive. Please provide evidence.

Rationale for proposal Evidenced By:-

DCHS has a proven track record of managing and governing the services it provides. The governance arrangements of a CFT are a major reason for choosing the CFT option in that they will enable DCHS to access a full membership who can influence its development as well as providing business rigour to underpin the ongoing improvement of its services.

• IBP attached

• External validation by Deloittes and CQC registration

• Delivery of all major quality, contractual and financial targets

• Continued improved stakeholder engagement and patient experience feedback


Appendix 1 - Population Health/Prevention Services

Behaviour Risk Reduction

Tobacco control and Smoking cessation services

Alcohol harm reduction (tier 1 and 2 services)

Obesity reduction – adults and children – weight management services

Healthy eating advice services

Infant nutrition inc breast feeding uptake

Physical activity

Mental well being services eg IAPT

Sexual health promotion

Substance misuse prevention services

Oral Health promotion

Cancer awareness and prevention

Healthy Schools

Health Trainers

Screening/Early Detection

Breast cancer

Cervical cancer

Colorectal cancer

Antenatal screening

NHS Health checks

Chlamydia screening

Diabetic retinopathy screening

Dental inspections in schools


Appendix 1 - Population Health/Prevention Services Cont…

Settings/Client Specific services

Falls prevention

Excess winter deaths/affordable warmth

Prison Health services /Offender Health promotion

Healthy workplace/Health at Work

Teenage pregnancy prevention

Community dental services

School nursing

Health visiting

Community safety and violence prevention (e.g. health services sharing data on assaults, domestic violence, health service contribution to sexual violence)

Major Incidents/Health Protection

Major incident preparedness and response inc pandemic influenza

Immunisation

Tuberculosis services

Infection control

Outbreak control & management

Public Health Intelligence

Dental epidemiological surveys

Derbyshire Community Health Services is responsible for providing NHS Services in the Derbyshire County area and is hosted by Derbyshire County Primary Care Trust.

Becoming a Community Foundation Trust

Making Healthcare Easier

July 2010


Introduction This paper and supporting documentation, aims to summarise why DCHS is ready to become a community foundation trust. Not only do we aspire to become a CFT but would also like the opportunity to become a teaching CFT as we believe we can support others to develop as we have done. DCHS has the formal support to continue this development journey from our staff, NHS Derbyshire County PCT, Derbyshire County Council and from local primary care teams. This paper therefore sets out the evidence for DCHS’ becoming a CFT against the criteria laid out in the Revision to the Operating Framework for the NHS in England 2010/11 and the 8 DH tests. Also attached are: A copy of our Integrated Business Plan (IBP) 2009 / 2013 updated in the light of the

operating framework and ‘Equity and excellence: Liberating the NHS’; A summary of our original and ongoing staff engagement and consultation; Copies of letters of support from Derbyshire County Council, the Chair of NHS

Derbyshire County’s Professional Executive Committee and from the DCHS staff partnership;

DCHS’ Quality Account.


The development journey so far Since our inception in 2006, DCHS has worked towards foundation trust / Monitor compliant systems and processes. We have always believed this approach to be in the best interests of our patients, staff and commissioners. Our track record demonstrates clearly the success of our approach as we have: consistently delivered year on year good quality and good value services; met all our key quality, activity and financial targets and delivered steadily improving levels of patient satisfaction and staff engagement. We also have received national recognition and external validation across the breadth of our activities: Deloittes assessed us as business ready as an autonomous provider organisation last

year; We were the first organisation to be registered with the Care Quality Commission and

have just had a very positive first unannounced visit; We have just been voted by staff as 7th best employer in the Healthcare 100 list, the

highest placed organisation in the East Midlands and the second best large employer nationally;

Our services have received national awards. In March 2009, DCHS submitted an expression of interest in becoming a community foundation trust stating that, ‘As a community Foundation Trust, Derbyshire Community Health Services will energetically explore new and better ways of delivering community-based care, raising standards of care for those it serves and advancing regional and national community services practice. We believe we are in a strong position to take on the challenges involved and are enthusiastic and committed to delivering the benefits the opportunity offers to our communities, our staff and our commissioners.’ Throughout this period, we have worked with Deloittes on a Board development programme aimed at achieving foundation trust status. Working with NHS Derbyshire County, our council and primary care colleagues as well as with our staff, we have reviewed the organisational options open to us. Together, our aspiration and vision to become a CFT is as strong today as at any time over the past 3 years.


