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Board of Directors Thursday 04 May 2017 08:30am Training Room 1 & 2, The Harbour, Windmill Rise, off Preston New Road, Blackpool, FY4 4FE Board of Directors Quality Committee Finance & Performance Committee Nomination / Remuneration Committee Audit Committee

Board of Directors Board/Trust Board... · 2017-05-10 · Board of Directors Meeting Board of Directors Meeting Location Training Room 1 & 2, The Harbour, Windmill Rise, off Preston

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Page 1: Board of Directors Board/Trust Board... · 2017-05-10 · Board of Directors Meeting Board of Directors Meeting Location Training Room 1 & 2, The Harbour, Windmill Rise, off Preston

Board of Directors Thursday 04 May 2017

08:30am Training Room 1 & 2, The Harbour,

Windmill Rise, off Preston New Road, Blackpool, FY4 4FE

Board of

Directors

Quality Committee

Finance & Performance Committee

Nomination / Remuneration

Committee

Audit Committee

Page 2: Board of Directors Board/Trust Board... · 2017-05-10 · Board of Directors Meeting Board of Directors Meeting Location Training Room 1 & 2, The Harbour, Windmill Rise, off Preston

Board of Directors

Meeting Board of Directors Meeting

Location Training Room 1 & 2, The Harbour, Windmill Rise, off Preston New Road, Blackpool, FY4 4FE

Date Thursday 04 May 2017

Time 8.30am

FORMAL BOARD (PUBLIC MEETING)

Reference Item Lead Action Enc. FOIA

Exempt

TB 039/17 Welcome and opening comments Chair Verbal

TB 040/17 Patient Story Director of Nursing

and Quality Discussion Verbal

TB 041/17 Apologies for absence and confirmation of quoracy

Chair Verbal

TB 042/17 Declarations of Interest Chair Verbal

TB 043/17 Minutes of the previous meetings Chair Decision Paper

TB 044/17 Action Tracker Chair Decision Paper

SCRUTINY & ASSURANCE

TB 045/17 Quality Committee Chairs Report Committee Chair Noting Paper

TB 046/17 Finance & Performance Committee Chairs Report

Committee Chair Noting Paper

Part exempt

TB 047/17 Audit Committee Chairs Report Committee Chair Noting Paper

TB 048/17 Chief Executive’s Report Chief Executive Discussion Paper

Part exempt

TB 049/17 Quality & Performance Report Chief Operating Officer

Noting Paper

BREAK – 10.35am

TB 050/17

Innovation Agency

Annual Report 2016/17

Business Plan 2017/18

Chief Executive Decision Paper

TB 051/17 Quarterly Workforce Report Director of Human Resources

Noting Paper

TB 052/17 Finance Report Chief Finance Officer Noting Paper

Part exempt

TB 054/17 Board Assurance Framework

BAF Risk Appetite Statement

BAF Risk register Q4 End ofYear Position

BAF Risk Register 2017/18

Associate Director of

Compliance and

Assurance

Decision Paper

Part exempt

Part exempt

Part exempt

Page 3: Board of Directors Board/Trust Board... · 2017-05-10 · Board of Directors Meeting Board of Directors Meeting Location Training Room 1 & 2, The Harbour, Windmill Rise, off Preston

FORMAL BOARD (PART TWO PRIVATE MEETING)

TB 055/17 Mental Health Inpatient Business Case

Chief Operating Officer

Decision Paper

TB 056/17 Red Rose Corporate Services

Business Plan 2017/18

Q4 16/17 Performance

Chief Finance Officer Decision Paper

STRATEGY (PRIVATE MEETING)

Reference Item Lead Action Enc. FOIA

Exempt

TB 056/17

Our Future Workforce

Workforce

Apprenticeship Levy

People Plan Implementation

Director of HR

Interim Director of the Quality Academy

Presentation

Paper

Paper

Verbal

TB 057/17 Date and time of next meeting

Tuesday 30 May 2017 11:00am straight after Audit Committee Board of Directors Meeting (Sign off of Annual Report and Accounts)

Chair Noting Verbal

Page 4: Board of Directors Board/Trust Board... · 2017-05-10 · Board of Directors Meeting Board of Directors Meeting Location Training Room 1 & 2, The Harbour, Windmill Rise, off Preston

Declaration of Interest – Board of Directors

Date of Declaration

Surname First Name

Job Title Nature of Interest

Do you envisage a conflict of interest between outside employment and

your NHS employment?

Nil Declaration

21/02/2017 Eva David Trust Chair Employed by Union Learn as National Manager

Yes TUC funds learning in relation to apprenticeship and Trade Union representation.

06/02/2017 Tierney-Moore Heather Chief Executive

1. Director of Lancashire Sport Partnership 2. Trustee of Community Integrated Care 3. Macmillan Allumni Patron 4. Retained Consultant Glenview 5. Patron Breakthrough Mental Health Charity

Yes Potential risk of CIC bidding to provide services in Lancashire that are also of interest to LCFT

13/02/2017 Furlong Gwynne Non-Executive Director & SID

1. NED - Prospect (GB) Ltd. (Subsidiary of Riverside Housing Association)

2. NED - Progress Housing Group 3. NED – Together Housing Group 4. CEO of Regain Sports Charity 5. Trustee of Chorley Youth Zone

No

13/02/2017 Ballard Peter Deputy Chair & Non-Executive Director Chief Executive DSE Service No

29/03/2017 Dickinson Louise Non-Executive Director

1. Director at Talegar Limited 2. Consultancy Services at Talegar Limited 3. Foundation Governor and Finance Chair at

St.Vincents Primary School

No

03/02/2017 Wilson Isla Non-Executive Director

1. NED - Progress Housing Group 2. Shareholder – FSquared Ltd 3. Shareholder - Ruby Star Associates Ltd 4. Consultancy/Advisory Work – Ruby Star

Associates

No

Page 5: Board of Directors Board/Trust Board... · 2017-05-10 · Board of Directors Meeting Board of Directors Meeting Location Training Room 1 & 2, The Harbour, Windmill Rise, off Preston

Declaration of Interest – Board of Directors

03/02/2017 Curtis David Non-Executive Director 1. Director at Clinical and Corporate Governance

Limited 2. Clinical Associate at MIAA (Advisory Section)

No

07/02/2017 Gregory Bill Chief Finance Officer

1. Trustee of Healthcare Financial Management Association

2. Governor of Stockport College 3. Co-opted member of Lancaster University

Financial and General Purpose Committee. 4. Director of Red Rose Corporate Services

No

25/01/2017 Possener Julia Non-Executive Director (Start date 01.02.2017)

1. Sole director and shareholder of JC Possener Limited. Provides management consultancy services. No formal/informal contracts with the Trust nor any other NHS organisations/organisations providing services to the NHS.

2. Lay member of the Lancaster University Management School and Faculty of Arts and Social Science Ethics Committee. Although the Trust and LU have a working relationship and collaborate such matters do not fall usually within these Faculties.

3. My partner's sister is the owner of a domiciliary care business which does have contracts with The Trust. I am including this for the sake of completeness. Bluebird Lancaster and South Lakeland Ltd. I have no formal nor informal involvement in that business.

No No business with the Trust or other NHS organisation or organisations providing services to NHS No unrelated faculties or formal or informal business.

13/02/2017 Roach Dee Executive Director of Nursing & Quality

06/02/2017 Marshall Max Medical Director

06/02/2017 Moore Sue Chief Operating Officer

07/02/2017 Gallagher Damian Director of HR

06/02/2017 Winterson Steve Director of Strategic

Partnership & Engagement

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BOARD OF DIRECTORS

Minutes of the Part One Board of Directors meeting held on 06 April 2017 in the

Boardroom, Sceptre Point

PRESENT: David Eva, Trust Chair (chair)

Heather Tierney-Moore, Chief Executive Sue Moore, Chief Operating Officer Bill Gregory, Chief Finance Officer Julia Possener, Non-Executive Director Deborah Cox, Deputy Director of HR Max Marshall, Medical Director Louise Dickinson, Non-Executive Director Gwynne Furlong, Non-Executive Director Jo Alker, Company Secretary David Curtis, Non-Executive Director Dee Roach, Director of Nursing & Quality Peter Ballard, Non-Executive Director

IN ATTENDANCE: Emma Allen, Staff Governor

Mark Grimshaw, Assistant Company Secretary Ashley Christian, Executive Assistant to CEO (minutes)

TB 023/17 WELCOME & OPENING COMMENTS The Chair welcomed everyone to the meeting. TB 024/17 APOLOGIES FOR ABSENCE & CONFIRMATION OF QUORACY Apologies had been received from Damian Gallagher and Steve Winterson. TB 025/17 DECLARATION OF INTEREST

The Board member declaration of interest register was provided. There were no additional declarations of interest.

TB 026/17 MINUTES OF THE PREVIOUS MEETING

A factual amendment was made to the minutes of the meeting held on 31 January 2017 to reflect the Board’s decision to ‘review the land option’ within agenda item TB 018/17 Chief Executive Report.

TB 027/17 ACTION TRACKER

The Chief Operating Officer noted the Harbour review paper was ready o circulate to the Board and would be circulated when the Specialist Services review had been finalised.

TB 028/17 CHAIR REPORT

The Chair reported back positively on his first Good Practice Visit and referenced other main updates within the report. The decisions made by the Board at the Board Development Session which were set out within the paper were ratified.

TB 029/17 CHIEF EXECUTIVE REPORT

The Medical Director outlined the background to the annual safety scorecard from a national confidential inquiry into suicide and homicide. He described the

UNCONFIRMED

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work to review the data internally to benchmark against other trusts and formulate the specific Trust response to the findings.

A discussion took place around how the Trust utilises this type of data to triangulate with the QPR. Assurance was provided that that there is a regular individual mortality review meeting attended by a Non-Executive Director with clear lines of escalation up to Board in line with national guidelines.

The Chief Executive highlighted an infographic which depicted the strategic influences across the region. The impact of the Five Year Forward View on the STP was discussed and additional information provided regarding the Bay & Fylde ACO progression.

Dee Roach & Peter Ballard joined the meeting

FOI Exempt

FOI Exempt

A Non-Executive Director prompted a discussion about new NHSE guidance on commissioning on mental health provision within the STP. The Medical Director and Chief Executive outlined the potential positive impact when the guidance is implemented

TB 030/17 QUALITY PERFORMANCE REPORT The Chief Operating Officer provided context and reasons for the referral to treatment times for ADHD and MAS (staffing and higher demand outside of the commissioned service provision). Some short term support from commissioners has been negotiated to level out this position.

Some negative performance cited for mental health liaison and contract activity was noted and context about the breach of 12 hour wait target in ED explained.

Success was noted in securing core 24 mental health liaison money but caveats applied to the funding were explained. An overview of the work to apply a data kite mark in the future was provided

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The February data position for prisons was noted within the report however it was confirmed that the provision of healthcare with all five Lancashire prisons had been handed over to new provider on 31 March.

The Chief Operating Officer confirmed some metrics within the QPR would be refined following the Board’s refresh of Trust strategy.

An discussion was held about the Liverpool prison provision following a Non-Executive Director query.

The Chief Operating Officer confirmed the progress of the Chorley crisis beds was on track for opening on 02 May.

TB 031/17 FINANCE REPORT The Chief Finance Officer described the increased level of confidence in achieving the control total with continued monitoring of the recovery plan by FRG. The positon on OATs as key driver of expenditure was stable and the Board noted the other key pressures were staffing and doctors in mental health. The month 12 position would be scrutinised at FRG prior to submission to NHSI and a clearer indication of the control total would be seen.

The Chief Finance Office described the key issues in forecasting for 2017/18;

The network specific impact on budget setting and planningneeded to be completed.

The CIP forecast was sound with certain schemes forecastingover-achievement which would support the achievement of2017/18 control total.

The embedding of ATS/CSUs to address capacity and flowissues is key to reduce OATs permanently

The revaluation exercise increases overall value by £18m with aknock on effect to capital and depreciation which may havenegative financial impact

TB 032/17 ANY OTHER BUSINESS The Board held a discussion about the development and legal complications of accountable care organisations and accountable care structures.

TB 033/17 PATIENT STORY A service user attended to tell his story about his journey to a learning disability diagnosis and how he has used his role in the local community as a leader of a men’s healthy eating group to provide support for other people with a learning disability. The Board reflected on some of the key points raised by the patient story including the support available for those diagnosed with a learning disability later in life and the real benefits of helping people to manage their own lives by helping through education and employment.

TB 017/17 DATE & TIME OF NEXT MEETING Thursday 04 May 2017, 08:30am

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Board of Directors

Agenda Item TB 045/17 Date: 04/05/2017

Report Title Quality Committee Chair Report

FOIA Exemption No Exemption

Prepared by Catherine Baron, Executive Assistant

Presented by David Curtis, Non-Executive Director

Action required Noting

Supporting Executive Director Executive Director of Nursing and Quality

PURPOSE OF THE REPORT:

Report purpose To provide an outline of the activity undertaken by the Quality Committee. The Committee Terms of Reference and Cycle of Business are included for endorsement.

Strategic Objective(s) this work supports

To provide high quality services

Board Assurance Framework risk 1.1 The Trust does not protect services users from avoidable harm and fails to comply with the CQC standards for the quality and safety of services

1.2 The Trust does not deliver safe, appropriate and therapeutic environments to deliver high quality services

3.1 The Trust fails to deliver the benefits of being a Health and Wellbeing provider.

4.1 The Trust is unable to attract, recruit and retain high quality staff impacting on a continued dependency on temporary staffing levels, affecting quality of care and financial costs

4.2 The Trust does not deliver effective education, training and leadership opportunities resulting in a workforce who are unable to deliver high quality, safe care

7.3 The Trust does not comply with Mental Health Legislation

CQC domain Well-led

1.0 INTRODUCTION This Chair Report outlines the activity undertaken by the Quality Committee held on the 12th April 2017.

2.0 COMMITTEE ACTION

The Trust Board is asked to note the content of the Chair Report for assurance.

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CHAIRS REPORT

CHAIRS REPORT OF: Quality Committee

DATE OF MEETING: 12th April 2017

BOARD ASSURANCE FRAMEWORK RISKS ALIGNED TO SUB-COMMITTEE:

1.1 The Trust does not protect services users from avoidable harm and fails to comply with the CQC standards for the quality and safety of services

1.2 The Trust does not deliver safe, appropriate and therapeutic environments to deliver high quality services

3.1 The Trust fails to deliver holistic whole person care (Physical and Mental Health)

4.1 The Trust is unable to attract, recruit and retain high quality staff impacting on a continued dependency on temporary staffing levels, affecting quality of care and financial costs

4.2 The Trust does not deliver effective education, training and leadership opportunities resulting in a workforce who are unable to deliver high quality, safe care

7.3 The Trust does not comply with Mental Health Legislation

AGENDA ITEMS BAF RISK DISCUSSION, ASSURANCE, RISK OR FURTHER ACTION

Emerging Issues 1.1, 1.2, 3.1, 4.1, 4.2, 7.3

National Guidance on Learning from Deaths – A gap analysis undertaken indicates that the Trust is compliant. NHS Improvement guidance related to staffing for Mental Health and Community Services has been analysed to assess the proposals against the Trusts current practices and assurance processes. It has been identified that the Trust is already ahead. Positive work around the e-Roster roll out has received recognition. A thematic review of A&E breaches has been commissioned and will be monitored by the Committee. Risk factors related to the changes to the Police and Crime Bill 2016-17 to reduce the maximum time a person can be detained under Section 136 are being explored and issues will be taken forward with the Chief Inspector. The Trust will be part of the next pilot of the Carter Review. Visits to the Trust will take place as part of the

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engagement process to help understand operational productivity, data and metrics and feed into discussions across the rest of the cohort.

Board Assurance Framework Report

1.1, 1.2, 3.1, 4.1, 4.2, 7.3

Consideration was given to each of the assurance reports during the meeting and the Committee received assurance that there had been no significant changes to the risks in the last quarter. One emerging risk was reported relating to the prescribing patterns within the Care Home Effective Support Service. Assurance was provided that there are mitigating actions to manage this risk.

Quality and Safety Surveillance Reports

1.1 Key priorities for the Trust are physical violence to staff, which remains consistent throughout the rolling 12 month period and the use of restraint, which has increased and is likely to be correlated to the increase in violence. Assurance was provided that as part of the Quality Plan, work is underway on the production of a 3 year plan to reduce incidents and the pursuing of the criminal process. Violence and aggression will be a priority for the Promoting Health Preventing Harm (PHPH) Group. The positive behavioural support plans will become key pieces of work. Core Skills compliance has improved however there are challenges in specific subjects, including safety important subjects. Assurance was provided that an improvement plan is in place. An emerging issue relating to the Trust’s performance around national audits and the POMHUK audits, particularly within the Adult Mental Health Network and the Specialist Services Network was reported. Steps are being taken to address the issues and to improve performance. The chair provided positive feedback with regards to the content of the report and the greater level of assurance received.

Raising Concerns Bi-Annual Report

1.1 Members received assurance around the activity during the last 6 months recorded under the Raising Concerns Policy along with the themes identified which relate mainly to staffing, management culture and conduct, working hours/flexible working and the impact of the Network Re-design. The benefits of migrating Dear David from Sharepoint to Datix were discussed. It is anticipated that this move along with the recruiting of raising concerns advocates will provide staff with more confidence in the anonymity of the system. Options around benchmarking performance will be explored. Future reports will be presented quarterly and will include more detail of the concern raised and the actions being undertaken to resolve the concerns.

Annual Staff Survey 2016 4.1 A summary of the results from the Staff Survey which compares Lancashire Care to 9 trusts that also provide Mental Health and Community Services was received. Assurance was provided that all areas requiring improvement are being mapped to the action plan in the Trust’s People Plan. This will be monitored via the People Sub-Committee and progress reported via the Chair Report.

Review of Quality Impact Assessments for Cost Improvement Schemes 2017-18

1.1 The Committee were provided with assurance around the process by which clinical oversight of Cost Improvement Plans (CIP) and Transformational Schemes is achieved. In total the Quality Impact Assessments for 78 CIP schemes were reviewed and the outcome was reported. The registration of schemes will continue and any remaining issues or concerns identified will be brought forward for discussion at the session due to be held in May. The Chair expressed concern regarding the lack of medical representation at the QIA review session.

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Assurance was provided that a process is in place which ensures the involvement of the Medical Director. Where a CIP is aimed at medical staffing the Medical Director does have input and works closely with the Executive Director of Nursing and Quality in the process of approval.

Promoting Health Preventing Harm

1.1 The Committee received an update following the first meeting of the Promoting Health, Preventing Harm Group. The Group chaired by the Medical Director is now in place to ensure that all areas of practice are subject to a consistent quality improvement process with the right support to enable prompt action and roll out across the Trust. The Sub-Groups are also in place and include Harm Free Care, Violent Reduction, Least Restrictive Practice and Physical Healthcare. All groups will provide an initial project plan and when complete will be rolled out across the Trust. Assurance was provided that as the new framework and structure are in place and with support from the Quality Improvement function, there is the capacity to and capability to deliver the key priorities.

Quality and Safety Sub-Committee Chair Reports

1.1, 1.2, 3.1 The Committee received the Quality and Safety Sub-Committee Chair Reports for the February and March meetings. It was noted that a review of mental health harm free care was commissioned by the Sub-Committee. An assurance report has been requested around HMP Liverpool actions.

Mental Health Law Sub-Committee Chair Report

1.1, 7.3 The Committee received the Mental Health Law Sub-Committee Chair Report for the February meeting. Areas of continued focus were noted and the improvement in the quality of the discussions was acknowledged.

People Sub-Committee Chairs Report

4.1 The Committee received the People Sub-Committee Chair Report for the March meeting. It was noted that a full detailed plan will be presented to the June Sub-Committee in relation to the Apprenticeship Levy to provide assurance that the delivery plan is on track to be implemented in April 2017. Progress has been made in relation to the People Plan Delivery Group.

Risk Assurance 1.1, 1.2, 3.1, 4.1, 4.2, 7.3

It was agreed that following discussions throughout the meeting adequate assurance had been received and there had been no impact on the risk scores relevant to the Committee.

Quality Account 1.1 Members undertook a development session on the Quality Account and received assurance on its development and production. A separate document “Our Quality Story” will be a public friendly publication which will be available in a number of accessible formats. The document will be supported and informed by the Quality Improvement Conference due to take place on the 12th May 2017. Members noted the priorities for improvement 2017-18 which are linked directly to the Care Quality Commission inspection action plan.

Any other business It was agreed that as of July 2017 meetings would take place bi-monthly for 2 hours.

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Board of Directors

Agenda Item TB 046/17 Date: 04/05/2017

Report Title Finance and Performance Committee Chairs Report

FOIA Exemption Part Exemption Section 43: Commercial Interests

Prepared by Mark Grimshaw, Assistant Company Secretary

Presented by Peter Ballard, Trust Deputy Chair

Action required Noting

Supporting Executive Director Chief Finance Officer

PURPOSE OF THE REPORT:

Report purpose To provide an outline of the activity undertaken by the Finance & Performance Committee.

Strategic Objective(s) this work supports

To provide high quality services

Board Assurance Framework risk 2.1 The Trust does not receive assurance of the accuracy, timeliness and consistency of data andreporting with the potential to compromise decision making and service quality 2.2 The Trust's ability to address and meet service demands is affected by uncertainty and inconsistency of commissioning arrangements. 5.1 The Trust does not have in place effective financial controls which could affect long term financial viability and sustainability 6.1 The Trust is unable to reposition in the marketplace to become established as a provider of choice achieving excellence 6.2 The Trust does not implement a transformational IT programme that ensures transition to a new intuitive clinical system across all services

CQC domain Well-led

1.0 INTRODUCTION

This Chairs Report outlines the activity undertaken by the Board level, Finance & Performance Committee held on 20 April 2017.

2.0 BOARD ACTION The Board of Directors is asked to note the content of the Chair’s Report for assurance.

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CHAIRS REPORT

CHAIRS REPORT OF: Finance & Performance Committee

DATE OF MEETING: 20 April 2017

BOARD ASSURANCE FRAMEWORK RISKS ALIGNED TO SUB-COMMITTEE:

2.1 The Trust is unable to reposition itself in the marketplace to become established as a provider of choice achieving excellence

2.2 Uncertainty and inconsistency of commissioning arrangements affects the Trust’s ability to address and meet service demands

5.1 The Trust does not achieve financial performance sufficient to maintain resilience and sustainability

6.1 The Trust fails to plan, develop and maintain infrastructure to support the ability to deliver safe, responsive and efficient patient care

6.2 The Trust fails to implement the full capabilities of the new EPR which will enable the redesign of service to maximise the clinical benefits to patients and reduce the instances of incomplete patient records

AGENDA ITEMS BAF RISK

DISCUSSION, ASSURANCE, RISK OR FURTHER ACTION

Estates Plan Update 5.2 The Committee received an update on the Estate Plan which had previously been presented to the Committee on 5/7/16 and was approved at Trust Board in July 2016. It set out a number of key areas where the Trust’s estate needs to change to support service delivery and quality, and also identified key sites that are non-operational and may become surplus to requirements at a future time.

Since the report had been written, the Naylor Report had been received and this is being analysed to ascertain what it may mean for LCFT and its Estate. There are a number of recommendations from this review including bringing estates strategic planning together, improved guidance on building standards, a need for STPs to develop estates and infrastructure plans and capital strategies. A report on the implications of the Naylor Report has been commissioned to come to the Board in June 2017.

Assurance was provided that the Estates Plan was broadly on track. Pace from an internal perspective is good but external technical factors often slowed progress. Options such as liaising with the Homes & Community Agency for difficult sites are being pursued. A request was made for the target dates within the plan to be circulated to the

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Committee before the next scheduled meeting.

It was noted that the Trinity Rationalisation Programme, which was key for CIP delivery, would be closely monitored through the DTS Programme.

Red Rose Corporate Services Update

5.2 FOI EXEMPT – SECTION 43 COMMERCIAL IN CONFIDENCE

Infrastructure Sub-Committee Chairs Report

6.1 6.2

Progress being made to protect the Trust against cyber-attacks was highlighted to the Committee. Further assurance has been sought on the gap analysis for achieving the ISO 27000:1 standard and an update will be provided to the July meeting. Assurance was provided that the Sub-Committee is continuing to monitor progress towards migrating away from unsupported operating systems such as Windows 2003 and Windows 2008.

The Committee also noted that the Sub-Committee would continue its role in monitoring and scrutinising progress against key milestones for the EPR Programme.

In terms of Estates, on-going difficulties with receiving compliance information from Lancashire County Council (LCC) and NHS Property Services regarding core sites was noted, despite formal correspondence being undertaken. The Sub-Committee will continue to monitor this and will provide an update at the next meeting.

ePR Deployment – Current Systems and Deployment Sequence

6.2 The Committee received an overview of the scope, interdependencies and proposed high level deployment sequence for the new EPR. Following consideration at EMT, the deployment of the EPR will be tested within the Neuro and Head Injury Team, Eating Disorders Team and the Learning Disability Service. The latter service has been added to Phase 1 of the deployment to ensure that the deployment takes place across a wide-ranging environment to test both technological and cultural factors. These full depth small scale deployments are complex with a wide range of touch points and will help to build confidence and test for a wider roll out of the system.

The Director of Health Informatics confirmed that the contractor (Servelec) was committed to the delivery of milestones scheduled to take place within the first 12 months, even if they take longer to complete. This included the full depth pilot deployment of the three services. The timetable is challenging and the first 12 months of the programme is critical to its overall success.

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Oversight and Delivery of the EPR Programme – Senior ResponsibleOfficer

6.2 In response to points raised at the January 2017 Committee, an update was provided on the management oversight of the EPR programme, with a particular focus to ensure that operational requirements and sponsorship are appropriately captured and reflected in the implementation. The outlined structure will ensure that the transformation of processes and clinical activity will be built into the programme and that the COO is in a position to directly shape the programme and have shared responsibility for realising the benefits from implementing the new EPR, alongside the CFO’s responsibility as senior responsible officer for the whole EPR programme.

In terms of assurance reporting, it was noted that the Infrastructure Sub-Committee will receive assurance on milestone delivery and the Business Development & Delivery Sub-Committee will receive assurance on benefits realisation. A substantial update for the Committee on the EPR programme is scheduled for September 2017.

Further assurance was sought on whether MIAA had the requisite skills to carry out a periodic review of progress on the EPR programme. Options are currently being considered and the Committee will be updated at its next meeting.

Business Development And Delivery Sub-Committee Chairs Report

2.1 2.2

Assurance was provided that the Trust is performing well against NHSI indicators. Data kitemarking for NHSI indicators has been introduced and this will also be rolled out across contractual measures.

In terms of contractual / performance issues, assurance was provided that improvements were being seen in areas that had been challenged such as ADHD and MAS.

A discussion was held on whether the initiatives put in place to improve the rate of sickness absence were sufficient, given the poor indicators noted in the Chair’s report. Significant work has been undertaken by HR in this area however; it was likely that the initiatives put in place would take time to provide traction against the sickness figures.

The Committee was informed that the Trust had initiated several schemes to mitigate the number of OATs throughout the year. This included the opening of crisis houses, the takeover of the 111 service and improvement of triage in A&E. It is expected that these initiatives will enable the Trust to maintain a consistent figure of 12-14 OATs which is the assumption within the Budget.

Delivering The Strategy (DTS)

5.1 Assurance was provided on the process that had been undertaken to identify the CIP schemes for 2017/18. The Trust has currently identified £9m against a target of £11.1m. The ‘long list’ of items has a value of £13.4m. Specific DTS programmes have been aligned to the Networks in order to embed the process in the day-to-day operations.

In addition to the £11.1m CIP target, £4m has been identified as overspend areas which are being targeted for reductions and included within Network Budgets. This approach isolates the programme CIPs and provides a clearer view on the challenge.

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Finance Sub-Committee Chair Report

5.1 The Committee was informed that the Trust has obtained £1m insurance cover for Cyber Security. This includes restoring the position after an attack and also ICO cover in respect of fines.

Assurance was provided on the Financial Control Environment which had received significant assurance following a Finance Systems audit. Minor recommendations were given, and these have already been addressed. As agreed at FRG, a review of Board reporting and a refresh will be proposed by the end of Q1.

It was agreed that the FRG would meet prior to July’s Committee meeting.

2016/17 Estate Valuation Assurance Process

5.1 The Committee received a breakdown on the details behind the property Revaluation and the resulting £1.3m impairment to Operating Expenditure and the Statement of Comprehensive Income in 2016/17. This will be reviewed in detail at the Audit Committee.

Risk Assurance All It was agreed that there had been no material impact on the risk scores relevant to the Committee.

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Board of Directors

Agenda Item TB 047/17 Date: 04/05/2017

Report Title Audit Committee Chairs Report

FOIA Exemption No Exemption

Prepared by Mark Grimshaw, Assistant Company Secretary

Presented by Louise Dickinson, Chair of Audit Committee

Action required Noting

Supporting Executive Director Chief Executive

PURPOSE OF THE REPORT:

Report purpose To provide an outline of the activity undertaken by the Audit Committee, highlight assurance received and risks identified.

Strategic Objective(s) this work supports

To provide high quality services

Board Assurance Framework risk 7.1 The Trust does not comply with the Monitor Licence 7.2 The Trust does not comply with statutory legislative requirements

CQC domain Well-led

1.0 INTRODUCTION This Chairs Report outlines the activity undertaken by the Board level Audit Committee on 25 April 2017.

2.0 BOARD ACTION The Board of Directors is asked to note the content of the Chair’s Report for assurance.

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CHAIRS REPORT

CHAIRS REPORT OF: Audit Committee

DATE OF MEETING: 25 April 2017

BOARD ASSURANCE FRAMEWORK RISKS ALIGNED TO SUB-COMMITTEE:

7.1 The Trust does not comply with Monitor Licence and other regulatory requirements under NHS improvements.

7.2 The Trust does not comply with statutory legislative requirements (Excluding Mental Health Legislation which is covered under 7.3)

AGENDA ITEMS BAF RISK DISCUSSION, ASSURANCE, RISK OR FURTHER ACTION

Corporate Governance & Compliance Sub-Committee Chairs Report

7.1, 7.2 Risk and Further Assurance The Committee received positive assurance in terms of Information Governance performance. The Information Governance toolkit had received a ‘significant assurance’ rating from an internal audit report and had also received a ‘satisfactory’ rating following submission to the Information Commissioners Office.

An emerging risk was flagged relating to changes in Data Protection Act regulation which are due to come into force on 1 April 2018. The changes are onerous and not sensitive to the impact on the health sector. The Trust is taking advice and seeking support around how the NHS as a whole responds to the changes.

Further Assurance As part of the year-end process, the Committee was apprised of work that was underway to strengthen the contract register process. The Finance sub-Committee will be monitoring progress on this work.

Further action Following a discussion on the proposal to carry out ‘governance health checks’ at the Corporate Governance and Compliance sub-Committee for the Networks and Support Services, the Committee has requested that an update on the underpinning process behind this is provided at the July meeting. This update will also incorporate the process behind the ‘risk management health checks’ which have already started.

The Terms of Reference for the Corporate Governance & Compliance sub-committee were discussed but not approved as it has been requested to review the content in the context of the new BAF risks for 2017/18. Other

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committee remits will also need to be reviewed in this context.

Year End Assurance Report

7.1, 7.2 Assurance The Committee received a specific year end assurance report against the Trust’s compliance with all provisions in the Code of Governance with the exception of B7.1.1 relating to length of term of office for NEDS. This would be resolved when the terms of office for one long standing NED concludes in November 2017. Additional assurance was provided in relation to the Declaration of Interests Register and Gifts & Hospitality Register. The new guidance on conflicts of interest produced by NHS England was highlighted and action is being taken to reflect this guidance in the Trust’s policies and processes. Assurance was also provided that the Trust was compliant with the requirements of its Provider Licence. As previously noted, the work underway to strengthen the systems underpinning the Contract Register was reaffirmed.

Breaches & Waivers / Losses & Special Payments

5.1 Assurance The Committee received assurance from the quarter 4 breaches and waivers report and losses and special payments report. There were no areas of concern to highlight and no avoidable waivers reported. Assurance was provided that transactions had been progressed in accordance with the Trust’s Standing Financial Instructions. The Committee requested that the format of the respective papers be further developed for future meetings to provide enhanced clarity.

Value for Money Report

5.1 Assurance The Committee received the Value for Money (VfM) Report and the following areas were highlighted as areas that had progressed successfully within 2016/17:

Workforce Review Group – this had been an active group which had been effective at changingbehaviours and enhancing the attractiveness of staff bank as an option. This had resulted in a reduction inagency usage, although there is still work to do.

Harbour Development – the Trust had been successful in capturing the benefits realization and lessonslearned with a report due to come to Board on this topic

Benchmarking – work has been carried out to utilise benchmarking information within contract discussionsto extend the scope of available resources.

Contract performance – the Trust has improved on demonstrating to commissioners with enhanced claritythe outcomes it is producing for the available funding. This is supporting contract negotiations.

A wide ranging discussion was held regarding the roles and responsibilities of the Audit Committee and the Finance and Performance Committee with regards to VfM. It was agreed that the VfM Annual Report would be added to the Cycle of Business for the F&PC. The Value for Money Plan 2017/18 will be considered by both committees with F&PC taking a lead on seeking assurance that the Trust is maximizing its use of resources and

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shaping the approach. The Audit Committee will focus on seeking assurance on the underpinning processes. It was noted that there is an opportunity for the organisation to be an exemplar in this area and that the work can be aligned with the strategy, the BAF, social value, NHSI guidance and requirements (following consultation on the subject) and the Carter Review. A further action was noted to explore how the Trust could best utilise available benchmarking information within continuous improvement cycles and processes.

Draft Annual Report 2016/17

7.1 Assurance The Chair made reference to the development and technical session that had been held with KPMG and it was highlighted that this had been helpful in strengthening the Committee’s scrutiny of the year-end process.

Discussion

The Committee received the draft Annual Report and was provided with an update on the process that had been undertaken to develop the document, including the work carried out by the Annual Report Working Group. Formal assurance (via a short paper) has been sought on the process to confirm the validity of the respective statements within the report. This will be provided with the updated Annual Report which is scheduled for further consideration at the meeting on 18 May. This updated version will incorporate the comments provided by the Committee members.

A particular query was raised on the staff survey results section. In relation to the score for KF29 ‘Percentage of staff reporting errors, near misses or incidents witnessed in the last month’, it was highlighted that there had been a 6% reduction from the previous year but the third party who compile the survey results had not identified this as a material deterioration. Further assurance has been sought on how areas of material deterioration are identified ahead of the 18th May meeting.

The Committee reviewed the draft Annual Governance Statement. Further work will be undertaken to reflect the strengthening of processes within Specialist Services in the narrative and this will be informed by the MIAA report which is scheduled to be considered by the Board in May 2017.

The Board Remuneration Committee is scheduled to sit to review and endorse the content of the Remuneration Report (subject to audit of the figures). These will be included within the Annual Report once available.

Draft Annual Accounts 2016/17

7.1 Discussion

The Committee received assurance against the collation of the draft accounts which, at the time of reporting, were still subject to audit review. It was highlighted that the Trust would receive an additional £1.467m from STF funding which would result in Control Total Basis Surplus position of £235k. An accounts briefing and report on accounting policy changes were received and assurance was provided on the following areas which had been flagged by the Committee as areas of material risk:

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Asset Valuation – the Trust has been subject to a revaluation which resulted in a net upward valuation ofland and buildings. There have been some individual impairments (as noted).

Income recognition – no specific issues have been identified. Harvey House – the outstanding amount had been collected and work to pursue the fourth guarantor

continues to progress. It is requested that this issue continues to be monitored by F&PC

Further assurance was sought on the monitoring of the rate at which the Trust is utilising cash in the context of strategic planning. The F&PC is requested to seek assurance on the appropriate scrutiny of the long term cash position within the 5 year planning assumptions and any potential risks to these assumptions.

Draft Quality Account 2016/17

7.1 Discussion

The Committee received the draft Quality Account and assurance was provided on the development process by the Director of Nursing. Drafts of the Quality Account had been considered throughout the year by the Quality & Safety Sub-Committee and two development sessions had been held with the Quality Committee. Comments from these sessions have been incorporated within the document. The draft has been shared with external stakeholders and feedback will be incorporated once it is available. The Audit Committee received a note from the Chair of the Quality Committee confirming the process and scrutiny that the Quality Account had been through with opportunities available for comment.

The most significant change for this year is the production of an additional ‘public facing’ document which has enabled the Quality Account to rationalize its content to focus on reporting requirements. A request has been made to ensure that reference to the ‘public facing’ document is made within the Quality Account so this change is made clear.

The Committee discussed the inclusion of certain clinical audit data and requested clarification on this selection process. This will be provided at the meeting on the 18th .

