Business Plan 2019/20-2021/22 - TEWV...Tees, Esk and Wear Valleys NHS Foundation Trust – Business Plan 2019/20 – 2021/22 – NHSI 4/4/19 1 Preface This Business Plan sets out the

Business Plan 2019/20-2021/22

CONTENTS

Section Title Page

Preface 1

1 Operating Environment 2

2 Trust Vision, Mission, Strategic Goals and Trust Strategic Priorities

4

3

Strategic Goal 1: Improve the quality of life of service users and their carers by working with them to provide excellent services

8

4 Strategic Goal 2: Continuously improve

the quality and value of our work 10

5

Strategic Goal 3: Recruit, develop and

retain and skilled, compassionate and

motivated workforce

17

6

Strategic Goal 4: To have effective

partnerships with local, national and

international organisations for the benefit

of the communities we serve

24

7

Strategic Goal 5: To be recognised as an

excellent and well governed Foundation

Trust that makes best use of its resources

for the benefits of the communities we

serve

27

8 Governors and Members 33

9 Implementation and Performance Management of the Plan

34

Appendix A Glossary 36

Appendix B This Means That statements 40

Appendix C Business Plan priority summary 42

Appendix D Board of Directors’ Dashboard 43

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Tees, Esk and Wear Valleys NHS Foundation Trust – Business Plan 2019/20 – 2021/22 – NHSI 4/4/19 1

Preface This Business Plan sets out the key priorities identified by Tees, Esk and Wear Valleys (TEWV) Foundation Trust’s Board of Directors to deliver its Strategic Direction and the plans to deliver them during 2019/20, 2020/21 and 2021/22.

This plan has been developed in line with our Business Planning Framework. Our Governors, experts by experience, service users and carers, clinical and managerial leaders and Board members have all been engaged through the process of developing the plan. We have also had opportunities for wider patient, family, carer and staff groups, Healthwatch representatives, local authority overview and scrutiny committees and Clinical Commissioning Groups to input ideas into the Trust’s Quality Account improvement priorities which are also included within this Business Plan.

The Trust welcomes the development of the NHS Long Term Plan and the planned initiatives being taken by NHS England and NHS Improvement and our local commissioning / delivery partners to support the implementation of this. Our Plan fully supports these national priorities and our Board remains committed to improving the quality of our services and increasing the value that we provide to our stakeholders and commissioners. By doing this we will continue to play our part in supporting the local health economies and the integrated care systems that we work within. We will continue to be supportive of our partners and help them address the challenges they face in the local systems. At the same time we will try to improve patient experience and outcomes. The key themes that underpin this Business Plan are therefore:

An overarching commitment to promoting Recovery; including developing personalised careplanning and trauma-informed care, provided by staff with the right skills and values andfacilitated by digital technology

A continuing focus on improving the quality of our services; and ensuring that they arepurposeful and productive;

A focus on supporting the whole health and social care system to work in a more integrated;effective and efficient way in each local health economy that we contribute to.

This Business Plan has been developed on the back of a stable financial position that has been in place since the Trust became a Foundation Trust in 2008. The financial strategy of the Trust ensures we can continue to maintain this position by continuing to take a prudent approach to financial planning in order to ensure that the long term delivery of our mission is supported by a strong financial position. This is becoming more challenging given the increasing referral rates faced by mental health services.

This plan focusses on things that TEWV will change, and shows what will change by when. It does not cover the Trust’s regular, ongoing, day to day work.

We hope that you find this plan interesting and informative. Inevitably some specialist terms and acronyms are used in this document. A glossary is provided at Appendix A, which explains some of these terms. If you have any questions or comments please email our Director of Planning, Performance and Communications, Sharon Pickering ([email protected]) or write to her at Tarncroft, Lanchester Road Hospital, Durham DH1 5RD.

Colin Martin Chief Executive

A signed paper copy is available on request.

mailto:[email protected]


1) Operating Environment

a) Overview of TEWV Foundation Trust TEWV provides a range of inpatient and community mental health and learning disability services for approximately 2 million people of all ages living in County Durham; Darlington; the four Teesside boroughs of Hartlepool, Stockton, Middlesbrough and Redcar and Cleveland; the Scarborough, Whitby, Ryedale, Hambleton, Richmondshire, Selby and Harrogate areas of North Yorkshire; the City of York; the Pocklington area of East Yorkshire; and the Wetherby area of West Yorkshire. Our children and young people’s wards, our adult inpatient eating disorder services and our Adult Secure (Forensic) wards serve the whole of the North East and North Cumbria. TEWV also provides mental health care within prisons located in North East England, Cumbria and Lancashire.