Support from GP commissioners and local authorities Formal letters of support from GP Commissioners and local authorities are attached which reflect our ongoing relationship with them over several years. We have reviewed organisational options with both sectors. They have each made it clear that their strong preference is for us to develop as a CFT rather than opt for organisational integration with DCC or with Chesterfield Royal Hospitals NHS FT. Collectively we believe this option best enables continued functional integration of our services. General Practice We have developed and are now implementing ‘DCHS Local’ with primary care and council teams. This aims to achieve flexible and responsive services developed with and around local communities and reflects the white paper’s announcements about GP commissioning. Depending on what local practices want, this can mean all or some of: Structuring our services around localities; Involving GPs in our recruitment processes; Giving practice teams simple service contact information and Developing locality service level cost and activity data Debating local service priorities such as models of providing community nursing,

integrated children’s teams, better access to and sharing of information; Setting up a joint venture board to jointly run and develop services; Offering practices support to run their back office functions thus making economies of

scale. Derbyshire County Council (DCC) We have a history of joint top team meetings and development sessions with DCC. We have formally agreed joint programmes of work and have a track record of jointly run services, notably our learning disability and intermediate care services, and we have joint appointees who are part of DCHS’ Executive Team and other management structures within both organisations. At the most recent Board to Board meeting, it was agreed to progress work in support of the Total Place concept in respect of: Alcohol and drugs; older people; challenging families Joint project management arrangements are being developed accordingly. We will continue to develop this functional integration across all our services, especially around health improvement, safeguarding, integrated children’s teams, personalisation, information sharing and estate usage.


Consistent with ‘Equity and excellence: Liberating the NHS’; delivery of public health services and health services for children Our IBP emphasises that DCHS does not just see itself as a service provider but aims: ‘to provide personalised and safe care, promote the health and well being of all, enhance the life chances of many and promote independence and opportunity wherever possible. By being local, we provide the right care for our community in the community.’ We have organised our management structure to include a health and well being division with dedicated senior leadership and have recently taken over the health promotion function from NHS Derbyshire County. Our health and well being division also has experience of running many of those services identified by Directors of Public Health as population health / prevention services broadly categorised as: behaviour risk reduction eg obesity awareness, sexual health promotion, oral health

promotion, obesity reduction – adults and children, infant nutrition inc breast feeding uptake, healthy schools

screening /early detection eg chlamydia screening, dental inspections in schools; settings / client specific services eg prison Health services /Offender Health promotion

healthy workplace/health at work, teenage pregnancy prevention, community dental services, school nursing, falls prevention, health visiting;

major incidents / health protection eg Major incident preparedness and response including pandemic influenza, immunisation, tuberculosis services, infection control and outbreak control & management.

With regard to health services for children more specifically, we are already an integral part of the local children’s trust board with regard to safeguarding. We are jointly developing the concept of integrated 0-19 years children’s teams based around secondary school catchment areas. We have regular top team management team meetings with the children and younger adults directorate of DCC and are working to a formally agreed programme of work. This includes developing the ‘team around the child’, embedding the common assessment framework and effective information sharing. In summary, we have worked with our Director of Public Health (a joint appointment with Derbyshire County Council) and DCC’s executive team, who are fully supportive of our proposals. This reflects the maturity of our relationship with DCC, our focus on health and well being and our size, which enables us to provide sufficient critical mass for financial and clinically effective delivery.


In the light of ‘Equity and excellence: Liberating the NHS’, we have agreed that we will continue to work with our DPH and DCC about the best way of joining up local NHS services, social care and health improvement, in recognition of the changing roles and responsibilities of local authorities.

Choice and competition NHS Derbyshire County has developed a market management strategy as part of its development as a world class commissioner. In summary, the PCT therefore supports DCHS’ development as a CFT as part of its market management strategy and approach to choice, competition and the development of ‘any willing provider’ because: it retains and strengthens a major provider offering a wide range of service provision

and securing robust opportunities for competition and choice in an economy with two very strong acute FTs and an emerging MH FT;

DCHS is better placed as a CFT to participate in developing a pathway and / or lead

provider approach to the PCT’s immediate priorities of end of life, stroke and dementia care. This is particularly the case as we develop ‘DCHS Local’ which would be more difficult as part of another NHS organisation;