Anti-Fraud Reporting 7.1, 7.2 Assurance

The Committee received the Anti-Fraud Services Annual Report 2016/17 and assurance was provided that the plan had been delivered and that the Trust had been assessed against the standards for providers issued by NHS Protect. Overall the Trust had been assessed as ‘green’ with only two ‘amber’ standards. These are not significant risks and work is planned to close these out within 2017/18.

The Committee also received the Work Plan for 2017/18. Assurance was provided on the process to develop the work plan which included taking into consideration national trends, previous investigations, conversations with the internal auditor about potentially vulnerable systems and comments from the Trust on areas of risk. The Chief Finance Officer confirmed that he had been engaged in the development of the work plan. Based on this assurance, the Committee approved the 2017/18 work plan.

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Overall, positive assurance was provided on the progress of anti-fraud investigation activity and the Committee was satisfied that reports continued to provide clarity and demonstrated that there was adequate pace behind identifying fraud and progressing investigations.

Clinical Audit 7.1, 7.2 Discussion

The Committee requested that the update focussed on those areas within the remit of the role of the Audit Committee. It was reaffirmed that the focus of the Audit Committee, in terms of clinical audit, is on the underlying processes and how it contributes to the overall quality improvement programme of the Trust. The Committee was informed that there is work being undertaken to agree how to provide a view to the Board on the efforts to improve and maintain quality in the round, including the use of clinical audit. This work is expected to be completed by the end of Quarter 1 and be presented to Board.

An update was provided on the 2017/18 Clinical Audit Plan. In discussing its development it was suggested that the plan should be considered by the Quality Committee in its April meeting, ahead of being received by the Audit Committee. This will be added to the Cycle of Business for the Quality Committee. Assurance was received that a process is in place for linking themes from complaints and concerns to the clinical audit annual plan. This link will be formalised within the Clinical Audit Protocol which is scheduled for consideration at the 18 May meeting. Another issue which will be considered when the protocol is discussed relates to whether failed re-audits are re-audited.

Internal Audit Progress and Follow Up Report

7.1, 7.2 Assurance The Committee received assurance that the 2016/17 Internal Audit Plan had been completed. Overall, the Committee received positive assurance from a number of internal audits which received significant or high assurance. Both the Information Governance Toolkit and ESR HR / Payroll audits had made improvements from the previous year (limited to significant and significant to high respectively). The reports that had received limited assurance (Absence Management & Lessons Learned) will be discussed in more detail at the next Committee meeting.

A discussion was held in relation to the Assurance Framework audit and whether the scope had included an assessment on risk scoring and whether it was sufficiently rigorous and moderated. The audit had considered risk scoring but had not assessed this in detail. Assurance was provided that a process was in place for moderating risk scoring and that this was supported by live assurance mapping from the corporate governance structure which helps to provide robust evidence. Executive Directors also score risks with support from EMT and the Board. The Internal Audit Plan 2017/18 includes a review that will explore the scoring of risk and its consistency across the organisation.

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Assurance was provided on the good progress in closing outstanding actions from the 15/16 and 16/17 internal audit programme and validation of closed actions would continue by MIAA.

Internal Audit Plan 2017/18

7.1, 7.2 Assurance Noting that the Audit Plan had been through a detailed and comprehensive consultation process with Executive Directors and the Chair, the Committee approved the plan.

Director of Audit Opinion and

Annual Report 2016/17

7.1, 7.2 Assurance A rating of ‘significant assurance’ was highlighted and this has been based on the opinion that the Trust uses and targets internal audit effectively as part of a system of internal control. This was accepted by the Committee.

Board Assurance Framework Risks

7.1, 7.2 Assurance

BAF risk 7.1 has reduced during Q4 to achieve the target score. This is due to a detailed piece of work which has been undertaken to develop a robust framework to monitor compliance with the individual provider licence conditions to support the annual declaration of compliance with the Provider Licence. Moving forward into 2017/18 the provider licence conditions will be monitored against the relevant BAF risk.

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Board of Directors

Agenda Item TB 048/17 Date: 04/05/2017

Report Title Chief Executive’s Report

FOIA Exemption Part Exemption

Prepared by Heather Tierney-Moore, Chief Executive

Presented by Heather Tierney-Moore, Chief Executive

Action required Discussion

Supporting Executive Director Chief Executive

PURPOSE OF THE REPORT:

Report purpose The purpose of this report is to provide Board members with an overall summary of the Trust position and highlight areas for further discussion.

Strategic Objective(s) this work supports

To provide high quality services

Board Assurance Framework risk 2.1 – The Trust does not receive assurance of the accuracy, timeliness and consistency of data and reporting with the potential to compromise decision making and service quality

CQC domain Well-led

Introduction This report aims to give Board members an overview of activity since the last Board meeting, both within the Trust and externally, alongside information updates.

QUALITY AND SAFETY

Serious Incidents During March 2017, the following serious incidents were reported:

(brief information is provided to protect confidentiality, the term suicide is only used once a Coroner’s Inquest

has returned a verdict of suicide)

Death of a patient (cause unknown) of a patient under the care of the Crisis Resolution and Home Treatment Team;

Death of a service user (suspected suicide) in Supported Accommodation Services;

Death of a prisoner (expected death, receiving palliative care) at HMP Preston.

Concerns around unacceptable care standards at the Harbour towards one patient;

Grade 3 Pressure Ulcer in District Nursing Services;

Death of an individual (suicide) seen by the Assessment and Treatment Team;

Death of a service user (suicide) seen by the Mindsmatter Service.

In all cases, a formal investigation is now underway and the incidents have been reported to

commissioners, NHS England and regulators as required under the NHS Serious Incident

Framework.

Learning from deaths The Care Quality Commission (CQC) and NHS Improvement circulated a joint letter regarding

Learning from Deaths. LCFT examines all deaths in the Trust and work is underway to introduce the

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recommendations from the letter into a structured process which utilises the recognised tool. Learning

disability deaths are already subject to an in depth process.

The requirements include collecting and publishing on a quarterly basis, specified information about

deaths in terms of numbers, qualitative information and learning and related actions taken. There is

additional emphasis on supporting bereaved families and carers and also on specific training for staff

involved in reviewing deaths.

The Medical Director and Executive Director of Nursing and Quality are leading this work and further

guidance relating to mental health and community trusts is expected.

Infection Control The Infection Control team have launched Aseptic Non Touch Technique (ANTT) and is rolling this

out across the trust. This international practice ensures that sterile, aseptic, clean and non touch

technique is practiced by our staff when undertaking any invasive procedures such as taking blood or

undertaking wound care.

This practice will ensure that the trust is actively practicing to reduce healthcare acquired infections (HAI)

which result in significant mortality and morbidity internationally. It is estimated that 30% of HCAI’s are

preventable and the use of ANTT is recommended to reduce that percentage.

The team has also commenced a Hand Hygiene Campaign in a bid to improve this practice across

the trust. This campaign will raise awareness of the importance of bare below the elbow in

conjunction with the launch of a revised uniform policy and will also include more hand hygiene audits

in all of our services.

Nursing Associates

17 Nursing Associates commenced at the end of March across all of our services. This important

initiative together with our work on new roles in clinical practice will not only improve our recruitment

but also enable the trust to “grow” its own workforce for the future. This is part of a national initiative

and will be closely monitored to assess both the impact and the future spread of this new training. The

Nursing and Midwifery Council is currently developing a register for these staff on completion of their

training to ensure regulation is in place for safe and effective practice.

Achieving Core skills compliance

Whilst overall core skills compliance continues to improve there are a number of hot spot areas where

individual training subjects are not fully met. Each ward and team require specific skills and

competence and the Networks have prioritised these and have worked with the Quality Academy to

develop robust recovery plans. Children and Young People and Community and Wellbeing Networks

are almost complete with mental health on track to achieve within a few weeks. For 2017/18 a

comprehensive review of core and essential skills has been undertaken to ensure that compliance is

achieved and maintained.

A Good Practice Visit occurred on 07 March 2017 to Austen Ward, The Harbour

The visiting team were:

Heather Tierney-Moore – Chief Executive LCFT

Isla Wilson – Non Executive Director

Michael Wedgeworth – LCFT Public Governor

Caroline Edwards – End of Life Nurse, Blackburn with Darwen

Michelle Prescott – Quality Improvement Lead

Julie Garlick – Quality Officer

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Austen Ward is a female advanced care ward at the Harbour which provides assessment and

treatment for people with mental health and physical health needs. The visiting team noted that the

environment felt very welcoming with a caring atmosphere reflecting a strong sense of compassion.

The visiting team commented there was a strong Multi-Disciplinary Team (MDT) and commitment to

team working on the ward.

It was noted that each member of staff has access to an iPad that links to the nerve centre, this

reflects a “to do” list for the multi-disciplinary team (MDT) and triggers actions when a person’s needs

and vital signs are not within normal limits. Poor Wi-Fi connectivity on occasions was identified as a

challenge and a member of the visiting team agreed to explore this further to understand if this is

unique to Austen ward and what measures can be addressed to rectify this.

It was noted that the team are exploring the benefit of having a General Practitioner working with the

team on the ward 2-3 days per week to support physical health pathways and the visiting team were

interested to hear how this progressed.

The Team Information Board was identified as an example of good practice and acknowledged the

Ward Managers plans to strengthen the team huddles to support a collective understanding of the

team’s data and information to inform quality improvements. In addition the team were asked to

consider how the feedback they receive from people using the service, families, carers and staff can

be used to inform their quality improvements going forward and the Quality Improvement lead will

engage with the ward to support this.

Experience Based Co-design

The Lancaster Learning Disability Team has been working with people who use the service to

understand their experience of care using the Experience Based Co-design methodology. On the

14th March they held their “Making the service even better” celebration event which was attended by

people who use services, stakeholders, commissioning colleagues, the team, network leads, the

Chief Executive and Quality Team. By understanding people’s experiences the co-design team have

identified key areas for improvement:

How the learning disability health team communicate about the service, including the co-design of a leaflet

People being able to contact the service, including the development of a contact card

Keeping people informed of any changes to the care provided, for example, changes to the person from the team visiting the individual

This work is now being progressed as an Always Event, with the co-design team testing, measuring

and evaluating the change ideas over the coming months.

Safer staffing

NHSI circulated a letter regarding mental health and community staffing on 15th March 2017. This

letter highlighted that draft resource documents have been produced as part of the National Quality

Boards (NQB) Safe, Sustainable and Productive Staffing series and is consulting on the documents.

The documents have been analysed to assess the proposals against our current practices and

assurance processes. LCFT is already ahead in using the methodologies and processes outlined and

is actively engaged in national work to provide further evidence based assurance. Feedback will be

given on these documents as requested to NHS Improvement and NQB.

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Chief Allied Health Professions Officer (CAHPO) for England –Visit

Suzanne Rastrick, CAHPO for England visited the South Cumbria & Lancashire Directors of Nursing

and AHP (Allied Health Professional) Leads on 30th March, following the launch of ‘AHPs into action’,

the National AHP Strategy – using AHPs to transform health, care and wellbeing. The Trusts

Executive Director of Nursing and the AHP Associate Director attended this and a clear mandate was

given from the Directors of Nursing to the AHP leads to progress implementing the strategy. The

Trusts AHP leads are integral to the work focusing on Bay area partners aligned to Lancashire &

South Cumbria Sustainability and Transformation Plan (STP) and Better Care Together Programme,

which prompted the visit by CAHPO for England.

The launch of the strategy with LCFT AHPs has commenced and our priorities are aligned to the

Impact, commitments and priorities described in the strategy. This provides a clear framework for

system leaders in LCFT to enable AHPs to transform care. A date is being planned for Suzanne

Rastrick to visit LCFT later in 2017 for a showcase of work implementing the strategy.

The Acute Therapy Service Review

The Acute Therapy Service (ATS) is an initiative that aims to support service users during a mental

health crisis by providing an alternative to the existing inpatient model. ATS is a psychologically led,

structured therapy service, based on the principles of Dialectical Behaviour Therapy (DBT). Referrals

are accepted from the community to avert a hospital admission and from in-patient services if the

person would otherwise have to remain on a ward.

A recent evaluation of the service aimed to assess the impact of the ATS. Twenty service users were

randomly selected, 10 attended the ATS as an alternative to admission (A2A) and 10 attended to

facilitate their early discharge (FED’s). Data was gathered for each participant over a 2 year period

and compared at 3 points, 12 months prior to ATS, time in ATS and 12 months post ATS.

The ATS Services in North and Central Lancashire recently won the Trust award for Frontline Service

of the Year and also The Chief Executive Award for Excellence.

FINANCE AND PERFORMANCE

Quality and Performance Report The Quality and Performance report can be viewed under agenda item TB 049/17. Financial Position Based on draft unaudited figures the Trust has achieved its control total. Including the Core STF

allocation of £2m and the bonus STF allocation of £1.4m Month 12 sees a provisional outturn

operating surplus before impairments of £235k (Month 11 deficit £3.4m). The measures identified to

recover the position in previous months have continued in this month, including the curtailing of

expenditure and improving network/corporate forecasts in the run up to the year end. These

improvements were partially offset by pressures, most significantly, in Specialised Services which

were impacted adversely by high levels of temporary staffing on the wards. However, the net position

across the Trust returned an underspend of c£0.5m in month before incentive payments. The Board

Balanced Scorecard demonstrates an EBITDA (earnings before interest, taxes, depreciation and

amortisation) of £14.4m against a plan of £13.3m. The new Use of Resources (UoR) metric is now

rated at 2, from 3 at month 11.

Capital Programme

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The Operational Plan for 2017/18 submitted to NHSI in December 2016 included a planned level of

capital expenditure of £9.6m. This sum was based on our understanding of the priorities at the time

and the availability of internally generated cash to fund the programme. The £9.6m is now effectively

the capital control total we will be expected to work to for NHSI.

The Board are asked to consider and approve the programme of capital works, to deliver the Trusts

requirements in line with planned objectives and within the funded control total of £9.6m. The full

capital programme can be viewed here. FOIA Exempt Commercially Sensitive

Red Rose Corporate Services FOIA Exempt Commercially Sensitive

Harvey House FOIA Exempt Commercially Sensitive

PEOPLE AND LEADERSHIP

Equality WRES standards In April the NHS Equality and Diversity Council released ‘NHS Workforce Race Equality Standard

2016 Data Analysis Report for NHS Trusts’. This report is designed to aggregate and analyse the

WRES data submitted by Trusts in July 2016 and provide a national picture of the progress made

since the introduction of the Standards in 2015.

The key findings of this report include:

White shortlisted job applicants are 1.57 times more likely to be appointed from shortlisting than BME shortlisted applicants, who remain noticeably absent from senior grades within Agenda for Change (AfC) pay bands

An increase in numbers of BME nurses and midwives at AfC Bands 6 to 9 is observed for the period between 2014 and 2016

BME staff in the NHS are significantly more likely to be disciplined than white staff members

The proportion of very senior managers (VSMs) from BME backgrounds increased by 4.4% from 2015 to 2016 – an additional 9 headcounts. However, BME representation at board and VSM level remains significantly lower than BME representation in the overall NHS workforce and in the local communities served

BME staff remain significantly more likely to experience discrimination at work from colleagues and their managers, although the percentage of BME staff reporting that in the last 12 months they have personally experienced discrimination at work from staff fell slightly

White and BME staff are equally likely to experience harassment, bullying or abuse from patients, relatives and members of the public in the last year

BME staff remain more likely than white staff to experience harassment, bullying or abuse from other staff though this fell very slightly last year

BME staff remain less likely than white staff to believe that their trust provides equal opportunities for career progression. However, the gap between white and BME staff on this indicator fell from 14.5 percentage points in 2014 to 12.6 percentage point in 2015.

The full report, an explanation of the methodology used and the caveats associated with the data can be found here. When considering how the Trust compares with others, the comparator tables in the report have classified LCFT as a mental health trust which does not give a true picture of our organisation. As a result, the comparison tables are for indicative purposes only.

Indicator 1 – Skill Mix

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% BME Support Staff at LCFT

Compared with all Trusts Compared with MH Trusts

Compared with Trusts in the North

8.2 Above average Above average Bottom Quartile

% BME Middle Staff at LCFT

Compared with all Trusts Compared with MH Trusts

Compared with Trusts in the North

5.5 Top Quartile Above average Above average

% BME Senior Staff at LCFT

Compared with all Trusts Compared with MH Trusts

Compared with Trusts in the North

21.1 Bottom Quartile Bottom Quartile Below average

% BME VSM Staff at LCFT

Compared with all Trusts Compared with MH Compared with Trusts in the North

1.1 Above average Above average Below average

Indicator 2 – Shortlisting/Appointment

Relative likelihood of white

staff being appointed to LCFT from shortlisting

compared with BME staff

Compared with all Trusts

Compared with MH Compared with Trusts

in the North

2.15 times more likely Bottom Quartile Bottom Quartile Bottom Quartile

Indicator 3 – Formal Disciplinary

Relative likelihood of

LCFT BME staff entering the disciplinary formal

process compared with white staff

Compared with all Trusts

Compared with MH Compared with Trusts

in the North

2.72 times more likely Bottom Quartile Below average Bottom Quartile

Indicator 4 – Non-mandatory Training

Relative likelihood of

white LCFT staff accessing non-mandatory

training and CPD compared with BME staff

Compared with all Trusts

Compared with MH Compared with Trusts

in the North

0.85 times as likely Top Quartile Top Quartile Top Quartile

LCFT data on this indicator was limited and this position in unlikely to be sustained in the 2017 return due to considerable improvements in reporting training data by race.

Indicator 5 – Harassment, Bullying and Abuse from Patients, Relatives and Members of the Public

% LCFT BME staff

experiencing harassment, bullying and abuse from patients, relatives and members of the public

Compared with all Trusts

Compared with MH Compared with Trusts

in the North

24% Better than average Better than average Better than average

Indicator 6 – Harassment, Bullying and Abuse from Other Staff

% LCFT BME staff experiencing harassment, bullying and abuse from

staff

Compared with all Trusts

Compared with MH Compared with Trusts

in the North

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18% Better than average Better than average Better than average

Indicator 7 – Equal Opportunities for Career Progression and Promotion

% LCFT BME staff believe Trust offers equal opportunities for career

progression and promotion

Compared with all Trusts

Compared with MH Compared with Trusts

in the North

92% Above average Above average Above average

Indicator 8 – Discrimination from Manager, Team Leader or Colleagues

% LCFT BME staff

personally experienced discrimination from a

manager, team leader or colleague

Compared with all Trusts

Compared with MH Compared with Trusts

in the North

21% Worse than average Worse than average Worse than average

Indicator 9 – Board Representation

% BME representation at LCFT Board

Compared with all Trusts

Compared with MH Compared with Trusts

in the North

8.3% Above average Above average Below average

The Board level data was attributable to one individual who has now left the organisation. The 2017

report will show 0% BME representation at LCFT Board level.

Over the past year, we have made considerable improvements in our data collection systems so that

the information we are using to make decisions is robust and accurate. We will continue these

improvements into the coming year.

We have also worked hard to integrate Equality and Diversity into our Quality, People Plan and Health

and Wellbeing Strategies so that good practice becomes part of everyday activity for everyone.

We continue to seek guidance, support and best practice examples from colleagues both inside and

outside of the NHS and will be taking up opportunities for partnership working and knowledge sharing.

We have launched a number of projects designed to engage directly with BME staff at Lancashire

Care so that we can understand some of the barriers they might face. These include looking at in

depth at disciplinary data, recruitment practices and development and progression opportunities. The

outcomes of these projects will form part of the WRES action plan for 2017 and will be additionally

informed by the up-to-date information which will be available to us following the 2017 WRES report

submission in July 2017. All of the work we undertake on WRES is published on the Trust website.

External Engagement The Quarter 4 Communication and Engagement report can be viewed here

GOVERNANCE AND ASSURANCE

MIAA Reviews: Specialist Services Part FOIA Exempt: Information Provided in Confidence Following concerns that were identified within the Specialist Services Network, a review of the

governance and performance arrangements was commissioned with a particular focus on Health &

Justice Business Unit. 12 months on from when those concerns were originally identified, the

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outcome of the review undertaken by the advisory-arm of Mersey Internal Audit Agency is made

available here. Immediate action has been taken to strengthen management oversight and processes

in place across all networks particularly utilising the organisational reset as an opportunity to set and

refresh standards and ensure consistency across all networks.

The action plan reminds the Board of the actions already undertaken and the further activity planned

to continue to strengthen those general management systems. This action plan will be monitored

through the Corporate Governance & Compliance Sub-Committee and assurance provided through to

the Audit Committee via the chairs report.

MIAA Reviews: The Harbour Part FOIA Exempt: Information Provided in Confidence MIAA were commissioned to undertaken an independent review of the opening of the Harbour

assessing the robustness of the planning, project management and mobilisation action taken to

support the ‘go-live’ in 2015. The final report provides points for consideration and recommendations

specifically relating to the procurement and implementation of the Nervecentre System.

The report conclusion provides confirmation that appropriate arrangements were in place to support

decision making to support the ‘go-live’ of the Harbour being mindful that there are some issue in

relation to information management – recording and storage. It notes that a robust project

management structure was put in place but identifies the need to ensure that stakeholder and staff

engagement forms part of that.

To ensure that all the points are captured and acted upon via the Infrastructure committee will monitor

the improvement plan and all action taken will be outlined to Finance and Performance Committee via

the Chairs report. In summary these include:

revisions to the process around business case development to clearly articulate the

requirements around engagement and communication both internally with staff and

externally with key stakeholders;

a clear process for the recording and storage of project management information;

a review of the process relating to ‘lessons learnt’ from projects and how they are

recorded and shared, and where relevant improvement action taken.

Scheme of Delegation Board members will be aware that a significant piece of work has been undertaken to develop a

Compliance Framework which identifies the primary legislation that is relevant to the organisation and

as part of this; the specific legislation directly related to the Board’s responsibilities. Further external

assurance is currently being sought on the Compliance Framework and the review of corporate

policies in line with the framework being undertaken. To ensure the requirements falling out of the

Compliance Framework are captured within the Trust’s Scheme of Delegation, an initial housekeeping

exercise has been undertaken. This is also timely following the organisational reset to ensure

documents such as the Decision Rights Framework remain fit for purpose.

The refreshed Matters Reserved for the Board and the Decision Rights Framework are provided to

the Board for review. No significant changes have been made at this point other than to ensure the

documents remain relevant however, as this work progresses further updates will be brought back to

the Board.

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Well-Led Action Plan The delivery of the Well-Led Action Plan has continued to be monitored internally through the

Company Secretary team. All actions are now complete with the exception of three as detailed

overleaf. Extended deadlines have been agreed and will continue to be monitored and reported

through to the Board on completion.

Ref Recommendation Action Delivery Date Owner

R7 Continue to review the portfolios of Board members to ensure sufficient capability, capacity and contingency for delivery of the Trust Strategy.

Chair and CEO to review the portfolios and succession planning for the whole Board as part of the scheduled review planned for Jan 2017. Any action to be taken following that discussion will be reported through to Nomination Remuneration Committee.

Deferred until a more appropriate time June 2017

Trust Chair/ Chief Executive

S15 The Board needs to expedite and support improvements to ensure that patient safety is maintained through an appropriately trained workforce.

A detailed Training Needs analysis will be completed to ensure training is bespoke to roles and professions. EMT have requested that additional work be undertaken to reconcile the budgets from across the organisation relating to training and reported back to EMT in February 2017.

December 2016 May 2017

Director of Nursing & Quality

S35 The workforce section of the quarterly performance report is comprehensive and includes a wide range of operational KPI’s with inclusion of Network Hotspots. This could be further improved through the addition of ‘cultural intelligence’ i.e. values, behaviours and attitudes.

As the People Plan gathers data on cultural intelligence it will be included in the QPR. A cultural assessment will be undertaken during Q3 of 2017 and the results reported to the Board. The reporting through the QPR will picked up as part of the wider review of the report.

December 2016 October 2017

Chief Operating Officer/ Director of HR (Director of Delivery)

BUSINESS DEVELOPMENT

FOIA Exempt Under Section 43 – Commercial Interest

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Board of Directors

Agenda Item TB 049/17 Date: 04/05/2017

Report Title Quality and Performance Report (QPR)

FOIA Exemption No Exemption Not Applicable

Prepared by Louise Corlett, Head of Delivery and Performance

Presented by Sue Moore, Chief Operating Officer

Action required Noting

Supporting Executive Director Chief Operating Officer

PURPOSE OF THE REPORT:

Report purpose To appraise the Board of Directors of key elements and themes from the Month 12 QPR

Strategic Objective(s) this work supports

To provide high quality services

Board Assurance Framework risk 2.1 The Trust is unable to reposition in the marketplace to become established as a provider of choice achieving excellence

CQC domain Well-led

PAPER DEVELOPMENT PROCESS:

Meeting Presented Action Date

BDD Sub-committee Louise Corlett 26/04/17

Board are asked to note the QPR for month 12 with following comments below.

In Month 12 (March), the Trust is reporting full compliance for all NHSI Indicators and has achieved full compliance with all NHS I indicators for 2016/17.

The Board are also asked to note the following: From Month 1, the Board Balanced Scorecard will be refreshed to align with the Trust’s

Strategic Priorities and this will be followed by a review of the metrics within each domain whichwill be completed in readiness for Q2 reporting.

Also from Month 1, this report will be presented in the context of the CQC domains and theinformation in the QPR used to provide assurance to the Board in terms of our status againsteach domain.

In Month 1, as a result of the changes required to systems in relation to the change to structureand hierarchies resultant from the organisational reset, workforce measures will be reported atTrust level only. Network level will be available for Month 1 and 2 in June 2017.

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Adult Mental Health

ADHD – Section 1.1 • ADHD continues to be challenged in relation to achievement of the 95% referral to treatment

target. Following a meeting with the Lead Commissioner in March, an option is being proposedlooking at an alternative model of delivery which will increase capacity available to see patientsover 25 who are new to the service and this is the area of pressure. It is important to note thatthe service continues to perform well in relation to existing patients.

Memory Assessment Service (MAS) – Section 1.1 A further improvement has been seen in M12 against the target to see 70% of patients within 6 weeks with 48% of patients assessed within this timeframe. The service has responded to a contract proforma received from the lead commissioner and there is a plan to address the waiting list in the 2 areas who are underperforming, namely Central and Pennine Lancs. A trajectory has been agreed and performance will be reported against this from month 1.

Patient Flow – Section 1.2 Inpatient adult mental health wards continue to be challenged with Bed Occupancy continuing to exceed >100%. Readmission rates continue to show a variable trend and remain above threshold this month for both 30 and 90 day readmission. The thematic analysis has highlighted that patients accessing the assessment wards are part of this cohort and discussions are underway about clinically appropriate patient pathways. Length of stay for mental health has reduced slightly in month from the peak in February and is below the year average of 35 days. The drivers of this are yet to be fully understood and will be further investigated. PICU length of stay has fallen to the lowest number of days since September in line with patient level reviews conducted by the Clinical Director. Despite the overall picture, the number of Out of Area Placements has reduced to an average of 20 throughout the month and it is expected to remain at this position until developments come on stream.

MHLT A&E 12 hour Performance - Section 1.2 In Month 12, 2.8% of all patients referred to the MHLT via A&E breach the 12 hour compliance target, and this represents 20 patients. This is a sharp rise from 8 in the previous month and is in contrast to an improvement in the 4 hour breach performance where 10% of referrals breached 4 hours (15% last month). This reflects an increase in overall referrals and a movement of the bottleneck from before the 4 hour period to after the 4 hour period.

NHSE have confirmed that Lancashire was successful in CORE 24 Liaison bid, with funding from April 2018. Currently, short term funding for additional staffing is in place and a proposal for an interim model between now and April 2018 is being developed.

Contract Activity Section 2.2 Mental Health contract activity is currently 6.67% against plan.

Children and Families

Children’s integrated therapy nursing services (CITNs) Occupational Therapy – Section 1.1 As expected, a further improvement has been seen again in M12 with the service reporting 95% against the 92% target for patients waiting under 18 weeks. Improvement actions remain in place, in particular for teams covering the BwD area, which are expected to result in compliance in month 1 of 17/18.

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Speech and Language therapy – Section 1.1 Whilst the performance continues to cause concern, with a slight deterioration against the 92% RTT standard of patients on the waiting list under18 weeks, staffing issues are being worked through and recruitment to posts is progressing as reported last month. Waiting times are being managed at individual patient level to ensure appropriate clinical prioritisation and a capacity plan to deliver an improvement trajectory can now be defined.

Child Psychology Therapies – Section 1.1 Performance has improved slightly to 65% against the 95% RTT for patients treated within 18 weeks. In addition the waiting list size has reduced markedly; however there are still a significant number of patients on the waiting list who have already exceeded 18 weeks, who as they are treated will impact on future performance. The management of the waiting list at patient level to enable appropriate clinical prioritisation is in place. Alongside this, a review of capacity and demand and a full waiting list cleanse is underway in order to plan the improvement trajectory.

Bed Occupancy- Section 1.1 Bed occupancy has increased in M12 in the Junction, with the Platform maintaining the M11 occupancy position. Both wards remain open in the run up to the move to the Cove and the current occupancy is consistent with the national picture.

Contract Activity Section 2.2 Community Contract (C&F) is currently -6.14% against plan for 17/18, a slight improvement on the percentage variance in M11. The position is resultant from underperformance in CITNs Occupational therapy and Speech and Language Therapy services, which is directly related to the issues with waiting times.

LCC Sexual Health Contract Section 2.2 The sexual health contract performance in M12, as indicated from previous month’s performance has not reached the revised contract total of 19,130 contacts (the original plan was 30,000). Whilst attendances were behind plan in M11, income was in line with plan, however the income is not known yet for M12.

Adult Community Services

Adult Community are in special measures for finances and operational control.

Summary Performance – Section 1.1 Adult Community Network achieved full compliance against all performance measures for M11

Community Contract – Section 2.2 Community Contract (ACN) is currently 7.69% against plan.

Specialist Services Network

CPA 7 day Follow up – Section 1.1 In month 12, the specialist service Network achieved 7 day follow up in 100% of cases (5 patients), this is a marked improvement on the position of 50% in M11 (1 patient).

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Prison metrics- Section 1.1 Demobilisation of the 5 Lancashire Prisons has been completed and handover to the incoming provider occurred at the end of March. There is now a focus by the Network on the HJIP measures for HMP Liverpool and resolution of the enablement issues will be central to this. A meeting with NHSE is planned for late April should further escalation be required.

The full QPR can be seen here.

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Board of Directors

Agenda Item TB 050/17 Date: 04/05/2017

Report Title Innovation Agency update

FOIA Exemption No Exemption Not Applicable

Prepared by Dr Liz Mear, Chief Executive of the Innovation Agency

Presented by Dr Liz Mear

Action required Decision

Supporting Executive Director Chief Executive Officer

PURPOSE OF THE REPORT:

Report purpose To update the Board of Directors on the progress and future plan of the Innovation Agency. To request permissions for future staffing arrangements and future accommodation arrangements.

Strategic Objective(s) this work supports

To innovate and exploit technology to transform care

Board Assurance Framework risk 6.1 The Trust fails to plan, develop and maintain infrastructure to support the ability to deliver safe, responsive and efficient patient care

CQC domain Effective

INTRODUCTION

The Innovation Agency is the Academic Health Science Network for the North West Coast Region and is hosted by Lancashire Care NHS Foundation Trust. Its role is to spread innovation, improve health and generate economic growth across the North West Coast region. It is part of a network of 15 Academic Health Science Networks across England. The Chief Executive of the Innovation Agency is the current chair of the national AHSN network.

A hosting agreement (and associated fee) is in place between the trust and the Innovation Agency, which specifies reporting of the annual report and business plan to the trust Board of Directors. This is also supplemented by the reporting of quarterly assurance reports, to the LCFT Finance Committee.

BACKGROUND

The Innovation Agency and the other 14 AHSNs received a licence and funding for a five year period from April 2013 to April 2018. A process is in place to renew these licences and it is anticipated that the Innovation Agency will be successful in achieving another five year licence and funding of c £2million per annum from NHS England.

NHS England have informed AHSNs of their budget allocations for 17/18, a small reduction has been received on the income provided by NHS England (funding from NHSE is £2,425,388) and the

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allocation from NHS Improvement for the Patient Safety Collaborative (PSC) is still awaited (anticipated to be c £470,000).

The Innovation Agency has been successful in bidding for other funding streams from Europe, Department of Health, Pfizer, NHS England and the Health Foundation, which have more than compensated for this small loss of income, with total funding being c £5,474,824 for 17/18 (this includes the anticipated PSC funding). This additional funding has enabled the recruitment of 6 externally funded staff for the economic growth area of work, a secondment from pharma and also allowed part-funding of salaries of many of the Innovation Agency staff members.

Documents for discussion/ consent

Two documents are attached to this overview for the Board’s information/ comment; The Innovation Agency’s Business Plan for 2017-18, which has been developed based upon

the strategic direction agreed by the Innovation Agency Board in January 2017, the NHS FiveYear Forward View and the two STP-type programmes in the region

The Innovation Agency’s Annual Report. The first section of the report sets out the keyachievements of the Network over 2015/2016 and highlights some of the events that theNetwork has used to break-down the barriers to innovation. In June 2017 the annual ImpactReport for the whole AHSN Network will be produced, which highlights the collectiveachievements of the 15 AHSNs.

Other items for approval 1. Innovation Agency staff and Non Executives are all recruited on short term contracts due to the

short-term nature of the licence. All contracts expire on or before 31.3.18. A structural review is currently underway to ensure that the staffing requirements of the agency are consistent with the budget figure that accompanies the new licence. This will mean the termination of some contracts, to ensure affordability within the new funding arrangements. It is requested that, in addition to the termination of some contracts, existing contracts are extended beyond 31.3.18, to the end of the next licence period, where they will ensure continuity of service. This will give continuity for the agency to continue its business in supporting the region and making an impact. It is also requested that consideration is given to a Mutually Agreed Resignation Scheme (MARS) for the Innovation Agency to alleviate the need for compulsory redundancies.

2. The Innovation Agency has premises at Sci-Tech Daresbury, which is a government-sponsoredscience park near Chester, hosting health, science and industry partners. The site was chosendue to its centrality to the region, covered by the Innovation Agency. In addition for the first fiveyears of occupation the costs of accommodation have been cheap due to the Agency nothaving to pay business rates as the site is in an Enterprise Zone.To meet the needs of partners it is proposed that, premises are sourced in Lancashire andMerseyside and a small office base only is maintained at Daresbury. This will mean enteringinto two additional leases, but with the objective of being nearer to partners and also keepingcosts of accommodation to a minimum. Two potential sites have been identified.

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RECOMMENDATIONS

The Board are requested to note and comment on the Business Plan and Annual Reportcontent.

Approve the proposal to enter into cost-effective leases nearer to partner sites.

FOIA Exempt under Commercial Interests

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1

Annual Report

2016 – 2017

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2

CONTENTS

CONTENTS .......................................................................................................................... 2

Chair’s introduction ............................................................................................................... 3

Chief Executive’s statement .................................................................................................. 4

What our partners say about us ............................................................................................ 9

How we operate .................................................................................................................. 11

How we supported local, regional and national NHS objectives .......................................... 12

How we delivered against our goals for 2016/17 ................................................................. 21

European programmes ....................................................................................................... 34

Organisational capabilities .................................................................................................. 35

Partnerships with other organisations ................................................................................. 42

Looking forward .................................................................................................................. 48

Financial performance ......................................................................................................... 48

Our Executive team ............................................................................................................ 49

Contact details .................................................................................................................... 49

Appendices ......................................................................................................................... 50

Appendix 1 .......................................................................................................................... 50

Appendix 2 .......................................................................................................................... 53

Advancing Quality Alliance (AQuA) programmes ................................................................ 53

specifically commissioned by the Innovation Agency 2016-2017 ........................................ 53

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Chair’s introduction

I am proud to chair the Innovation Agency, even more so at a time when our partnership working with colleagues throughout the region and nationally is showing positive results and, as evidenced by our latest independent survey, is obviously valued.

The past year has been significant for many reasons, not least for our new, improved approach to engagement with patients and residents. We now have a dedicated patient and public involvement lead and a Senate of patients and residents who meet regularly and are involved in our programmes of work.

The Senate plays a particularly important role in Connected Health Cities, a major Department of Health funded programme which we are co-ordinating on behalf of the region. This will pilot the use of data to identify how to improve health and care services in three key clinical services for the region. Helping the public to understand the value of shared data is critical to the programme’s success.