b) Environment In developing this plan the Trust’s Board has fully considered changes and trends in the external and internal environment and the impact these could have on the organisation’s ability to achieve our vision, mission and 5 strategic goals (see section 2) and through these to provide high quality, sustainable services to the population that we serve. The Board has also considered a number of issues raised by stakeholders (including experts by experience, service users and carers, Trust clinicians / staff, views of partners etc.). The issues most widely raised through engagement were:

Crisis / urgent care services are not fully meeting patient needs - staff are perceived to operate under high pressure and are unable to meet service user expectations;

Service users’ feelings around the time it can take to access services if they become unwell after discharge from services, or the experience of transfer between services;

Insufficient emphasis on demand reduction / early intervention;

Care planning adding insufficient value to service users and careers / Trust clinicians;

Insufficient joined up system working;

Variations between what is commissioned across the system;

Insufficient capacity to provide timely therapies;

Workforce retention and recruitment challenges;

Staff wellbeing (particularly related to work-related stress);

Insufficient / ineffective use of technology;

Bed configuration / usage / availability. The Board also considered other environmental issues and trends such as:

NHS England’s Long Term Plan;

Transforming children and young people’s mental health provision Green Paper;

Transforming Care (national programme for Learning Disability services);

The recovery movement, and increased emphasis on the wider wellbeing of service users;

Emerging evidence from the USA that trauma-informed care can improve clinical outcomes

Safe Staffing guidance;

Current and future clinical staff supply issues;

The CQC’s findings from their inspection of our services in 2018

Demographic change (increases in young and old age groups; increasing diversity);

Referral trends;

Continuing delayed discharge issues in some communities served by the Trust, which are linked to insufficient care sector capacity;

Some poor quality inpatient estate, particularly but not exclusively that inherited by the Trust on taking over responsibility for North Yorkshire and York services;

Carter Review, Model Hospital and NHS Benchmarking comparative data;

Developments in technology and the requirement to move towards a paperless NHS;

The government’s cross departmental suicide prevention plan.


Financial context of the NHS and wider public sector, including local authority budgets whichhas a potential impact on:o the capacity of the nursing / care home sector and hence on Trust inpatient admissions and

discharges,o social care resource, which can impact on speed of mental health act assessments,

discharges and general support for patient recovery in the community,o supported housing availability, which can impact on service user recovery and on re-

admission rates,o the scope of substance misuse services procured by local authorities and their capacity to

support people with both mental health and substance misuse issues (dual diagnosis)effectively;

National and local focus on reducing the numbers of suicides, and learning from deaths;

Increased national and local focus on access to treatment of people with autism spectrumdisorders, in the context of the requirements of the Autism Act 2009.

c) Sustainability Transformation Plans / Integrated Care Systems.There are 3 STP / ICS footprints that relate to the areas we provide services within. These are:

Cumbria and North East (TEWV provides mental health and learning disability services acrossCounty Durham, Darlington, Teesside, Hambleton, Richmondshire and Whitby); and somespecialist eating disorder, children’s’ and secure adult inpatient services to people across thewhole STP area

Humber, Coast and Vale (TEWV provides services to the Scarborough, Ryedale, York, Selbyand Pocklington parts of this STP area);

West Yorkshire (TEWV provides services to the Harrogate and Wetherby areas).

We have engaged fully in the development of all of the ICS /STPs. The common themes relevant to mental health across these are:

Delivering the service changes and developments arising from the 5 Year Forward View forMental Health and the NHS Long Term Plan;

Reducing out of area inpatient placements;

Implementing the next phase of the Transforming Care initiative (i.e. reducing reliance on NHSAssessment and Treatment beds in the treatment of patients with learning disabilities andincreasing the capacity and capability of community providers);

Strengthening the place-based links between primary care and mental health services toprovide mental health services that are integrated with primary care and acute care, anddelivered close to home;

Promoting independence and recovery.

Promoting early intervention and prevention (e.g. perinatal services);

Identifying ways for service users to access help quickly in order to reduce instances of crisis,but also to improve urgent care services when these are required;

Supporting initiatives to improve the physical health of people with a mental illness or a learningdisability.

d) Key Drivers for this plan arising from our environmentThe plans set out in this document are designed to meet the challenges thrown up by the changesin our operating environment, as described above.

Our plan:

Shows that we understand the importance of promoting a culture that values co-production andpersonalisation of services, as this contributes to service user wellbeing and helps us identify andeliminate non-value adding activity;

Recognises the need to work with commissioners and other system partners to find sustainablesolutions to implementing the national vision and standards for mental health and learningdisabilities;


Continues to reflect the improvements in reducing admissions to specialist beds by using NewCare Models flexibilities to transfer resource from inpatient treatment to community-basedservices in CAMHS, and adult secure services;

Reflects the need to focus even more tightly on improving quality and outcomes whilemaintaining financially sustainability. This includes continuous process improvement to help usto meet national access and waiting time standards and to reduce out of area admissions;

Addresses the workforce challenges for mental health and learning disability services, includingan increasing focus on leadership and culture;

Includes a focus on improving the infrastructure that supports modern services, includinginformation technology and estate.