DCHS is retained as an additional provider of learning disability and mental health

services, which would otherwise be primarily focused on Derbyshire Mental Health Trust;

As a separate CFT, DCHS is also better placed to offer choice, competition and play a

role in the development of clinical pathways in the PCT’s other priorities, namely frail elderly and emergency services, learning disability, children’s’ health, smoking cessation and obesity services;

As a CFT, DCHS is best placed to develop its capacity to build appropriate

partnerships. We have already demonstrated our willingness to work in partnership with other providers. Examples are our joint venture agreements with Buxton GPs on Buxton services and with the Royal Derby Hospitals around outpatient and diagnostic services. We have also developed a renal dialysis centre in Ilkeston in conjunction with QMC, Nottingham, and are working with Derbyshire Health United on a joint approach to urgent care services and a single point of access.


Options In June 2008, McKinseys facilitated a review of the strategic options for the future organisational form of the PCT's provider arm (as DCHS then was) with the PCT Board. The options considered fell into 3 categories: an 'as is' option, either as a directly managed part of the PCT or as an autonomous

provider organisation; horizontal integration with either another community services provider, a mental health

provider or with a local authority; vertical integration, either with an acute trust or with a primary care/PBC provider. These options were considered against a range of criteria:

Patient care o Improves patient outcomes o Choice of care (contestability) o Improves patient experience (e.g., ensures appropriate access, easy to

navigate for patient and/or carer, responsiveness) o Enhances preventative health efforts

VfM o Incentives to improve productivity o Reduce payment duplication (ie. PCT currently paying twice for some

services) o Legitimate activity containment o Supports independence governance

Positive benefits from separation o In-line with PCT vision and acceptable to the Board o Improves staff experience (e.g., morale, retention) o Feasible within NHS constraints o Crease commercially viable community services o Easy to ‘administer’

At that stage, the most favoured option was to proceed as an autonomous provider organisation. Since that time and as DCHS has developed as an organisation within a policy framework that offered CFT as an option, the FT route was evaluated as the favoured approach by the PCT Board, the DCHS Board, the local authority, and PBC commissioners. The PCT has actively pursued the options of FT, Social Services integration and MH integration, but as each of these has progressed has become apparent that the allowable options available to the PCT are limited.


Details of our political, economic, social, technological, legal and environmental (PESTLE) and strengths, weaknesses, opportunities and threats (SWOT) analysis are contained within the DCHS IBP which summarises the analysis of the organisational options. This built on the original options analysis work by McKinseys,. This led to the Board’s preferred option of developing DCHS as a community foundation trust, as laid out in the expression of interest submitted in 2009. This analysis and preferred option has been reviewed with stakeholders over the past month against the 8 DH tests and criteria outlined in the revised operating framework. The preferred option for NHS Derbyshire County, DCHS, DCC, primary care commissioners and DCHS’ staff remains the development of DCHS as a CFT. In stating this preference, we would wish to also explore in more detail the concept of the staff membership FT model as outlined in the revised operating framework. Staff Engagement Attached is a summary of the jointly run staff engagement and consultation process completed during 2009 with our Trade Union partners and of the main themes from the engagement process currently being undertaken and which will run from July to September. It remains overwhelmingly the case, this year and last, that staff prefer the CFT option. We have agreed with the SHA and with staff that in confirming our readiness to progress as a CFT, we would wish to consider the original CFT model and the staff membership FT model.


Deliverability Given Deloitte’s assessment of DCHS’ business readiness, the progress we have continued to make since that assessment and our ongoing development work, it is the considered opinion of both the NHS Derbyshire County and DCHS Boards that DCHS could operate as a successful NHS Trust from April 2011 and as a successful CFT from April 2012. A robust project structure has already been agreed and will be instituted with immediate effect from receiving SHA / DH approval to proceed. In outline, we see the process proceeding to the following timetable:

NHS Derbyshire County Board approval July 2010 Approval to proceed from SHA (expected) September 2010 Approval to proceed to NHS trust status from DH

Transactions Board September/October

2010 Due diligence (PCT/DCHS) Oct-Dec 2010 Cooperation and Competition Panel approval December 2011 Draft establishment, transfer orders and transfer agreement to

DH January 2011

DH Transaction Board sign off opening balance sheet January 2011 Establishment, transfer orders and transfer agreement before