Our strong connections with system leaders are leading to more involvement in transformation planning and we welcome the opportunity to support the changes ahead. Having been part of the system transformation process from the start, we will be helping with the adoption and spread of innovations and service improvements, which are enablers to future changes. To support system transformation we have grown our workforce, using the money from a successful funding bid to grow our business support team and developing posts into our two Sustainablity and Transformation Plan regions to support the adoption and spread of innovation over the coming years.

Switching to digital solutions isn’t just happening at service and system level; individual citizens are being urged to go online and use apps, to help manage their own care. Bridging the skills gap both in our health and care workforce and in our local population is something we all know is needed. We have supported a project to address this need in Lancashire and South Cumbria; and will be supporting our three Global Digital Exemplar trusts in Merseyside.

The region is becoming a powerhouse for digital health systems and solutions and a magent for investment; we have some of the country’s most innovative companies and clinicians and we are delighted to work with them in creating a health and care system fit for the future.

Gideon Ben-Tovim OBE Chair

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Chief Executive’s statement

This has been a fantastic year for the Innovation Agency; I am delighted that our work with partners is showing an impact both on health and on the local economy.

It was heartening to see the results of our annual stakeholders’ survey; it shows that we have made great progress in establishing ourselves as a valued partner, as you will read below.

We are very proud of the results of our collaborations with organisations in different sectors; it is great to be playing a part in such a vibrant, entrepreneurial region.

You will read in this report how we are working closely with system leaders on the changes necessary to meet the challenges facing the NHS, through the whole system transformation programmes, test bed, Global Digital Exemplars, vanguards and Healthy New Towns.

We have helped organisations around the region to introduce or develop innovations which are improving care and achieving efficiencies. We have provided our own funding to support the creation of seven new innovation centres in our region, where innovations can be developed, and to fund adoption of proven innovations across the region.

We have brought substantial investment to the North West Coast through funding for business support and digital innovations by securing £3.5m European funding plus £3m match funding, to improve the health of our residents by supporting local businesses that have developed innovative healthcare products

I would particularly like to highlight our continuing success in preventing strokes through our multi-strand reducing Atrial Fibrillation programme. In 2016/17 we estimate that we have prevented 256 potential stokes through atrial fibrillation detection potentially saving c £5.6m in NHS resources.

I am extremely proud of our success in launching the £4 million Connected Health Cities programme, which we are leading in the North West Coast, to plan future services for those residents with COPD, epilepsy and issues with alcohol.

We have continued our sponsorship of patient safety leadership programmes and have built up our network of patient safety champions across the region. We have successfully led a national Sepsis Cluster, with a particular focus on detecting sepsis and deteriorating conditions in care homes.

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In addition to focussing on our regional partners, we have been a strong supporter of national AHSN Network programmes, which bring great benefit to our region. As Chair of the national AHSN Network I have been privileged to be involved in shaping the Accelerated Access Review; Test Bed Wave 2 programme; and Innovation and Technology Tariff. The Innovation Agency has been a key partner with a number of other AHSNs in delivering the National Innovation Accelerator programme; the Clinical Entrepreneurship programme; and a joint campaign to reduce strokes due to atrial fibrillation, across England.

As our fourth year ends, we are looking forward to continuing our work to meet the aspirations of the Five Year Forward View and to help our region through these challenging times.

Dr Liz Mear Chief Executive

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Highlights of the year These are summarised below.

256 potential stokes avoided through atrial fibrillation detection, potentially saving

around £5.6m in NHS resources:

There are more than 10,000 people with atrial fibrillation (AF) who are not receiving optimal treatment in the North West Coast. People with AF who are untreated or whose treatment is not effective are at a five-fold greater risk of having a stroke compared with the rest of the population.

• Through public campaign work in Merseyside and Lancashire and use of innovative technology, abnormal pulses were detected in more than 60 people.

• More than 60 patients are now receiving treatment to preventing stokes, predicted to save at least two extra visits to clinic (120 clinic visits per year). This work is estimated to have saved up to £24,000 per person or £1.4m in NHS care costs in the first year alone.

• 130 AliveCor Kardia devices have been distributed to GPs and nurses in the region and 30 MyDiagnosticks are now in GP surgeries, pharmacies and in adult social care. MyDiagnosticks can screen about 100 patients per month; the Kardia can screen about 50 per month per user.

• For every person identified with AF out of this screening, the research shows that one in 25 would have had a stroke in the given year.

• More than £250,000 worth of matched investment has been pledged by partners including LGC, Bayer, Boehringher-Ingleheim, Pfizer and Diiatchi-Sankyo and Bristol Myers-Squibb.

• Genotype guided dosing has brought personalised medicine to more than

100 citizens, establishing the correct dose of warfarin for patents with AF. Three hospitals have introduced genotyping into their clinics and more have been identified. Acceptability to patients and staff is high. A health economic evaluation is underway and will report in September 2017. We estimate that using this test avoids two clinic visits per person – saving 200 clinic visits for patients receiving the test

£6.5 million secured to support small and medium sized (SMEs) life science businesses to develop health innovations from which citizens across the region will benefit.

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• Six staff have joined the Innovation Agency commercial team, and partners have recruited a further six staff, to help 282 SMEs access the healthcare market; key outputs will include: 34 new products launched; 74 new products in develpment; 49 new SMEs will be supported 4.1 million citizens in the North-West Coast region will benefit from health innovations.

Investment by the Innovation Agency of around £1million has enabled c £100 million of

additional funding to be attracted to build innovation hubs and business incubators across the region so that life sciences SMEs can locate in the region, develop products, create jobs and improve health

This additional funding has come from NHS, universities, industry, EU and UK Government. This investment led to the development of the following facilities:

• Health Innovation Campus, University of Lancaster, due to open in 2019 • Liverpool Bio-Innovation Hub at University of Liverpool - opened February 2016 • Alder Hey Research and Education Centre - opened October 2015 • Alder Hey Innovation Hub for digital and sensor technologies - opened March

2016 • Centre for Integrated Health Science, Chester, Countess of Chester NHS

Foundation Trustl and Cheshire and Wirral Partnership NHS Foundation Trust - opened April 2015

• Accelerator Hub, Royal Liverpool & Broadgreen University NHs Trust – due to open in 2017

• Chorley Digital Park – due to open in 2018 £4m external investment gained in the development of a Learning Health System – the

Connected Health Cities programme. Emergency unplanned care (COPD and epilepsy) and alcohol related care are the care pathways that we are focusing on in the region. The work comprises:

• A collaboration between the Innovation Agency, University of Liverpool, Lancaster University and AIMES Grid Services, plus Lancashire Teaching Hospitals NHS Foundation Trust and the Royal Liverpool and Broadgreen University Hospitals NHS Trust

• The development of linked health related data sets

• Analysis of the care pathways to identify improvements across the system

• An integrated plan for the workforce to support digital education

• Public engagement and patient and citizen collaboration

• Create a sharing environment that enlists the trust and active involvement of NWC citizens through the Northern Citizen Jury and the North West Coast Public Involvement and Engagement Senate.

Keeping people out of hospital by gaining funding to increase domiciliary care

technology investment by £612,000 for Liverpool City Council as part of the Sustainable Technology for Older People – Get Organised (STOPandGO) project.

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This is a Public Procurement of Innovation pilot project co-funded by the ICT Policy Support, European Union programme. The goal of STOPandGO is to produce and validate data that will support the development of improved procurements across Europe, of innovative healthcare and social services enhanced by technology, for elderly people. It is hoped that the project will benefit more than 5,000 citizens and service areas will include integrated care, domiciliary care and dementia.

Through our business support, innovation spread and European funding bids we have had a significant impact on the local economy, helping to secure £2m from grants, revenue and venture capital funding for local small and medium size businesses (SMEs). We were responsible for the creation of 17 additional jobs in in our region; and we played an active role in helping to secure a total of 49 contracts for businesses and NHS Innovation Fellows.

• We have continued to support partners in their ongoing journey towards digital interoperability. In the Lancashire and South Cumbria region we have supported the Lancashire Person Record Exchange Service (LPRES), which through its electronic sharing of data is improving the quality of care for residents and

saving around £2 million per year by joining up regional clinical record systems. We supported applications for the Global Digital Exemplars, gaining three in the Merseyside region, with a total investment of £40 million. Our 5YFV Transformation Fund and digital investment fund awarded funds to our Alliance region partners to further develop their digital solutions for outpatients. We started a programme to develop a North West Coast Digital Strategy, to position the region as a hub of digital innovation and magnet for investment.

We supported an electronic transfer of care system in East Lancashire NHS Foundation Trust which led to a reduction in readmissions of 0.8 per

cent, or 60 patients in a year, saving the trust £200,000. We have now been engaged by NHS England to spread electronic transfer of care

systems to 12 trusts in our region, in a pilot study which will be evaluated by a university partner.

Our community of Innovation Scouts has grown from 50 to 70, including a new

cohort of mental health Scouts and senior staff from local authorities and universities. One of our Scouts programmes has involved spreading the use of 3-D printing of

organs before surgery, which is now adopted by three of our hospitals, reducing anaesthetic and surgery time for patients.

We supported the bid for the Lancashire and Cumbria Innovation Alliance Test

Bed and have been involved in the rollout of technology into residential

homes, with 100 residents already benefiting from these digital home solutions. We support the communications function of the programme, have a seat at the Test Bed Board and on the national adoption and spread steering group.

We were successful in our application for the region to be a three-star European

Active and Healthy Ageing Reference Site – this will allow us to enhance services for our older and frail residents, drawing together our existing programmes to support active and health lives for our citizens.

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We have been an active supporter of our two Sustainability and Transformation

Plan regions, sitting on Boards and working groups, offering a menu of support options and funding for region-wide programmes such as the development of health coaching. We have worked with these regions to develop two roles for innovation

adoption and spread. The postholders will be co-funded by the Innovation Agency and local organisations and will work across both regions to ensure the adoption/adaption and spread of innovative practice.

We have continued to support the rollout of the 100,000 Genomes programme which in 2016/17 has sequenced the genes of around 350 patients with cancer and

1100 patients with rare diseases across seven hospitals in our region; with an

eighth hospital due to go live in April 2017. We have established and funded an Genomics Ambassador/ Project Manager post and our CEO is Vice Chair of the programme Board and sits on the national 100,000 Genomes Steering Board.

We have worked in a supportive role to all our Local Enterprise Partnerships

(LEPs) and our jointly funded post with Liverpool LEP has enabled us to be a part of shaping the life sciences and health strategy for the region and supporting more

than £140 million of investment in the Liverpool City Region over the past year.

Our work supporting NICE Guidelines in relation to reducing alcohol harms in our region and understanding the barriers to uptake, was published.

We have significantly increased our investment in patient and public

involvement, establishing a Citizen Senate and supporting a number of programmes in the region

What our partners say about us

Stakeholders Survey 2016 The second independent survey of our stakeholders was conducted by YouGov on behalf of NHS England. There were great results in all areas, endorsing our partnership approach. Key findings were that 82 per cent would recommend working with us; and 72 per cent of stakeholders agree that our priorities are aligned to local priorities. There was a very positive response to the questions, have we provided valuable support on the following:

• Identification, adoption and spread of innovation: 82 per cent • Facilitating collaboration: 84 per cent • Providing leadership to the local health economy: 83 per cent

In the future, stakeholders asked for a clear path for new and small businesses to engage with CCGs and local authorities; help for CCGs and the wider NHS to understand and adapt to change and transformation in the NHS; and support for new ways of delivering education and training.

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Ten comments from those surveyed:

Dave Sweeney, Halton CCG: “They are the epicentre of innovation, this has been achieved through hard graft, getting out to the partners, bringing in external funding, delivering visions and enabling fizzy innovators to achieve their dreams by breaking through barriers.”

Dave Horsfield, Liverpool CCG: “We have excellent working relationships with the staff, aligning our strategic direction and most importantly an ability to effectively communicate and share key activity and data.”

Mandy Dixon, Lancaster Health Hub, Lancaster University: “Given the large geographic area covered by the Innovation Agency, there is always a danger that areas such as Lancashire are overlooked in favour of larger cities. However, the Innovation Agency's ambition to focus on development hubs across their patch is encouraging and I hope this will continue going forward.”

Joe McArdle, Strategic Economic Development Unit, University of Chester: “The AHSN has been very good at identifying engagement points to extend reach beyond Liverpool, looking at how we strengthen association, and collaborating with Manchester AHSN. We are still to develop links with West Midlands but it is a future direction and collaboration that could support Local Digital Roadmap developments.”

Mr Iain Hennessey, Clinical Director of Innovation at Alder Hey Children’s NHS

Foundation Trust: “I feel like our organisation dovetails with the AHSN, it’s always great to work with them. We feel very well supported and prioritised. I have always found the AHSN to be an excellent organisation; well led and full of enthusiastic individuals willing to go above and beyond.”

Brian O’Connor, European Connected Health Alliance: “We believe that the senior leaders of the Innovation Agency provide clear and decisive leadership in a complex sector and embrace collaboration.”

Mark Jackson, Liverpool Heart and Chest Hospital NHS Foundation Trust: “Great people to work with, very supportive. Scout movement very good.”

John Whaling, Liverpool City Region Local Enterprise Partnership: “Excellent partners in all regards, combining strategic leadership with delivery focus.”

Andrew Michaelson, Care Innovation (Nationwide) Ltd: “Most valued: Fantastic networking and engagement.”

Andy Beesley, Medication Management Solutions: “Most valued: breaking down barriers between secondary care and small businesses.”

Mike Leaf, Turning Over: “Without bodies like the AHSNs, the spread of good practice and the engagement of private sector/academia/ NHS in a collaborative manner would not happen...it would be spasmodic and piecemeal rather than coordinated and integral.”

The full survey report can be found on our website.

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How we operate The Innovation Agency is governed by a Board of 40 representatives from the following areas:

• Provider trusts • Commissioners – CCGs and NHS England • Strategic Clinical Network • Local Enterprise Partnerships (LEPs) • Public Health England • Health Education England and Local Workforce Education Groups (LWEGs) • Universities • NIHR Clinical Research Network: NWC • NIHR Collaboration for Leadership in Applied Health Research and Care North

West Coast • Association of British Pharmaceutical Industry (ABPI) • Association of British Healthcare Industries (ABHI) • Healthwatch • Research research and innovation centres

The Board meets at least five times a year and members are expected to attend at least three out of five meetings to ensure that the Innovation Agency achieves its goals and objectives and complies with all relevant performance metrics.

Expert groups

In the last year we have set up expert groups to provide direction on key areas of our work; economic growth; patient safety; and digital health.

Public and patient engagement

In 2016 we established a Patient Involvement and Engagement Senate (PIES), with membership consisting of 25 patients and patient advocates, meeting regularly and getting involved in different aspects of the Innovation Agency’s operations. The strategy is to involve the patient voice in our programmes of work through the Senate and through direct

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contact with patients in hospitals and through patient charities, on relevant work programmes.

The Senate focuses on patient safety and on the North West Coast Connected Health Cities programme, re sharing data to improve health and future health infrastructure; and members are helping to support a Citizens Jury for the wider North of England Connected Health Cities programme.

Senate members also sit on Innovation Agency staff recruitment panels; and on shortlisting panels for our NWC Research and Innovation Awards.

One Senate member sits on our Patient Safety Steering Group and another two belong to a panel which scrutinises submissions to our online platform for showcasing innovations - the Innovation Exchange.

Our Patient and Public Involvement (PPI) Lead works within various groups including the AHSN PPI Network; 100,000 Genomes PPI board and Operational Management Group; INVOLVE Diversity and Inclusion sub-group; Connected Health Cities work streams; AQuA PPI Member and MY Data patient group member among others.

Our values and culture

We have adopted the values in the NHS Constitution:

Working together for patients; respect and dignity; commitment to quality of care;

compassion; improving lives; everyone counts.

In addition, we have identified further values which reflect the way we work:

Doing things differently Enabling partners to think creatively Being courageous in change Co-creating, co-designing, co-producing Team working We were delighted to be awarded Investors in People Gold Award after just three years of operation. This reflects a dynamic programme of staff development including monthly skills and knowledge sessions; weekly learning sessions; regular appraisals and relevant training and monthly surveys of how well we are demonstrating our values. How we supported local, regional and national NHS objectives

Collaborating locally

We have been an active supporter of our two Sustainability and Transformation Plan regions, sitting on Boards and working groups, offering a menu of support options and funding for region-wide programmes, eg the development of Health Coaching. We have worked with these regions to develop two roles for innovation adoption and spread. The postholders will be co-funded by the Innovation Agency and local organistions and will work across both regions to ensure the adoption/adaption and spread of innovative practice.

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We support some of the clinical work streams closely, for example with our work around cardiovascular disease (CVD) and we were a founder membership of the CVD Collaborative. We are actively working with their teams to understand their challenges and offer support.

Our business plan for the coming year is focused on the needs of both programmes; and our latest funding competition asked for bids which would help to meet the aims of the programmes.

Test bed and vanguards

We were integral to the bidding process for the test bed in our region, the Lancashire and Cumbria Innovation Alliance. We sit on the test bed board and also support and fund communications and stakeholder engagement. We have a seat on the Test Bed Steering Board and the SRO for the programme is the Chief Executive of our host organisation, Lancashire Care NHS Foundation Trust. We support local new models of care sites with bespoke products, which have included system modelling tools, leadership development and coaching for the new vanguard leaders, workforce planning of new roles and a networking and sharing event for all Northern vanguards. A summary of all vanguard sites in our region can be found in Appendix 1.

The Fylde and Wyre Vanguard is looking at new, proactive ways of caring for elderly and frail patients with two or more long term conditions. We sponsored their use of SIMUL8,a computer simulation tool to model projected financial and resource expectations following the introduction of new care models.

This pioneering work is expected to reduce visits to emergency departments by 27 per cent; non-elective admissions by 27 per cent; and outpatient visits by 40 per cent.

Andrew Harrison, Finance Lead, Fylde Coast Vanguard, said:

“The simulation allowed us to experiment very quickly with models of care in terms of types and numbers of contacts to fit with our budget predictions.

The real benefit will be in refreshing the simulation data regularly with service usage data, which will quickly tell us whether our predictions are right and enable us to predict performance trajectories; in this way we can act quickly to ensure that the new models of care are working as we expect.”

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In addition we have two Healthy New Town sites. There are 10 sites across the country covering more than 76,000 new homes with potential capacity for around 170,000 residents. This is an opportunity for the NHS to shape the way these new sites develop and to test creative solutions for the health and care challenges of the 21st century, including obesity, dementia and community cohesion. The two sites in the North West Coast are Halton Lea in Runcorn with 800 homes, and Whyndyke Farm in Fylde, Lancashire with 1,400 homes. We have been working with these sites to identify digital health technologies which can be used to improve the health of residents. Collaborating across the North of England

Northern AHSNs forum

Executive teams from the four Northern AHSNs meet regularly; we work together on delivering the Connected Health Cities programme across the North; and we have run joint events such as the ‘Vanguards of the North’ meeting, ‘Better Conversation’ health coaching launch; and Diagnostics Showcase to share learnings across our region.

We import many AHSN-led programmes from other networks and also host visits from other AHSNs who wish to learn from our programmes, especially our commercial work.

We work closely with the Northern Health Science Alliance (NHSA), on a range of areas to strengthen our economic growth and research offer in the North. Our CEO Dr Liz Mear is a Director of the NHSA Board, representing all four AHSNs and our Commercial Director Lorna Green sits on the Operational Board.

Well North

The Innovation Agency is a supporter and contributor to the Well North Project and our Chief Executive is a Director of the Board of Well North, which is funded by Public Health England and local regions. This project seeks to promote a move from a high cost medical model to a high value healthcare system, by harnessing the strengths of local citizens. The aims of the programme are to:

• Address inequality by improving the health of the poorest, fastest

• Reduce levels of worklessness, a cause and effect of poor health

• Reduce premature mortality

• There are three Well North sites in the NWC area - in Sefton, the Halton CCG area and West Lancashire CCG area.

• We have supported innovation projects in all of these regions, which are based on the needs of local people e.g. a troubled families coordination tool in Sefton, a social prescribing app in West Lancashire, the CATCH app to improve children’s health in Halton and also funding for a social prescribing platform for the ‘Baby Box’ programme to support expectant mothers across Halton.

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Collaborating nationally

We contribute extensively to shaping and coordinating the national AHSN Network, particularly through our Executives’ time; our CEO is Chair of the AHSN Network; our Commercial Director is vice chair of the Commercial Directors Forum; and our Communications Director leads on Patient Safety Collaborative communications. Our Chair or our Vice Chair has been present at every AHSN Chairs meeting.

We continue to support national NHS priorities, such as the National Innovation Accelerator (NIA), which we have funded, supported and sat on the Board since the launch of the NIA. Some of the Innovation Fellows we have supported are as follows.

Dr Penny Newman

We organised a large event for stakeholders in the North of England and led on communications to launch Innovation Fellow Dr Penny Newman’s health coaching initiative, Better Conversation. We have put in funding to enable the programme to be adopted across Lancashire and South Cumbria.

Dr Penny Newman said: "The Innovation Agency have been invaluable in supporting ‘Better Conversation’ and health coaching. From initial endorsement at the NIA programme board to help with writing resources, filming, communications and event management this led to a highly successful launch event in September in Liverpool and scaling locally and nationally.

“Thousands of clinicians are now using health coaching skills to better enable people to self-manage and help the NHS save costs. The programme is growing in Leeds, Lancashire, West Suffolk, Norfolk, Hertfordshire, Cambridge, London, Bristol and Somerset.”

Francis White

Francis White is the UK promoter of AliveCor mobile ECG monitors, which identify possible atrial fibrillation, a leading cause of stroke. We have promoted AliveCor along with another device, MyDiagnostick; and have invested £15,000 in devices which have been given to GPs, nurses and community staff as part of our AF stroke prevention programme in the North West Coast. In the last year, around 10,000 screenings were carried out, potentially identifying as many as 500 cases of atrial fibrillation and preventing an estimated 20 strokes, with a predicted saving to the NHS of £240,000.

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Francis White said: “The support of the Innovation Agency has enabled AliveCor to reach increasing numbers of GPs and CCGs both in their region and nationally. Selling a low cost innovation presents unique challenges in getting the message across without large investments in teams and marketing (that would, in turn, put up prices).”

Dr Maryanne Mariyaselvam

Maryanne Mariyaselvam has spoken at our events; and we promote the Non-Injectable Arterial Connector (NIC) in our presentations and also by including samples in our iBags.

The NIC improves the safety of all patients requiring an arterial line in operating theatres and intensive care by preventing wrong route drug administration.

It is being used in the following trusts in our region: Royal Liverpool and Broadgreen University Hospitals; The Walton Centre; Lancashire Teaching Hospitals; and University Hospitals of Morecambe Bay; and we are actively spreading it to other trusts through our personal contact with medical directors.

Clinical Entrepreneurs

We helped to design the Clinical Entrepreneurs programme and have continued to support the entrepreneurial junior doctors, through invitations to speak at our events and introductions. We hosted a Clinical Entrepreneurs pit-stop event on behalf of Professor Tony Young.

National Innovation Programmes

We supported the development and announcement of the Innovation and Technology Tariff; and have been an integral part of the small national AHSN Network team, working with the Office for Life Sciences and the Department for Business, Energy and Industrial Strategy on the Accelerated Access Review.

Our work on the national clinical priority areas includes:

• a health coaching programme, to change the way clinicians talk to patients, empowering them in decisions about their care;

• a diabetes event focused on the health of haulage workers, who are a prominent part of the workforce in our region;

• sponsorship of a number of technologies to support improved mental health;

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• a mental health innovation learning set for our five mental health trusts; • sponsorship and promotion of an app for those caring for people with dementia

that has been downloaded by 10,000 users. We have funded and supported a number of innovations into the child and maternity vanguard including Episcissors, the Common Approach to Children’s Health (CATCH) app and a social prescribing platform for Baby Box.

Genomics

We have been a key supporter in the rollout of the 100,000 Genomes programme locally and nationally. At the beginning of the programme we supported bid-writing and pitching; and we sponsored the establishment of robust governance arrangements for the region-wide programme, with a view to rapid adoption and spread across the region. Liverpool Women’s NHS Foundation Trust lead the programme and we support them in a number of ways;

Our CEO is vice chair of the regional board, which monitors adoption and spread of the work. We sponsor the Programme Manager/ Adoption and Spread Ambassador role in the North West Coast Genomic Medicine Centre, for which we adopted a model used by the West Midlands AHSN; and our CEO sits on the Genomics England Steering Board.

In addition to supporting the national programme we have sponsored a pioneering, personalised medicine project in three hospitals involving genotyping of patients who are using warfarin, in anti-coagulation clinics.

The gene testing is carried out by simple mouth swabs which are analysed within minutes using desktop equipment provided by LGC, a life sciences measurement and testing company.

The results enable staff to prescribe accurate doses of warfarin, which reduces visits to outpatient clinics and improves the quality of care for patients. The work is led by Professor Sir Munir Pirmohamed of the University of Liverpool’s Wolfson Centre for Personalised Medicine and funded by the Innovation Agency and the NIHR CLAHRC NWC. A total of 113 patients were recruited and a study of results is due to be published in September 2017. Our work supporting NICE Guidelines in relation to reducing alcohol harms in our

region – understanding the barriers to uptake.

In 2015, we recognised the need for the development of a programme to reduce alcohol harms in our region and developed a range of activities to support this. One of the projects within the programme was working to support the NICE Implementation Collaborative (NIC) which looks at the barriers in uptake of the NICE Technology Appraisal (TA 325) relating to nalmefene – a product which helps high risk drinkers to reduce their intake of alcohol along with ongoing psychological support. Working in this area is challenging and we needed to understand the barriers to uptake of evidence-based information in the complex area of alcohol misuse. We were keen to ensure that insights into this issue were captured from our region in order to provide recommendations for commissioners in the field of alcohol misuse.

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Key project objectives were to:

understand the key issues surrounding implementation of NICE TA325 and the steps required to overcome them

take stock of barriers to commissioning, service design, and implementation and prescribing

assess clinician awareness of nalmefene, TA325, and the supporting policies and pathways

highlight best practice where possible through case studies. Participants in our area were:

Liverpool CCG Blackburn with Darwen CCG Wirral CCG St Helens CCG St Helens Council Wirral CCG Wirral Metropolitan Borough Council

We were very pleased to publish the final report (in 2017) which the two contributing AHSNs (Oxford and Innovation Agency) shared with the national AHSN Network, regional CCG Medicines Management Leads, Local Authority Public Health Leads and stakeholders involved in alcohol services. This report also gives indicators into how patients can gain benefit from future innovations that are clinically effective and bring long term value and cost benefits to the NHS and social care. Industry associations

We work closely with industry associations; both the Association of British Healthcare Industries (ABHI) and Association of British Pharmaceutical Industry (ABPI) have places on our Board. We worked closely with ABHI throughout the year and and jointly organised a ‘Big Brains’ breakfast event to feed into the ‘grand challenges’ of the Industrial Strategy.

We presented to the ABPI patient and public involvement forum; and we worked closely with ABPI on the Closing the Gap programme. This involves working with three other AHSNs and Queens University Belfast, to embed clinical pharmacists in GP practices in order to review patients with multiple medications. We are working with two practices in Kirkby, Merseyside and Pendle, Lancashire, who have recruited more than 80 patients onto the programme. Early indications show successful interventions by the pharmacists in reducing inappropriate medications. The evaluation report will be published in autumn 2017.

A secondee from Bayer is currently working with us on the AF Collaborative.

With our regional partners BioNow and Medilink, our work includes sponsoring their annual awards and working together on regional programmes.

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Our work with universities

Since our inception we have worked very closely with our academic partners. In 2016 they asked us to move away from networking and into supporting them with funding and roles within the healthcare system. We have done this by involving them in:

• Evaluation of key regional programmes • Investment in Innovation Hubs on their sites, providing support for businesses who

are tenants and networking the hubs to share good practice • Supporting them with funding bids, being a key partner in these and networking

them with potential partners • Supporting specific training programmes, eg Post Graduate Medical Programmes • Involving them in key programmes, eg Connecting Health Cities

• Delivering programmes on behalf of the Innovation Agency eg digital health

programmes for health professionals and our regional evidence-based commissioning programme

• Five out of our nine universities are now represented on our Board, helping to shape our work plan

Our work with Local Enterprise Patnerships (LEPs) We have a strong relationship with the four LEPs in our region. Since the inception of the Innovation Agency we have invested funding into our LEPs and 12 months ago co-resourced a post with Liverpool LEP, which has yielded great results. The post holder was responsible for:

Leading the work to obtain Interreg Europe infrastructure funds worth more than £300,000 for Liverpool City Region partners and around £1.7m for all partners across Europe;

Aligning Living Lab activities in the Liverpool City Region and improving health innovation economic policy

Supporting potential inward investment in health and life sciences across Liverpool City Region worth more than £140m over the past year

Establishing a Liverpool City Region Life Sciences and Health Board to oversee the industry growth strategy and associated implementation plan for the region

Delivery partner for the Liverpool City Region ERDF funded business support project. "The Innovation Agency is a key partner for the Liverpool City Region Local Enterprise Partnership. The organisation’s willingness to collaborate and co-fund activities, has meant that we have been able to support the region’s health and life sciences sector to a far more significant level with demonstrable commercial outputs than already achieved,” Mark Basnett, Managing Director of the Liverpool City Region LEP.

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Our public and patient involvement (PPI)

In 2016 we recruited a lead for patient and public involvement, Debbie Parkinson, who established a Patient Involvement and Engagement Senate (PIES), meeting regularly and getting involved in different aspects of the Innovation Agency’s operations.

PIES membership includes ten patients with conditions including COPD; four patient governors from Lancashire Teaching Hospitals; Blackpool Teaching Hospital and Liverpool Heart and Chest Hospital; patient advocates from British Lung Foundation and Dementia Care; and local residents with an interest in different health topics.

The strategy is to involve the patient voice in our programmes of work, through the Senate and through direct contact with patients in hospitals and through patient charities, on relevant work programmes.

PPI: Connected Health Cities

The Senate focuses on the North West Coast Connected Health Cities (CHC) programme, about sharing data to improve health; and members supported a Citizens Jury for the wider North of England Connected Health Cities programme.

They have been learning about the use of healthcare data and different approaches to gaining patient consent. Guest speakers have included commissioners from Liverpool CCG; CEO of AIMES Grid Services; University of Liverpool CHC Project Manager; CHC Programme Lead and Innovation Agency senior staff.

Various Breathe Easy support groups have been visited and patient stories have been written and published on the CHC website; as well as a blog and a PIES newsletter.

PPI: Changing how we work

The Innovation Agency now embeds the voice of the patient in its programmes of work and involves Senate members operationally, for instance:

Patients are invited to speak at Innovation Agency events such as hackathons and Ecosystem events;

Senate members join our staff recruitment panels; A Senate member joins the panel for shortlisting NWC Research and Innovation

Awards; A model of patient consent for CHC has been directly informed by Senate members; Patient and public feedback is now included on all new products showcased on our

Innovation Exchange.

PPI: Other programmes of work

The Senate is involved in patient safety and members have been helping to review our Patient Safety Collaborative strategy.

The PPI Lead helps to provide public feedback on new technologies. An example is the development of a mobile phone based self care technology in our European funded

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ENSAFE project, which benefitted from feedback from a focus group organised by the PPI Lead.

Other focus groups have been formed through working with patient centred organisations such as Genie in the Gutter, to gain views on data sharing as part of the Connected Health Cities work.

The PPI Lead attends outpatient clinics relevant to CHC programmes, to talk to patients about their views on shared data – and to explain the benefits of joining up information systems.

She has been called on by senior nursing staff at the Royal Liverpool and Broadgreen University Hospitals. to help set up new patient groups – for ME sufferers; and for alcohol related brain injury patients.

She regular provides presentations to community groups around the North West Coast and is helping to strengthen our involvement in important work streams in our region.

PPI: Widening our networks

The PPI Lead belongs to various groups including the AHSN PPI Network; 100,000 Genomes PPI Board and Operational Management Group; INVOLVE Diversity and Inclusion sub-group; Connected Health Cities work streams; AQuA as a PPI member; and the MY Data patient group.

Comments from colleagues:

Andy Shakeshaft, Associate Director::

“The patient’s voice is heard on innovations which have been implemented across the North

West Coast which are included as case studies on the Innovation Exchange. This has

enabled us to sense check our innovations and ensure they are in line with patient

expectations.”

Dr Julia Reynolds PhD, Associate Director, Connected Health Cities programme:

“Our PPI Lead has sought the views of locally based groups such as the Breath Easy groups

(COPD), Whitechapel and Genie in the Gutter (alcohol service users) and epilepsy support

groups in Preston. These relationships are crucial in helping us develop our model for

implementing patient information sharing preferences in our region.”

How we delivered against our goals for 2016/17

Our regionally agreed goals were to:

• Accelerate delivery of safer, better care • Develop a network of health innovation centres

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• Support economic growth through small and medium-sized enterprises (SMEs) and industry

• Drive digital innovation, empowering citizens and workforce

Goal 1: Accelerate the Delivery of Safer, Better Care

The Innovation Agency forms part of the network of Patient Safety Collaboratives across England funded by NHS Improvement. Each network empowers local patients and healthcare staff to work together to identify safety priorities and develop solutions.

Our Patient Safety Expert Group meets quarterly to review progress and develop the strategic approach to patient safety for our region.

We have commissioned and delivered leadership programmes for patient safety, further developing our network of patient safety champions.

Recognition of Sepsis and rapid access to treatment is a national priority. We have led the national AHSN sepsis cluster and commissioned a report of the readiness of provider trusts to adopt the NICE sepsis guidelines. Our work has also included the development of an e-learning tool aimed at care home staff to facilitate the early detection of sepsis. Working with the Sepsis Trust and others we are coordinating efforts to standardise and deploy early warning scores system wide.

We organised a hackathon focused on care of deteriorating patients, in collaboration with the Royal Liverpool and Broadgreen University Hospitals and the University of Liverpool. This resulted in several ideas which we are now supporting, including the winning idea for a campaign to improve hydration in acute care.

Former sepsis patient Julie Carman, a volunteer with UK Sepsis Trust, spoke about her experience at the hackathon.

She said: "A series of seemingly small failures led to delays which almost cost me my life. I know that no one involved in my care deliberately meant to cause me harm but never the less my recovery was very slow with massive personal cost to me, my family and additional financial costs for the NHS.

“We can all do something… increase awareness of sepsis; ensure a care plan is in place to treat sepsis promptly; and offer ongoing support to patients."

We have sponsored a project in care homes to highlight to carers, family and potential care home residents what they should be looking for in a care home. Our care home guide is available to the public through HealthWatch.

In addition to the above we have sponsored work to prevent falls in an elderly population, building on the award-winning Steady On Programme.

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Preventing atrial fibrillation-related strokes

We continue to promote diagnostic and treatment innovations in atrial fibrillation (an irregular or fast heart rhythm), which has been part of our successful programme of work to reduce strokes since 2013.

We calculate that this work has led to 256 potential strokes being avoided, potentially saving around £5.6m in NHS resources:

There are more than 10,000 people with atrial fibrillation (AF) who are not receiving optimal treatment in the North-West Coast. People with AF who are untreated or whose treatment is not effective are at a five-fold greater risk of having a stroke compared with the rest of the population.

Through public campaign work in Merseyside and Lancashire and use of innovative technology, abnormal pulses were detected in more than 60 people. More than 60 patients are now receiving treatment to preventing stokes, predicted to save at least two extra visits to clinic (120 clinic visits per year). 130 AliveCor Kardia devices have been distributed to GPs and nurses in the region and 30 MyDiagnosticks are now in GP surgeries, pharmacies and in adult social care. MyDiagnosticks can screen about 100 patients per month; the Kardia can screen about 50 per month per user. For every person identified with AF out of this screening, the research shows that one in 25 would have had a stroke in the given year. More than £250,000 worth of matched investment has been pledged by partners who include LGC, Bayer, Boehringher-Ingleheim, Pfizer and Diiatchi-Sankyo and Bristol Myers-Squibb. Working in collaboration with Greater Manchester AHSN we rolled out an AF landscape tool in a dashboard format dashboard which summaries outcomes of people with AF in each CCG area.

North East and North Cumbria AHSN have produced the Atrial Fibrillation – a step by

step guide, simple guidelines for GPs and other clinical staff detailing what to do when a patient presents with AF. This has been a useful support guide for our AF Collaborative community and we have distributed 500 copies.

This year has also seen the start of genotype guided dosing for warfarin patients in anticoagulation clinics. This is a ground-breaking programme and is supported by our region’s expertise in pharmacogenetics. We rolled out this pioneering programme to three hospitals – the Countess of Chester, Warrington and the Royal Liverpool. An evaluation is being carried out by the University of Liverpool and Lancaster University.