Finally, although this is a plan for TEWV Foundation Trust, we recognise that we are part of wider health and social care systems, and this plan includes a recognition of the important of working in partnership and working differently to ensure that the those health systems are sustainable.

Sections 3 to 6 of this document sets out the current position for the Trust and sets out the actions that the Trust will take to address the challenges summarised above.

2) Trust Vision, Mission, Strategic Goals and Trust Board’s Business PlanPriorities

a) VisionThe Trust’s vision is: To be a recognised centre of excellence with high quality staff providinghigh quality services that exceed people’s expectations.

b) MissionThe Trust’s mission is: To improve people’s lives by minimising the impact of mental ill-healthor a learning disability.

c) Strategic GoalsThe mission and vision drives our strategic and operational plans through five strategic goals –these are the things that drive our priorities

1) To improve the quality of life of service users and their carers by working with them toprovide excellent services

2) To continuously improve the quality and value of our work3) To recruit, develop and retain a skilled, compassionate and motivated workforce4) To have effective partnerships with local, national and international organisations for

the benefit of the communities we serve5) To be recognised as an excellent and well governed Foundation Trust that makes best

use of its resources for the benefit of the communities we serve.

Each of these goals has a detailed set of “this means that” statements (see Appendix B) which set out what success would look like in the medium term, and which are used to drive the priorities set out below.

Diagram 1 on the next page shows how our mission, which is recovery focussed, is underpinned by our strategic goals, strategic priorities, operational priorities and Quality Account priorities

.


Diagram 1 – TEWV Strategic Direction

Mission: To improve people’s lives by minimising the impact of mental ill-health or a learning disability.

Vision: To be a recognised centre of excellence with high quality staff providing high quality services that exceed people’s expectations.

Strategic Goal 1: To improve the quality of life of service users and their carers by working with them to provide excellent services Strategic Priority 1: Develop and implement a trauma-informed care approach across our services Operational Priorities:

Develop and implement a Trust-wide approach to enabling people who have autism to access mental health services

Complete the transformation of our York and Selby services

Implement the agreed delivery model for people living in Hambleton and Richmondshire who require our services

Improve the physical environment at Roseberry Park Hospital

Implement the NHS Long Term Plan for Mental Health as agreed with each of our Commissioners

Strategic Goal 2: To continuously improve the quality and value of our work

Strategic Priority 2 Ensure we provide the right care in the right place

Quality Account Priorities

Further improve the clinical effectiveness and patient experience at times of transition from CYP to AMH services

Make Care Plans more Personal

Develop a Trust-wide approach to dual diagnosis which ensures that people with substance misuse issues can access appropriate and effective mental health services

Reduce the number of preventable deaths

Review our Urgent Care services and identify a future model for delivery

Strategic Goal 3 To recruit, develop and retain a skilled, compassionate and motivated workforce Strategic Priority 3 Ensure we have the right staffing for our services now and in the future Strategic Priority 4 Make a Difference Together by embedding TEWV’s values and behaviours throughout the organisation

Strategic Goal 4 To have effective partnerships with local, national and international organisations for the benefit of the communities we serve Operational Priorities:

Implement the Transforming Care Agenda

Implement the agreed future delivery model for people living in Harrogate and Rural District / Wetherby who require our services

Strategic Goal 5 To be recognised as an excellent and well governed Foundation Trust that makes best use of its resources for the benefits of the communities we serve Strategic Priority 5 Deliver our Digital Transformation Strategy Strategic Priority 6 Identify and reduce waste

Overarching Priority: Implement a recovery-focussed approach across all services

Tees, Esk and Wear Valleys NHS Foundation Trust – Business Plan 2019/20 – 2021/22 6

d) Delivering our Mission The Trust’s mission “To improve people’s lives by minimising the impact of mental ill-health or a learning disability” is directly delivered by our overarching strategic priority of “Implement a recovery-focussed approach across all services.” The Trust’s commitment to a recovery approach steers us away from a traditional model of healthcare which focuses on treating illness and removing symptoms, and instead concentrates on meeting the wide diversity of individuals’ needs to promote wellbeing. The recovery model recognises the importance of relationships, hope, a positive identity, a meaningful life, choice and empowerment in everybody’s wellbeing and works to address these needs. Promoting recovery requires a change in practice for staff, moving from a “we know best”, paternalistic, and sometimes disempowering stance to once which embraces service user choice and shared decision making and recognises the strengths, assets and resources of individuals. The first few years of delivering the Trust’s recovery strategy have focused on

Raising awareness of what is meant by recovery across the organisation;