Parliament February/March

2011 Establishment of NHS Trust 1st April 2011 Commencement of FT application process April 2011


Achieving the 8 DH tests The PCT and DCHS have also reviewed our CFT proposal against the 8 tests which were outlined in the DH guidance ‘Transforming community services – the assurance and approvals process for PCT-provided community services issued in February 2010. A summary of evidence against these 8 tests is given below. Greater detail is provided within the attached integrated business plan. QUALITY IMPROVEMENT 1. Improving outcomes The fit with the PCT Commissioning Strategy and priority outcomes as identified in World Class Commissioning, including joint commissioning plans Supported by NHS Derbyshire County and Derbyshire County Council as an integral

part of their strategies and supporting policies including market management, competition and choice;

That there are robust plans which show how patient experience for all groups will be significantly improved, and assess the impact on inequalities. As part of strengthened governance arrangements, DCHS has already established a

patient experience committee and a dedicated patient experience and quality report at Board level, including patient stories.

There are strategies in place, summarised in the IBP, to transform the patient

experience and our patient feedback provides evidence of good progress already. 2. Improving quality That there are identified improvements in quality of service outcomes to be delivered DCHS’ has agreed identified improvements in quality of service outcomes with

commissioners and in its recently published Quality Account. This is formally overseen through the quality management group led by commissioners.

That there is a clear plan and capability to shift from acute to out of hospital care NHS Derbyshire County has a clear strategy within which DCHS is playing an integral

role eg long term conditions and urgent care. DCHS has effected a reduction in length of stay in its community hospitals from 31 to 22 days as part of its drive to improve community capacity and efficiency.


DCHS and Derbyshire Health United have been working in line with the NHS Derbyshire County’s Urgent Care Strategy to develop integrated services that provide high quality accessible urgent care, supporting the most effective use of NHS/LA resources across Derbyshire.

We also have Health & Social Care award winning examples of joint primary,

community and social care schemes around admission prevention and discharge support.

That the improvements in quality will be sustained DCHS can already evidence a 3 year track record of quality improvement as evidenced

by its patient experience data, external assurances received and contractual performance. The opportunities afforded by CFT governance arrangements, especially a clear membership strategy and participation, will hold us to account for ongoing quality improvement.

3. Service integration - see sections above on GP commissioner and local authority support, on public health and children’s health services and on competition and choice. The proposals demonstrate at patient and pathway level how service integration will be enhanced to improve care Development of DCHS Local with primary care; Implementation of agreed work programmes with DCC; Continued development of partnerships to support PCT and PbC priorities such as in

stroke, end of life care, urgent care, learning disability and mental health services. Show how the proposal supports primary, community, secondary, children’s services and social care partners to increase prevention through more integrated approaches Continued emphasis as a CFT on our health and well being services outlined above in

line with our IBP; Continued work with DCC on Safeguarding, integrated 0-19 childrens teams linked to

secondary schools and development of ‘ Total Place’ projects; Continued work with jointly appointed Director of Public Health to shape the health

improvement agenda in the light of changing roles and responsibilities outlined in ‘Equity and excellence: Liberating the NHS’.


4. Stakeholder engagement This is covered elsewhere under the sections on support from GP commissioners and local authorities and staff engagement. EFFICIENCY OF SOLUTION 5. Efficiency improvements The proposals will help deliver the efficiency improvements set out in the NHS Operating Framework 2010/2011 The IBP sets out a challenging programme of efficiency improvements over the plan’s

lifetime. This will be strengthened as part of the CFT Monitor assurance process but over the past 3 years, DCHS has delivered productivity programmes worth on average 3.5% of turnover and a surplus of 0.5% of turnover;

Nearly 50% of the 2010 / 11 productivity plan has already been realised as actual

recurring savings. The proposals explain how, and the extent to which, they will deliver technical efficiencies in 2010/2011 and 2011/2012 One of the key principles in the Integrated Business Plan productivity plan is ensuring

that waste and non-value adding processes are driven out of systems and services to maximise technical efficiency.

By ensuring that all DCHS current services are kept together maximum efficiency can be acheivied from support and back office systems and services can benefit from the economies of scale from being a countywide provider.

The challenging financial environment is pushing DCHS more and more to drill down into our cost base and to understand what drives the cost and how it can be better controlled. DCHS has implemented Service Line Reporting within services as a lever with clinical services to gaining “ownership” to the total costs of service delivery and ensuring that those who are able to influence costs do so.