Through our Medicines Optimisation work stream we have supported the ‘Closing the Gap’ project which is trialling the role of embedded pharmacists in GP practices. We are supporting two GP practices in our region which are part of this project, Wingate Surgery in Kirkby, Liverpool and Pendle View Surgery in East Lancashire. We are one of three AHSNs in England (with Wessex and East Midlands) participating

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alongside Northern Ireland; this project is being evaluated by Queens University, Belfast.

Electronic transfer of care

In the last year, we have supported an electronic transfer of care project at East Lancashire Hospitals, based on the system Refer to Pharmacy.

This enables electronic transfer of discharge information to community pharmacists and GPs, to improve safety and reduce medicine wastage.

Based on evidence from the last year, the hospital has reduced readmissions by 0.8 per cent or 60 patients, saving £200,000.

We have now been funded by NHS England to roll out electronic transfer of care systems to 12 trusts in our region, in a pilot study which will be evaluated by a university partner.

So far, we have enrolled two sites which will be adopting different IT systems, PharmOutcomes at Countess of Chester Hospital and Refer to Pharmacy at Mid Cheshire Hospital. Ten other trusts have expressed an interest in participating and roll out plans are being developed for the coming year.

In 2016 we hosted a successful Diabetes Summit which focused on patients who hold HGV licences and have associated life-style issues, which cause diabetes.

We supported Lancashire Healthwatch's 'Enter and View' programme which led to the production of a toolkit to help care homes plan service improvements; and the production of a 'Mum's Test Checklist' to help families choose a care home for a relative. The work provides insight for the care home providers into how their services are perceived and at the same time provides assurance to commissioners regarding the quality of services on offer in this sector. One of the main aims of our patient safety programme is to build capability and capacity for safer care. We have supported leaders in our region and we commissioned our improvement partner, AQuA to deliver leadership and improvement courses.

This included 13 bursaries for senior NHS colleagues to take part in an Accelerated Patient Safety Programme hosted by AQuA and delivered by the Institute for Healthcare Improvement.

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One of the 13 was Dr Maryam Crews, Royal Liverpool and Broadgreen University Hospitals: “(As a result of the learning) We’re looking to change the way we change….encouraging greater staff engagement in the process across the board, allowing enthusiasts to lead their own projects but with help from those with experience of enthusiasm in QI and using PDSA methodologies to undertake small tests of change. It’s a large scale and ambitious change in the way we do things, but we have the perfect environment to undertake QI initiatives so it’s welcomed.”

We funded training to develop middle managers as leaders of quality improvement and safety, with 25 people on each of two cohorts on a five day development programme. The course covered understanding safety data, leading patient safety reviews, culture and organisational development and lessons from outside the NHS.

Following the success of a ‘skills for safety improvement’ course the previous year, we funded a further three cohorts of 30 people to undertake this course, which included practical skills in resilience, human factors and appreciative inquiry using action learning.

In the coming year, we have partnered with the Health Foundation to recruit individuals from our region to the Q community, to improve health and care quality.

Active and healthy ageing

The Innovation Agency was one of four Northern health organisations which received international recognition for work on active and healthy ageing, after applying to be a three-star ‘reference site’ for the European Innovation Partnership on Active and Healthy Ageing.

The European Commission defines a Reference Site as ‘regions, and cities, integrated hospitals/care organisations that implement a comprehensive, innovation-based approach to active and healthy ageing and can give evidence and concrete illustrations of their impact on the ground’.

The four also included Greater Manchester AHSN, North East Coalition for Active and Healthy Ageing, and Yorkshire and Humber AHSN. The Innovation Agency was recognised for an ‘innovative and comprehensive approach to healthy ageing with concrete evidence of the impact of their work on patients’ health’.

John Farrell, formerly from the Department of Health, Social Services and Public Safety, Northern Ireland, said:

“I would like to congratulate the Reference Sites in the North of England on their recognition

as being among some of the most advanced Reference Sites in Europe. Their collaborative

approach in engaging health and care providers, government, industry and researchers in

the development and adoption of innovative solutions have helped to improve health and

care outcomes for patients, and offered new models and approaches which will help

transform the way services are delivered. This recognition along with the technological and

innovative solutions being developed will help to open new commercial markets across

Europe and beyond.”

Our work over the next year will focus on reducing frailty and increasing the number of healthy life years for our older citizens.

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Goal 2: Develop a network of health innovation centres:

Each year the Innovation Agency earmarks funding to invest in projects or initiatives to stimulate change and to support its partners and local economy. To play our part in addressing limited infrastructure to support the health and life sector in the region, in 2014/15, we invited all regional partners to apply for funding to support innovation infrastructure development.

We provided investment totalling £956,000 which in part, enabled these projects to secure significant funding from other sources including the NHS, universities, industry, EU and UK Government.

This led to the development of the following innovation facilities:

• Health Innovation Campus, University of Lancaster, due to open 2019

• Liverpool bio-innovation hub, the William Duncan Building at University of Liverpool, opened February 2016

• Alder Hey research and education centre, Institute in the Park, opened October 2015

• Alder Hey Innovation Centre for digital and sensor technologies opened March 2016

• Centre for Integrated Health Science, Chester, Countess of Chester NHS Foundation Trust and Cheshire and Wirral Patnership opened April 2015

• Accelerator Hub, Royal Liverpool & Broadgreen University NHS Trust due to open summer 2017

• Chorley Digital Park, planning permission granted and development due to complete 2018

These investments have helped establish a sustainable regional infrastructure, creating jobs, developing skills and attracting research funding and inward investment over the long term.

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Subsequently we have worked with each of the centres to showcase their key assets and develop their strategies and collaboration networks.

• Where the funding was used to provide match for much larger funding bids we supported the writing of bids

• Where needed for collaboration we introduced partners • We engaged local SMEs so they could input to the design phase based on their

needs for incubation space • We introduced project leads to other established incubators for advice and

inspiration • We have showcased to key stakeholders (eg DIT, KTN and Innovate UK) to

support inward investment and funding applications.

For large, capital projects such as the William Duncan Building in Liverpool; and the Institute in the Park at Alder Hey Children’s Hospital, our funding was used as part of the match required to secure significant EU funding.

With the Innovation Hub at Alder Hey we funded the development of a 1000sqm space underneath the new hospital which enabled the trust to leverage ‘in kind’ contributions from developers and industry partners. The centre is now open and has hosted hackathons, supported by the Innovation Agency, to develop ideas with local SMEs and academics to address problems faced by the staff. One of these ideas is now becoming a reality; with the Innovation Agency’s support, a local SME recently secured €50,000 to develop the solution.

Funding of £25,000, matched by Chorley Borough Council, led to a successful proposal to develop a digital campus that will house smart homes and an SME incubation centre; this secured £4.1m ERDF funding towards the £8.4m development.

For Lancaster University our support was provided in the form of funding for an Entrepreneur in Residence post to provide dedicated resource to develop the business plans for the Health Innovation Campus. This development has now secured £41m.

More than £100m of investment into the region has been leveraged by these projects. The support of the Innovation Agency has had a significant influence on this achievement, whether this has been financial support or as a resource to work with the various centres, to become operational and establish partnerships.

Cath Burns, Employment Skills and Business Support Manager, Chorley Borough Council, said: “By working in partnership with the Innovation Agency, and using both their expertise

and funding, we have been able to significantly advance our vision for Chorley to become a

key hub for digital health business growth in the UK."

Some of the innovation centres we have supported will facilitate patient and public involvement. The digital hub in Chorley will include a living lab, in which residents will be involved in developing Internet of Things-enabled smart homes solutions alongside SMEs.

Similarly, the Innovation Team at Alder Hey Children’s Hospital have secured ERDF funding to work with local SMEs to co-create innovative solutions in the Innovation Hub.

Co-creation of products with end users will lead to the right products being developed for specific needs, which in turn will improve performance and outcomes of care.

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During 2016/17 we have continued to work with each centre and have agreements in place with each of them including;

• Provision of ongoing support to all centres to secure further funding and shape strategies

• Supporting SMEs within the facilities to drive development and adoption of new healthcare technologies

• Continuing to grow the regional infrastructure, creating jobs, developing skills and attracting research funding and inward investment

We established an Economic Growth Steering Group in 2016 including representatives from local universities, the Knowledge Transfer Network, Local Enterprise Partnerships, and regional business networks Medilink NW and Bionow. This group is now supporting us to deliver a region wide strategy, building on the combined strengths and complementary strengths of all health innovation centres in the region.

Goal 3: Support economic growth through SMEs and industry

Innovation Agency Business Connect programme

Part of the role of the Innovation Agency and the AHSNs nationally is to support the health and economic wellbeing of our populations by supporting the adoption and spread of innovative healthcare products and solutions at scale and pace into the NHS market. A large proportion of this support is delivered to SMEs, a sector which employs more than 85 per cent of all employees nationally.

In the last year the intensive support we have provided to small and medium size businesses in our region has led to funding of £2m, the creation of 17 additional jobs; and we have played an active role in helping to secure a total of 49 contracts for businesses and NHS Innovation Fellows.

The AHSNs are unique in being able to offer a healthcare specific range of business support interventions including:

• Clinical input to product development • Procurement and tenders • Clinical evaluation • Real world validation • Access to clinical experts • Establishing collaborations for co-development of new products with end users • Driving the adoption of new technologies in the NHS • Developing the business case for adoption • Help with tailoring marketing for the NHS • Support to target finance (grants, venture capital etc.)

It is very difficult for a small business to ‘sell’ their healthcare innovation into the NHS, yet it is well known that many of these organisations have the technology to support the transformation of services.

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AHSNs have a pivotal role in supporting trusts and CCGs to innovate in the way their services are provided in order to meet the challenges of the gaps identified, by driving the adoption and spread of relevant healthcare innovation. This in turn supports SMEs to grow and to employ more staff, and to develop new healthcare innovations.

A strategic decision was taken to look for ways to expand the capacity of the Innovation Agency to meet the demand for support from healthcare SMEs across the patch. We identified funding opportunities within the European Regional Development Funds (ERDF) that could be used to support health and life science SME growth, product commercialisation and job creation and submitted three SME support bids (as lead delivery partner in two bids and in collaboration as a delivery partner with a third bid).

We were successful in gaining all three bids which cover three of the four sub-regions within the Innovation Agency footprint, leveraging a total of £3.5 million of European Regional

Development Funds to support at least 282 SMEs over the next three years. This is supplemented by £3 million match funding from our partners, making a total investment of £6.5 million

This means that we can offer a much larger programme of healthcare SME business support. In summary:

• We will support 282 healthcare SMEs • SMEs will recruit 156 additional members of staff; jobs will be created due to

expansion through successful funding applications, investment and product commercialisation

• 34 SMEs’ new products will be launched into the healthcare market • 74 new products will be developed to address unmet healthcare needs • 49 start ups will be supported to innovate and access the healthcare market

This builds on a successful record of working with small businesses to bring innovative healthcare products into the NHS, creating jobs and improving care provision.

Dr Jonathan Day, Leanvation, said: “It is only as a result of the intervention of the Innovation

Agency’s commercial team that we were able to break through barriers to joining NHS

frameworks. It was the breakthrough we were waiting for; there is strict governance in the

health service which means that only a limited number of approved companies are allowed

to provide supplies.”

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Dave Burrows, Managing Director, Damibu: “Our connection with the Innovation Agency is a

core part of our business. As well as general support through EcoSystem events and

newsletters, we've had specific support which resulted in gaining funding for what is going to

be one of our key future products. I am continually surprised about how open and helpful all

staff members are."

Damibu were given help to apply to the European Institute of Innovation and Technology (EIT) Health Accelerator fund, successfully securing €50,000 to develop an idea into a market ready product. The idea came from an Innovation Agency-sponsored hackathon; an interactive dashboard display to guide medical teams when resuscitating patients in life threatening emergencies.

Henry Pinchbeck, CEO, 3D LifePrints: “Thanks to the support of the Innovation Agency in the last year, 3D LifePrints have maintained our existing workforce and hired an additional two staff members in the region. Once the (Transformation Through Innovation) grant from the Innovation Agency is received it will enable 3D LifePrints to hire a further two staff to work in and around the Royal Liverpool and Liverpool Heart and Chest hospitals.”

SBRI

We support the Small Business Research Initiative (SBRI), ensuring local businesses are aware of the opportunities and supporting those which are successful in securing funds. We also assess funding grants so that this gives us the knowledge to support our companies who are submitting applications.

Transformation Through Innovation Fund

To support our NHS partners to achieve their 5YFV ambitions, we offered the opportunity to bid for a grant through a Transformation through Innovation Fund in 2016/17.

There were 64 applications and an external expert panel of judges reviewed those shortlisted. Twelve projects were funded, with a total spend of £483,000. These are projects which will improve treatments, monitor health remotely and reduce hospital admissions:

• Video consultations at home for outpatient appointments at St Helens and Knowsley Teaching Hospitals NHS Trust – reducing pressure on outpatients and decreasing inconvenience for patients;

• Using 3D printed models of organs to support surgery preparation at two Liverpool hospitals, this work is a regional adoption and spread programme;

• Expanding a teletriage programme in Wirral care homes; • Spreading the CATCH app from Cheshire to improve children’s health in Halton; • Spreading the successful ‘Baby Box’ programme to expectant mothers across

Halton with additional online support; • A social prescribing app to help GPs support their patients to change lifestyles and

reduce reliance on health services in Skelmersdale; • Portable technology to improve the care of patients with atrial fibrillation, in East

Lancashire; • A falls prevention programme in Lancashire residential homes; • A Lancashire and South Cumbria health coaching initiative to give patients more

control of their own health and care; • A gaming app for childhood asthma;

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• Lancashire wide capability for digital connections between any member of staff and the general public, to support new models of care; alongside alignment of NHS Lancashire email systems enabling secure email between health and social care staff and citizens;

• Suppport for the implementation of the Warrington Care Record

Partnerships

We set ourselves the challenge to establish collaborative partnerships with larger companies and international organisations to support pathway transformation and now have agreements and / or collaboration plans in place with the Massachusetts Institute of Technology, Pfizer, Bayer, Roche, Amgen, Diiatchi Sankyo, Lundbeck, Medtronic and Boehringher-Ingleheim.

Organisation Nature of collaboration

Massachusetts Institute of Technology Co-design and facilitation of health and care hackathons and a National Innovation Leadership Summit due to conclude in 2017

Lundbeck Funded report for National Innovation Centre on barriers to uptake of drugs to reduce alcohol consumption. Completed Oct 16.

Roche Supporting the roll out of self-monitoring of warfarin patients in Lancashire alongside the Innovation Agency. Exploring potential collaborations in Europe through EIT Health partnership

Amgen Funded pharmacist to work with GP practices to identify patients with osteoporosis

Medtronic A programme manager sits on steering group of the LinQ project

BMS-Pfizer Awarded £100k from Medical and Educational Goods and Services (MEGS) AHSN innovation fund, to support the development of innovation in the anti-coagulation pathway

Bayer Joint working agreement has been signed enabling us to obtain access to audit and case finding support and a project manager who has been seconded to the Innovation Agency to work on our North West Coast AF Collaborative

Boehringher-Ingleheim Diiachi-Sankyo

We are working to identify opportunities to collaborate through MEGs and possible joint working arrangements

We are also in discussions with two pharmaceutical companies regarding collaboration and support for further collaboratives in other disease areas in 2017; these are chronic obstructive pulmonary disease (COPD) and heart failure. We also have plans to apply for further funding in 2017/18.

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We host an Industry Expert Group, which meets quarterly to share our activity updates and consider future work together.

Goal 4: Drive digital innovation that empowers citizens and the workforce.

Digital technology is a crucial enabler in the transformation of health and social care and throughout the last four years the Innovation Agency has supported digital innovation at a number of levels:

• We have sponsored the adoption of individual atrial fibrillation diagnostic digital technologies such as AliveCor and MyDiagnostic in a range of settings including playing a role in the Cheshire Safe and Well service led by the Fire and Rescue Service;

• We are funding a pilot study in Lancashire of Diasend for patients with Type 1 diabetes to self-monitor at home. It consists of a small transmitter device, plugged into a standard electricity socket, enabling test results stored in patients’ blood glucose meters to be automatically uploaded to a secure web server;

• We provided funding for the roll out of 500 licenses for the Lincus app in Liverpool City Region, to allow people to monitor their mental health and wellbeing;

• In East Lancashire we funded a project with MyHealth targeting nine GP practices which are monitoring patients using warfarin, to create a system to support self-monitoring. Patients self-monitor by using devices such as the AliveCor Kardia plus the app MyHealth, which feeds information back to the clinic and ultimately saves frequent clinic visits;

• We have funded the spread of a free health app, CATCH, for parents of children aged 0 – 5, to reduce dependency on NHS services in Halton. During August and September 2016, Eastern Cheshire CCG received 122 survey responses from 1,535 users, which indicate high satisfaction by users and a cost saving to Eastern Cheshire CCG and Southern Cheshire CCG of £2,889, with a total estimated saving of £23,556, within the two month period;

• We are supporting the trial of FebriDx, a point of care test which distinguishes a virus from bacteria;

• We have promoted the use of apps and web-based tools as a means of accessing healthcare services, such as House of Memories, which was developed in Liverpool and now has 10,000 users nationwide;

• We have supported My mhealth who have supplied 5,000 licences for myCOPD, myDiabetes and myAsthma to Knowsley CCG;

• We have supported partners in their ongoing journey towards digital interoperability, notably the Lancashire Person Record Exchange Service (LPRES) and data sharing.

• We supported the applications of Global Digital Exemplars and we will support their work throughout the life of the programme.

• We have networked digital entrepreneurs with our NHS organisations through our quarterly Ecosystem events and other events, for example a round table discussion at the Liverpool City Region Health is Wealth conference; and individual introductions.

Connected Health Cities is a £20 million, learning health system across the North of England. The Innovation Agency leads the North West Coast programme. With our partners in the region we have established a team who will create insights, from

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routinely collected data in multiple organisations, into care pathways in the areas of alcohol misuse and use of unplanned care services, COPD and epilepsy.

During the year, a data ‘ARK’ has been constructed by AIMES Grid Services on their Liverpool site which is ready to receive data, having been tested and found to meet the necessary information governance and data security requirements.

In Lancaster University, four PhD students have been recruited to the project who will explore areas including human/computer interaction and models of consent.

Meanwhile in the University of Liverpool the Analytics Hub Team has been recruited into the department of Biostatistics, ready to generate the algorithms to analyse the aggregated dataset. This is the first project of its kind in our region and we have started to engage the public and a number of charities and groups to build on our conversation around data sharing and patient information sharing preferences. We have also facilitated this through our participation in citizen juries, which helps us understand in depth how people understand data and public services.

In other work, we are developing a Regional Digital Strategy for which an expert group has begun to meet during the year. This blueprint will build on the local CCG digital roadmaps and incorporate the major areas of interoperability work that is already established in the region such as LPRES in Lancashire, iLINKS in Merseyside and the Wirral and Cheshire shared record programmes.

We have supported bids towards Global Digital Exemplars and are delighted that three of our local trusts have been awarded this status. Their contribution will be integral to our digital strategy and our strategy will be partly based on their programmes.

In Lancashire and South Cumbria we provided £50,000 which was match funded by Health Education England, to explore the potential for developing a Digital Health Skills Academy and this was used to:

• Set up and deliver an Academic Digital Health Module for students delivered by Cumbria University to 25 health and social care professionals;

• Undertake an audit of patient generated social media profiles across all practices; • Support Healthwatch Lancashire with a review of digital needs across primary

care in Lancashire; • Develop a programme across primary care to support the development of staff

and patients with long term conditions to use ‘low tech’ solutions as well as increase uptake in online services;

• Review the current landscape in relation to the delivery of digital health learning resources and provide a demonstrator design for a Virtual Digital Health Skills Academy to address any gaps in current provision and to prepare the regional workforce for the future.

This work has highlighted that a Digital Health Skills Academy could be of great value to the region not only in terms of workforce development but also to support wider investment programmes designed to increase online access and promote self care.

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European programmes We are key partners in a number of European programmes, mainly focused on digital innovation and active and healthy ageing. Sustainable Technology for Older People – Get Organised (STOPandGO)

STOPandGO is a Public Procurement of Innovation pilot project co-funded by the ICT Policy Support Programme of the European Union. The goal of STOPandGO is to produce and validate reference material that will support the development of coherent procurements across Europe regarding the provision of innovative healthcare and social services enhanced by technology, for elderly people.

The STOPandGO procurement process focuses on the integration and the simultaneous improvement of models of care and cure, to provide services augmented by a coherent set of interoperable technologies. It is hoped that the project will benefit more than 5000 citizens and service areas will include integrated care, domiciliary care and dementia.

There are multiple partners across four countries - UK, Netherlands, Italy and Spain. The Innovation Agency is one of the knowledge partners in the UK together with procurement partner Liverpool City Council.

The domiciliary care services proposed in the UK will benefit a significant number of citizens in our region. The €4m procurements from the project receive a generous contribution from the EU, further supporting the providing partners in the region. We have secured an initial £612,000 for Liverpool City Council and we hope to secure more funding for the region from this programme.

Elderly oriented, Network based Service Aimed at independent liFE (ENSAFE)

ENSAFE - is a European Ambient Assisted Living programme which aims to trial technology interventions with older people with mild to moderate care needs to improve their life outcomes.

Following extensive end-user consultation and subsequent technology development, four pilot testing sessions are due to start in different EU countries to trial a variety of smart phone and sensor-based systems. In the UK, we are collaborating with Riverside Housing and a local SME, Ice Creates, to provide a mobile phone-based system of monitoring health, connecting users to a wider care network, to promote independence.

Horizon 2020 funding for Liverpool Heart and Chest NHS Foundation Trust

We helped Liverpool Heart and Chest Hospital to secure almost £1million EU Horizon 2020 funding to enable an innovative way to procure technologies which will help patients with bradycardia, a slow heartbeat.

This is part of the Ritmacore programme, which aims to deploy an innovative service for patients with bradycardias in a number of hospitals across Europe.

We are working to secure opportunities for other hospitals in the North West Coast to participate and benefit.

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EIT Health KIC

The Innovation Agency is an Associate Partner of the European Institute of Innovation and Technology Health Knowledge and Innovation Community.

EIT Health promotes entrepreneurship and innovations in healthy living and active ageing. It enables citizens to lead healthier and more productive lives by delivering products, services and concepts that improve quality of life and contribute to the sustainability of healthcare across Europe.

In the last year we have received funding from the EIT Health Accelerator programme, through which we will provide support to SMEs from six European countries to bring their health-related products to new markets. We hope to support up to three new businesses to establish new companies in the UK.

In 2016 one of our local SMEs, Damibu, was awarded €50,000 EIT funding after their involvement in one of our hackathons. We continue to promote funding and partnership.

Digital Hospital Transformation Short Course (SHiFT)

We have been approved as a partner in developing and delivering a four day intensive course for senior healthcare professionals about digital hospitals, in Budapest, August 2017.

With 30 places available, the course aims to support and develop leaders of the future in transformational digital health technologies. We have secured 12 fully funded places on this programme for professionals from our region.

Assistive Living Technology and Skills – ALTAS

We are a partner in this EU project to develop online learning for health and social care staff that will ultimately enable their clients to benefit from smart solutions to live independently, self-care and improve their health and well-being.

Once completed this package of e-learning will be rolled out across Europe. Our role is to disseminate the learning to stakeholders.

Organisational capabilities

We developed three core capabilities to drive delivery of our principal Goals, as follows: Capability 1: A broker of collaborations and networks

We do not work alone; achieving the objectives of our region and nationally always involves collaborations, so our networks are essential. We have set up and are organising or supporting the following groups of health professionals in our region. Innovation Scouts

We now have 70 Innovation Scouts, largely across the NHS but increasingly, also in local government and university sectors. In the last year we have set up a new sub group of Scouts for mental health.

We have engaged across the health and care ecosystem with a clear focus on using digital solutions and developing an innovative culture to achieve improvements and better value.

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We have offered skills and resources through expert knowledge, mentorship, coaching and virtual learning opportunities. In the past year, the Scouts have taken part in workshops, networking and visits to innovative organisations in this country and internationally. Innovation Scouts are selected by Chief Executives and typically are directors, senior managers or clinicians.

What the Innovation Scouts say

Scouts were surveyed about the benefits of the network and asked, ‘What has been the biggest benefit to you?’ They answered:

“Broader, wider networking, sharing (and pinching) ideas.”

“A new innovation competition launched in my hospital.”

“Connections with health/academia/industry that were not otherwise possible.”

“The Scouts programme combats the potential feeling of loneliness that accompanies innovators.”

Innovation Scout Awards

We presented a total of six bronze and ten silver awards at the Innovation Scouts’ second anniversary event; and one gold award, to consultant paediatric surgeon Mr Iain Hennessey, Clinical Director of Innovation at Alder Hey Children’s Hospital in Liverpool.

The awards recognised the contribution made by Scouts to their own organisations and to the wider health system, spreading knowledge and introducing innovative technologies and approaches which they see working well elsewhere.

Helen Bevan, Chief Transformation Officer, Horizons, “The work the NWC are doing on Innovation Scouts and hackathons is of national and global significance.”

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Collaborating on 3D printing of organs

A collaboration between surgeons at three North West Coast hospitals started with an introduction at an Innovation Scouts event. They were connected after a Scout from Liverpool Heart and Chest Hospital was introduced to 3D printing of organs by a Scout in Alder Hey Children’s Hospital, where they have been pioneering the use of 3D models.

The models are rendered using images from MRI and CT scans and are 3D printed on site in a variety of materials by 3D LifePrints. The collaboration has now extended to the Royal Liverpool and Broadgreen University Hospitals, following a successful bid to the Innovation Agency’s Transformation Through Innovation Fund.

One of 3D LifePrints’ productions was a heart with a blocked pulmonary artery, which helped the surgeon to plan the first incision and to brief his team, leading to a successful operation to remove the blockage.

Specialist cardiology registrar Dr Rob Cooper said: “If by using a 3D model of a heart we reduce surgery time by just 30 minutes, we avoid complications, improve the chances of success and reduce costs.”

OD leads network

We have facilitated meetings of organisation development leads from across the region to form a network through which they can support the innovation agenda and connect with like-minded colleagues.

Quality improvement network

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We sponsored an ‘Ignite’ event which led to the creation of a clinical network of 170 quality improvement enthusiasts and specialists; and a system-wide hackathon incorporating human factors, from which the outcomes were a number of solutions which have the potential to improve patient safety.

Q community

The Innovation Agency has partnered with the Health Foundation to grow the Q community in the North West Coast. Q is a connected community working together to improve health and care quality and connects people with improvement expertise across the UK.

We are leading on recruitment in our region during March and April 2017 and we will be creating opportunities for people to come together as an improvement community – sharing ideas, enhancing skills and collaborating to improve health and care.

AF Collaborative

We have established an AF Collaborative to share best practice and provide training and peer support for GP practices with an interest in the effective identification and management of patients at risk of a stroke due to AF. This approach combines best practice and quality improvement techniques, alongside innovative case finding and detection technology such as the AliveCor Kardia device.

Events

We run events throughout the year which bring together partners from different sectors with whom we are collaborating, to address clinical priorities and to encourage the uptake of innovations. We have increased the impact of our events through improved communications to share resources following events, such as videos and presentation slides, promoted through social media. In 2016/17 we ran 27 events, including hackathons; and sponsored or had stands at a further 17 events focused on showcasing innovation and good practice.

An example in the last year was our diabetes summit for employers of long distance haulage drivers. This attracted large businesses including Eddie Stobart and Biffa Waste Management, and led to a pledge from the companies to raise awareness of Type2 diabetes. They will promote ways of avoiding the risk of developing diabetes; and the need to manage the condition, particularly among those who drive for a living where the impact of collapsing at the wheel of a lorry has the potential to cause multiple fatalities. We sponsored an 'innovation challenge' on mental health and hazardous drinking behaviour at Edge Hill University. The challenge took place during October half term and more than 50 students volunteered their time to contribute. The teams will present their solutions in April 17. Once a quarter we hold a Digital Ecosystem event, which brings together digital and med-tech health businesses, health care organisations, local authorities, universities and service users to build understanding of the needs of the NHS and wider public sector and to showcase and promote adoption of digital innovations which are already having an impact in improving the lives of residents. In March 2017 we held our 11th Ecosystem event. These events evaluate very positively and truly represent ‘the triple helix’ concept in our region.

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Awards events

Awards events are a useful way to highlight best practice and we organised our own North West Coast Research and Innovation Awards event collaboratively, with NIHR CRN NWC and NIHR CLAHRC NWC.

It was our second annual awards event, presenting a total of 15 awards, five for each partner with our own categories highlighting and celebrating successful innovators in health care.

The winning nominations were promoted through our social media channels – Twitter, Facebook and LinkedIn; and they received good media coverage, with a total of 16 articles in local press. This event is now an established highlight in the North West Coast health calendar.

We also sponsored external awards events which highlighted best practice in our region, as follows:

• Excellence in Supply Awards, hosted by North West Procurement Development

• Bionow Awards, showcasing the best of the Northern life sciences sector

• North West Medilink Healthcare Business Awards celebrating innovation, growth and commercial success in the Healthcare Technologies and Life Sciences sector

• NW Informatics Awards, hosted by the Skills Development Network

• NW Adult Learner Awards, innovation in health category

We also sat as judges on a range of national awards including HSJ Awards, Patient Safety Awards, BMJ Awards, Association of Healthcare Communications and Marketing Awards. The AHSN Network’s presence at national events was organised or supported by our event management and communications team, including Patient Safety Congress, NHS Confederation, NHS Expo and Patient First. Hackathons

We imported hackathon expertise from the Massachusetts Institute of Technology (MIT) Hacking Medicine team to the North West Coast. Having taken part in an MIT Grand Hack and worked alongside their trainers in our own first two hackathons, we now have a team of experts qualified to deliver CPD accredited training in hackathon methodology.

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The demand for training has increased as people become aware of the power of hackathons. Our hackathons energize people and encourage them to think differently about ways to improve quality and efficiency, helping to spread a culture of innovation. Innovations emerging from hackathons in the past year include: sensors for early detection of skin damage, a hearing screening app and a campaign to improve hydration of patients. We have developed a supportive network of trained hackathon facilitators who keep in contact and help each other when they run their own hackathon events. Participant’s feedback: Michelle Cloney, Deputy HR Director, East Lancashire Hospitals NHS Trust: “Fantastic creative training event – a really great opportunity to engage better with front line staff and service users to reshape and co-produce what we need for future health and social care services.” Communications Strategy A strategy for communications and engagement was implemented to maximise the reach of our communications through social media and e-newsletters.

Inspired by the Mayo Clinic Social Media Network, we launched a community of health care professionals interested in championing the use of social media to improve health care.

An ‘#EngageWell’ event was attended by 80 individuals, with a magnified reach to more than 110,000 Twitter users. Presentations were later viewed on SlideShare more than 5,000 times.

The frequency of e-newsletters was increased from bimonthly to monthly; and a Business Connect newsletter was launched to business stakeholders every six weeks. A Facebook company page was set up, to engage with all partners, public and patients. Key outputs and results for 2016/17: Eight stakeholder newsletters and five Business Connect newsletters issued 45 press releases and 20 blogs published Twitter following increased by 55 per cent from 2,700 to 4,200 SlideShare uploads: Presentation views: 6,560 Presentation uploads: 44 Media coverage: 116 press cuttings and one BBC local radio interview LinkedIn: 336 followers YouTube: Channel now holds 196 videos Capability 2: Showcasing high impact innovations We have adapted an online Innovation Exchange which was initially developed by our colleagues in Yorkshire and Humber AHSN.

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The Innovation Exchange connects health and social care professionals, businesses, organisations and individuals who are looking for improved and more effective and efficient ways of working. It includes case studies and supporting resources provided by around 60 entrepreneurs, with about 180 active users as at March 2017. Submissions to the Innovation Exchange are assessed by a panel using a standardised protocol to choose innovations which have the greatest potential to contribute to the delivery of Innovation Agency goals. Our team then promotes the innovations to our network, by matching the product with our database. The next phase of development will involve collaborating with Yorkshire and Humber AHSN more closely, by merging the innovation assessment panels. iBags

A very popular feature of our presentations developed in 2016 is our ‘iBags’ - branded shoulder bags containing a range of innovative products, so that participants at events and meetings can see and feel some of the products which are transforming care. This ‘show and tell’ method of sharing innovation always brings a presentation to life and has been adopted by Wessex AHSN.

The bags contain:

AliveCor Kardia; Arc Angel; Leanvation latex free gloves; the Hydrant; Living It Up activity tracker; MyDiagnostick; Non Injectable Arterial Connector (NIC); Episcissors 60; 3D models of a child’s heart, partial brain, skull, and kidney; carbolic soap to promote House of Memories app; leaflets re Better Conversation health coaching toolkit; and the CATCH app.

We have also produced files of ‘iFacts’ – cards for each of the items, describing what it is and how it is being used; these have been distributed to our staff and to the 70 Scouts.

Our Innovations Scouts promote innovations by using the iBags and the iFacts; and by promoting PIP – see below.

Capability 3: Improving skills in adopting and evaluating innovations

Putting Innovation into Practice

We have developed a Putting Innovation into Practice programme (PIP) which is available on our website to support health care partners. This is a self-guided online tool to develop capability for innovation adoption.

PIP covers all elements of the innovation pathway: Creating a culture for innovations to thrive; identifying ideas; gathering evidence of what works; tools to support implementation; evaluating their effectiveness; supporting further adoption; and rewarding success.

PIP is complemented by our Innovation Exchange, (see Capability 2).

Evaluation

Evaluation is a key part of our work. We have commissioned a number of specific evaluations to support the development of our programmes and our partners’ programmes

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which allows us insight into what works where and for whom. This supports our spread and adoption agenda and also gives us insights into the development of programmes:

• An economic model for identifying hypertension (delivery partner HCD Economics) • A survey of GPs and other staff using Kardia Alive Cor devices (internal) • An evaluation including economic evaluation of implementing the genotype testing

service (Liverpool and Lancaster universities – in progress) • An evaluation of the patient consent model of the 100,000 genomes programme

(University of Central Lancaster UCLAN) • Report on implementation of innovative medical technology in hospitals (internal) • An evaluation of MyDiagnosticks in a variety of settings (UCLAN – in progress) • Evaluation of self-monitoring for warfarin (UCLAN – in progress) • An evaluation of implementing the Heart Failure Evidence into practice

programme (MSD) • Evaluation of StartBack (internal) • Evaluation of Dry January campaign (Liverpool John Moores University) • Evaluation of Evidence for Innovation into Practice programme (internal) • Economic model for self-monitoring to support business case (internal) • Evaluation of the AF pathway in hospitals (NHS trusts/UCLAN) • Evaluation of AF Collaborative (UCLAN – in progress) • Audit of Diabetes Summit (internal) • Evaluation of Steady On falls programme (UCLAN) • Audit of osteoporosis medicines optimisation programme (internal) • Evaluation on our point of care testing programme (Edge Hill University).

We have also provided support for evaluations for our partner organisations through the commissioning process, supporting them with the development of logic models and other tools to help them identify evaluation goals and to assess suitable providers to commission the evaluations. Commissioning can take a formal or informal approach. Our evaluation partners are a range of academic institutions with active in the field of work, through to private providers with specific expertise.

We have a range of approaches from light touch, which may be a survey or some audit measures to establish if a project is delivering its objectives, through to academic work, using more rigorous research methods and statistical techniques. Outputs vary from internal reports to academic papers in peer reviewed journals.

Partnerships with other organisations

NHS England

NHS England is the main funder of all AHSNs and assure themselves on a quarterly basis that the Innovation Agency is meeting its duties in accordance with the Innovation, Health and Wealth principles, and in line with the objectives of the Five Year Forward View.

The Innovation Agency has a close working relationship with NHS England North and the sub-regional teams as well as a strong relationship with colleagues on a national level.

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Our vision of reducing health inequalities and contributing to a vibrant local and national economy are consistent with the principles of NHS England.

NHS Improvement

NHS Improvement funds the Patient Safety Collaboratives which are run by the AHSNs and we work with their patient safety team at a national level, through the Patient Safety Leads Forum. We hosted a visit by NHSI National Director of Patient Safety Dr Mike Durkin in August 2016 at which we described the highlights of our patient safety work.

NIHR CLAHRC NWC

Collaboration between the Innovation Agency and the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) NWC is underpinned by our membership of each other’s Steering Board, regular meetings of relevant staff and a joint annual awards event for the region.

We are working together on implementation of genotype-guided dosing of warfarin; on the North West Coast Connected Health Cities Programme; and more recently on a ‘Health system approach to improving and innovating in the management of people with atrial fibrillation through medication optimisation’.

The implementation of genotype-guided dosing for warfarin in patients with atrial fibrillation to improve anticoagulation involves collaboration with industry partners (LGC Ltd) and has been ongoing since 2014 and should finish by the end of June. The medication optimisation project was a joint bid to Pfizer and follows on directly from this successful genotype-guided dosing collaborative project.