Promoting co-production by developing an expert by experience programme (those with lived experience working alongside staff in all aspects of service development) and a peer support programme (lived experienced workers working with other service users to support their recovery);

Developing recovery college provision and reducing an overly risk averse culture. Now in its fourth year the recovery programme is developing these strands and as well as looking at specific barriers and boosters to recovery orientated practice and developing training and tools to overcome these;

Developing recovery standards (tangible examples of what recovery means in practice) for teams to work towards;

Working with the British Institute of Human Rights to ensure shared decisions are made within an ethical and legal framework;

Working with Health Foundation to embed Shared Decision Making within TEWV; Developing training to help staff work with service users in extreme distress - promoting

listening and validating skills and recognising the relational aspects of care as vital; Promotion and implementation of a harm minimisation approach to care - ensuring our services

minimise all forms of harm, including iatrogenic harms and maximise wellbeing; Commencing a redesign of Care Programme Approach processes and products to ensure that

they are increasingly aligned with a recovery/wellbeing/needs-focused philosophy. Achievements to date have included:

7 Dedicated peer roles have been introduced in Tees locality and there are plans in place to extend into forensic services and perinatal services in 2019;

Recruitment and training of 7 experts by experience cohorts has been completed;

We have successfully established our “physical” recovery college (ARCH) in County Durham and have plans to introduce courses into Low Newton Prison. The Recovery College On-line (RCO) continues to increase the range of resources available including a dedicated CAMHS resource with co-produced courses. This is now being turned into a regional resource for use across the Cumbria and North East STP;

Completion of a “deep dive” / demonstration site (Stockton psychosis team) to demonstrate outcomes and explore barriers to change and inform the development of future Recovery for leaders training (which will be part of wider Trust leadership training);

Appointment of dedicated recovery leads in place in all clinical specialties to support the Recovery approach.

Our plans for this strategic priority for 19/20 are shown in the table overleaf:


Overarching Priority: Implement a recovery-focussed approach across all services Due Date

Evaluate current position of Experts by Experience programme to support a sustainable future expansion, and agree next steps

Q2 19/20

Prepare paper for phase 3 of the Recovery Strategy (this will determine the content of actions in 2020/21 and 2021/22 for this priority).

Q3 19/20

To continue to deliver and develop our (Durham) physical Recovery College (ARCH) and the online Recovery College (RCO)

Q419/20

To complete appropriate Impact Assessments in relation to the DIALOG method of developing and reviewing care plans and seek approval via the relevant Boards/channels

Q1 19/20

Provide agreed recovery input to Trust leadership training Q1 19/20

Develop Recovery standards (to help front-line teams determine how far away from delivering recovery best practice they are)

Q1 19/20

Undertake a review/evaluation of current Care Programme Approach (CPA) training packages

Q3 19/20

Commence work with British Institute of Human Rights to develop products to support staff consideration of human rights in decision making

Q1 19/20

Establish 10 new paid lived experience roles (peers and experts by experience). Q4 19/20

Develop specific additional recovery training to complement the Trust leadership training Q2 19/20

Our other Strategic Goals and corresponding Strategic Priorities and Operational Priorities underpin the delivery of our Mission and Strategic Priority on recovery as described in Diagram 1. By delivering these priorities we will ensure that:

Services are available to meet people’s needs which are informed by latest evidence in terms of the impact of Trauma on peoples mental health and well-being (Strategic Priority 1);

The services we provide are designed and delivered in ways that ensure they work effectively as part of a wider system that recognises that people’s physical and mental health are integral to their overall wellbeing. This means that service users will be able to access services quickly for assessment, formulation, care planning, treatment and discharge without unnecessary waits or carriers (Strategic Priority 2);

We have the right staff, with the right skills, in the right place at the right time (Strategic Priority 3);

All our staff live our values in their day to day work with service users, their carers and other stakeholders (Strategic Priority 4);

We harness the benefits of digital technology to free up clinical time, give patient access to their records, improve communication and safety and start to develop our capability in the use of self-care digital tools and artificial intelligence (Strategic Priority 5);

We ensure we use our resources wisely and add value to the people who use our services, their carers and the wider system. (Strategic Priority 6).

We also have several Operational Priorities – these are narrower in scope, either because they focus on a particular place, or a defined diagnosis / service. In addition, each Locality also has a Local Business Plan which contains actions and metrics which show how that Locality is implementing the NHS Long Term Plan agenda, including service development and financial efficiency. These Local Plans are monitored by the relevant Locality Management and Governance Board (LMGB). The most significant initiatives within these Locality Plans will also be monitored by the Trust Board and are grouped together under Priority 13. Finally TEWV also has our Quality Account Priorities– these are quality related priorities that emerge from our engagement with stakeholders and feature in both our Quality Account and Business Plan. Appendix C contains a summary table of all of the priorities, showing the lead for each and when they will be delivered by.