As we move into an “any willing provider “ market place, as a standalone provider and are open to more competition from other providers we will have will have to drive out further out efficiencies if we are to compete effectively..

The proposals set out how allocative efficiencies will be delivered in 2011/2012 and thereafter The Integrated Business Plan outlines how DCHS intends to work closely with

commissioning organisations and other key stakeholders to ensure that services which we intend to provide will meet the needs of our local communities.


Developing services beyond organisational boundaries by partnership working/ cross organisational working and patient pathway development work.

The Integrated Business Plan was developed on the basis of key socio-economic data and future assumptions to ensure that our services continue to meet the changing needs of our communities.

The Integrated Business Plan outlines how DCHS will ensure we achieve our required efficiency savings but also ensure that patient outcomes and quality of service aren’t compromised but are maximised.

Identified reductions in fixed costs including management and transaction costs Our IBP already set out a challenging programme of management cost reductions of

nearly £2m over the lifetime of the plan. We are now reviewing in the light of more recent guidance on management cost reductions.

Within 2010 / 11 we have already exceeded our original target of management cost

reductions and are therefore confident of delivering our target over the lifetime of our IBP.

6. Infrastructure utilisation The proposals will identify steps to increase utilisation and efficiency of back office estate and other infrastructure. They will identify scope to share use of assets more efficiently with other partners including local authorities One of our IBP projects is focused on back office functions, testing for duplication,

effectiveness, efficiency and value for money. We have kept our scope broader than the traditional functional back office definition and have in scope all transactions and processes that span across our organisation. We aim to develop a ‘value for money’ assessment process that can be used across all processes that combines efficiency, efficient and value for money so the team and managers can identify the key improvement areas across the organisation.

DCHS Local explicitly refers to working with primary care to jointly provide back office

functions and DCHS is linked into county wide work streams reviewing the use of assets with the whole health and social care community;

How will the proposal improve the utilisation of all NHS owned or used estate and infrastructure? As part of the IBP, an estate strategy has been developed with commissioners to

reduce the use of the estate by 20%. As a CFT, depending on the agreed policy direction with regard to assets, DCHS would

use CFT freedoms to speed up its implementation of this strategy.


The proposals will identify any surplus assets and infrastructure that will be released by the proposals The agreed estate strategy already makes proposals to this end and detailed analysis

of our estate usage has been undertaken. As a CFT, DCHS would have greater freedom to develop more innovative solutions to its use of estate.

SUSTAINABILITY 7. Sustainability Show how proposals will be sustainable in the long and short term, clinically, financially and in terms of infrastructure DCHS already has a track record of sustained performance for the past 3 years across

the range of its activities and has been externally assessed as business ready by Deloittes;

DCHS already has a robust governance framework to oversee the quality assurance of

its clinical services with internal information and external validation to evidence effectiveness and continuously improving quality.

This governance framework has recently been strengthened through a patient

experience committee led by an independent committee member and these arrangements will be further reviewed as part of the Monitor assurance process;

Financially, DCHS already operated autonomously from the PCT with its own bank

account and financial management processes, and dedicated finance management team. Currently led by an Acting Associate Director, it is recognised this leadership team will need to be strengthened but DCHS can show a sustained track record of revenue and capital management, full audit assurance and ongoing development of financial systems such as service level reporting, sensitivity analysis, scenario development and risk management;

A full review of DCHS’ infrastructure is being undertaken currently. However, no major

weaknesses are anticipated given the external validation which has already been undertaken and which is ongoing as part of the Deloittes Board development programme. There are areas in terms of financial leadership, membership development, marketing and tendering which may require some strengthening.

Show how the proposals will give PCTs with LA and PBC partners the leverage in the local health economy to deliver

strategic commissioning plans continued service transformation and realignment


continuing contestability and service Innovation

An effective commissioning process is already in place and this will be developed albeit

with GP clusters rather than the PCT in the longer term; The ongoing development of DCHS Local will be a key mechanism for levering in

strategic change, service transformation, integrated services and service innovation; As part of our teaching CFT proposal, DCHS will continue to take forward its QIPP

programme, as set out in the IBP. Notable within this is the Leadership Innovation programme which has supported 100 leaders to become confident in the use of service improvement techniques using lean thinking principles and techniques such as dep dives and rapid improvement events. We have also implemented the Jonah project which has reduced lengths of stay in community hospitals by 9 days, increased patient contact time by 18% and reduced costs to commissioners by £1.5m by reducing occupied bed days;