In the Connected Health Cities programme, we will be collaborating over the next three years on a series of projects that will impact on the lives of citizens who have COPD and alcohol issues.

Looking to the future, 2017/18 will be an exciting year for CLAHRC NWC as several larger studies end or near completion, such as: Psychological support for people with stroke (ADOPTS); Improving access to support for perinatal women through peer facilitation: a feasibility study (PEARS); genotype guided dosing; and Improving access and coordination of care for adults presenting to emergency care with seizures: Care Pathway for Seizures (CAPS); the first wave of implementation projects through the Partners Priority Programme progress with a second wave starting in the autumn of 2017. These studies provide lots of opportunities to collaborate around adoption and spread of evidence-based new ways of working.

NIHR CRN North West Coast

The Innovation Agency and the Clinical Research Network (North West Coast) have a strong and collaborative relationship that is pivotal to driving forward research excellence across the region.

This year, the Clinical Research Network (North West Coast) surpassed a major milestone in recruiting over a quarter of a million patients to clinical trials since 2008.

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The Innovation Agency plays a key role in creating the right environment to spread health technology and innovation and together, both organisations have helped improve health outcomes for the local population.

Along with the Innovation Agency and NIHR Collaboration for Leadership in Applied Health Research (CLAHRC NWC), the Clinical Research Network organised the second joint NWC Research and Innovation Awards event. For the CRN in particular the evening was an opportunity to celebrate research excellence through collaboration and say thank you to all the front-line researchers and wider multidisciplinary teams and especially patients across the NHS.

Patient and public involvement and engagement in clinical research remains an area of joint focus and collaboration. Sharing of best practice has ensured the region successfully engages with many stakeholders. The region boasts research ambassadors embedded in the NHS who are pivotal to help the CRN NWC in the delivery of research and the adoption and diffusion of innovations and new technologies. Only by joint working has this been achieved in a number of clinical areas of unmet need.

Furthermore, the Innovation Agency has provided much needed innovation funding to researchers within the Clinical Research Network, playing a critical and enabling role for clinical trials to reach their successful end points.

During the year, cross representation on boards of both organisations and productive relationships at all levels of the partnership have continued. The region remains committed to continuing joint working that will secure improvements in the health of the population we jointly serve.

Strategic Clinical Network and Senates

The Strategic Clinical Network (SCN) for the North West Coast is now a neighbour of the Innovation Agency, in Vanguard House, Daresbury, which is helping to strengthen relationships between our two teams. We are working more closely and meeting more often, formally and informally.

We continue to work together on cardiovascular disease; and we share some resources – for instance our European programmes manager has been helping with bid writing; and the SCN Associate Director was a judge on our patient safety hackathon.

The SCN successfully bid for a grant in our Transformation Through Innovation Fund, to introduce health coaching in treating patients with diabetes. Additionally we sit on the board of the Cheshire and Merseyside and Greater Manchester and Lancashire Clinical Senate; and the SCN Associate Director is a member of our Board. Advancing Quality Alliance (AQuA)

Rather than charging a fee for service, the Innovation Agency asks for this fee to be paid to AQuA for them to deliver Quality Improvement programmes that provide the foundation for a culture of innovation. In addition the Innovation Agency commissions bespoke programmes, from AQuA for the Patient Safety Collaborative. For 2016/17, the Innovation Agency commissioned the Advancing Quality Alliance (AQuA) to deliver two programmes of work as

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part of our Patient Safety Collaborative (PSC). This was the second phase of programmes that were designed and delivered on behalf of the Innovation Agency by AQuA. Recognising the need for continuity and development from the previous year, AQuA created programmes that built up from earlier introductory approaches, allowing staff and organisations to expand and enhance their knowledge and skills in supporting and delivering safer care. These programmes were provided to organisations from the NHS and wider public sector within the Innovation Agency footprint. An appendix describing the programmes is attached to this annual report (Appendix 2)

Northern Health Science Alliance

The Northern Health Science Alliance Ltd (NHSA) is a partnership established by the leading universities and NHS hospital trusts in the North of England to improve the health and wealth of the region by creating an internationally recognised life science and healthcare system.

Our CEO Dr Liz Mear is a director of the NHSA Board, representing the four Northern AHSNs.

The NHSA links eight universities and eight NHS teaching trusts with the four Northern AHSNs. This represents a patient population of over 15 million people. The NHSA acts as a single portal bringing together the strengths of the North around research, health science innovation and industry to provide benefits for researchers, universities, hospitals, patients as well as commercial partners.

In the last year, we have worked together on Connected Health Cities; and on promoting the north of England to national stakeholders.

Partnerships with academia

Evidence based commissioning – the Evidence Champions programme

We launched a Postgraduate Certificate Evidence Champions Programme alongside our commissioned partner, Lancaster University. This programme teaches commissioners to make the best use of evidence in making decisions about new products and service improvements in their areas. The first cohort includes leaders from across health and social care. We have developed this programme based on the successful work of West of England AHSN.

Our hackathon training course has gained CPD certification from Lancaster University. (see Capability 1)

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Evaluation: We have involved university partners in various evaluation programmes (see Capability 1) Digital health learning

We sponsored Cumbria University to deliver a digital health programme and 20 health professionals took part in a course which included an overview of what technologies are available, how they can be used and success stories from those who have used them in frontline clinical practice. This was followed by sessions on how to evaluate the benefits, how to present a business plan for change and practical support to plan your own digital health or social care service. Students will be publishing work-based digital project case studies that will be made available for the benefit of the wider health and social care economy; and a series of workshops will run through 2017 highlighting the learning and development experienced by the cohort and identifying where they may be able to use their skills to support the region’s transformational programme. A further cohort is being recruited for 2017. We are working with the Liverpool Life Sciences University Technical College (UTC) to support the creation of a new Life Sciences UTC in Wigan, which is due to open in September. The plans for the education programmes will be aligned to match the needs of our future life sciences workforce. We signed a collaboration agreement with the Massachusetts Institute of Technology Hacking Medicine team which was the first of its kind, creating opportunities to work with world leading experts in innovation. The collaboration will culminate in a national Innovation Leadership Summit during 2017. University research hubs We are integral partners of two research hubs in the region, Lancaster Health Hub and Liverpool Health Partners. Lancaster Health Hub Lancaster Health Hub is a strategic platform involving health organisations across Lancashire and Cumbria. Led by Lancaster University, it enables the organisations to work together to drive locally-led research and innovation, to enhance evidence-based, high quality healthcare, and to support local economic growth and job creation.

The partnership draws upon skills and expertise in all academic departments at Lancaster University, which is rated within the top 10 UK universities, plus: Blackpool Teaching Hospitals NHS Foundation Trust, Mersey Care NHS Foundation Trust (Calderstones site); Lancashire Care NHS Foundation Trust, Lancashire Teaching Hospitals NHS Foundation Trust, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancashire North CCG, NHS Fylde and Wyre CCG, University of Cumbria and Healthwatch Lancashire.

Lancaster Health Hub also serves as a platform for broader strategic and infrastructure initiatives. Lancashire is the only area in the country to have been successful in securing three NHS England initiatives within its patch (Fylde Coast) and the university is a key partner in these. This includes a NHS England Test Bed, a NHS England ‘Healthy New Town’ and a NHS England Vanguard site, the ‘Fylde Coast Local Health Economy’.

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The Hub co-ordinated the original £1.7m proposal for the Lancashire and Cumbria Innovation Alliance (LCIA) Test Bed and in the last year has continued to play a leading role in its success, alongside the Innovation Agency. The LCIA Test Bed is progressing well, involving several technology partners including Philips Healthcare.

The Hub is a partner in the NHS England Whyndyke Garden Village Healthy New Town in Fylde, Lancashire, which will include the development of 1,400 homes. They have been working with the Hub to identify digital health technologies which can be used to improve the health of residents.

All of these initiatives are paving the way for the development of the Health Innovation Campus at Lancaster University and the Health Hub is playing a key role in the development of what will be a major new asset for the region. Planning permission has now been granted and building is under way from 2017. Phase one of the campus will have a strong focus on population health and prevention and is scheduled for completion by the end of 2019.

To support this significant development for the North West Coast, over the past two years the Innovation Agency has funded a senior business engagement post within the Hub, which has facilitated cross-sectoral collaborations which are essential to future health innovation.

Related to this, the Health Hub is a partner in the Innovation Agency-led European Regional Development Funding (ERDF) business support programme in Lancashire, working with more than 100 Lancashire SMEs with innovative healthcare products which will benefit both patients and healthcare professionals. This is an important programme for Lancashire’s economic development.

Liverpool Health Partners (LHP)

We work with LHP in the Liverpool Alcohol Research Alliance (LARA) which delivers successful bid submissions and specialty expertise; plans are now underway for a Liverpool Alcohol Research Institute.

The Liverpool Health Genomics Laboratory, funded by Liverpool Health Partners, formally opened in July 2016. This is an important part of the NWC Genomics Medicine Centre. Our Medical Director sits on the Genomics and Translational Medicine Steering Group.

Liverpool Health Partners are developing an informatics strategy for health data science, with an ambition of establishing an Integrated Health Informatics Platform for the Liverpool City Region. We were part of their strategic launch event, Digital Frontiers.

We sponsored a major event organised by Liverpool Health Partners, ‘Health is Wealth’, attended by 300 delegates over two days. It was the second Health is Wealth conference and this is now an established annual event, bringing together healthcare professionals, academics and businesses involved in transforming healthcare in our region. The Innovation Agency organised an 'Innovation Exchange Zone' exhibition area for SMEs being supported through their ERDF funded business support programme; and a round table discussion for health informatics leaders and SMEs, to explore opportunities for closer working, especially with the Global Digital Exemplar trusts.

Our CEO is a member of the LHP Board and senior LHP staff attend our Board meetings.

Local Enterprise Partnerships (LEPs).

We have representation on our Board from Cheshire & Warrington, Liverpool City Region and Lancashire LEPs. The support from all three was instrumental in shaping our bids to secure £3.5m ERDF funding, with partners, for the new business support programmes and we will work closely with the LEPs and their growth hubs to deliver these.

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We jointly fund a health and life science growth sector post with Liverpool City Region LEP and our Commercial Director is on their Health and Life Sciences Board.

Liverpool Health and Wellbeing Board

Our Chair Gideon Ben-Tovim OBE is a Board member.

North West Learning and Development Collaborative

The North West Learning and Development Collaborative includes the Innovation Agency, Greater Manchester Academic Health Science Network, AQuA, the North West Leadership Academy and Health Education England. Our collaboration has created a connected set of partners who have well established, formal and informal relationships. The depth and breadth of these relationships enables alignment of combined skills and resources to tackle the challenges facing the North West health and social care economy. The Collaborative provides development for boards, leaders, managers; it supports coaching skills, mentoring skills, Lean methodology and improvement methodology for front line staff. Creating this climate supports a culture of innovation across the North West Coast. Looking forward Our business plan for 2017 to 2018 is focused on five goals, which were established following consultation with Board members and workshops to identify priorities for the region. They are: Goal 1: Support system transformation through the adoption of innovations that

enhance quality and value

Goal 2: Support innovation clusters and SMEs to drive economic growth

Goal 3: Drive adoption of digital innovation

Goal 4: Deliver NHS Improvement Patient Safety Collaborative programme

Goal 5: Collaborate with the Network of AHSNs

Financial performance (to follow when accounts are finalised)

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Our Executive team Chief Executive: Dr Liz Mear Commercial Director: Lorna Green Director of Innovation and Research: Lisa Butland Interim Medical Director: Dr Phil Jennings Director of Communications and Engagement: Caroline Kenyon

Contact details

www.innovationagencynwc.nhs.uk [email protected] @innovationnwc 01772 520263 Innovation Agency Vanguard House Keckwick Lane Sci Tech Daresbury Halton WA4 4AB

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Appendices

Appendix 1

Vanguard sites in the North West Coast region

Fylde Coast Local Health Economy

A new community-based service called ‘extensive care’ is providing proactive support for people aged 60 and over, who have two or more long-term conditions. Under the service, patients benefit from a harmonised team of health and care professionals working together to provide the support they require to keep them out of hospital. This includes helping people to understand and manage their health conditions but also other aspects of their life which might impact upon their general wellbeing.

Complementing the extensive care service are locally based neighbourhood care teams which provide support to people who require the ongoing management of one or more long-term conditions. These teams see GPs working with community and other care services across ten neighbourhoods on the Fylde Coast to provide better coordinated care closer to home for patients.

Shared electronic care records and a single point of contact for all out of hospital services on the Fylde Coast ensure seamless care regardless of a person’s support needs.

Healthy Wirral

The partners are focused on shaping local services around what really matters to everyone in Wirral.

To do this, the organisations are working much more closely together, commissioning services jointly, supporting joined-up local services, and working in partnership with the large and diverse local communities and voluntary sector.

The vanguard is using support from the national new care models programme for working with new technologies to develop a new system where electronic patient records are shared across all health providers – creating Europe’s first ‘population health management digital infrastructure’.

The information that can be gained from the system – such as the numbers of people with certain health conditions and any trends or patterns in who becomes unwell – can be used to better plan the services that people need and improve the efficiency of the health and care system.

Better Care Together – Morecambe Bay

Twelve new health and care teams are being created, including professionals (nurses, doctors, social workers) from across primary, secondary and community care. These teams have a mix of different health and care skills.

They will be based in local areas and called ‘integrated care communities’. These professionals will work together, across the area, in three clinical networks.

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The aim is to deliver consistent care for individuals but with priorities localised (for example the priorities for the people of Kendal will be different to those for the people of Barrow-in-Furness). Care will be provided as close to home as it can be with people going to hospital only when they need the specialist care that only a hospital can provide.

Key to success is that whole communities become much more involved in better managing their own health and wellbeing, as improved population health cannot be achieved just through service delivery.

West Cheshire Way

This vanguard is showing how the national programme’s support for organisations to empower patients and to better integrate the buying and delivery of services can make a difference to patients while also easing pressure on NHS services.

There will be easier access to more joined-up services in the community through new health and social care teams, wellbeing coordinators and direct access to physiotherapy for patients.

By working together with clinicians to design self-care plans, where appropriate, individuals, their families and carers will be given the tools and confidence to understand and manage their health condition themselves as far as possible.

GPs and community teams will act as the first port of call for accessing coordinated support for children and young people. Adults with long-term conditions will be identified and supported to minimise the impact of their conditions on their daily lives, again with care models designed together with clinicians.

Vulnerable older people who are most at risk of poor health and wellbeing will be identified by GPs. They will then work with that person’s nominated care coordinator (who works with health and social care teams to help people obtain care, understand their options and make care decisions) to develop care plans and ensure care is provided by teams with members from the specialties needed.

The Neuro Network – The Walton Centre

The programme will build on the vanguard partners’ extensive history of working together in networks to deliver neurology (help for problems within the nervous system) and spinal services.

The Walton Centre will work closely with other hospitals, GPs and community services to improve the quality of care and reduce variations in standards, ultimately benefiting patients with neurology and spinal conditions.

It already provides neurology services at district general hospitals across Cheshire, Merseyside, Cumbria and North Wales, holding clinics and helping look after patients on the wards. The vanguard will use the national support available to develop joint working further across Cheshire and Merseyside.

The aim is to deliver improved results for patients and better use of resources within the local Merseyside and Cheshire area, as well as strengthening the acute support available in hospitals on a seven-day basis.

This way of working across a network is one that can be followed across the NHS as a whole to benefit patients nationally. It is recognised that there are too few consultant neurologists to provide a self-sufficient service in every district general hospital, and working

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together in this way allows local care to be available while still using resources efficiently and effectively.

The team is planning to establish a spinal network to further improve services for patients spinal conditions, increase the specialist support and advice currently given to GPs and local hospitals.

The Neuro Network will also standardise care for patients with back pain. At present, treatment can be inconsistent and patients often experience significant delays in getting the right care for their needs.

There is currently considerable variation in the surgery that is offered, and this will be addressed through different services working together as a regional spinal network for both urgent and planned spinal surgery, closing a gap in care and quality.

As well as the benefits the vanguard work will bring for patients, staff will benefit thanks to the opportunities it offers for engaging in innovative service development. This will include using modern technology within their working environment and the chance to undertake new roles such as the advanced neurology nurse posts that are being developed.

Cheshire and Merseyside Women’s and Children’s Services

The vanguard is addressing the challenges facing services for women and children locally by creating a new approach between commissioners (those organisations that plan and buy services), clinicians and providers that goes beyond organisational boundaries.

These challenges include a greater demand for services and an increase in patients with more complex needs as well as variation in quality of services. No single organisation, commissioner or provider working alone can resolve these issues and this vanguard will also enable organisations to work together to tackle challenges around workforce like recruitment, retention, retirement and the skills available in the workforce, as well as overall financial sustainability.

In addition, the vanguard is engaging more with the people who use services, so it can better understand their needs and create more personalised or targeted support, improving health and wellbeing.

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Appendix 2

Advancing Quality Alliance (AQuA) programmes specifically commissioned by the Innovation Agency 2016-2017 For 2016/17, the Innovation Agency commissioned the Advancing Quality Alliance (AQuA) to deliver two programmes of work as part of their Patient Safety Collaborative (PSC). This was the second phase of programmes that were designed and delivered on behalf of the Innovation Agency by AQuA. Recognising the need for continuity and development from the earlier PSC, AQuA created programmes that built up from earlier introductory approaches, allowing staff and organisations to expand and enhance their knowledge and skills in supporting and delivering safer care. These programmes were provided to organisations from the NHS and wider public sector within the Innovation Agency footprint and are described below.

1. Safety Leadership for Middle Managers This programme was specifically designed to provide middle managers across the footprint with the opportunity to develop technical and non -technical skills that will help them understand the issues they face daily to monitor, challenge and improve safety within their organisations.

Developing and harnessing these skills enable staff to develop their role, and understand the approaches they can take to increase impact within their own sphere of influence and beyond. The programme is designed to help stretch and expand the critical thinking of attendees and to provide them with greater insight into the role of safety across health and social care. Attendees were encouraged to reflect on their learning and to share how they have applied their learning both during the classroom elements and since the programme ended.

Programme overview

Two cohorts with a total of 46 participants underwent the five day programme Programme workbook was developed including resources, references, reflection

pages and further reading Attendees were encouraged to use reflection throughout each module of the

programme Directed actions and action learning approach for self-improvement and development Support and networking throughout and beyond programme

Feedback from delegates:

“Everything will be looked at in a new light due to the result of this learning programme.”

“All of the modules provided their own key messages that safety is integral to quality improvement initiative. Also, safety is everyone's responsibility.”

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2. Network Spread and Sustainability

This three-day programme was designed to offer participants the opportunity to learn, develop, practice and understand the ‘softer skills’ that support safety improvement.

By combining Individual Resilience, Human Factors and Appreciative Inquiry this programme enabled staff to understand the emotional and interpersonal approaches that influence their own and the behaviours of others. It included follow-on coaching support and engagement to encourage attendees to embed changes, assess the implications of their learning and sustain any impact within their organisations.

Programme overview

Three cohorts with a total of 68 people took part in the three-day programme Attendees encouraged to access their organisation’s ‘Sign up to Safety’ plan and

connect their learning from the programme to support their local delivery of these Support and networking throughout and beyond programme

Participant feedback:

“Makes you think about yourself and your interaction. Good insight into resilience and understanding how to improve my resilience and recognise teams’ resilience.”

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Business Plan 2017-2018

1

Innovation Agency Business Plan 2017-18 Contents 1. Executive Summary ..................................................................................................................................................................... 2

2. Background on Academic Health Science Networks ............................................................................................................... 3

3. 2016/2017 Impact Highlights ....................................................................................................................................................... 3

4. Context 2017-18 ........................................................................................................................................................................... 7

5. Our Core Purpose and Goals.................................................................................................................................................... 10

6. Income and Impact ................................................................................................................................................................................. 16

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1. Executive Summary

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2. Background on Academic Health

Science Networks AHSNs were established by NHS England in 2013 to deliver a step-change in the way the NHS identifies, develops, adopts and spreads innovation. AHSNs are predicated on partnership working between the NHS, local government, academia, the private sector, voluntary bodies and other external partners*. AHSNs have shown that they can enable national innovation platforms, such as the Small Business Research Initiative (SBRI) for Healthcare, the Patient Safety Collaboratives and the National Innovation Accelerator programme, to drive implementation and adoption at a regional and national level*. We can identify areas of greatest priority and rapidly scale up those innovations which have the best prospect of improving outcomes and reducing costs within healthcare. NHS England has re-stated a commitment to funding Academic Health Science Networks. This licence will last for five years from April 2018. The collaborative nature of the work of the Innovation Agency (the Academic Health Science Network for the North West Coast) means that we work with many strategic partners who are mentioned in this plan.

In March 2016, at the request of partners, the North West Coast Academic Health Science Network was rebranded as:

This clearly communicates our core purpose. This business plan is the result of careful deliberation with our partners to identify areas in which we can have the most impact in accelerating the pace and reach of innovation.

* The review of Innovation Health and Wealth

http://www.rand.org/content/dam/rand/pubs/researchreports/RR1100/RR1143z1/RAND_RR1143z1.pdf ) outlined how AHSNs and the SBRI programme (run by

AHSNs) contributed delivery of the Innovation, Health and Wealth Policy.

3. 2016/2017 Impact highlights 256 potential stokes avoided through atrial fibrillation

detection, potentially saving around £5.6m in NHS resources:

There are more than 10,000 people with atrial fibrillation (AF) who are not receiving optimal treatment in the North West Coast. People with AF who are untreated or whose treatment is not effective are at a five-fold greater risk of having a stroke compared with the rest of the population.

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• Through public campaign work in Merseyside and Lancashire and use of innovative technology, abnormal pulses were detected in more than 60 people.

• More than 60 patients are now receiving treatment to preventing stokes, predicted to save at least two extra visits to clinic (120 clinic visits per year). This work is estimated to have saved up to £24,000 per person or £1.4m in NHS care costs in the first year alone.

• 130 AliveCor Kardia devices have been distributed to GPs and nurses in the region and 30 MyDiagnosticks are now in GP surgeries, pharmacies and in adult social care. MyDiagnosticks can screen about 100 patients per month; the Kardia can screen about 50 per month per user.

• For every person identified with AF out of this screening, the research shows that one in 25 would have had a stroke in the given year.

• More than £250,000 worth of matched investment has been pledged by partners including LGC, Bayer PLC, Boehringer Ingelheim, Bristol-Myers Squibb and Pfizer Alliance and Daiichi Sankyo.

• Genotype guided dosing has brought personalised

medicine to more than 100 citizens, establishing the correct dose of warfarin for patents with AF. Three hospitals have introduced genotyping into their clinics and more have been identified. Acceptability to patients and staff is high. A health economic evaluation is underway and will report in September 2017. We estimate that

using this test avoids two clinic visits per person – saving

200 clinic visits for patients receiving the test

£6.5 million secured to support small and medium sized life

science enterprises (SMEs) to develop health innovations from which citizens across the region will benefit.

• Six staff have joined the Innovation Agency commercial team, and partners have recruited a further six staff, to help 282 SMEs access the healthcare market; key outputs will include: 34 new products launched; 74 new products in development; 49 new SMEs will be supported 4.1 million residents in the North West Coast region will benefit from health innovations.

Investment by the Innovation Agency of around £1 million has enabled around £100 million of additional funding to be attracted to build innovation hubs and business incubators across the region so that life sciences SMEs can locate in the region, develop products, create jobs and improve health

This additional funding has come from NHS, universities, industry, EU and UK Government. This investment led to the development of the following facilities:

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• Health Innovation Campus at Lancaster University, due to open in 2019

• Bio innovation hub, the William Duncan Building at the University of Liverpool - opened February 2016

• Alder Hey research and education centre, Institute in the Park - opened October 2015

• Alder Hey Innovation Hub for digital and sensor technologies - opened March 2016

• Centre for Integrated Health Science, Chester - opened April 2015

• Accelerator Hub, Royal Liverpool and Broadgreen University Hospitals – due to open in 2017

• Chorley Digital Park – due to open in 2018 £4m external investment in the development of a Learning

Health System – the Connected Health Cities programme. Emergency unplanned care (COPD and epilepsy) and alcohol

related care are the care pathways that we are focusing on in the region. The work comprises:

• A collaboration between the Innovation Agency and the University of Liverpool, Lancaster University and AIMES Grid Services

• The development of linked health related data sets

• Analysis of the care pathway to identify improvements across the system

• An integrated plan for the workforce to support digital education

• Public engagement and patient and citizen collaboration

• Create a sharing environment that enlists the trust, and active involvement, of NWC citizens through the Northern Citizen Jury and the North West Coast Public Involvement and Engagement Senate.

Keeping people out of hospital by gaining funding to increase

domiciliary care technology investment by £612,000 in one area of the region as part of the Sustainable Technology for

Older People – Get Organised (STOPandGO). This is a Public Procurement of Innovation pilot project co-funded by the ICT Policy Support, European Union programme. The goal of STOPandGO is to produce and validate data that will support the development of improved procurements across Europe regarding the provision of innovative healthcare and social services enhanced by technology, for elderly people. It is hoped that the project will benefit more than 5,000 citizens and service areas will include integrated care, domiciliary care and dementia.

Through our business support, innovation spread and European funding bids we have had a significant impact on the local economy, helping to secure £2 million from grants, revenue and venture capital funding for local small and medium size businesses (SMEs). We were responsible for the creation of 17

additional jobs in in our region; and we played an active role in helping to secure a total of 49 contracts for businesses and NHS Innovation Fellows.

• We have continued to support partners in their ongoing journey towards digital interoperability. In the Lancashire

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and South Cumbria region we have supported the Lancashire Person Record Exchange Service (LPRES), which through its electronic sharing of data is improving

the quality of care for residents and saving around £2

million per year by joining up regional clinical record systems. We supported applications for the Global

Digital Exemplars, gaining four in the Merseyside area, with a total investment of £45 million. Our Transformation Through Innovation Fund and digital investment fund supported our Alliance regional partners to further develop their digital solutions for outpatients. We started a programme to develop a North West Coast Digital Strategy to position the region as a hub for digital innovation and a magnet for investment.

We supported an electronic transfer of care

system in East Lancashire Hospitals which led to a reduction in readmissions of 0.8 per cent, or 60

patients in a year, saving the trust £200,000. We have now been engaged by NHS England to spread

electronic transfer of care systems to 12 trusts in

our region, in a pilot study which will be evaluated by a university partner.

Our community of Innovation Scouts has grown from 50

to 70, including a new cohort of mental health Scouts and senior staff from local authorities and universities. One of our Scouts programmes has involved spreading the use of

3-D printing of organs before surgery, which is now adopted by three of our hospitals, reducing anaesthetic and surgery time for patients.

We supported the bid for the Lancashire and Cumbria

Innovation Alliance test bed and have been involved in

the rollout of technology into residents’ homes, with 100 residents now already benefiting from digital home solutions. We support the communications function of the programme; have a seat on the test bed Board and on the national adoption and spread steering group.

We were successful in our application for the region to be a three-star European Active and Healthy Ageing

Reference Site – this will allow us to enhance services for our older and frail residents, drawing together our existing programmes to support active and healthy living for our residents.

We have been an active supporter of our two Sustainability and Transformation Partnerships, sitting on Boards and working groups, offering a menu of support options and funding for region-wide programmes, eg the development of health coaching. We have worked with these regions to develop two roles for innovation adoption and spread. The post holders will be co-funded by the Innovation Agency and local organisations and will work across both regions to

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ensure the adoption/ adaption and spread of innovative practice.

We have continued to support the rollout of the 100,000 Genomes programme which in 2017/18 sequenced the genes of 350 patients with cancer and 110 patients with rare diseases across seven hospitals in our region, with an eighth to go live in April 2017. We established and funded the post of Genomics Ambassador/Project Manager and our CEO is Vice Chair of the programme Board and sits on the national 100,000 Genomes Steering Board.

We have worked in a supportive role with all our Local Enterprise Partnerships (LEPs) and our jointly funded post with Liverpool LEP has enabled us to be a part of shaping the life sciences and health strategy for the region and supported over £140 million of investment in the Liverpool City Region, worth over £140 million over the past year.

Our work supporting NICE Guidelines in relation to reducing alcohol harms in our region led to the publication of a report about understanding the barriers to uptake.

Full details can be found in our Annual Report for 2016/17.

4. Context 2017-18

NHS England outlined their strategy to respond to reduced funding for health and social care and an ageing population, in the Five Year Forward View; implicit in the paper is a move away from competition towards collaboration. The North West Coast response: NHS commissioners and providers have made significant progress in driving productivity improvements. The region has six NHSE Vanguards to design and test new ways of working;

• Healthy Wirral • Cheshire and Merseyside Women’s and Children

Services (Halton CCG) • The Neuro Network (The Walton Centre, Liverpool) • West Cheshire Way • Fylde Coast Local Health Economy • Better Care Together (Morecambe Bay health

community)

We also support a local ‘Rugby Vanguard’, alongside Halton CCG, using our local sports clubs to improve health of families. The Innovation Agency has given bespoke support to the vanguards in the areas of senior leader development, a diagnostic programme, system modelling, health coaching expertise and logic modelling, plus funding for the products to support the ‘specialist’ vanguards.

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The Innovation Agency was part of developing and applying for the Lancashire and Cumbria Innovation Alliance test bed, which is rolling out technology to support frail elderly people with dementia and other long term conditions to keep healthy at home. We have a seat on the Test Bed Steering Board and the SRO for the programme is the Chief Executive of our host organisation, Lancashire Care NHS Foundation Trust. In addition we have two Healthy New Town sites. There are 10 sites across the country covering more than 76,000 new homes with potential capacity for around 170,000 residents. This is an opportunity for the NHS to shape the way these new sites develop and to test creative solutions for the health and care challenges of the 21st century, including obesity, dementia and community cohesion. The two sites in the North West Coast are Halton Lea in Runcorn with 800 homes, in the areas of our partner Halton CCG; and Whyndyke Farm in Fylde, Lancashire with 1,400 homes, in the area of our partner Fylde Coast CCG. We have been working with these sites to identify digital health technologies which can be used to improve the health of residents. Sustainability and Transformation Partnerships (STPs)

More recently plans have been developed across health and care economies, building on the shared challenges in our regions;

the Healthier Lancashire and South Cumbria programme focusses on Healthier Lancashire and South Cumbria and has:

a strong focus on prevention, with a view to improving health and well-being and reducing avoidable deaths including those from suicide. This preventative approach also extends to early diagnosis of people with conditions such as diabetes and cancer and people with long-term conditions such as diabetes and heart failure will be given advice and tools to monitor their conditions.

a strong focus on mental health not just physical health and there will be more investment into GP services and community care. To ensure that services work together to support local residents and their families, health and social care will be joined up.

For those residents who need hospital care the quality of hospital care will be a key focus to ensure that residents receive the best care of their nearest hospital, or at a more specialist hospital where specialised expertise is required

The programme places greater emphasis on achieving sustainability by accelerating the priority initiatives within the local health and care economies and existing programmes to keep pace and momentum in delivery of known gaps – Carter, RightCare, Vanguards, LDPs, (ii) Introducing a population health model at scale across the footprint, with prevention strategies, comprehensive health promotion and wellbeing programme, community resilience and mobilisation, and support for people to co-produce health gains. This will maximise learning from Vanguards in developing comprehensive, wraparound, aligned mental health and physical health services for: urgent care; integrated primary and community services; prevention, self-help and education; and regulated care. (iii) A

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‘one service approach’ to acute physical and mental health services. The population based care delivery model to understand the impact and roadmap for implementation of: technology, workforce, partnerships and estates.

Cheshire and Merseyside 5YFV is England’s second largest STP area and due to the size and diversity of the region, is working in three smaller Local Delivery Systems – North Mersey; the Alliance (Mid Mersey) and Cheshire and Wirral. It includes the merger of the Royal Liverpool and Aintree University Hospitals and there is a focus on four themes:

Support for healthier lifestyles; Joint working with local government and the voluntary sector

to develop joined up care, with more of that care offered outside hospitals;

Designing hospital services to meet modern clinical standards and reducing variation in quality; and

Reducing costs in managerial and administrative areas, maximising the value of our clinical support services and adopting innovative new ways of working, including sharing electronic information across all parts of the health and care system.

The Innovation Agency is involved in supporting both regional programmes at a senior level and is co-resourcing posts in both programmes to support collaborative working and drive adoption and spread of innovation. We sit on working groups around high quality care and digital health, co-fund/ supported a number of programmes around health coaching, system modelling and reporting processes.

There remain significant technical opportunities to transform healthcare, particularly in digital health. The Government’s ambition is for paperless working in the NHS by 2018 and ‘digitally interoperable and real-time’ health and social care records by 2020. Local digital roadmaps have been developed to achieve these goals and trusts have been asked to fill out digital maturity assessments to underpin a new digital maturity index. 'Personalised Health and Care 2020' promised a new ‘digital front door’ for the NHS, combining NHS Choices and the NHS 111 service that replaced NHS Direct. NHS England’s ‘widening digital participation programme’ seeks to increase citizen engagement. The North West Coast is in a strong position, having four out of 16 Global Digital Exemplar trusts in the region: Royal Liverpool and Broadgreen University Hospitals; Wirral University Teaching Hospitals; Alder Hey Children’s Hospital and Mersey Care. In addition the test bed programme is using digital technologies to keep vulnerable people out of hospital. The Innovation Agency has supported major interoperability projects such as LPRES in Lancashire and iLINKS in Mersyside. Moving forward, we plan to capitalise on these strong foundations and using the building blocks of our CCG local digital roadmaps describe a bold digital strategy for the region. We will work with other partners to upskill both patients and professionals in digital tools and technology such that our region can fully realise the potential of digitally enabled healthcare and is recognised as a prime area for investment in this sector.

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5. Our Core Purpose and Goals

Core Purpose Our core purpose is to transform health, generate economic growth and advance technology’

• We are catalysts for the spread of innovation at pace and scale - improving health, generating economic growth and helping facilitate change across whole health and social care economies

• We connect regional networks of NHS and academic organisations, local authorities, the third sector and industry - responding to the diverse needs of our patients and populations through partnership and collaboration

• We create the right environment for relevant industries to work with the health and social care system.

In 2017/18 our goals focus on addressing priorities defined by local stakeholders; informing and supporting system transformation priorities; returning on inward investment generated last year; taking advantage of digital technology opportunities; and delivering our commitment to NHS Improvement to improve patient safety and build regional capacity to build and sustain a positive culture of ‘safety first’. This year will also be a transition year to more shared work with the national network of AHSNs, which will support the adoption of innovation between AHSNs and accelerate the learning about how innovation can be successfully adopted in different sectors of the health and care system.

We will focus on opportunities which strengthen healthy and active ageing; and cutting across all five goals is a commitment to integrate the management of physical and mental health. Goals

Goal 1: Support system transformation through the adoption of innovations that enhance quality and value

“The Innovation Agency informs and facilitates to introduce innovations through their expertise of proven innovations and what has worked elsewhere.”

An Innovation Agency Board member What we will do: The Innovation Agency is committed to supporting our two regional transformation collaborations to deliver system change. We are supporting formal structures of collaboration by championing a culture of innovation, and supporting organisations and systems to achieve a state of ‘innovation readiness’. This will in turn support service transformation and achieve optimal effective use of health and care resources. We will support the wider system by harnessing the diversity and talent of our members and connect people with shared goals through communities of practice; mobilising people on a large scale for improvement through innovation. We will create and facilitate opportunities for people to come together, share, learn and deepen understanding of common issues facing our systems.

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We are well placed to continue to support and develop a culture of innovation through creating a framework of the necessary skills required at all stages of the innovation pathway and providing tools and techniques to spread these across the region. What we will do: Support our STPs and regional programmes, with new roles,

which will adopt and spread innovation. Work in a consultancy style, to offer our ‘putting innovation into

practice’ programme, providing access to an on-line self-help toolkit and resources, access to knowledge and skills sessions and locally delivered workshops, working with university partners to develop accredited innovation modules.

Support the Innovation Scouts, Evidence Champions and the Q community to be engaged and positioned so that they maintain a clear focus on improvement through innovation, use digital solutions and develop an innovative culture across our systems to achieve better value in health and care. They will be invaluable in supporting effective transfer of knowledge, and will be a source of expertise for the wider health and care system through mentorship, coaching and virtual learning opportunities.

Continue to support the adoption of innovations (particularly digital) showcased on our Innovation Exchange, our on-line platform aiming to raise awareness of innovations for health and care services. Innovations will be clustered according to our partners’ priorities and care pathways and we will notify users of the platform when new innovations of relevance are identified.