3) Strategic Goal 1 (To improve the quality of life of service users and their carers by working with them to provide excellent services)

The tables below set out plans to deliver our first strategic goal. This includes Trauma Informed Care (TIC) strategic priority and several operational priorities. Trauma informed care is an important element in promoting service user wellbeing. The Trust is learning from best-practice in the United States as we develop and implement our approach.

Strategic Priority 1: Develop and implement a Trauma Informed Care approach across all services

Due date

Extend Recovery College On-Line (RCO) courses to include Disaster/ Major incident Planning

Q1 19/20

Development of CAMHS specific Trauma Clinical Link Pathway (CLiP) Q2 19/20

Develop Intranet TIC resources - Formulation trauma informed guidelines Q1 19.20

To contribute to Trust leadership training programme so that it is trauma informed Q2 19/20

MHSOP – Review current Suicide prevention training package to incorporate trauma informed care approaches

Q2 19/20

Develop bespoke level 1 and 2 training plan with Teesside university Q1 19/20

To provide training to PAT (Positive Approaches Team) on TIC Q1 19/20

Develop and run trauma-informed Yoga workshop staff Q3 19/20

Develop a measurement of organisational culture change pre and post TIC Q1 19/20

Agree next stage of study using Clever Together (crowdsourcing) platform Q1 19/20

Agree and organise the required number of half day retreat focussed sessions for trauma focussed therapists

Q4 19/20

Our relevant operation priorities linked to this strategic goal are set out in the table below.

Operational Priorities for this Strategic Goal

Priority Current Position Plans for 19/20 to 21/22

Develop a Trust-wide approach to enabling service users with autism to access Trust mental health services

Level 1 Autism Awareness training is part of the Equality and Diversity mandatory training and is given to all new staff and existing staff as part of their mandatory training renewal.

Level 2 Face to face autism awareness training continues to be rolled out and is well received by participants (1,427 out of approx. 6,700 staff trained by end Jan 2019).

The autism Clinical Link Pathway (CLiP) continues to be piloted in North Yorkshire.

Level 2 training delivered within relevant Children and Young people’s teams by Q4 19/20

Adapted CLiP for Children and Young People's services approved by Service Development Group (SDG) (Q2 19/20)

Roll out Children and Young People's services CLiP pilot (Q4 19/20)

Scope additional future training (Q1 19/20)

Deliver Level 1 Autism Awareness training to 90% of new staff (Q4 19/20)

Deliver Level 2 Understanding Autism training to all front facing teams (Q4 19/20)

Roll out Reasonable Adjustments CLiP (Q4 19/20)


Complete the transformation of our York and Selby services

Construction work has started on the new adult and older people’s inpatient unit at Haxby Road in York;

The Trust, working with commissioners has procured a “safe haven” (crisis café) which is run by the voluntary sector.

New inpatient unit commissioned and open by Q1 20/21

Lime Trees (CAMHS community service) reprovision complete by Q4 21/22

Selby Community Hub operational by Q2 21/22



Deliver the agreed new model of care for Adult Mental Health and Mental Health Services for Older People in Hambleton and Richmondshire

Ward 14 and 15 at The Friarage closed to admissions on 1

st January 2019 and

were fully closed by the end of February.

Construction work on new community hub commences (Q3 19/20)

New community hub open (Q4 21/22)

Improve the physical environment at Roseberry Park

The Trust has responded to the defects found at Roseberry Park Hospital estate by decanting its older people’s wards to Sandwell Park in Hartlepool so that full building investigation work can take place. A MIST fire-suppression system has been installed.

During 19/20 the full programme for building work will be agreed. This will include the return of the older people’s wards to Roseberry Park and the decanting of the secure wards to a new building on-site at Roseberry Park to allow issues in that part of the estate to be rectified, as well as the ongoing decanting of non-secure wards to Sandwell Park to enable estate work to take place. The current expected end date for these works is projected to be Q1 2024/25

Other Significant Operational Delivery plans

Durham and Darlington:

CYP – Further develop neurodevelopmental pathway (Q4 19/20)

AMH – Development of rehab hub (Q4 19/20)

LD – Complete review with LA of integrated community teams (Q4 19/20)

Teesside:

AMH - Improve community rehab provision through the review of inpatient provision (Q2 19/20)

LD - Review of environment within Bankfields to make the most effective use and identify where more could be done to support patients (Q3 19/20)

LD: - Evaluate the future health contribution to LD services within Teesside (Q4 19/20)

MHSOP - Following changes to Dementia Care Pathway review current systems and processes (Q2 19/20)

CYP - Review options for bed reconfiguration on West Lane site (Q2 19/20)

North Yorkshire and York

MHSOP – Review of inpatient provision across Scarborough, Whitby, Ryedale and York (Q3 19/20)

LD - Develop and implement a proposal for the enhanced community service and appropriate alternatives to mental health admissions (Q1 2021/22)

Forensic and Offender Health

Development and enhancement to the Secure Services Mental Health Community Team (Q2 19/20)

Activity Projections The table below shows the most likely scenario for external referrals, contacts and occupied bed days. The 18/19 figures are end of year estimates, and the 19/20 figure for referrals and contacts is generated from a statistical analysis of recent trends. These projections are based on our current services and are not driven by service expansion. The occupied bed day forecast takes into account planned changes to bed numbers but assumes that occupancy levels will remain steady.