DCHS will continue to develop innovative partnerships and will seek to be a mature

partner in the local health and social care community. Show how the proposals will ensure that the local health economy has and retains a sufficiently skilled workforce to lead, develop and deliver new service models DCHS has a comprehensive People Strategy attached as part of the IBP. This sets out

how DCHS will develop its workforce. DCHS has been voted by its staff as the 7th best healthcare employer in the Healthcare

100 listings, the best performing organisation in the East Midlands and the 2nd best large employer nationally;

DCHS plays its part with the other Derbyshire NHS organisations in developing joint

approaches to workforce development where possible; Currently we are working with John Lewis to import the best of their working practices

for our staff and patients where possible. We are also looking at a more flexible employment model to ensure we can respond effectively to the impact of the ‘any willing provider’ model and increasing competition envisaged by the recent white paper.


8. Whole system fit Demonstrate how solutions will deliver whole health economy effectiveness and Efficiency As a CFT, NHS Derbyshire County and DCHS believe DCHS can be a more effective

player within the PCT’s market management strategy as an effective and efficient provider of a wide range of services;

Similarly, as an independent provider, DCHS will be even better placed to play its role

in emerging pathways of care especially around stroke, end of life, urgent care, dementia and learning disability services and to develop the necessary partnerships;

Currently 13 acute providers discharge Derbyshire patients into the county. DCHS’

ability to work across the acute, community, primary and social care interface in supporting the out of hospital and urgent care strategies is critically important;

DCHS will also be able to develop its capacity to support other organisations in their

QIPP programmes building on its own success to date. Show how the proposals will fit into current and future patterns of acute and out of hospital provision All stakeholders are agreed that as a CFT, DCHS will be best placed to support PCT,

PbC and DCC strategies for acute and out of hospital provision by continuing to develop an integrated set of services which are greater than the sum of their parts, supported by a single point of access and able to both keep people out of institutional care and support their rehabilitation into the community as quickly as is appropriate.

Show how the proposals will contribute to delivering significant wider health system improvements in allocative efficiency NHS Derbyshire County has approved the DCHS IBP as part of the management of

the reduction of whole system costs. The savings from the IBP are transacted through the contractual mechanism to deliver resources back into the PCT for reallocation through the LOP process into the PCT’s strategic priorities.

A strong health and social care community exists within Derbyshire with 2 successful

acute FTs and a mental health trust which will shortly achieve FT status. NHS Derbyshire County supports the development of a strong and independent community services as part of its strategies to improve choice, competition, community based care pathways and service integration.

Have any potential adverse impacts of the proposals elsewhere in the local or wider


health economy been identified and are there proposals for the management of those impacts? This proposal is felt to offer far greater benefit to the whole health economy than any of

the other options considered by DCHS or by NHS Derbyshire County. There is one potential disbenefit in DCHS retaining OPMH and LD service provision for

the North of the County while provision in the South is by the MH Trust. It could be considered that 2 different models of provision could detract from efficiency and service improvement. However, commissioners are of the view that robust management through service specifications and through the new national contracts will allow for alignment between the two providers while offering the benefit of competitive tension to drive up standards further.

Conclusion This paper and its supporting documents outlines why DCHS should and can become a community foundation trust. We are very proud of the services that we provide in DCHS and the difference that we make to people’s lives across the county. As a CFT we believe we can build on our previous success, and continue to develop and deliver excellent local health services across Derbyshire. Expectations of, and demand for, our services is continuing to grow and we are entering a financially challenging period for the NHS. We know that we have to respond to these challenges by working differently, joining services up better and delivering improvements in quality and value. We are convinced that we can do this best as a CFT. Our primary purpose of providing personalised and safe local health services across the county remains unchanged whatever organisational form we eventually adopt. We will continue to focus on our local communities’ needs and how we can best work to address them, as we work with NHS Derbyshire County and our other stakeholders on our longer term future. ------------------------------------------------------------------------------------------------------------------------

Partnership Statement to Support DCHS Application for CFT Status

The Trade Unions and Professional Organisations within NHS Derbyshire County, representing staff within Derbyshire Community Health services (DCHS) are fully supportive of this application for Community Foundation Trust (CFT) status – on behalf of staff within the organisation.