Maintain collaborative work with universities, local and national improvement bodies; (Health Foundation, NHS Improvement,

North West Leadership Academy, AQuA and Haelo) to enable us to increase knowledge and skills across our system in quality improvement methodologies and evidence based improvement science, including for example an online Quality Improvement tool called LIFE.

Further develop our successful application of design thinking methodology to systems collaboration. The demand for training and coaching for our Massachusetts Institute of Technology (MIT) accredited hackathon events across our geography (and beyond) has increased as it proves to be an excellent way to support organisations and individuals to be innovative. Our hackathons will continue to energise people and allow participants to think differently and to find new ways of doing things to improve quality and increase value, further developing the culture of innovation and improvement that we work to embed. We will use this methodology to co-design and run a national Innovation Leaders’ Summit to identify and address the barriers to the adoption of innovation.

Supporting high profile spread and adoption programmes where we are a partner in either a regional, national or international community of interest. This maximises our access to the latest innovation and provides a platform to promote the adoption of local innovations, supporting our aims to spread innovation, improve health and economic growth. These include:

• Reducing strokes due to atrial fibrillation (AF) (through the national AF Community of Practice and our local AF Collaborative; medicines optimisation – a patient safety priority detailed in goal 4 (through the national MO Best Practice Collaborative);

• Healthy and active ageing (through the Northern Health Science Alliance and four Northern AHSNs) and

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• Spread of digital tools to support mental health (through the European Connected Health Alliance).

“Fantastic, creative training event – real opportunity to engage better with frontline staff and service users to reshape and co-produce what we need for future health and social care services” Michelle Cloney, Interim Director of HR & OD, Warrington Hospital Goal 2: Support innovation clusters and SMEs to drive economic growth “By working in partnership with the Innovation Agency, and using both their expertise and funding, we have been able to significantly advance our vision for Chorley to become a key hub for digital health business growth in the UK”

Cath Burns, Head of Economic Development, Chorley Council

“The Innovation Agency demonstrated a deep understanding of the strategic economic development plans for the Lancashire region, and offered great value in linking these to the opportunity to support SMEs in healthcare and digital sectors, and the ultimate goal of improving health and wealth in Chorley”

Clive Noak – Business Case Developer, Strawberry Fields Digital Hub, Chorley

What we will do: The Innovation Agency has already played a significant role in supporting the development of health innovation centres and we will continue to support their development by recognising the key links and commonalities for the regional innovation centres, support them to optimise the strategic positioning, purpose and profile of each centre and promote the network of centres to drive investment into the North West. We will support health innovation centres to develop their networks and enhance each centre's capability to capture grants and attract investors. We will develop a strategy for showcasing the centres nationally and internationally, building on, but not duplicating, the plans and activities of the individual centres and LEP support already provided. The aim of this showcasing is to ensure that innovative health products are developed and adopted in our region and beyond, In 2017-18, in partnership with our Local Enterprise Partnerships and supported by European Regional Development Funding, we will focus on providing greater support to small and medium sized businesses, enabling the adoption of innovative technologies to secure sales growth and inward investment. Our medium term goal is for the Innovation Agency to become a nationally leading host for healthcare business support programmes.

We will focus on providing SMEs with opportunities and support to work with centres across the region, to help facilitate product development and grow innovation based on good evidence and planning. We will also help SMEs to articulate unmet needs within

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the healthcare system and foster collaboration to assess needs, co-create solutions, commercialise practitioner led innovations and de-risk change. In order to achieve this, we will: Map health innovation centres across the region highlighting key

assets and describing these assets as a regional asset base. We will provide this map to each centre to enable them to collaborate or develop a differentiated position.

Link the strengths of the region to the northern powerhouse agenda and nationally through Innovate UK and use international partnerships and activities to showcase as appropriate

Connect each centre to our networks in the UK and abroad Support funding applications Link the regional innovation centres to STP innovation leads,

and work with those centres to make direct links to NHS providers and commissioners

Understand the SME offer from each centre and act as a single (but not exclusive) access point to all centres

Establish a group with a lead from each centre and plan a major event to showcase the region.

Identify pathways to adoption for innovations to become commercially viable and support each centre to put innovation into practice to reduce risks to investors and funders

Deliver a business support function to SMEs

Support local SMEs to access European markets through the EIT Health programme and provide business support to three European SMEs, funded by EIT Health

“Thanks to the support of the Innovation Agency through 2016, 3D LifePrints has maintained its existing workforce and hired an additional two staff members in the region. The new grant from the Innovation Agency ‘Transformation Through Innovation’ fund in 2017 will enable 3D LifePrints to hire a further two staff to work in and around Royal Liverpool and Broadgreen Hospitals and Liverpool Heart and Chest Hospitals.”

3D LifePrints CEO Henry Pinchbeck

Goal 3: Driving adoption of digital innovation What we will do: We will drive and support the introduction of digital technology to bridge the gap between citizen demand and capacity, focusing on national priorities of mental health and long term conditions such as chronic obstructive pulmonary disease (COPD), cardiovascular disease and dementia. We already play a leadership role in the Connected Health Cities programme which unites local health data and advanced technology to improve health services for patients in northern England. This programme aligns with our objective to make better

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use of the information and technology that already exists in our health and social care system to improve the health of patients and ensure services are more joined up. By working with patients, health practitioners and experts in digital health we will deliver research that is relevant, effective and has a real impact on public health. We will accelerate the adoption of digitally enabled self-care by working in partnership with key stakeholders in the health, social care and third sectors, who have demonstrable capacity to drive major change within the local health economy We will achieve this by building on the existing CCG local digital roadmaps. A regional strategy is in development and support will be provided to enable collaboration, spread knowledge and best practice, and develop the NWC as a geography that is ‘digitally ready’ for research and investment. We will support the diffusion of knowledge and technologies from the Global Digital Exemplars in the North West Coast (Royal Liverpool and Broadgreen University Hospitals NHS Trust, Alder Hey Children’s NHS Foundation Trust, Wirral University Teaching Hospital NHS Foundation Trust and Mersey Care NHS Foundation Trust) to other providers. In order to achieve this: We will focus on implementation of digital projects in each one

of our principal goals (digital as a cross cutting theme). Digital projects are described in the programmes to deliver each goal.

We will work at a system level to: Map STP, CCG and provider (including Digital Exemplars)

digital road maps identifying opportunities for collaboration and spread of innovation across the North West Coast

Share collaboration and learning opportunities with key stakeholders, and facilitate partnership working to accelerate uptake of innovation

Provide support to our ongoing digital projects e.g LPRES, digital outpatients, app development etc

Showcase examples of digital innovation on our Innovation Exchange and match innovation to stakeholder needs

By mid-year we will have identified three showcase examples (at least two of which will come from the Global Digital Exemplars) and support widespread implementation across the North West Coast

Goal 4: Deliver NHS Improvement Patient Safety Collaborative programme “… Avoidable harm should serve as a golden thread linking through the patient safety initiatives …”

An Innovation Agency Board Member A national network of 15 Patient Safety Collaboratives is funded by NHS Improvement to provide safety improvements across all healthcare settings.

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The Collaboratives are led by the 15 Academic Health Science Networks to tackle the leading causes of avoidable harm to patients. The Collaboratives empower local patients and healthcare staff to work together to identify safety priorities and develop solutions. During the coming year the Collaboratives will work jointly across England on a number of key priority areas and we will take a lead role in at least two of these national workstreams, accounting for around a third of our total programme:

The ‘deteriorating patient’ will focus on the early detection and treatment of sepsis and acute kidney injury

Maternity

Mortality

Building a safety culture within organisations with a focus on human factors

In addition we will continue to deliver a local patient safety programme informed by the needs of our stakeholders through our patient safety expert group. This programme includes: Atrial fibrillation: We will continue our work to deploy detection

technology and encourage adoption of the CCG AF dashboard; we will incorporate genomic testing and patient held testing for warfarin patients (aligned with Goal 1).

Point of care testing: We will evaluate the use of a novel technology in a primary care setting aimed at improving antibiotic stewardship and identifying sepsis.

Medicines optimisation: We are introducing pharmacists into GP practices through the ‘closing the gap’ programme and will evaluate their impact on prescribing safety and efficiency; Additionally the electronic transfer of care programme will share medication, admission and discharge details between acute hospitals and community pharmacies which we are introducing into the region and plan to deploy across our provider network.

Falls: the award winning regional programme ‘Steady On’ will be deployed into care homes and is designed to identify those residents at risk of falls who could benefit from early intervention.

Care home programme: We will upskill staff working in this sector with e-learning packages and deploy tools such as the Anticipatory Care Calendar. This work will enable the early recognition of conditions such as dehydration or sepsis and allow timely intervention, avoiding hospital admission.

Fracture prevention: we will work with our CCGs to proactively identify those patients at risk of osteoporosis and fracture ensuring that preventative medication can be offered. In the known high risk group will we also perform a review of treatment ensuring it remains clinically appropriate. Ultimately we aim to reduce hip fractures.

Capability building: We will share knowledge with partner organisations with whom we will work collaboratively to produce a workforce skilled in change management methodologies and ready to adopt innovation. This will include work delivered on our behalf by AQuA; Q Fellows; Clinical Evidence Champions; Innovation Scouts.

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Goal 5: Collaborate with the Network of AHSNs

To optimise the scale of transformational innovation. The Innovation Agency will be recognised as a leader of this shared national purpose.

“The Innovation Agency is the only place where NHS organisations can engage with other groups about the wider health and social care agenda.”

Nikki Allen, Head of Medical Directorate, NHS England To gain greater benefits for service users we will place more emphasis on the role of the Innovation Agency as a member of a network of 15 AHSNs, leveraging this network to import good ideas from other parts of the health and care system and to export innovation which has delivered local value. The Innovation Agency will be an ‘agent for change’ in: accelerating the adoption of innovation across health and care prioritising a process for collective working, where AHSNs

converge on projects and specific functions and deliver the benefits of dissemination at scale

developing capability and disseminating knowledge of ‘what works’ in spreading innovation across the health and care sector by further development and sharing our Putting Innovation into Practice programme

making the linkages between health and social care so that innovation can be applied across both sectors for the benefit of residents

6. Income and Impact Income We will generate income from multiple sources:

• We are granted a licence to operate as an Academic Health Science Network by NHS England, and receive income which covers a proportion of our costs.

• We grow our business by securing inward investment to benefit our stakeholders; we retain sufficient funds to cover costs of servicing additional activity.

We currently generate income from a number of sources including

• NHSE (AHSN licence specifications, specific projects eg technology implementation)

• NHSI (national patient safety programme) • ERDF and EIT Health (SME support services) and Horizon

2020 (innovation procurement projects) • Department of Health (Connected Heath Cities) • Companies (e.g. Joint working agreements with pharma) • Health Foundation (patient safety grant)

Our target for 2017/18 is to maintain our total income and drive value from this resource and to source additional income for 2018/19 onwards.

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Impact Before each project is started and when each project concludes, significant thought is given to how impact is demonstrated and evaluation takes place. At the end of each project we will strengthen our focus on analysing and communicating the impact of our work, with simple messages about how to adopt the particular innovation. This will enable service leaders to assess the value of adopting each innovation and will support widespread adoption across the North West Coast and the whole of the NHS.

In addition to publishing high impact case studies we measure our impact using metrics which all 15 AHSNs have agreed with NHS England:

• £ Inward investment • number of citizens benefiting from AHSN activity • number of sites that have implemented AHSN led or

enabled innovations • number of innovations that have been implemented and

spread • number of contracts awarded to supported companies

These metrics will be developed further in 2017, alongside revised Patient Safety and Accelerated Access Review metrics.

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Contact us: Email: [email protected] Website: www.innovationagencynwc.nhs.uk Mail: Vanguard House Sci Tech Daresbury Keckwick Lane Daresbury Halton WA4 4AB Tel: 01772 520263 or 01772 520262

Follow us on: Twitter @innovationnwc LinkedIn Facebook YouTube

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Appendix 1 – Projects which will deliver our principal objectives 2017/18 Project name: Specific objectives

Q1 milestone Q2 milestone Q3 milestone Q4 milestone Year-end impact

Goal 1 : Support system transformation through the adoption of innovations that enhance quality and value 1.1 Enhance capacity for

FYFV/STP footprints

to adopt and embed

proven innovations.

Embed a jointly funded member of Innovation Agency staff into the FYFV footprint and STP footprint to work across boundaries, understand challenges, capture lessons learned and work to implement programmes of work focused on adoption of innovation.

Agree job description, recruit to joint posts.

Set objectives with post holders

Monitor objectives and contribution to adoption and spread of innovation across the two systems

Evaluate delivery of agreed objectives Produce lessons learned report

Impact stories resulting from spread and adoption support for STP programmes (Inc vanguards etc)

# sites using different innovations

# Innovations implemented

# STP projects delivering value within North West Coast exported to STPs through the AHSN Network to benefit other regions

# contracts awarded to companies to deliver STP priorities

1.2 Improve capacity for FYFV/STP to Put Innovation into Practice (PIP)

Work with two organisations to improve their innovation readiness

Work with two organisations to improve their innovation readiness

Work with two organisations to improve their innovation readiness

Evaluation of bespoke PIP programme produced.

#adoption and spread projects set up as a result of bespoke input with

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2017/18 Project name: Specific objectives

Q1 milestone Q2 milestone Q3 milestone Q4 milestone Year-end impact

Develop a bespoke consultancy approach (based on our Putting Innovation Into Practice Programme with organisations/system. Undertake activities within organisations and across systems to enable coaching/training/education in order to build ‘innovation readiness’

organisations

1.3 Facilitating adoption accelerators as vehicle for effective adoption of innovation

Create shared goals and common interests aligned to FYFV/STP and Innovation Agency priorities. Providing structure, facilitation of skills and knowledge and head space for collaborative action that increases value across the whole system of health and care.

Innovation Scout programme evolved into two ‘adoption accelerators’ that can focus on priorities in the FYFV/STP and support the system to engender innovations and new ways of working into plans and designs. Create a programme of wraparound support using PIP methodology created.

Continued support for ‘adoption accelerators’ with regular team coaching and facilitation.

Continued support for ‘adoption accelerators’ with regular team coaching and facilitation.

‘Adoption accelerators’ evaluated; evaluation findings used to decide to continue or change focus.

#adoption and spread projects set up as a result of bespoke interventions by adoption accelerators

1.4 Evidence Champions programme

Continue delivery of the programme alongside Centre for Excellence in

Continue delivery of the programme alongside Centre for Excellence in

Evaluate programme to determine future commissioning.

Deliver event to showcase work projects. Iterate development of

Participant case studies of using evidence-based

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2017/18 Project name: Specific objectives

Q1 milestone Q2 milestone Q3 milestone Q4 milestone Year-end impact

Through our commissioned educational support, develop leaders within commissioning organisations that are provided with the knowledge and skills for evidence based approaches to clinical commissioning.

work-based learning (CETAD)

work-based learning (CETAD)

programme with CETAD. commissioning

1.5 Innovation Exchange:

Use our database of local and national innovations (including the NIA programme), we will highlight innovations which have greatest opportunity to deliver regional objectives.

Link the Innovation Exchange with that of Y&H AHSN And improve the website to provide greater visibility of innovations. Align innovations along pathways of care/FYFV/STP priorities. Assessment criteria defined and all innovations measured against these

Innovation Exchange promoted across the North West Coast through ongoing comms campaign. Phase 1 ‘adoption accelerators’ showcasing innovations and relationships brokered between SMEs and providers to enable adoption.

Support adoption of innovations for each transformation region assessed as ‘most likely to succeed’ (aligned with need and demand) with spread and adoption Cheshire & Merseyside, Lancashire and South Cumbria)

Support innovations for each transformation region assessed as ‘most likely to succeed’ Learning from use of Innovation Exchange captured and evaluated and effectiveness determined. Achievements celebrated at Scouts event.

# sites using different innovations

# innovations implemented

1.6 Increase capabilities for organisations and wider system to benefit from hackathons

Develop the Innovation Agency/ MIT Hackathon brand and increase the capacity for organisations and whole systems, to deliver hackathons as a

Develop the hackathon offer for local STP/FYFV needs. Develop hack evaluation method and follow up of solutions.

Deliver 1 Coached hackathon 1 Hackathon training

Deliver 1 Coached hackathon 1 Hackathon training

Evaluation of hackathons delivered to assess system impact in terms of adoption and spread of designed solutions. Determine future use of hackathon methodology.

# system-wide Innovations implemented

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2017/18 Project name: Specific objectives

Q1 milestone Q2 milestone Q3 milestone Q4 milestone Year-end impact

method of using design thinking to tackle ‘wicked’ system problems, accelerating development of diverse teams who work on issues and support a culture of innovation that is sustained.

1.7 Leadership for Innovation Summit

Work with MIT and local system to co-design a national event that identifies, raises awareness and tackles barriers to the adoption of innovation.

Co-design workshop and Summit with MIT Hacking Medicine Start workshops with front line staff Confirm key stakeholders for Summit

Complete workshops. Agree themes for the Summit

Hold National Innovation Leadership Summit with key stakeholders and agree actions to be taken regionally and nationally to address the barriers to adoption of innovation

Write up and sharing of lessons learned.

1.8 Refocus ecosystem events

Introduce systematic collections of actions and evaluation of the impact in terms of adoption and spread of the innovations showcased and shared at each ecosystem event

Hold Eco12 on digital methods of working with mental health issues and open to key regional/ national stakeholders Explore collaboration with Northern AHSNs to increase impact

Introduce hosting agreements so that the system supports the events through venue sharing etc Hold Eco 13

Hold Eco14 Review impacts of Eco 12 Hold Eco15

# innovations implemented

1.9 Reducing strokes caused by atrial fibrillation (AF)

Develop procurement framework for Alive Cor Kardia in line with NHS England guidelines.

Deliver training and innovative devices for 20 practices

Complete training roll-out. AF Champions recruited and trained

AF Champions active in campaigns and other activities

# of CCGs working

with us to improve AF pathway

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2017/18 Project name: Specific objectives

Q1 milestone Q2 milestone Q3 milestone Q4 milestone Year-end impact

Work with the regional AF Collaborative – introducing a package of training, technology, case-finding and quality improvement for GP practices

Introduce systems for using new technology and digital systems to support patients (genotype guided dosing, self-management, apps, CCG AF dashboard); providing patient focussed campaigns to raise awareness of AF.

Train community AF champions in partnership with the Stroke Association.

Recruit a further 20 practices from two more CCGs (wave two) Recruit two sites for self-monitoring and genotype dosing.

Review AF dashboard utilisation data. First wave practices evaluations completed.

Second wave practices evaluations completed. Monitoring for sites and recruitment of two more CCGs. Evaluation of MyDiagnostick. Feedback from CCGs re utility of dashboard via survey monkey or similar

Update AF dashboard, based on feedback. Review evaluations of wave 1 and wave 2 practices.

# GP practices working with us

# reduction of AF related strokes

# patients we have newly identified with AF as part of our work

# patients who are managed within NICE guidance

#patients who receive genotype guided dosing for warfarin

#patients using warfarin who are self-monitoring

# AF champions active in the region

# increase in patients with AF who are anti-coagulated

# of detection devices deployed.

1.10 Mental health innovation

To improve mental health using digital innovation.

Priorities agreed for adoption with the MH Innovation Scouts, in line with national priorities. Digital Ecosystem event held showcasing national and international

Agree bespoke support to each organisation to support the adoption of innovation

Impact stories resulting from spread and adoption support

# innovations

implemented

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2017/18 Project name: Specific objectives

Q1 milestone Q2 milestone Q3 milestone Q4 milestone Year-end impact

examples of best practice

1.11 Active and Healthy Ageing (AHA)

To improve healthy life years by two years per adult over the next 5 years.

Agree programme with Northern AHSNs and national clinical director to maximise the impact of our reference site status

Plan delivery programme across the North Plan and issue invites for a Northern AHSN AHA symposium.

Deliver Northern AHSN AHA symposium and case study showcase as a call to action for the region. Publish good practice case studies and select those for adoption.

Commence delivery programme.

# innovations adopted

# organisations adopting innovations

1.12 Review projects funded through Innovations with Impact (IWI) and Transformation Through Innovation (TTI) funds.

In 2015/16 the Innovation Agency funded 18 projects to support adoption of innovation; these projects are now coming to an end. In 2016/17 12 projects supporting STP and 5YFV priorities were funded through our Transformation Through Innovation (TTI) competition and these will be monitored across the year

Reviews completed for all IWI projects that have completed, including lessons learnt and proposals to support further spread and adoption for those that have had an impact. Quarterly monitoring reports completed for TTI projects. This includes health coaching and reducing outpatient appointments by using digital methods of working.

Quarterly monitoring reports completed for TTI projects.

Quarterly monitoring reports completed for TTI projects.

Evaluation reports completed for TTI projects that have completed, including lessons learnt and proposals to support further spread and adoption for those that have had an impact. Quarterly monitoring reports completed for TTI projects not yet completed.

# innovations adopted

# organisations adopting innovations

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Goal 2: Support innovation centres and SMEs to drive economic growth 2.1 Support the development of Innovation centres: In 2016/17 we supported regional centres to secure funding, develop their business plans and establish partnerships; we have established collaboration agreements with each outlining how the Innovation Agency will collaborate with each of them.

Map health innovation centres across the region highlighting key assets and describing these assets as a regional asset base. We will provide this map to each centre to enable them to collaborate or develop a differentiated position. Establish a regional group with a lead from each centre and plan a major event to showcase the region.

Link the strengths of the region to the northern powerhouse agenda and nationally through Innovate UK. Make appropriate introductions to forge potential collaborations with international network. Produce a presentation to showcase the regional centres at appropriate events and conferences and online. Have a clear plan in place with each centre to support their specific needs

Collective plan agreed with all centres outlining the role we will play (alongside the centres themselves, LEPs and other sub-regional support agencies) to support inward investment and capability development with the region. Regional showcase event held.

Network of innovation centres established with clear evidence of collaboration between members of the network eg joint projects, collaborative bids, joint events.

£ inward investment

# new tenants in innovation centres due to significant activity by the Innovation Agency

# businesses locating in the region

£ grant funding into Innovation Agency

£ grant funding into regional partners where we supported applications

# innovations adopted

# organisations adopting innovations

2.2 Develop and deliver ERDF funded Business Support Service: a healthcare business connect service supporting approx. 280 SMEs across 3 projects with delivery partners; creating 100 new jobs over the next 3 years and over 70 new healthcare products.

16 businesses supported 2 new products

developed Communications plan agreed with key stakeholders (e.g. growth hubs, LEPs, Bionow and Medilink) to ensure clear message to SMEs regarding support available.

20 businesses supported 3 new products

developed Communications plan implemented

21 businesses supported 3 new products developed 3 new products to market 2 jobs created

17 businesses supported 5 new products developed 4 new products to market

# businesses supported

# jobs created

£ funding into SMEs

# new products to market

# Contracts awarded to companies

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supported and £ value

# new to company products

2.3 Develop capability and capacity to win investment and increase inward investment in grants and private capital: A new post was created in November 2016 to target funding opportunities for the Innovation Agency, regional partners and local SMEs. The post will focus on identifying opportunities, bid writing, securing external funding and delivering funded projects. By winning additional income for the region from national and international opportunities such as Horizon 2020, SBRI and EIT Health. It is our aspiration to secure sufficient external funding to create new jobs within the NWC region and the Innovation Agency itself and deliver projects that will transform how care is delivered.

Submit 2 bids to EIT Health for 2018 funding. Update the funding landscape report and identify potential opportunities for the Innovation Agency, network partners and local SMEs to apply for.

Submit, or support partners / local SMEs, to submit applications to at least 2 opportunities

Submit, or support partners / local SMEs, to submit applications to at least 2 opportunities

Submit, or support partners / local SMEs, to submit applications to at least 2 opportunities

£ grant funding into Innovation Agency

£ grant funding into regional partners where we supported applications

# innovations adopted

# contracts for business and £ value

2.4 Successful delivery of EU funded innovation projects:

Detailed project plans in place for all 4 projects for 2017/18. Deliver projects to plan

Deliver projects to plan and on budget with partners

Deliver projects to plan and on budget with partners

Deliver projects to plan and on budget with partners

# innovations adopted

# organisations

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StopandGo

ENSAFE

Ritmacore

P/M Fit

SHIELD

and on budget with partners

adopting innovations

# contracts for SMEs

£ funding into region

Goal 3: Drive adoption of digital innovation 3.1 Develop a Regional Digital Health Strategy.

Building on the existing CCG digital roadmaps a regional strategy will be developed and implemented. This will spread knowledge and best practice, enable trans regional collaboration and describe the NWC as a geography that is ‘digitally ready’ for research and investment.

Aspiration and ambition defined via Vision, Primary Aims, Drivers and KPIs Draft primary aims with local DH representatives in place and consensus built around shape and positioning of a regional strategy Progress communicated to stakeholders (health care partners)

Progress to date locally plus local assets reviewed and potential regional value add identified ‘Use Cases’ collated to explain the changes in leading DH enabled services for health care professionals and members of the public Potential resources and funding to support further regionally aimed initiatives identified Progress communicated to stakeholders (health care partners)

Prioritisation of potential opportunities completed to create potential multiyear waves of change A ‘data saves lives plan’ in place (digital health 3yr plan) with supporting initiatives Potential for the creation of a digital health hub with potential B2C ecommerce explored Progress communicated to stakeholders, now including the general public

Ideas for ongoing programme management / to carry out further yearly strategic evaluations identified and proposed Priority digitally enabled change for the coming year clarified further and confirmed Progress communicated to stakeholders , now including the general public

# Sites implementing digital platforms or technologies

# digital technologies adopted

3.2 Connected Health Cities: Develop and engage with citizens regarding patient information; implement information sharing

CHC governance and teams established Creation of the Ark Creation of suitable

Additional NHS data sites identified (primary and secondary care) Additional social care data sites identified

DARs applications for all sites identified in Q2 submitted SME engagement process defined and implemented

Identification of items for scale and spread Development of data visualisation tools – framework for testing and

Data flows from NHS Digital established

Analysis of data begins in target clinical areas

Early insights emerge

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agreements between organisations; link and analyse data sets in COPD and alcohol; deliver digital workforce development plan; implement plan for industry; identify key CCGs to start the implementation of the connected health cities vision and roll-out; deliver a robust approach to clinical engagement;

system to receive NHS Digital data DARs application for Liverpool CCG assessed and received Analyst team in place to review data Preliminary analytics conducted – phase 1 algorithms Patient Senate established and meeting regularly Information Sharing Gateway in place in the Ark Framework for public engagement established Framework for working with industry established Engagement event delivered (Lancs and Liverpool) Technical requirements re speed of access defined Map of digital skills providers and organisational support identified

Preliminary – phase 1 reports from analysis provided Engagement structure for algorithm outputs established Pathway framework defined Defined workforce plan Big data programme mapped and agreed Engagement with BI – map of requirements Data adoption pathway process mapped and business support identified CHC evaluation defined Delivery of Digital workshops/similar Protocols for research developed.

Review of data visualisation tools and liaison with end users Phase 2 algorithms created and run Links with key hospitals and community services established re outputs Links with community, GP and Social Care established

evaluation developed Process for trialling consent prototype model established Phase 2 reports disseminated Patient journeys mapped and interventions identified Staff survey report delivered Data applications/arrangements for Phase 3 in development

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Digital Think Tank established CTEAD Modules designed PhD student recruited NHS Clinicians seconded

3.3 Provide support to

our ongoing digital

projects e.g LPRES, digital outpatients, app development etc

Monitor projects and provide support for adoption and spread

Monitor projects and provide support for adoption and spread

Monitor projects and provide support for adoption and spread

Monitor projects and provide support for adoption and spread

# number of digital records # of reduced outpatient appointments

Goal 4: Deliver NHS Improvement Patient Safety Collaborative 4.1 Develop a network of patient safety champions; Create a community of practice with a common purpose to improve the quality of care in our region. Providing opportunities for people to come together as an improvement community – sharing ideas, enhancing skills and collaborating to make health and care better.

Recruitment window for NWC 9/3 – 10/4. Q promoted through comms plan, webex information calls held, assessment training for assessors completed. Applications collated and delegated to assessors by 14/4. Plans for national collaborative Q event to be held in NWC in place and agreed with Health Foundation

Assessment completion deadline 15th May, borderline meeting review held and final agreement reached. Progress report to Health Foundation completed. Feedback to all unsuccessful applicants completed. Comms to new members. Welcome event hosted. Plans for national Q event with Health Foundation finalised

Work with members to develop forward plan developed with members, members to support agreed STP/FYFV/IA priorities. Agree members to deliver improvement workshops/webinars Deliver agreed Q activities National Q event in NWC with Health Foundatiion held

Networking of networks of patient safety champions to ensure adoption and spread of good practice across the region,

# people participating in the patient safety champions and Q-fellows network

Connected community of more than 200 quality improvers across the NWC. Evaluation through RAND and Health Foundation. Programme of work that Qs are supporting.

# diagnostic technologies in use and patients

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diagnosed

# people trained in skills which will improve patient safety

High impact story detailing knowledge of the journey through the system for those with

4.2 Implement Life QI system Manage the implementation and use of the online Quality Improvement platform across the North West Coast.

Plan for launch and management of system developed. Users increased from 50 – 100.

Ongoing support and liaison with developers provided to ensure continued usage and increased users.

Usage report Evaluate system and publish findings and recommendations.

#active users on QI Life system

4.3 Antibiotic point of care testing: Evaluate novel POC products in a clinical setting as enablers to the Sepsis Identification and Antimicrobial resistance work streams.

Clinical partner to pilot a POC test identified Academic evaluation partner identified Clinical and academic evaluation protocol agreed

Patients recruited in to the evaluation (approximately 400)

Results evaluated Findings and recommendations published

Evaluation gives a clear steer for the adoption and spread of point of care testing

4.4 Genotyping:

Implement genotyping to guide the use of warfarin in order to improve the risk benefit ration. (See also Atrial Fibrillation section 1)

Data collection from Phase 1 completed (University of Liverpool) Analysis plan for evaluation in place Agreement and roll-out programme for three

Data collection for Cheshire sites completed Draft Cheshire evaluation complete Cheshire next steps and actions discussed.

Cheshire impacts and actions taken forward. Cheshire evaluation findings incorporated into Lancashire forward plan. Implementation on third Lancashire site

Lancashire Evaluation and programme ongoing. Patients being recruited Feedback from patients feeds into evaluation and development of the service.

Case for Genotype dosing made to NHS England and other potential funders

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Lancashire a/c services developed Evaluation framework in place for Phase 2. Partnership with Stroke Association Established and AF Ambassadors recruited

Training and support for Lancashire sites completed Implementation of genotype service in 2 sites Activities scheduled for AF Ambassadors Collaboration with the North East programme established and joint workshop agreed

Lancashire evaluation in progress Patients recruited at sites AF Ambassadors active in regions Genotype workshop delivered and evaluation findings included

Case for Genotype dosing made to NHS England Awareness of the programme raised at NHS E level and AHSN network level

4.5 Development of the Steady On falls programme: Implement technology to improve prediction of falls through history and citizen questionnaires and direct use of physio and occupational health resources to where they can have greatest impact.

Purchase technology and train staff in using the technology in community settings. Identify community settings and care homes where technology can be used to highlight risks of falls with residents

Complete a series of workshops using the technology. Establish a baseline using a patient questionnaire of their perceived risk of falling. Using the technology to identify mitigate the risk. Rollout to Care Homes across east and central Lancashire. Will provide training to staff in care homes on falls and the prevention of falls.

Follow up with those residents to see if there has been any improvement. Complete another set of workshops To work Care Homes across east and central Lancs. Will provide training to staff in care homes on falls and the prevention of falls.

Evaluate results to see if using the technology has resulted in falls being prevented, Whether highlighting the risk of falls to residents prevents falls. To work in care homes across east and central Lancashire. Will provide training to staff in care homes on falls and the prevention of falls. Evaluate care home training using baseline data and NWAS call outs Provide case study and recommendations

# number of falls prevented

#number of reduced admissions to hospital

4.6 Medicines Optimisation: ‘Closing the Gap’ project to introduce specialist clinical pharmacists

Collaborating GP practices identified. Pharmacists embedded and medication reviews

Evaluation and results Publish findings and recommendations to Executives

Two new partnerships with GP surgeries established

# number of patients receiving a

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begin

medication review Pharmacist

recommendations quantified in terms of 1. Prescribing Safety Impact (clinical examples) 2. Prescribing Efficiency Impact (costs saved)

4.7 Care Home Safety Programme

Develop and deliver a programme to manage deteriorating conditions of care home residents to prevent hospital admission

To start roll out of programme, within North West Coast across a series of care homes. Establish a base line of data with regards to number of call outs to GPs, ambulance services and residents taken to A&E in each care home participating Ensure the ACC tools and Sepsis and AKI learning are fit for the elderly care home sector – work with clinicians to establish this. To complete digitalisation of the ACC and pilot with care homes. Establish whether using the early warning score alongside the ACC will provide better care and monitoring of deteriorating conditions

Monitor the pilot with quarterly results against the baseline. Complete financial modelling of cost saving based on 1st quarter to show/identify any cost savings Using Qualys identify quality to residents health in being identified early Disseminate the findings of the survey to key stakeholders whether by a paper or an event for care homes in the North West Coast

Monitor the pilot with quarterly results against the baseline. Evaluate the pilot, publish results

Develop a project plan for scaling up and adoption nationally using the results from the pilot

# Number of care homes participating in the scheme

# Patients evaluated using the tool

Demonstrate impact on GP visits (anticipate reduction)

Demonstrate impact on hospital admission (anticipate reduction)

Demonstrate feasibility and acceptability for care home staff using the tool. Refinements made subject to feedback received.

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Work with local areas on the NHS England framework for Care homes Undertake a survey within the NWC area to establish what is already being carried out in Care Homes. Establish good practice

4.8 Fracture Prevention Project

Identify patients at risk of fragility fracture and support effective preventative treatments to avoid hospital admission

Identify locations with patients at greatest risk of hip fractures Engage relevant CCG and GP practices for collaboration

Initiate assessment process based on 1. Calcium/Vit D therapy

review 2. Review practice

registers to identify high risk patients for osteoporosis

3. Review of patients on bisphosphonate therapy

Continue patient review process

Evaluate project and produce recommendations report for spread and adoption

# number of participating practices

# number of patients reviewed

# number of therapy interventions made based on review findings

# number of hip fractures avoided based on intervention

4.9 Provide clinical and commercial support to the 3 Patient Safety Hackathon winners

Support project owners to scope their innovations for feasibility.

Support project owners to form effective partnership collaboration arrangements.

Provide coaching and mentoring support for project development

Assess feasibility for the concept to enter the Innovation Pathway/ for adoption and spread via the AHSN Network or other routes

Evidence of collaborations created

#Products fit to enter Innovation Pathway

#hours coaching/support received

Number of successful funding bids

4.10 Electronic transfers of care: support organisations to improve communication, clinical workflow and more effective transfers of care,

Demonstrator events supported at 2 hospitals. Establish operational protocols and governance Evaluation framework

Rolled out to further 3 Trusts Evaluation of programme underway

Rolled out to further 3 Trusts

Evaluation programme reports.

£ Hospital savings

# reduced numbers of readmissions

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for sending discharge summaries to GPs using direct electronic transmission to send and receive discharge summaries.

established

4.11 Electronic Prescribing (EPACT 2 databased roll out): Working with NHSBSA to develop training resources to capitalise on the introduction of the new ePACT2 prescribing database. The new improved system will allow near real time downloads of prescribing data to individual practice level opening opportunities for greater insight into prescribing safety and efficiency.

Training resources developed with BSA Moodle platform developed Go live with early adopters completed CCG/GPs engaged in learning events

Case study developed

Rolled out across early adopter GP practices

Lessons learned to inform future rollout and action plan developed for adoption and spread

#Sites implementing ePACT2

Benefits of ePACT2 for prescribing efficiency and audit identified for spread and adoption

Goal 5: Collaborate with the Network of AHSNs 5.1 Continue to support the National Innovation Accelerator programme

Identify those NIA products which fit with local need

Use our Adoption and Spread posts in STPs to draw up delivery plans for the product

Adoption and spread of products

Adoption and spread of products

#NIA products spread across the system including health coaching, NIC, AliveCor, episcissors

5.2 SBRI product adoption

Support companies who have been awarded grants to translate investment into

Identify those SBRI products which fit with local need

Use our Adoption and Spread posts in STPs to draw up delivery plans for the product

Adoption and spread of products

Adoption and spread of products

# SBRI products spread across the system

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sales within the NWC region and nationally. 5.3 Accelerated Access Review implementation (this goal may be subject to change depending on national policy)

Acceptance of an AHSN programme to deliver the AAR

Detailed project plans in place to horizon scan for AAR potential products

Deliver products to plan and on budget with partners

Deliver products to plan and on budget with partners

#AAR transformational products spread across the system

5.4 Continue to support the 100,000 Genomes Programme

Provide strategic leadership, support for programme management and adoption and support to the GMC and the 100,000 Genomes Project

Support the roll out of genome sequencing to patients with cancer and rare diseases

Support the roll out of genome sequencing to patients with cancer and rare diseases

Support the roll out of genome sequencing to patients with cancer and rare diseases

Support the roll out of genome sequencing to patients with cancer and rare diseases

Regional targets met

5.5 Innovation Technology Tariff: Facilitate deployment of technologies identified through the Innovation Technology Tariff: 1) Guided mediolateral episiotomy to minimise the risk of obstetric anal sphincter injury 2) Reduction of bacterial contamination and accidental administration of medication 3) Prevention of ventilated associated pneumonia in critically ill patients 4) Applications for the self-management of Chronic Obstructive Pulmonary Disease 5) Frozen Faecal

NHSE Webinars promoted across the NWC region to all commissioners and providers Suitable clinical partners for the deployment of the innovations identified.