ACTIVITY TYPE

2016/17 2017/18

% change from

previous year

2018/19

% change from

previous year

2019/20

%change from

previous year

Number of external referrals

81,069 84,824 +5% 92,852 +9% 102,962 +11%

Total contacts

3,118,250 3,216,603 +3% 3,127,168 -3% 3,095,910 -1%

Occupied Bed Days

295,039 277,008 -6% 271,779 -2% 260,565 - 4%

We are expecting the increase in referrals to be concentrated in Older People’s and Children and Young People’s services. Demand for working-age adult services will also rise, particularly for IAPT services.

These projections are based on past trends and do not factor in the potential medium to long term increases in demand in communities where there are significant housing developments planned.

It is not possible to plan bed number changes with certainty due to the ongoing consultation on the future configuration of mental health services for Harrogate and Rural District / Wetherby.

4) Strategic Goal 2 (To continuously improve the quality and value of our work)

a) TEWV’s definition of quality

TEWV’s current Quality Strategy (2017-2020) was approved by the Board of Directors in December 2016. The strategy sets out our ambition for quality which is: To ensure safe, patient centred and effective high quality care and treatment. It also includes a Quality Vision for the Future, which is:

We will provide care which is patient, carer and staff co-produced, recovery-focussed and meets agreed expectations;

We will provide care which is sensitive to the distress and needs of patients, carers and staff. Staff will respond with kind, intelligent and wise action to enable the person to flourish;

Care will be flexible and proactive to clinical need and provided by skilled and compassionate staff with the time to care;

Care will be consistent with best practice, delivered efficiently and where possible, integrated with the other agencies with whom we work;

The Trust will support staff to deliver high-quality care and will provide therapeutic environments which maintain safety and dignity.

The strategy includes 3 goals, each with a range of measurable objectives. These goals are: 1) Patients, carers and staff will feel listened to and heard, engaged and empowered and treated

with kindness, respect and dignity; 2) We will enhance safety and minimise harm; 3) We will support people to achieve personal recovery as reported by patients, carers and

clinicians. Our Staff Compact, Trust Values and processes such as appraisal, supervision, daily lean management and clinician revalidation are core elements of our approach to maintaining and improving quality.

b) Quality Governance TEWV’s governance arrangements have been developed to ensure that quality assurance is provided from Board to Ward and Ward to Board. Our framework specifies the arrangements within each Locality as well as at Board level, and has structures that promote consistency across the Localities for each clinical specialism (CAMHS, Adult Mental Health, Older People, Learning


Disabilities and Forensic / Offender Health). Clinicians and Managers are “grouped” throughout the structure – e.g. Medical Director / Chief Operating Officer/Director of Nursing (at Board level); Deputy Medical Director / Director of Operations/Head of Nursing (at Locality level). In addition to this the Trust has a dedicated Director of Quality Governance who oversees corporate quality functions such as Patient Safety, Patient Experience, Clinical Effectiveness and compliance with regulatory functions such as the Care Quality Commission and Ofsted. To support the Board in fulfilling its role, a number of committees have been established to provide an overview and assurance on the activities within their terms of reference, identify risks and gaps in assurance. In terms of quality, the Resources Committee provides oversight and assurance to the Board on resource planning and deployment (including the financial strategy, capital plan, the workforce strategy and the information strategy) to support the delivery of the Operational/Business Plan. The Quality Assurance Committee (QuAC) provides assurance to the board on, the delivery of the frameworks (patient experience, patient safety, clinical effectiveness and clinical assurance) supporting the Quality Strategy as well as oversight and the provision of assurance on, key quality governance systems and processes. Each of the Localities within TEWV has a Quality Assurance Group (QuAG) for each speciality (also known as Directorates) – for example our 3 geographical Localities each have QuAGs for Adult Mental Health; Older People; Children & Young People and Learning Disabilities. Their particular responsibilities include compliance with CQC requirements and delivering on the quality indicators that are within the contracts. They are also responsible for the development and maintenance of the Directorate Risk Register, acting on patient experience and patient safety information and sharing relevant information with other Directorate QuAGs of the same specialty via the Service Development Groups. The Directorate QuAGs are accountable to a Locality Management and Governance Board (LMGB). Each of the Localities has its own LMGB. These boards have responsibilities beyond quality and assurance; but nevertheless are a crucial route for assurance to QuAC on quality issues and receive assurance and exception reports from the Directorate QuAGs. The LMGBs provide assurance and escalate issues to the Quality Assurance Committee. This meets monthly and is chaired by a Non Executive Director. It:

Provides assurance to the Board of Directors on the quality and safety of clinical services as outlined in the Quality Strategy - this includes receiving and discussing assurance reports from the clinical governance infrastructure, the Locality Management and Governance Boards (LMGBs) on a rotating basis and the established corporate assurance working groups of the Committee, as well as developing meaningful discussion and progress reports on the Quality Account priorities;

Escalates any risk to the delivery of quality to the Board of Directors in accordance with the Trust’s integrated governance arrangements;

Provides assurance to the Board of Directors on CQC regulatory requirements and findings from CQC inspections and Mental Health Act visits;

Receives assurance from a number of sub-groups that report directly to QuAC such as: the Drug and Therapeutics Committee; Physical Health and Well Being Group; Infection, Prevention and Control Committee; Patient Safety Group; Patient Experience Group; Clinical Effectiveness Group and the Safeguarding and Public Protection Group.

The Trust has also established a number of systems and processes to support these integrated governance arrangements. Key to this is TEWV’s business planning and performance management frameworks. The Business Plan is also a key element of the Trust’s governance arrangements. It enables to the Trust to identify actions to be taken to move the organisation towards achievement of its Strategic Goals, to improve patient care and identify how resources will be deployed. The development of the Business Plan is based on an annual cycle which is closely aligned to that of the Quality Account and includes:


the triangulation of information from a range of sources including workforce, performance, activity, quality and finance

identification of key issues and implications of changes to the environment enabling priorities and key objectives to be developed

the development of service plans to deliver the priorities/key objectives including discussions and the provisional agreements of budgets.

The Trust’s performance management arrangements include the production of reports for the Board of Directors on progress on achieving the Trust’s Strategic Direction (including progress on the milestones within the Trust’s Business Plan) and the monthly Board Dashboard report (see appendix D). This highlights variances in performance against a set of agreed performance, quality and workforce indicators, standards and targets. Our Quality Governance structures rely on the supply of timely, accurate data so that quality issues can be quickly identified and actions put in place as requested. The Trust has developed an Integrated Information Centre that electronically downloads data from all our major information systems such as PARIS (our fully electronic patient record), ESR (staff system) and the finance system. This enables interactive reporting and the interrogation of the most up to date performance information at all times. It also facilitates the reporting of relevant information and analysis at various levels to enable managers and clinicians at all levels to triangulate data and pursue continuous improvement. These reports include:

Board; LMGB, Ward and Team Dashboards;

A monthly Board Safe Staffing report (which triangulates staffing levels with other quality data, including incidents and complaints);

LMGB reports to QuAC;

Reports from QuAC subgroups such as; Clinical Effectiveness; Patient Safety; Patient Experience; Infection; Prevention and Control Committee; Safeguarding and Public protection.

Quality information available on a daily basis for managers via our Integrated Information Centre;

Weekly serious incident report for Executive Management Team;

Quarterly thematic analysis of learning from incidents (broken down by specialty and locality)

Specific reports on patient safety, patient experience etc.

Weekly and monthly quality data for the EMT performance Visual Control Board and OMT weekly performance ‘huddle’

TEWV also has five Speciality Development Groups (Adult Mental Health, Older People, Children & Young People, Adult Learning Disabilities, and Forensic). These are chaired by the Senior Clinical Director for that speciality and have a Trust-wide membership. Their primary role is the improvement of trust-wide quality within the specialty, including:

Sharing and spreading good practice, benchmarking and identifying speciality-wide improvement needs;

Implementing “evidence based practice”, usually by the development of and working to patient pathways, which in turn are based on NICE guidelines, or in their absence other published best practice.

c) Evidence of Quality

The CQC undertook an unannounced inspection during June 2018 and inspected six core services, concluding with a “Well-led” review In July 2018. The core services inspected included Adult Mental Health wards, Mental Health Services for Older People wards, Children and Young People Services Tier 4 wards, Forensic, Adult Mental Health Community Teams and Adult Autism & Learning Disability Community Teams. The Trust has retained a ‘Good’ rating overall with no elements being rated as inadequate. The CQC found that without exception, all staff were enthusiastic, caring and compassionate. They described being able to clearly see the pride everyone takes in the work that they do. They particularly highlighted good medical engagement, professional nursing leadership and were


impressed with the quality improvement activities including the daily lean management process which the Trust has implemented. On visiting the wards CQC noted that there was always good interactions between staff and patients and across many areas care plans were felt to be more person centred which is a significant improvement from findings of the previous inspection. Key areas highlighted for improvement were as follows (there were no “must-dos” relating to CAMHS):