As Partnership Representatives/Staffside from a wide number of Trade Unions and Professional Bodies (including UNISON, RCN, CSP and UNITE) we represent staff across the organisation. As Trade Unions and Professional Organisations and also jointly with management we have engaged comprehensively with staff across DCHS over the last 18 months on a number of related issues including organisational form, development of the DCHS Integrated Business Plan, service changes and developments. This engagement has taken place in many different forums including large scale staff engagement events, staff meetings, staffside discussion - and recurrently throughout the consultations staff have consistently shown their whole hearted support for DCHS to continue to develop its role as a county-wide provider of high quality community services and to achieve its vision of being the best provider of local healthcare, and feel assured that this is best achieved through the organisation developing to become a CFT.

Regional officers of our Trade Unions and professional organisations are fully aware of the discussions within DCHS through engagement with their local representatives – and have demonstrated their support for a future organisational form supported and shaped by DCHS staff, at regional forums.

As a CFT, staff recognise that the organisation would then be able to fully implement its IBP and People Strategy – and best enable its staff to have greater involvement and engagement in the shape and direction of DCHS and its developing partnerships with other organisations, through which maximum benefits for its patients and clients would be achieved.

Lynn Booth (UNISON) Chris Fenton (UNISON)

Nicky Owen (CSP) Helen Ritchie (RCN)

Staff Partnership and Locality Leads (On behalf of DCHS Staffside)


Transforming Community Services

Staff Engagement Summary as at July 2010

1

Background As part of the Transforming Community Services programme a staff engagement process was previously held during Q2 and Q3 of 2009/10 with over 500 staff, in order to seek their views about the future organisation form of Derbyshire Community Health Services. This process in 2009 clearly concluded that the preferred option by staff was to pursue to a Community Foundation Trust application. Derbyshire Community Health Services was unable to put forward an application for Community Foundation trust as part of the 1st wave and therefore pursued other arrangements to ensure meeting the Transforming Community Services trajectory. Following the recent publication of the Coalition Government state and more recently White Paper ‘Equity and Excellence – Liberating the NHS’, it is clear that applications are now sought for a 2nd wave of Community Foundation Trust applications. Derbsyhire Community Health Services are keen to pursue this option again and to ensure this is also supported by the staff of Derbsyhire Community Health Services a second staff engagement process is being undertaken.

2

Engagement Structure and Process Overall 11 events have been planned across the whole of Derbyshire within the mail clinical sites, and in all localities. These events have been planned to occur over the summer months. Good attendance has been seen at the events with a wide range of professional/staff groups attending:

Nursing – 26% Other – 22% Administrative – 16% Managerial – 15% Allied Heath Professionals – 13% IT, including DHIS staff – 6% Medical – 1%

There was also strong staff side representation at these meetings, supporting the view of the staff groups.


3

Outcomes The main themes arising from the engagement events are:

The extremely strong preference from our staff remains to pursue a Community Foundation Trust application, reasons staff have given for this are:

o A desire to remain as part of the NHS and values that this represents; o To ensure that wherever possible all DCHS services can be kept

together to ensure quality and positive patient experience; o To ensure that DCHS can have a stable base and form, on which to

deliver patient care and build on ensuring high quality patient care; o To develop DCHS as a viable commercial entity within the market

place; o Staff are incredibly proud of what they achieved in DCHS and want an

organisational form which will continue to support all services to continue this work;

o To ensure all staff can access the NHS terms and conditions; o Staff expressed strong opposition to integration with Acute

organisations and opposition to splitting DCHS up across a number of organisations, which they felt would pose a risk to their hard work in developing and delivery quality services;

o To ensure a staff voice and input through the membership and Governor model that becoming a Foundation Trust can offer.

A small number of anxieties were expressed about Community Foundation Trusts, primarily:

o Would there be any changes to current terms and conditions; o Is moving towards a Community Foundation Trust moving us towards

privatisation of the NHS;

4

Conclusions The outcomes of the engagement so far indicate overwhelming support of our staff within Derbyshire Community Health Services to pursue a Community Foundation Trust application. It is felt by our staff that this would give Derbyshire Community Health Services the strongest organisational form to meet the quality, clinical productivity, and commercial challenges facing the organisation. This organisational form is felt by our staff to allow them the best opportunity to develop and deliver the highest quality clinical services for the population of Derbyshire County.

Documents

Becoming a Community Foundation Trust Assurance and Evidence · Strategic Plan and TCS. A capability to deliver can be demonstrated through the following examples: • DCHS role in