Collaboration plans for spread and adoption agreed with NHS partners and suppliers

Implementation of programmes

Evaluation report detailing level of adoption and health economics.

# ITT products spread across the system

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Business Plan 2017-2018

36

microbiota transplantation (FMT) for recurrent Clostridium difficile infection rates 6) Management of Benign prostatic hyperplasia as a day case 7) Mobile ECG

5.6 Test Bed Wave 2 implementation

Acceptance of an AHSN programme to deliver the wave 2 Test Bed Programme, with partners

Detailed project plans in place to select Test Beds

Test Bed sites announced at NHS Expo

Delivery of Test Bed work programme commences with AHSN support

Successful process delivered with clearly specified benefits for residents

5.7 Atlas of Healthcare Solutions

Promote innovations from our region nationally, through the AHSN Network Atlas directory of case studies. Promote within our region, other innovations on Atlas

Add one innovation and promote via social media and newsletters; promote other AHSN innovations

Add one innovation and promote via social media and newsletters; promote other AHSN innovations

Add one innovation and promote via social media and newsletters; promote other AHSN innovations

Raised awareness beyond our region of innovations already having an impact and achieve spread to other AHSNs. Raised awareness and achieve spread of innovations from other AHSNs to NHS in our area.

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Board of Directors

Agenda Item TB 051/17 Date: 04/05/2017

Report Title LCFT Q4 Workforce Board Report 2016/17

FOIA Exemption No Exemption

Prepared by Damian Gallagher, Director of HR

Presented by Damian Gallaghe, Director of HRr

Action required Noting

Supporting Executive Director Chief Executive

PURPOSE OF THE REPORT:

Report purpose To support and inform the Board’s delivery of the LCFT Workforce Strategy

Strategic Objective(s) this work supports

To employ the best people

Board Assurance Framework risk 4.1

CQC domain Well-led

Introduction: The LCFT Workforce Board Report has been designed to provide the Board with a quarterly update on the organisations performance against ten agreed workforce Key Performance Indicators (KPI’s).

The data presented is supported with narrative that highlights the current workforce management challenges being experienced by the Business. The structure of the narrative is designed to provide high level information about the remedial and supportive activities and actions being taken to manage performance improvement and provide assurance to the Board that the organisation is committed to effectively managing and mitigating the identified workforce management risks.

This report provides performance against the workforce indicators for the Quarter 4 period, 01 January 2017 to 31 March 2017. The data presented in this report is sourced from the following LCFT Directorates:

Human Resources Finance Quality Academy

Information to support the preparation of narrative is provided by HR Business Partners in conjunction with Network Management.

Members of the Board are invited to note the content of the report and are encouraged to ask any questions and make requests for further information with the Director of Human Resources.

Workforce KPI Performance Headlines: The workforce indicators set out on page 3 of the Workforce Board Report present LCFT’s overall performance against the ten workforce KPI’s in the Quarter 4 period. The full report can be seen here.

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Performance is rated against the Trusts defined targets, using the Red and Green indicators adopted by LCFT. These are supplemented with an indicative performance trend arrow. The trend is set against performance reported in the previous quarter.

From 1st April 2017, the Organisation will change shape following completion of the Organisational Reset programme. This will see the Quarter 1 report for the 2017/18 Operating year change to reflect the new organisational structure of three Networks, Mental Health Network (MHN), Community & Wellbeing Network C&WN) and the Children & Young Persons Wellbeing Network (C&YPWN) and the Support Services (formally Corporate).

1. Peripheral Workforce RelianceLCFT’s use of a Bank and Agency workforce has increased steadily through the Q4 period, endingthe 2016/17 operating year with a 12.02% Flexible Labour Reliance rate. This is an improvementon the 2016/17 Q1 closing rate of 13.93% and slightly higher than the 2015/16 Q4 closing rate of10.37%. Overall the level of Agency workers has decreased as the Bank Worker fill rate hassteadily increased.

All Networks have refreshed targeted improvement plans in place for the 2017/18 operating year toaddress Bank and Agency expenditure and flexible labour reliance, as aligned to the 2017/18Financial Plan.

2. Operational GapThe Trust operating gap has remained below the Trust target of 5% throughout the operating yearand LCFT reports a stable Q4 closing rate of 3.01%.

The total operating gap (including Sickness Absence and Annual Leave absences) is 16.5% at theclose of Quarter 4. This is an increase on the Quarter 3 closing percentage of 9.1 % and has beenimpacted by a higher level of Annual Leave taken in the month of March 2017.

3. Sickness AbsenceSickness Absence has decreased through Q4 reporting a rate of 5.93% for the Trust at the close ofthe operating year. All Networks report their commitment to a new Network targeted SicknessAbsence Management project that aligns closely with the Trust ‘Back to Basics’ AttendanceManagement Action Plan and Networks are currently developing their attendance improvementtrajectories to support their achievement of sustainable improvement in the new operating year.

At the close of the operating year, long term and short term sickness absence are moving moretoward an even split with 52.66% of absences being attributable to Long Term Sickness (Absenceslasting 28 days or more in one episode).

4. Vacancy RateThe Board Report provides two rates to support the assessment of vacancies.

Establishment Vacancy Rate: The number of vacancies the business runs with against itsBudgeted Establishment

Active Vacancy Rate: The number of vacancies being actively recruited to (this is acount of any vacancy that is within the recruitment process fromrecruitment authorisation through to starting with the trust).

The budgeted establishment vacancy rate has remained relatively stable through the Q4 period and reports a closing rate of 8.82% (against 8.71% at the close of Q3).

The number of these in active recruitment is high at 76.20% at the close of Q4. This equates to 335 ‘live’ recruitment events totalling 306.74FTE across the Trust. 61 of these vacancies are at

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the internal redeployment recruitment stage (59.1FTE) and 274 vacancies are in Open Recruitment (247.64FTE).

A new Vacancy Management Workflow was introduced in January, which ensures that all vacancies approved to progress to recruitment by the Trust Vacancy Review Panel (VRP) enter an internal Redeployment Consideration phase before being released externally, for open recruitment.

5. Safer Employment Compliance

Core WorkforceCompliance in recruiting and employment, across the Core Workforce, continues to perform wellwith 100% compliance in Safer Recruitment practice and 98.73% for Safer Employment practice.

Bank WorkersCompliance within the Bank Only Worker population for Safer Recruitment Practice also continues to perform well and is reporting 100% compliance in Quarter 4. This Quarter sees the introduction of the first stage of the Bank Worker Engagement Compliance KPI’s and reports 97.63% compliance rate for the Quarter.

6. Turnover RateQuarter 4 has seen an increase in the Trust Turnover rate, reporting 13.38% at the close of thequarter. This remains above the Trust defined target of 10% and shows an increase at the close ofthe Quarter as a result of the TUPE transfer out of the Lancashire Prisons Workforce.

The 2017/18 Operating Year Quarter 1 Workforce Performance Report will see a reportingenhancement to the Turnover reporting suite with the introduction of Redeployment managementperformance and Financial Impact Trajectory.

7. Appraisal PerformanceQuarter 4 of the 2016/17 performance year is the final cycle of PDR management. This reportincludes an indicator to demonstrate the number of 2016/17 PDR final reviews that have beenconducted, as at the close of the performance year.

The 2017/18 Quarter 1 report will present an additional slide for PDR, indicating the PDR signoffperformance for the 2016/17 performance year.

The Quarter 4 Appraisal report uses four categories to measure PDR activity and performanceagainst the Trust target:

The proportion of employees who have either: 1. The proportion of employees who have a PDR in place and who have completed their final

review. 2. Have completed the Medical Workforce Appraisal process.

1. The proportion of New Starters, within the 60 day grace period, who have registered with theePDR system but do not yet have personal objectives in place.

2. Members of the Medical Workforce who have arrangements in place to complete their MedicalAppraisal and are inside the approved timescales for completion.

3. The proportion of employees who have a PDR in place with Objectives who have notcompleted the 2016/17 Final Review.

The proportion of existing employees who have either: 1. Registered with the new ePDR system but have no objectives agreed.2. Have not registered with the ePDR system and for whom we have no information.3. Members of the Medical Workforce who have not completed the Medical Appraisal

process and are outside of their ‘Appraisal birthday’.

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The proportion of New Starters, within the 60 day grace period, who have not registered with the ePDR system.

The overall Trust Appraisal compliance rate for Quarter 4 (inclusive of the Medical Workforce) is 76.85%. This represents the number of employees who are either rated Green or Amber, according to the categories above.

Although overall compliance remains below the Trust target of 85%, Quarter 4 has seen a further improvement on the Quarter 3 positon and delivers a significant improvement on the 2015/16 performance year closing figure, which reported a PDR compliance rate of 47.39%.

3. Mandatory & Statutory Training ComplianceOverall mandatory and statutory training compliance continues to improve month on month and isreporting an overall compliance of 88% at the close of Quarter 4, achieving the Trust compliancetarget of 85%. Significant improvements have also been achieved in this area over theperformance year and compares favourably against the 2015/16 closing compliance figure of75.6%.

The People sub-committee continues to monitor this target closely and each Network reports improvements in compliance and accuracy of centrally held compliance data. The Trusts focus on Mandatory and Statutory Training delivery options and compliance are scheduled to remain a high priority through the 2017/18 operating year.

4. InductionThe Induction completion rate continues to deliver a stable improvement, reporting a closingperformance rate of 96.2% for Quarter 4.

Damian Gallagher HR Director

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Board of Directors

Agenda Item TB 052/7 Date: 04/05/2017

Report Title Finance Report

FOIA Exemption Part Exemption Not Applicable

Prepared by

Presented by Bill Gregory – Chief Finance Officer

Action required Noting

Supporting Executive Director Chief Finance Officer

PURPOSE OF THE REPORT:

Report purpose To summarise and analyse actual and forecast financial performance and standing of the Trust, the implications and any proposed management action.

Strategic Objective(s) this work supports

To provide excellent value for money in a financially sustainable way

Board Assurance Framework risk 5.1 The Trust does not achieve financial performance sufficient to maintain resilience and sustainability

CQC domain Effective

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Summary

Out‐Turn Plan VarSustainability

EBITDA 3 14,411 13,257 1,154Surplus/(Deficit before Impairments/Disposals 3 235 ‐1,390  1,625Impairments/Disposals 3 ‐1,254  0 ‐1,254 Deficit after Impairments/Disposals 3 ‐1,019  ‐1,390  371

CIPs (against Trust Plan) 3 12,316 12,286 30Cash and Liquidity 3 13,084 11,561 1,523Capex 3 7,309 7,749 440UOR*

Capital Service 1 3 3Liquidity 3 1 2I&E Margin 2 2 3I&E Variance 3 1 1Agency 1 3 2Overall 2 2 2

*Note that in line with the Single Oversight Framework the UoR indicators reflect absolute positions and not performance against plan

Sustainability A

Liquidity

Capital and Financing

Use of Resources  (UoR) risk ratings

Changes

Current

Based on draft unaudited figures the Trust has achieved its control total. Including the Core STF allocation of £2m and the bonus STF allocation of £1.4m Month 12 sees a provisional outturn operating surplus before impairments of £235k (Month 11 deficit ‐£3.4m). The measures identified to recover the position in previous months have continued in this month, including the curtailing of expenditure and improving network/corporate forecasts in the run up to the year end. These improvements were partially offset by pressures, most significantly, in Specialised Services which were impacted adversely by high levels of temporary staffing on the wards. However, the net position across the Trust returned an underspend of c£0.5m in month before incentive payments. The Board Balanced Scorecard demonstrates an EBITDA (earnings before interest, taxes, depreciation and amortisation) of £14.4m against a plan of £13.3m. The new Use of Resources (UoR) metric is now rated at 2, from 3 at month 11. 

At £13.1m cash shows a decrease of £6.3m from last month (£19.4m), mainly due to planned payments of PDC and financing charges (£4.2m) and planned Capital Expenditure (£2.2m). Cash finished the year £1.5m ahead of plan, mainly as a result of opening cash (£1.5m) and capital slippage (£2.4m) as offset by STF monies (payments for which will occur in 2017/18. Note that cash was broadly in line with that forecast at M11, see Cash and Liquidity for more details.

Overall year to date performance against the new UoR (draft) is rated at 2 against a plan of 2.

The Trust is slightly behind the revised forecast, but the outturn is within tolerance and broadly in line with the position expected by NHSI (94% ‐ including the saving of £2m against the original plan to support the Trust's cash mitigation plans).  

At the time of writing STF allocations are provisional, and though any changes are not expected to impact on achieving the control total, changes may impact the financial position presented. Information also continues to arrive that may have an impact on the accounts, and although these largely relate to the firming of estimates and are not expected to have a material impact on the accounts, a material impact remains a possibility. Furthermore although the Trust has discussed with the auditors any areas that might be deemed significant, the audit has yet to be completed and figures therefore remain subject to change.

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Forecast ForecastYTD YTD Out‐turn Out‐turn

Mar 2017 Feb 2017 at Mar 2017 at Feb 201712 11 Note 12 12 Note

Plan ‐1.390 ‐1.274 Plan ‐1.390 ‐1.390

Major Variances Major VariancesCIP Surplus 0.030 0.000  ‐  See CIP section CIP Surplus 0.030 0.000 ‐  See CIP sectionOATs ‐1.329 ‐1.000  ‐  See OATs section OATs ‐1.329 ‐1.313  ‐  See OATs sectionStaffing ‐6.330 ‐5.603  ‐  See also Bank and Agency section Staffing ‐6.330 ‐6.069  ‐  See also Bank and Agency sectionOther Bud Vars 2.327 1.381  ‐  See Services section Other Bud Vars 2.327 1.854 ‐  See Services sectionIncome & Reserves 3.529 3.139  ‐  See Reserves section Income & Reserves 3.529 3.478 ‐  See Reserves sectionSTF Funding 3.477 0.000  ‐  STF Funding 3.477 2.010Impairments ‐1.335 0.000 Impairments ‐1.335 0.000Minor Variances 0.000 ‐0.002 Minor Variances 0.000 0.070Variance 0.371 ‐2.084 Variance 0.371 0.031

Actual ‐1.019 ‐3.358 Actual Forecast ‐1.019 ‐1.359

‐‐

Surplus ‐ YTD  (£m) Surplus ‐ Out‐turn  (£m)

This month sees an operating deficit of £1.0m, £.015m ahead of plan when technical adjustments are accounted for.The position includes £1.3m of impairments (which can be excluded from the Sustainability fund calculation, and £3.5m of sustainability of which £1.5m is an additional incentive payment for meeting the target.

‐10,000.0

‐8,000.0

‐6,000.0

‐4,000.0

‐2,000.0

0.0

2,000.0

Plan CIP Surplus OATs Staffing Other BudVars

Reserves STF Funding Impairments

‐1,390.0 30.0 ‐1,329.0 ‐6,330.0 2,326.9 3,529.3 3,477.0 ‐1,335.0

‐10,000.0

‐8,000.0

‐6,000.0

‐4,000.0

‐2,000.0

0.0

2,000.0

Plan CIP Surplus OATs Staffing Other BudVars

Income &Reserves

STF Funding Impairments

‐1,390.0 30.0 ‐1,329.0 ‐6,330.0 2,326.9 3,529.3 3,477.0 ‐1,335.0

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Forecast ForecastYTD YTD Out‐turn Out‐turn

Mar 2017 Feb 2017 at Mar 2017 at Feb 201712 11 Note 12 12 Note

Plan 333.286 303.753 Plan 333.286 333.286

Major Variances Major VariancesCommunity Services 2.324 0.625 ‐ Note 1 Community Services 2.324 0.547 ‐ Note 1Mental Health 5.470 5.732 ‐ Note 2 Mental Health 5.470 6.332 ‐ Note 2Specialist Services ‐0.178 0.072 ‐ Note 3 Specialist Services ‐0.178 0.079 ‐ Note 3Non NHS Healthcare In ‐2.751 ‐2.607 ‐ Note 4 Non NHS Healthcare In ‐2.751 ‐2.822 ‐ Note 4R&D ‐0.012 ‐0.030 R&D ‐0.012 ‐0.029ETR 1.388 1.119 ‐ Student Income ETR 1.388 1.153 ‐ Student IncomeMiscellaneous 3.018 2.718 ‐ Note 5 Miscellaneous 3.018 2.928 ‐ Note 5STF Bonus 1.467 0.000 STF Bonus 1.467 0.000

Minor Variances ‐0.001 0.000 Minor Variances ‐0.001 ‐0.047

Variance 10.726 7.630 Variance 10.726 8.141

Actual 344.012 311.383 Actual Forecast 344.012 341.427

1

2345 Major increases in respect of AHSN, HR and Test Bed funding ‐ see appendix for detailed impact.

Monthly Income Variances  (£m) Cumulative Income Variances  (£m)

Both Rheumatology and Longridge Hospital funding contribute to year to date increase plus, significantly, additional Prison funding. Major decrease is due to demise of the Community Equipment Service (CERS), realising a reduction of £2.4m in year. Major increases include contractual settlement reached re CCGs, CAMHS, Early Intervention, Resilience, OATS and Acute Therapy Service funding.Minor decrease is in respect of funding for additional activity and increased acuity.Major decrease expected is respect of Healthier Lifestyles contracts, changes to inflation and Sexual Health.

0.000

5.000

10.000

15.000

20.000

25.000

30.000

35.000

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

Actual/Forecast

Plan

0.000

50.000

100.000

150.000

200.000

250.000

300.000

350.000

400.000

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

Actual/Forecast

Plan

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Forecast ForecastYTD YTD Out‐turn Out‐turn

Mar 2017 Feb 2017 at Mar 2017 at Feb 201712 11 Note 12 12 Note

Budget 289.416 265.945 Budget 289.416 289.667

Major Variances Major VariancesMental Health ‐6.863 ‐6.198 ‐ Note 1 Mental Health ‐6.863 ‐6.866 ‐ Note 1Specialist Services ‐3.072 ‐2.948 ‐ Note 2 Specialist Services ‐3.072 ‐2.860 ‐ Note 2Property Services 0.000 0.000 ‐ Note 3 Property Services 0.002 0.000 ‐ Note 3Corporate 2.701 2.171 ‐ Note 4 Corporate 2.699 2.361 ‐ Note 4Adult Community 0.618 0.548 ‐ Note 5 Adult Community 0.618 0.650 ‐ Note 5Children & Family 0.969 0.863 ‐ Note 6 Children & Family 0.969 0.835 ‐ Note 6Other Clinical 0.344 0.343 Other Clinical 0.344 0.353

Variance ‐5.302 ‐5.222 ‐5.302 ‐5.527

Actual 294.718 271.166 Actual Forecast 294.718 295.195

1

2

34

5

6 Children and Families has improved in month despite redundancy provisions. 

Mental Health in year overspend is driven more acutely by excess staffing costs on wards.  Actions to review the patients in inpatients setting, their appropriateness for the ward and levels of staffing associated with acuity are advanced and should furnish us with the appropriate information to discuss necessary action with the respective commissioners. There is some CIP slippage, and £1,350k overspend on OATS. The Network's position is diminished further by taking on overspends from Older Adult.Specialist Services are behind plan driven by high use of bank & agency on wards where high levels of acuity are having to be dealt with. The position has been exacerbated since December by high sickness levels and issues with rostering. Additionally, Prison services have struggled to recruit permanent staff and have therefore experienced high levels of agency staff and the associated cost pressures. The impact of the Kennet Prison closure has been accounted for. Expenditure has increased in prisons due to uncertainty prior to the service transferring to a new providerProperty Services are operating in line with plan.

YTD Service Net Expenditure Variance  (£m) Forecast Service Net Expenditure Variance  (£m)

Corporate Services forecast are contributing underspends, most significantly with regard to mental health drugs (in Medical Director) where year to date underspends of £0.6m and full year underspends a little higher are being returned. Most other areas are also returning underspends both in year and full year, driven by cost control and vacancies, however Human Resources continues to overspend (£0.1m full year), but IT is delivering significant underspends on both pay and non‐pay (£0.9m).Adult Community's position is improved by the transfer of Older Adult to Mental Health Network and the delivery of additional savings targets following additional focus on non‐pay.

‐£8,000

‐£6,000

‐£4,000

‐£2,000

£0

£2,000

£4,000

Adult MentalHealth

SpecialistServices

PropertyServices Corporate

AdultCommunityServices

Children &Family Other Clinical Total

Service Forecast Variance 

‐£8,000

‐£6,000

‐£4,000

‐£2,000

£0

£2,000

£4,000

Adult MentalHealth

SpecialistServices

PropertyServices Corporate

AdultCommunityServices

Children &Family Other Clinical Total

Service Year to Date Variance

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CIP Achievement  (£)

NotesDTS PerformanceOverall performance against monitored and approved schemes was in line with plan. The Rehab Gateway scheme has not delivered against plan, however this was compensated for across Corporate Programmes.

Schemes not Transacted£14k of schemes weren't identified within the PMG programme, these were compensated for by overperformance in Corporate Programmes. 

Performance vs PlanOverall delivery is in line with the  plan submitted to NHSI.

Delivering the Strategy ‐ 2016/17 PROGRAMMES

Programme No.

Programmes Project Ref ProjectsActual YTD Performance Plan YTD  Var Annual Performance Annual Plan  Var

T01A Central Lancashire Existing Business 744,271                       740,071                       4,200                            744,271                        740,071                       4,200                           T01B CEHWB ‐ Tier 3 & 4 CAMHS 299,868                       299,868                       ‐                                299,868                        299,868                       ‐                               

T01CSkype/telemedicine/telehealth implementation incl. Test Beds (Trust wide)

150,000                         150,000                         ‐                                  150,000                         150,000                         ‐                                 

T02A B&A Efficiency (Trust Wide) ‐                                ‐                                ‐                                ‐                                 ‐                                ‐                               T02B Admin Optimisation (Trust Wide) 435,247                       435,247                       ‐                                435,247                        435,247                       ‐                               

T02CConsultant Job Planning and rota efficiency (trust wide)

147,082                         147,082                         ‐                                  147,082                         147,082                         ‐                                 

T03A Specialist rehab gateway ‐                                753,000                       753,000‐                        ‐                                 753,000                       753,000‐                       T03B Medicines optimisation and ePMA 258,000                       258,000                       ‐                                258,000                        258,000                       ‐                               T03C Prison Health Redesign 100,000                       100,000                       ‐                                100,000                        100,000                       ‐                               T03D Liaison and Diversion Criminal Justice 198,924                       198,924                       ‐                                198,924                        198,924                       ‐                               T04A Monitor agency cap 539,089                       400,000                       139,089                       539,089                        400,000                       139,089                      T04B MARS 611,109                       611,109                       ‐                                611,109                        611,109                       ‐                               T04C Direct Engagement Model 302,909                       250,000                       52,909                         302,909                        250,000                       52,909                         T04D Finance ‐ Commissioning and Contracts 3,230,000                   2,630,000                   600,000                       3,230,000                     2,630,000                    600,000                      T04E Procurement Incl nurse and benefit realisation 14,500                         14,500                         ‐                                14,500                           14,500                          ‐                               T04F Estates ‐ Site rationalisation and efficiencies 1,106,016                   1,106,016                   ‐                                1,106,016                     1,106,016                    ‐                               T04G Corporate overarching ‐ Travel savings 496,807                       496,807                       ‐                                496,807                        496,807                       ‐                               

T04HCorporate overarching ‐ Corporate services business plans

1,223,162                     1,223,162                     ‐                                  1,223,162                      1,223,162                      ‐                                 

T04I Corporate overarching ‐ Network business plans 2,459,583                   2,459,583                   ‐                                2,459,583                     2,459,583                    ‐                               T04J Corporate overarching ‐ Network redesign ‐                                ‐                                ‐                                ‐                                 ‐                                ‐                               

12,316,567                   12,273,369                   43,198                           12,316,567                   12,273,369                   43,198                           

Schemes not identified within the PMG ‐                                  13,631                            13,631‐                           

Transaction phasing ‐                                  ‐                                 

Forecast Outturn 12,316,567                   12,273,369                   43,198                           12,316,567                   12,287,000                   29,567                           

2 Excellence in Patient Flow

1 Prevention and Community Wellbeing

4 Corporate Services

3 Specialist Services

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Month Month Month MonthMar 2017 Feb 2017 Mar 2017 Feb 2017

12 11 Note 12 11 Note

Agency Spend 1,006 661 Bank Spend 1,613 1,330

Network Analysis Network AnalysisAdult Network 515 312 ‐ Note 2 Adult Network 894 681 ‐ Note 2Adult Community 100 74 ‐ Note 3 Adult Community 138 125 ‐ Note 3Children & Families 42 ‐8 ‐ Note 4 Children & Families 76 61 ‐ Note 4Specialist Services 363 297 ‐ Note 5 Specialist Services 480 426 ‐ Note 5Corporate Services ‐15 ‐14 ‐ Note 6 Corporate Services 26 36 ‐ Note 6

Actual 1,006 661 ‐ Note 1 Actual 1,613 1,330 ‐ Note 1

1

2

345

6

The Trust was given a target of £7.695m by NHS Improvement for agency spend. The Trust finished the year £3.7m above target (48%), this delivers a Use of Resources rating of 3 (see also Use of Resources section). 

Specialist Services Network bank and agency costs are partly due to the contract for Liverpool and Kennet Prisons and partly to acuity and sickness levels on inpatient wards. This is exacerbated by staff in Lancashire prisons reacting to the new provider. Measures have been put in place to improve internal temporary staffing controls. Overall temporary staffing has again deteriorated in month.Corporate Services agency costs are minor within AHSN, Director of Nursing, HR and IT and are considered short term in nature. The credit is a result of the transaction of the Direct Engagement Model.

Agency Costs Over Time (£'000) Bank Costs Over Time (£'000)

A high level of vacancies is supported by bank and agency and total staffing deployed is again above establishment. The five week month has adversely impacted the position.Adult Networks bank and agency costs are primarily due to the level of acuity on inpatient wards being beyond the level established. The position has deteriorated this month for agency and bankAdult Community bank and agency costs have similarly deteriorated slightly, but are at a much lower level following the transfer of Older Adult services.Expenditure is fairly minor within Children and Families, but delivering a deteriorated improved position on bank.

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar2014/15 1102 1004 1070 996 1108 1089 1063 1141 1015 899 988 11812015/16 935 1108 932 1180 1119 1176 1139 1183 1170 1072 1289 12092016/17 1536 1521 1728 1390 1238 1570 1154 1219 1401 1289 1321 1613

0200400600800

100012001400160018002000

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar2014/15 1050 929 928 1254 1250 1146 1125 939 1248 1146 1050 12542015/16 1030 988 1262 1242 909 1202 1149 939 1073 1077 978 11742016/17 1098 862 1250 1184 986 1133 781 827 825 738 661 1006

0

200

400

600

800

1000

1200

1400

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

Actual 1,098 862 1,250 1,184 986 1,133 781 827 825 738 661 1,006 11,351Plan 927 827 727 625 575 575 573 573 573 573 573 573 7,695Variance ‐171 ‐35 ‐524 ‐559 ‐411 ‐558 ‐208 ‐254 ‐252 ‐165 ‐88 ‐433 ‐3,656% of Plan ‐48%

Page 142: Board of Directors Board/Trust Board... · 2017-05-10 · Board of Directors Meeting Board of Directors Meeting Location Training Room 1 & 2, The Harbour, Windmill Rise, off Preston

Month Month OutturnMar 2017 Feb 2017 Mar 2017

12 11 Note 12 Note

Plan ‐4.5 0.1 Plan 11.6Major Variances Major Variances

I&E 4.1 1.1 ‐ Note 2 I&E 1.7 ‐ Note 2Capital & financing ‐1.5 0.6 ‐ Note 2 Capital & financing 2.4 ‐ Note 2Contract Vars and Adjs ‐2.6 0.5 Note 3 Contract Vars and Adjs ‐4.2 Note 3Debtors ‐3.2 3.2 ‐ Note 4 Debtors ‐0.8 ‐ Note 4Timing of settlements to suppliers 1.6 ‐1.7 ‐ Note 4

Timing of settlements to suppliers ‐0.9 ‐ Note 4

Provisions and deferred income 0.4 0.8 ‐ Note 5

Provisions and deferred income 2.1 ‐ Note 5

Opening cash 0.0 0.0 Opening adjustment 1.5

Minor Variances ‐0.6 ‐0.1 Minor Variances ‐0.2

Variance ‐1.8 4.4 Variance 1.5

Actual ‐6.3 4.5 Note 1 ForecastActual/Forecast 13.1 ‐ Note 1

1

234

45 Provisions and Deferred Income  remain above plan generating gains of £2.1m, a combination of redundancy and other higher than planned provisions (£0.8m); and higher than anticipated levels of deferred income (£1.3m). 

Monthly Cash and Liquidity Variance  (£m) Forecast Cash and Liquidity  (£m)

Again as expected, Timing of settlements to suppliers  has recovered from last month and are now only slightly below plan.

Though I&E Performance  shows some improvement this is primarily due to STF bonus monies which are reflected in higher Contract Vars and Adj .

As expected last months early settlements have not been repeated and with c£1m of NHS block (mainly NHSE) and £0.7m council debt (now settled) paid late Debtors  are now slightly behind plan (‐£0.9m) . 

Cash finished the year £1.5m ahead of plan, mainly as a result of opening cash (£1.5m) and capital slippage (£2.4m) as offset by STF debt (note that cash was broadly in line with that forecast at M11).

At £13.1m cash shows a decrease of £6.3m from last month (£19.4m), mainly due to planned payments of PDC and financing charges (£4.2m) and high Capital Expenditure (£2.2m). 

Contract Variations and Adjs  mainly relate to outstanding STF monies. 

‐8.000

‐6.000

‐4.000

‐2.000

0.000

2.000

4.000

6.000

Apr May Jun Jul Aug Sep Oct Nov Dec Jan

Opening cash balance

Financing and Other

Capital and Investment Activities

Changes to WC

Non Cash Flows

Surplus/(deficit) after tax

0.000

5.000

10.000

15.000

20.000

25.000

Apr May Jun Jul Aug Sep Oct Nov Dec Jan

Forecast

Plan

Page 143: Board of Directors Board/Trust Board... · 2017-05-10 · Board of Directors Meeting Board of Directors Meeting Location Training Room 1 & 2, The Harbour, Windmill Rise, off Preston

Out‐Turn Revised Revised AnnualMar 2017 Forecast Variance Forecast Plan Variance£000 £000 £000 £000 £000 £000

IT Schemes 1.833 1.834 0.001 1.834 3.600 1.766 ‐ Note 1

Estate and infrastructure SchemesPrecommitments 1.974 1.957 ‐0.017 1.957 1.612 ‐0.345 ‐ Note 2

Large Schemes 1.685 1.915 0.230 1.915 1.600 ‐0.315 ‐ Note 3

High Priority Schemes 0.379 0.474 0.095 0.474 1.051 0.577 ‐ Note 4

Backlog maintenance 0.433 0.427 ‐0.006 0.427 0.330 ‐0.097General 1.005 1.141 0.136 1.141 1.807 0.666 ‐ Note 5

Total 7.309 7.749 0.440 7.749 10.000 2.251

1

2345

Capital Expenditure

Capital spend in 2016/17 was £7.3m broadly split £2m on IT and £5.3m on Estates and Infrastructure. Though c£2.7m below plan, pressures on the Trusts operating performance early in the year led to a review of the Trusts Capital Expenditure resulting in a planned reduction of c£2m. Furthermore disposals were also less than planned (reducing available Cdel) and some minor slippage were flagged for carry over with NHSI and as a result net capital expenditure was within tolerance and in line with the position expected by NHSI. 

Discussions surrounding the EPR procurement strategy have been finalised resulting in the project now being managed through revenue. IT plans, including capital expenditure requirements, have been revised in the light of the decision with inevitable changes to forecast. This has been managed through the acceleration of future expenditure plans into the current year.  Schemes are now largely complete and are broadly inline with revised forecast.Ward 22 is complete though there has been some slippage on Moss View/CAMHS development arising from defective works.Some minor slippage on Lifts and Fire Alarms at Guild LodgeMinor slippage on several smaller schemes.

Page 144: Board of Directors Board/Trust Board... · 2017-05-10 · Board of Directors Meeting Board of Directors Meeting Location Training Room 1 & 2, The Harbour, Windmill Rise, off Preston

Use Of Resource Metric for Lancashire Care NHS Foundation Trust

units sensePlan

YTD ending 31-Mar-17

Actual YTD ending 31-Mar-17

Variance YTD ending 31-Mar-17

Plan Year ending 31-Mar-17

Threshold 1 2 3 4

Capital Service Cover 2.5 1.75 1.25 <1.25Capital Service Cover Liquidity 0 -7 -14 <-14

I&E Margin 1.00% 0.00% -1.00% <=-1%Capital service metric 0.0x 1.436 1.627 0.190 1.436 Variance from plan 0.00% -1.00% -2.00% <=-2%Capital service rating Rating 3 3 3 Agency 0.00% 25.00% 50.00% >=50%

Liquidity Metric WeightingCapital Service Cover rating 20.00%

Liquidity metric £m (2.855) 3.402 6.257 (2.855) Liquidity rating 20.00%Liquidity rating Rating 2 1 2 I&E Margin rating 20.00%

Variance From Plan rating 20.00%I&E Margin Agency Spend 20.00%

I&E Margin metric % (0.42%) 0.07% 0.49% (0.42%)I&E Margin rating Rating 3 2 3

I&E Variance From Plan

I&E Variance from plan metric % 0.49%I&E Variance from plan rating Rating 1

Agency

Agency metric % 0.00% 47.52% 47.52% 0.00%Agency rating Rating 2 3 2

Use Of Resources Rating

Overall rating unrounded Rating 2.00 If unrounded score ends in 0.5 Rating -Rounded score Rating 2

Use Of Resources Rating before overrides Rating 2

4 Rating Trigger for Use Of Resources Rating Text NO TRIGGER

Use Of Resources Rating after 4 rating override Rating 2

Control total override - Control total accepted Text i Yes

Is the provider in Financial Special Measures? Text i No

Use Of Resources Rating after overrides Rating 2

Finance and use of resources is one theme of 5 in the Single Oversight Framework. Segmentation and therefore autonomy and support is dependent on performance across all themes.

Note that under the Single Oversight Framework a score of 1 is now the best rating and 4 the worst. A rating of 4 on any metric  or an average  rating of 3 triggers a concern and a potential support need. 

Overall performance against the new UoR (draft) is rated at 2 against a plan of 2. 

• Capital Service is currently rated at 3 against a plan of 3, an increase in operating performance of c£1.2m would be required to increase rating to a 2 and a decrease in operating performance of c£3.3m would be required to reduce the rating to 4.

• Liquidity is currently rated at 1 against a plan of 2, a deterioration in the liquidity metric of c£3.1m would be required to reduce the rating to 2. 

• Surplus Margin is currently rated at 3 against a plan of 3, an increase in operating performance of c£3.3m would be required to improve the rating to a 1 and a decrease in operating performance of c£0.2m would be required to reduce the rating to 3.

• Variance from Plan is currently rated at 1, with a buffer of £1.7m against a rating of 3.

• The agency score is 3 based on a metric of  47.5%

Page 145: Board of Directors Board/Trust Board... · 2017-05-10 · Board of Directors Meeting Board of Directors Meeting Location Training Room 1 & 2, The Harbour, Windmill Rise, off Preston

Actual/Forecast represents weighted averageOverride represents Actual/Forecast Rating

Outturn Outturn Outturn Outturn OutturnMar 2017 Mar 2017 Mar 2017 Mar 2017 Mar 2017

12 12 12 12 12

Plan 3 Plan 2 Plan 3 Plan 2 Plan 3

Actual/Forecast 3 Actual/Forecast 2 * Actual/Forecast 4 Actual/Forecast 3 * Actual/Forecast 4

*Scoring a 1 on any metric will cap the weighted rating to 2, potentially leading to investigation.

Key Points

FSRR have been replaced by Use of resources (UoR) and are included for reference ‐ 

 ‐  ‐  ‐  ‐ 

Surplus Margin is rated 3 against a plan of 2, with a buffer of c£0.2m against a 2. An increase in operating performance of c£3.3m would be required to improve the rating to 4.Variance from Plan rated 4 against a plan of 3, with a buffer of c£1.7m against a rating of 3.

FINANCIAL SUSTAINABILITY RISK RATINGS

Based on the current unaudited position and subject to further changes to STF allocations the current FSRR rating is a 3 against a plan of 3.Should further STF monies be allocated the reported position may improve.Capital Service is rated of 2 against a plan of 2, with a buffer of c£3.3m against a rating of 1 and a gap of £1.2m from a rating of 3.Liquidity is rated 4 against a plan of 3, a deterioration in the liquidity metric of c£3.1m would be required to reduce the rating to 3.

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

Oct‐15 Jan‐16 Apr‐16 Jul‐16 Oct‐16 Jan‐17

FSRR ‐ Overall

Actual/Forecast Plan

0.0

0.5

1.0

1.5

2.0

2.5

3.0

Oct‐15 Jan‐16 Apr‐16 Jul‐16 Oct‐16 Jan‐17

FSRR ‐ Capital Service 

Actual/Forecast 4 3 2

‐16.0‐14.0‐12.0‐10.0‐8.0‐6.0‐4.0‐2.00.0

FSRR ‐ Liquidity

3 2 1

‐2.50%

‐2.00%

‐1.50%

‐1.00%

‐0.50%

0.00%

0.50%

1.00%

FSRR ‐ Variance from Plan

Actual/Forecast 4 3 2 1

‐2.5%‐2.0%‐1.5%‐1.0%‐0.5%0.0%0.5%1.0%1.5%

Oct‐15 Jan‐16 Apr‐16 Jul‐16 Oct‐16 Jan‐17

FSRR ‐ Surplus Margin

Actual/Forecast 4 3 2 1

Page 146: Board of Directors Board/Trust Board... · 2017-05-10 · Board of Directors Meeting Board of Directors Meeting Location Training Room 1 & 2, The Harbour, Windmill Rise, off Preston

Reserves

Annual statement of Revenue Reserves

Budget Charge VariancePay Reserve 575 ‐99 674 Sundry Year End CreditsNon Pay Reserve 1,337 0 1,337 Balance of funds remainingPressures Reserve 585 189 396 Mainly year end insurance chargesBade Debt Provision 0 283 ‐283 Mainly in respect of Commissioner incomeAdditional Recovery Measures 960 ‐1,235 2,195 Additional Schemes to address gapMARS Gain ‐135 ‐135 0 In year savings from MARS schemeCIP Reserve 0 0 0 Fully transactedOATs Provision 0 0 0 Now crystallised in Mental Health year end positionAgency Cost Savings ‐900 ‐805 ‐95 In year savings from Medical and clinical staff caps

2,422 ‐1,802 4,224

Page 147: Board of Directors Board/Trust Board... · 2017-05-10 · Board of Directors Meeting Board of Directors Meeting Location Training Room 1 & 2, The Harbour, Windmill Rise, off Preston

` MATTERS

ID Meeting DaPaper Status

2016/14 May‐16 Matters Included

2016/13 Mar‐17 Matters

Included

2016/12 Mar‐17 MattersIncluded

2016/11 Feb‐17 MattersIncluded

2016/10 Jan‐17 Matters Included

2016/09 Sep‐16 Matters Included

2016/07 Jul‐16 Matters Included

2016/08 Jun‐16 Matters Excluded

2016/01 May‐16 Matters Included

2016/02 May‐16 Matters Included

2016/03 May‐16 Matters Included

2016/04 May‐16 Matters Included

2016/05 Nov‐16 Matters Excluded

2016/06 May‐16 Matters Included

02/08 May‐14 MattersExcluded

NHSI have advised that changes to discount rates could have a significant adverse impact on organisations. Changes to TreasuryDiscount rates have therefore been incorporated into the valuation of provisions and impact is reflected in I&E.

The Trust undertook a full revaluation of its estate resulting in a net increase in asset value of c£18m (c9%), which when combinedwith impairments as a result its own internal reviews resulted in a net increase in the carrying value of its estate of £17.5m, a netincrease in revaluation reserve of £18.8m and an impairment charge of c£1.3m to Income and Expenditure. The Trust Estate valuewill have a significant impact on capital charges for 2017/18. 

SubjectDraft figures indicate the Trust will have access to the Sustainability and Transformation fund, this has now been included in theresults as well as initial estimates of STF bonus funds. 

The final OATs position is now factored in to the 2016/17 Outturn.

On‐going Claims‐ Speculative VAT claims continue to be pursued in relation to older developments and changes in rulings. A recent ruling nowsupports our claim, but the claim is by no means certain to succeed. Up to £2m no gain assumed. 

We are coming under increased challenge from Commissioners as part of the year end contract reconciliation process, likelyrelated to pressures applied to them. We are rebutting all these challenges, but prudently a risk of £0.25m has been provided for.

Progress on the recovery of Harvey House monies has resulted in cash receipts and the release of some of the associatedprovisions. Discussions over the remainder continue.

The contract with SpecCom is now signed.

The Trust has met LCC and is hopeful a way forward has been agreed but major contracts remain unsigned.  

The Trust has been granted c£2m from the Sustainability and Transformation fund, this has now been included in the month 3accounts process. NHS Improvement have now published the new "Single Oversight Framework", a paper was presented to the Finance Committee.

The Trust has secured mobilisation funding for the Southport contract.

NHSE have formally given notice on the cessation of the prison services at Kennet. Financial implications are being assessed anddiscussions with commissioners have been finalised. 

NHS Improvement have indicated that there will not be Capital Control Total for 2016/17. 

The Trust is actively exploring the potential for land sales. Gains may crystallise in 16/17 dependent on timing.

Page 148: Board of Directors Board/Trust Board... · 2017-05-10 · Board of Directors Meeting Board of Directors Meeting Location Training Room 1 & 2, The Harbour, Windmill Rise, off Preston

OUT OF AREA ACTIVITY

Apr‐16 May‐16 Jun‐16 Jul‐16 Aug‐16 Sep‐16 Oct‐16 Nov‐16 Dec‐16 Jan‐17 Feb‐17 Mar‐17 TotalCurrent Forecast £ 440 710 740 730 602 504 415 532 481 448 369 358 6,329

LCFT Share 440 560 0 620 380 0 141 532 327 0 0 329 3,329Commissioner Share 0 150 740 110 222 504 274 0 154 448 369 29 3,000

1234

5

Work is advanced in identifying patients within PICU capacity (both Trust and OATS) who should be covered by non‐Lancashire CCG contracts and this additional activity will form the basis of discussions with the relevant commissioners.

The Network developed a trajectory against which performance was monitored. 

Commissioners have asked for, and are receiving, monthly actual performance against the profile.

The Trust provided £2m for OATs, which was the level deemed affordable at planning and not intended to remove all risk. Commissioners matched this to give a funding envelope of £4m. Commissioners have confirmed their additional £1m of funding.

A review of the OATs position resulted in allowances in the network position of £1.3m. Overall expenditure was £6.33m.

Page 149: Board of Directors Board/Trust Board... · 2017-05-10 · Board of Directors Meeting Board of Directors Meeting Location Training Room 1 & 2, The Harbour, Windmill Rise, off Preston

Board of Directors

Agenda Item TB 054/17 Date: 04/05/2017

Report Title Refresh of the Risk Appetite Statement , End of Year BAF review and Proposed BAF Risks for 2017/18

FOIA Exemption Part Exemption Appendix 2 – BAF Risks Appendix 5 – Proposed BAF Risks

Prepared by Andrew Mawdsley, Compliance and Risk Assurance Business Partner Julie-Ann Bowden, Associate Director of Compliance and Assurance

Presented by Julie-Ann Bowden, Associate Director of Compliance and Assurance

Action required Discussion

Supporting Executive Director Chief Executive

PURPOSE OF THE REPORT:

Report purpose 1. Review and approve the Risk Appetite statement for2017/18.

2. Review and approve the 2016/17 end of year BoardAssurance Framework position .

3. Review and approve the proposed 2017/18 BoardAssurance Framework Risk Register.

Strategic Objective(s) this work supports

To provide high quality services

Board Assurance Framework risk This report contains an update relating to all 2016/17 BAF risks and proposes the BAF risks for 2017/18

CQC domain Well-led

PAPER DEVELOPMENT PROCESS:

Meeting Presented Action Date

Executive Management Team Julie-Ann Bowden Discussion 20.02.17

Board Development Session Julie-Ann Bowden Discussion 28.02.17

Executive Management Team Julie-Ann Bowden Discussion 27.03.17

Board Development Session Julie-Ann Bowden Discussion 06.04.17

Executive Management Team Julie-Ann Bowden Discussion 18.04.17

INTRODUCTIONThis report provides the Board of Directors with an opportunity to consider the refreshed Risk Appetite Statement 2017/18, the end of year BAF review and the proposed BAF risks for 2017/18.

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PART ONE – RISK APPETITE STATEMENT REFRESH

1.0 BACKGROUND 1.1 The Trust’s Risk Appetite Statement was last reviewed in October

2015. A detailed review of the risk appetite statement has been undertaken during Q4 which has taken into consideration discussions with Board members at the Board Development Session in February 2017 and the Board of Directors meeting in April.

1.2 The Trust’s refreshed strategy has supported the review of the risk appetite statement in ensuring

that risk appetite is aligned with the refreshed Strategic Priorities and Blueprint statements. 2.0 REVISED RISK APPETITE STATEMENT 2.1 In contrast with the previous risk appetite statement, the revised risk appetite statement does not

allocate an overarching level of risk appetite that the Board is prepared to consider when making decisions. In place of the overarching level of risk appetite an individual narrative description has been aligned to each of the strategic blueprints. The refreshed risk appetite statement can be found at Appendix 1.

2.2 The categories considered to align risk appetite to the strategic priorities are cautious, moderate

and adventurous. As a result of the discussions at the Board Development Session in February 2017 and Board of Directors meeting in April, the risk appetite aligned to each strategic priority is ‘adventurous’. This is explained in the opening narrative of the risk appetite statement and the individual risk appetite narratives aligned to each of the blueprint statements describe what an adventurous risk appetite means for each strategic priority.

2.3 The appetite toward regulatory standards is ‘averse’. The opening narrative on page one of the

risk appetite statement has been updated to clearly highlight that where decisions that may impact on compliance then the appetite of ‘adventurous’ should not be considered and that full due diligence should be undertaken.

2.4 Where a request is being made for a decision from EMT or Board, the paper will be required to

include rationale as to how the proposal aligns with the risk appetite in that area. Where there is misalignment then an explanation will be required as to why an exemption is required. On both occasions full demonstration of the due diligence undertaken to support the proposal will need to be described.

Decision requested: To approve the 2017/18 Risk Appetite Statement.

PART TWO – END OF YEAR BAF POSITION

1.0 BACKGROUND 1.1 The Board of Directors has overall responsibility for ensuring that systems and controls are in

place that are adequate to mitigate any significant strategic risks which threaten the achievement of the strategic objectives.

1.2 The strengthened management processes around the analysis and evaluation of risk and

assurance supported by the governance arrangements, continues to promote detailed analysis. This has provided Executive Management Team with an opportunity to look at the aggregation of risk from a management perspective and examine the impact on the strategic priorities of the organisation.

1.3 One of the foremost developments during 2016/17 has been the introduction of dynamic

assurance mapping. The process is primarily supported by the flow of improved assurance evidence through the corporate governance meetings. The assurance mapping is used to

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support the discussions with the Executive leads and their senior management teams and collects controls and assurances and identifies where there maybe any gaps.

2.0 RISK MANAGEMENT

2.1 Effective review of the Board Assurance Framework (BAF) and 15 and above risks is carried out at each committee and sub-committee for the BAF risks and 15 and above risks aligned to their area of responsibility. This provides an opportunity to review the information relating to the BAF risks and escalate any associated risks that need reporting. The 15 and above risks are scored using the Trust’s standard risk scoring matrix and are aligned against the relevant BAF risk so that Executive Directors have the opportunity to review significant operational risks as reported on Datix. These risks may also collectively impact on the strategic risks contained within the BAF. The review of 15 and above risks takes place in management meetings across the organisation as well as in the governance committees at corporate level in the organisation.

2.2 The Risk Forum has met three times during Q4 and has provided opportunity to review risks by theme across the organisation. In addition, Networks and Support Services have brought risks for discussion where there is a need for more collaboration across the organisation to manage and mitigate these risks.

2.3 To support the Q4 review of the BAF risks the Compliance and Assurance team has undertaking assurance mapping throughout the quarter. The information has mainly been identified through attendance at committees and sub-committee meetings and review of chairs reports from all sub-committees.

3.0 REVIEW OF THE BAF STRATEGIC RISK REGISTER Q4

3.1 The quarterly review process provides an opportunity for Executive Director leads to meet with the Associate Director of Compliance and Assurance to discuss the update of their relevant risks. All these meetings have taken place and adjustment to the BAF risks has subsequently been undertaken. The proposed end of Q4 position for the BAF risks with associated 15 and above risks can be viewed in Appendix 2.

3.2 The 15 and above risks are scored using the Trust’s standard risk scoring matrix and are provided as part of this report, aligned against the relevant BAF risk so that Executive Directors have the opportunity to review significant operational risks as reported on Datix. These risks may also collectively impact on the strategic risks contained within the BAF.

3.3 The Heat Maps for the year can be reviewed in Appendix 3. There has been a positive movement in terms of the totality of the risk exposure at strategic level along with a recognition that a number of risks will transfer into 2017/18 due the continuation of a high level of risk in those particular areas. The following risks have changed score at the end of Q4:-

BAF risk 2.1 The Trust is unable to reposition in the marketplace to become established as a provider of choice achieving excellence.

The risk rating has been reduced in Q4 partly due to the completion of the refreshed Trust Strategic Plan 2017-22. The Trusts strategic intent within the context of the local health and social care economy has been determined and highlights how engagement with the STP will be key to achievement of the strategy. The change in nature of the risk that the organisation faces moving forwards is reflected in the new risk for 2017/18 (BAF risk 2.1 and 2.2)

Original Score 01.04.16

Score at Q1

Score at Q2

Score at Q3

Score at Q4

Target Score

16 16 16 16 12 8

4x4 4x4 4x4 4x4 3x4 2x4

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BAF risk 5.1 The Trust does not achieve financial performance sufficient to maintain resilience and sustainability.

This risk has reduced in score during Q4 due to continued progress in the quarter to implement our recovery plan, including the additional measures to curtail expenditure and improve network/corporate forecasts in the run up to the year end. This has resulted in increased confidence that the control total will be achieved.

BAF risk 6.1 The Trust fails to plan, develop and maintain infrastructure to support the ability to deliver safe, responsive and efficient patient care

This risk has reduced during Q4 due to the improved assurance reporting by Estates and Health Informatics to the Infrastructure sub-committee which has further developed the provision of evidence based assurance across the business of the sub-committee.

BAF risk 7.1 The Trust does not comply with Monitor Licence and other regulatory requirements under NHS Improvements

This risk has reduced during Q4 to achieve the target score. This was due to a detailed piece of work which has been undertaken to develop a robust framework to monitor compliance with the individual provider licence conditions to support the annual declaration of compliance with the Provider Licence. Moving forwards into 2017/18 the provider licence conditions will be monitored against the relevant BAF risk.

BAF risk 7.2 The Trust does not comply with statutory legislative requirements (excluding Mental

Health Legislation which is covered under 7.3) This risk has reduced during Q4 as a result of the work that has taken place to develop a Compliance

Framework to improve understanding of the legislative arrangements of the organisation. Alongside this a review of corporate policies is being undertaken to ensure that relevant legislation is included. Moving into next year this risk will be the risk will be managed at an operational level.

3.4 There were no risks that increased in score at the end of Q4. In total there were three risks that achieved their target score during 2016/17

Original Score 01.04.16

Score at Q1

Score at Q2

Score at Q3

Score at Q4

Target Score

20 20 20 20 15 10

4x5 4x5 4x5 4x5 3x5 2x5

Original Score 01.04.16

Score at Q1

Score at Q2

Score at Q3

Score at Q4

Target Score

16 16 16 16 12 4

4x4 4x4 4x4 4x4 3x4 1x4

Original Score 01.04.16

Score at Q1

Score at Q2

Score at Q3

Score at Q4

Target Score

15 15 15 15 5 5

3x5 3x5 3x5 3x5 2x4 2x4

Original Score 01.04.16

Score at Q1

Score at Q2

Score at Q3

Score at Q4

Target Score

16 16 16 16 8 4

3x5 3x5 3x5 3x5 2x4 1x4

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4.0 REVIEW AND THEMING OF RISKS 4.1 The following themes have consistently been reported to Trust Board

over the last 12 months. Following the end of the Q4 review process, these themes are still considered to be appropriate, with the relevant updated wording as below:

4.1.1 Financial Pressures

The financial situation has remained challenging during Q4 especially in Specialised Services with the impact of approaching the end of the Prisons contracts. However progress with implementing the recovery plan has continued and the gap to the control total has been reduced to £0.4m at the end of month 11. It is anticipated that the control total will be achieved by the end of 2016/17.

4.1.2 Commissioning Environment

The main risk in relation to the commissioning environment is around LCC contracts. The refreshed BAF risks for 2017/18 have are designed to reflect the environment that the Trust is operating in. The commissioners are conformable with what is being delivering which has increased their confidence in the Trust as a provider and also enhances the reputation of the Trust

4.1.3 Capacity and Flow

The level of OATS has been sustained at a consistent level during Q4. There are a number of alternative to admission schemes in place from now, some of which are subject to minor capital and recruitment. These schemes have been developed taking account of occupancy and OATS modelling. The main impact of OATS moving forwards is from a financial perspective.

4.1.4 Workforce

The Trust continues to have ongoing significant risk on the basis that recruitment remains a significant challenge for clinical staff. Compliance with the EWTD compliance remains a risk in Q4 mainly due to Bank workers who also have substantive jobs in the Trust taking the required 11 hours break between shifts. A review of WTD policy is taking place to assist with the mitigation of this risk. Challenges remain with core skills compliance in some areas e.g basic life support BLS and ILS.

4.1.5 Patient Safety

The strong operational risk profile across a number of BAF risks which highlight the significant challenge in keeping patients safe has remained throughout 2016/17. Risks that support this theme relate to a cross section of types of risk including ensuring staff have the appropriate skills/knowledge through education, training and leadership and safer staffing.

Decision requested: To approve the 2015/16 BAF end of year position.

PART THREE – PROPOSED BAF RISKS FOR 2017/18

1.0 BACKGROUND

1.1 The refresh of the Trust’s Strategic Priorities has provided the opportunity to consider improvements to how the BAF risks for 2017/18 are framed to be more representative of the challenges that the Trust faces moving forwards. The Compliance and Assurance team has worked closely with the Strategy and Business Planning team to align the proposed BAF risks with the refreshed strategy.

1.2 The framing of the BAF risks for 2017/18 has been undertaken alongside the end of year review of the 2016/17 BAF risks. Considering the journey of the risks over the year is a key factor in how risks will transfer into the next financial year. Appendix 4 includes the outline of how the risks from 2016/17, where appropriate, are transferring into the new BAF for 2017/18 and the supporting rationale for this.

1.3 The proposed BAF risks were discussed by the Board of Directors on 6 April 2017 where an exercise took place to review the proposed BAF risks for 2017/18 to ensure that they are representative of the challenges that have the potential to impact on the Trust’s delivery of the refreshed strategic priorities.

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2.0 PROPOSAL FOR THE BAF RISKS FOR 2017/18

2.1 The review of the BAF strategic risk register at the end of Q4 has identified the closing position and closing risk score of the 2016/17 BAF risks. The risks that have transferred over have transferred with their end of year score. Further work has been carried out to develop the information contained within the BAF risks in terms of assurances and controls and the setting of in-year and final target scores. There are a number of new BAF risks for 2017/18 which reflect the refreshed strategy and environment the Trust is now operating in. A detailed assessment of the controls and assurances for these risks has been carried and initial risk target and target scores have been set.

2.2 Following discussions at the Board of Directors meeting in April a small number of alterations have been made to how the risks are framed. Work has been carried out to set the initial risk position for each of the BAF risks and it is anticipated that this will develop further during Q1. The reframed BAF risks for 2017/18 can be found at Appendix 5.

2.3 Moving forwards into 2017/18 the operational planning objectives will be reported against each BAF risk to support the management and mitigation. An exercise has been undertaken with the assistance of the Strategy & Business Planning team to align the 2017/18 objectives with the BAF risks for next year. The reporting of objectives against the BAF risks will provide further assurance of actions in place to develop and deliver additional controls once the objectives are delivered.

Decision requested: To approve the proposed BAF risks for 2017/18.

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Appendix 1

Risk Appetite Statement 2017-18

The principles of governance require the Board to formulate a Risk Appetite Statement which enables decision making based on an understanding of the risks that the organisation has identified. The risk appetite statement forms part of the Trust’s overall approach to risk management and is a method through which the Board communicates expectations for risk-taking to the wider organisation to improve oversight of risk by the Board.

The Board recognises the complexity of risk issues in decision-making and accepts that each case requires the exercise of judgement (applied in line with the Decision Rights Framework). However, there are indicators on the limits that the Board would see as outside of their tolerance and the Risk Appetite Statement can be used to inform decision making in connection with risk.

The Board recognises that its long term sustainability depends upon the delivery of the strategic objectives. Risk appetite is mapped against the Trust’s Strategic Objectives and a tailored risk appetite statement is aligned to each of the blueprint statements. This provides a clear understanding of the Board’s tolerances and appetite for risk taking against each strategic priority is necessary to steer and influence decision making in the pursuance of the achievement of the strategic objectives. Risk appetite is also aligned to BAF risks to assist with the management of these strategic risks. The aligned strategic priorities, blueprint statement and BAF risks are provided in the table on page 2 of this document.

The Board have set a risk appetite of ‘adventurous’ across all strategic priorities. This reflects the environment that the organisation is currently operating in and the need to be innovative when considering options for improvement and ways of delivering new models of care for example. A risk appetite of adventurous does not indicate that the Board is actively seeking to undertake ‘risky behaviour’. It is more about being brave in seeking solutions and exploring courageous options.

Each strategic BAF risk has an individual risk appetite rationale that reflects the Board’s adventurous approach to taking risk. This does not mean that high risk scores will be accepted and it does not impact on the setting of the risk scores. An adventurous approach to risk appetite is more about the actions that the organisation is going to take to mitigate the risk and the due diligence that is taken to support this.

In terms of meeting regulatory standards, the Board’s risk appetite is averse. This is in relation to risks that could result in the Trust being non-compliant with legislation, or any of the

applicable regulatory frameworks in which we operate. On this basis the risk appetite aligned to the strategic priorities should not be taken into consideration for compliance related decisions and full due diligence should be taken to ensure that all risks relating to regulations are taken account of when requesting a decision to be made.

There is a clear expectation for decisions relating to bids and tenders to demonstrate that risk appetite has been incorporated into the decision-making process through reporting to the Executive Management Team or the Board of Directors. The Risk Appetite Statement does not negate the opportunity to potentially make decisions that result in risk taking that is outside of the risk appetite. In all circumstances the proposals to support decision making are expected to be able to demonstrate that due diligence has been taken.

For more information on the application of Risk Appetite please access the Trust’s

‘Guide to Risk Appetite and its application’.

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Strategic Priority Strategic Blueprint Risk Appetite Description Strategic Risks

Co

mp

as

sio

n

To provide high quality services

We will ensure that people who use our services are at the heart of everything we do, and the people who deliver and support delivery of services are motivated, engaged and proud to provide high quality, compassionate, continually improving care. We will empower people to share their stories so that we know how we are doing and we will listen to learn and to improve quality together. We will continue to strive to be the best that we can be by upholding our 8 quality commitments and the ‘I’ statements, empowering everyone to embrace these personal pledges.

We are willing to take risk in those activities that have been identified to improve quality and clearly impact on motivating, engaging and empowering people who deliver and support delivery of services.

1.1 If we do not meet regulatory standards for quality and safety we will not be fit for purpose as care provider.

1.2 If we do not create a culture of learning then we will be unable to provide high quality care.

1.3 If we do not provide integrated physical and mental health services we will lose opportunities to improve patient outcomes.

Inte

gri

ty To deliver

sustainable services that meet the needs

of local people

We will collaborate with partners to deliver system wide transformation and we will be an active partner in delivering a bespoke offer to a number of Accountable Care Systems by

being the prime provider of specialist, acute and community mental health services, and a lead provider in delivering new models of integrated physical and mental health out of

hospital services, and realising the benefits of our geographical footprint to deliver system wide sustainable

infrastructure solutions and organisational vehicles for new models of care.Whilst our principal footprint for delivery of services is Lancashire and South Cumbria, we will continue to seek opportunities across North West STP footprints.

We are willing to accept risks that will enable delivering system wide transformation and collaboration with partners. This may include new and novel business both inside and outside the principal footprint of Lancashire and South Cumbria.

2.1 If we do not work collaboratively with partners we will not be able to influence system wide transformation.

2.2 If we do not deliver new models of care we will cease to be a creditable lead provider.

Tea

mw

ork

To become recognised for

excellence

Our service users and carers will tell us that our services are of high quality. Our people will recommend us to family and friends. We will be respected by our commissioners and other providers as a co-producing partner in shaping new service models that deliver our aligned strategies with an emphasis on place based care.

We are willing to accept risks or circumstances where difficult decisions are taken for the right reasons where the benefits clearly outweigh the risks. Risks are actively taken where the benefits of ‘social capital’ demonstrates a significant reward.

3.1 If we do not engage with our patients and service users we cannot achieve excellence and quality.

3.2 If we fail to project our achievements then our reputation will not improve.

Re

sp

ec

t

To employ the best people

We will develop an organisational culture and leadership team equipped to meet its strategic intent and the needs of both its workforce and the population it serves; in short, a culture of high performing, continually improving and compassionate care. Staff will be motivated, engaged, high performing and proud of the service they provide. We will proactively support staff to look after their own health and wellbeing, and to reach their full potential. We will identify and grow our future leaders. People will want to work here.

We are willing to take risks in relation to innovative approaches to development of our workforce and are prepared to take risks to ensure that our staff are of the highest quality, supported in their own health and wellbeing and in reaching their full potential.

4.1. If we do not support the health and wellbeing of staff we will struggle to attract, recruit and retain our workforce.

4.2 If staff are not provided with extensive education, training and leadership development we will not have an organisational culture that supports high performance.

Ac

co

un

tab

il

ity

To provide financially sustainable services

We will restore and maintain financial balance, and provide services that offer excellent value for money without compromising financial sustainability. We will work with local partners to deliver system wide efficiency measures. We will actively seek business opportunities that add value for local people.

We are willing to take risk that represents a consistent focus on the best possible return for the organisation, local partners and local people.

5.1 If we do not meet financial objectives we will not be able to provide sustainable services.

5.2 If we do not work with partners to deliver system wide efficiencies this will undermine our own financial position and that of the STP.

Exce

llenc

e To innovate and exploit technology to

transform care

We will develop and promote digital enabled care, and lead research and innovation to enhance patient experience, reduce costs and/or improve quality. We will have a culture where staff are given the time, training and resources to research and innovate. Research will validate innovations and innovations will direct research. Partnerships with third party organisations will enable rapid execution and exploitation of innovation projects.

We will accept risk where innovations are identified that will enhance patient experience, reduce costs and/or improve quality. We will actively seek higher risk/higher return projects and strive to establish pioneering partnerships that can support execution and exploitation of innovation projects.

6.1 If we do not develop and maintain infrastructure, we will not be able to deliver safe, responsive and efficient care.

6.2 If we do not exploit the full capabilities of the new EPR system and wider technology to redesign services we will miss important opportunities to improve care.

Risk Appetite against Strategic Priorities and Blueprint Statements 2017-18

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BAF Heat Maps 2016/17

Almost Certain

Likely

Possible

Unlikely

Rare

Insignificant Minor Moderate Major Catastrophe

5

4

3

2

1

1 2 3 4 5

Consequence

Lik

elih

oo

d

4.26.2

1.1 1.2

2.1 6.1

7.2 7.3 5.1

3.1 7.12.24.1

Almost Certain

Likely

Possible

Unlikely

Rare

Insignificant Minor Moderate Major Catastrophe

5

4

3

2

1

1 2 3 4 5

Consequence

Lik

elih

oo

d

4.2

6.2

1.11.2

2.1 6.17.2

7.3

5.13.1

7.1

2.2

4.1

Risk Key

HIGH

MEDIUM

LOW

Original Risk Score April 2016 Risk Score at Q1 Risk Score at Q2

Risk Score at Q3 Risk Target

Almost Certain

Likely

Possible

Unlikely

Rare

Insignificant Minor Moderate Major Catastrophe

5

4

3

2

1

1 2 3 4 5

Consequence

Lik

elih

oo

d

4.2

6.2

1.1

1.2

2.1

6.17.27.3

5.13.1

7.1

2.2 4.1

Risk Score at Q4 – End of Year 16/17

Almost Certain

Likely

Possible

Unlikely

Rare

Insignificant Minor Moderate Major Catastrophe

5

4

3

2

1

1 2 3 4 5

Consequence

Lik

elih

oo

d

4.2

6.2

1.1

1.2

2.16.1 7.27.3 5.1

3.1 7.1

2.2

4.1

Almost Certain

Likely

Possible

Unlikely

Rare

Insignificant Minor Moderate Major Catastrophe

5

4

3

2

1

1 2 3 4 5

Consequence

Lik

elih

oo

d

4.26.2

1.1 1.2

2.1 6.1

7.2 7.3 5.1

3.1 7.12.24.1

Appendix 3

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MATTERS RESERVED FOR THE BOARD

1.0 GOVERNANCE AND RISK ARRANGEMENTS

Matters Reserved for the Board – May 2017

1.1 Approve and review a comprehensive Scheme of Delegation including a schedule of Matters Reserved for the Board 1.2 Approve and review the allocation of Board members to committees of the Board 1.3 Approve and review a Board Cycle of Business and associated schedule of Standard Board Reports 1.4 Establish committees of the Board and regularly review their membership 1.5 Approve and keep under regular review a schedule of matters delegated to committees, Terms of Reference and Standing Orders for committees of the Board 1.6 Approve the governance arrangements for the Board acting as a corporate Trustee 1.7 Approve the division of responsibilities between the Chair and Chief Executive 1.8 Approve the governance arrangements relating to joint ventures or other associated organisations 1.9 Approve changes to the main operating divisions of the Trust 1.10 Approve significant changes to the Executive or Senior Management Structure that may impact on the delivery of the Trusts strategic plans 1.11 Approve the Annual Governance Statement 1.12 Approve the Standard Terms of Trading 1.13 Approve the Annual Plan including appropriate declarations/statements 1.14 Approve an appropriate strategy for the management of risk and ensure that it is operating effectively.

Comment - Slight amendment to wording – removal of “on the recommendation of the Chief Executive”

1.15 Approve decisions relating to the use of risk pooling mechanisms such as the NHSLA or alternative insurance or self-funding mechanisms 1.16 Approve and maintain a register of the use of the corporate seal 1.17 Approve and review a schedule of required policy statements for the Trust and clearly identify those policies reserved for the Trust Board to approve itself 1.18 Approve the overall levels of insurance for the Trust including Directors and Officers Liability Insurance (D&O) Liability and indemnity cover 1.19 Approve the risk appetite statement for the Trust 1.20 Approve adequate insurance cover in accordance with the risk management policy

2.0 APPOINTMENTS

2.1 Appoint a Non-Executive member of the Board to Chair 2.2 Approve the appointment of one of the independent Non-Executive Directors to be the senior independent director, in consultation with the Council of Governors 2.3 Approve and review the process for the appointment and effectiveness of the Mental Health Act Managers 2.4 Approve the appointment of a Local Counter Fraud Specialist 2.5 Approve the appointment of Bankers subject to full tender 2.6 To appoint an accountable person for security at an Executive Level within the Trust. To appoint a NED to support, and where appropriate, challenge the Security Management Director on issues and recommendations relating to security management at Board level.

Comment - Additional item adding following requirement flagged through the Compliance Framework

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(Secretary of State Directions to NHS Bodies on Security Management Measures 2004 (amended 2006))

2.7 To appoint an Executive Director as Safeguarding Lead for all safeguarding issues Comment - Issue identified from Compliance Framework - Department of Health working together to safeguard children 2010, Children Act 2004 section 11, duty to safeguard and promote welfare Vulnerable Adults - Mental Capacity Act & Mental Health Act

3.0 BUSINESS PLANS AND BUDGETS

3.1 Approve a 10 year visioning document, 5 year plan and Annual Plan 3.2 Approve the organisations values following consultation with the Executive Directors and members of Trust staff 3.3 Approve the Capital Expenditure Plan and any changes to the plan in year Comment - Addition of wording “and any changes to the plan in year”. This mirrors the language used in MRB 7.5 which is proposed to be deleted due to duplication.

3.4 Approve the long term closure or retention of beds that are not approved as part of the Annual Plan 3.5 Approve the annual budget

4.0 BUSINESS DEVELOPMENT

4.1 Approve the organisational structure and its proposed funding streams 4.2 Approve any material extension of the Trust’s activities into new and novel business or geographic areas 4.3 Approve any decision to cease to operate or divest in all or any material part of the Trusts activity 4.4 Approve the introduction or discontinuance of any significant activity or operation 4.5 Approve the Business Case for all Novel Contracts and anything above £2million 4.6 Approve any change to Trust Name (as a result of merges or acquisitions) 4.7 Approve the Trust’s commercial, resource and supporting strategies 4.8 Approve the strategic direction and funding streams for operating subsidiaries or associated legal entities under the direction and control of the Trust

5.0 INVESTMENT DECISIONS AND TREASURY MANAGEMENT

5.1 Approve the Trust priorities and any supporting Business Case for capital investment 5.2 Approve the Treasury management scheme 5.3 Approve requisitions in excess of a value of £2 million within approved budget allocation 5.4 Approve the overall CIP delivery and Network level CIP delivery plans in line with the agreed Financial Strategy 5.5 Approve the revalidation of previous years CIP plans

6.0 INTELLECTUAL PROPERTY

6.1 Approve the commitment of staff resources/ funding to develop intellectual property 6.2 Approve the commitment of funds and time to creating a brand, marketing and managing the brand 6.3 Approval changes to the existing brand including name, strapline, mission and vision

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7.0 FINANCIAL AND PERFORMANCE MONITORING

7.1 Approval of the approach to Pricing, Standing Financial Instructions and financial approval limits 7.2 Approve the content and format of the Trust Board Performance Monitoring Report 7.3 Determine, approve and review clear and measurable indicators for success against clinical, quality, operational and financial delivery standards 7.4 Approve the Trust’s long term financial plan 7.5 Approve the Capital Expenditure Plan and any changes to the plan in year (DRF clause 12.1) Comment - Proposed to be removed due to duplication with MRB 3.3. 7.5 Approve the Capital Expenditure Schemes where there is an approved Business case but the scheme is not included in the Approved Capital Expenditure Plan 7.7 Approve the Standing Financial Instructions (DRF clause 20.3) Comment - Proposed to be removed due to duplication with MRB 7.1

7.6 Approve the decision to take out a loan 7.7 Approve the Credit and Working Capital facilities and their terms and covenants 7.8 Approve expenditure (pay and non-pay) budgets within the overall forecast income 7.9 Receive Annual Report on Whistleblowing Comment - Proposed addition in response to The Prescribed Persons (Reports on Disclosures of Information) Regulations 2017 - require prescribed persons (to whom a worker can report whistleblowing in certain circumstances) to produce an annual report on any matters that are reported to them.

8.0 AUDIT ARRANGEMENTS

8.1 Approve Trust Policies in relation to Policies reserved for the Board to determine 8.2 Approve the Trust’s submissions to NHSI Comment - Wording proposed to change to reflect that NHSI do not require monthly returns but instead require monthly financial and technical submissions.

9.0 APPROVAL OF ANNUAL REPORTS AND ACCOUNTS

9.1 On the recommendation of the Audit Committee approve and sign the Annual Report, Annual Plan, Financial Statements and Quality Account

10.0 CONTRACTS

10.1 Approve alteration to the terms and conditions of staff 10.2 Approve contracts under seal at all values

11.0 LEGAL MATTERS

11.1 Approve the settlement of commercial litigation 11.2 Approve the establishment of new Trust Instruments 11.3 Approve the formulation or dissolution of legal entities