“Must Do” issue highlighted by CQC Adult MH services

MHS for Older

People

Adult Learning Disability

Forensic

Ligature risk assessments x

Privacy & dignity x

Risk assessments x

Physical health recording after rapid tranquilisation x x

Seclusion recording x

Staffing levels x

Personalised care planning x

Blanket restrictions / restrictive practices x x

Nurse call alarms x

Recording of covert medication x

Capacity to consent being considered and recorded x

Activities at weekends x

Fridge and clinic room temperature recording x

The Trust sets itself targets on key quality metrics (in its Board Dashboard, Strategic Direction Scorecard, Quality Strategy Scorecard and Quality Account) and progress and issues are discussed at QuAC, Trust Board, Quality Account stakeholder meetings, and local authority Overview and Scrutiny meetings. The Board also receives reports on patient feedback and staff survey / Friends and Family Test results.

d) Risks to Quality The most significant risks to the quality of the services provided by TEWV are:

Patient safety, quality and outcomes could be compromised if we fail to recruit and retain sufficient qualified and compassionate staff. There is a risk that this leads to difficulties appointing sufficient consultants to meet current and future workforce demands and a failure to meet planned nurse staffing levels (these risks are being mitigated by our right staffing strategic priority (see section 5);

There are risks to quality and reputation if demand for services, particularly in CAMHS, continues to increase (this risk is being mitigated through our engagement with CCG and NHSE commissioners (see section 6), and our use of “new care models” budget flexibilities to increase CAMHS crisis team provision and reduce occupied bed days;

The recovery of patients could be compromised if we fail to maintain a culture which promotes user-focussed high quality personalised care in all our services (this is being mitigated through our Recovery, Trauma Informed Care and Making a Difference Together priorities – see sections 2, 3 and 5)


e) Learning from Deaths In line with the National Quality Board (NQB) guidance, the Trust has developed a Learning from Deaths policy along with a number of other northern mental health and community trusts as part of a collaborative approach to learning from deaths. We have made it a priority to work more closely with families and carers of service users who have died and to ensure meaningful support and engagement with them at all stages, from notification of death right through to actions taken from investigation. A recent conference was held with bereaved families who have had experience of the serious incident process to identify how we can improve it. The Trust has standardised its approach to reviewing deaths in line with the NHSI guidance and can demonstrate improved identification and reporting of deaths. The Trust collects data on all known deaths and has a process in place to determine the scope of deaths which require further review or investigation. To support staff in their decision making regarding the investigation of deaths, staff have clear policy guidance, setting out criteria for categories and types of review. The Trust has increased the scope of deaths for review and increased the number of mortality reviews undertaken over the past year. The Board of Directors (meeting in public) receive a quarterly Learning from Deaths dashboard and report summarising learning. This information is included in the Trust’s Quality Account and an annual Patient Safety report. We also ensure learning is cascaded to frontline clinical staff on a regular basis by use of Patient Safety Bulletins, Learning Lessons information and Incidental Findings thematic summaries. Examples of learning include a thematic review of co-morbid substance misuse and alcohol which has also been identified as a Quality Account / business plan improvement priority (see section f below) resulting in the development of protocols and training for staff and work undertaken on leave processes which has led to demonstrable improvements in safe practice. We have also extended our Quality Account / Business Plan priority on reducing preventable deaths into 19/20 (see section f below) and this priority includes learning from deaths related actions.

f) Quality Issues and Plans The quality issues currently facing the Trust are identified from our reports above, investigations and feedback from staff, patients / carers (including experts by experience), external stakeholders and partners in care. Quality issues are fed into the Trust’s Business Planning process. Our Quality Account stakeholder engagement workshops (which help identify quality improvement priorities and influence the detail of associated actions) are a fully integrated element of this process, and therefore our Quality Account priorities sit within our wider Business Plan.

All of our strategic priorities have a quality element to them. However, our specific strategic priority for this goal is Improve the Purposefulness and Productivity of our Services (PPS). This will build on the legacy of past community-focussed work. That work is helping our staff manage the increase in referrals by introducing new tools such as huddles, direct inputting into the patient record from their homes which helped the Trust to deliver a significant increase in contacts. We now intend to have a wider focus on the whole system including inpatient and urgent care services. In addition, this section includes the 5 quality improvement priorities for 2019/20 from our Quality Account. The urgent care priority (Priority 18) is linked to PPS, while personalising care plans is linked to our Recovery programme.

Strategic Priority 2: Ensure we provide the right care in the right place Due date

Develop and implement an automated escalation process which enables bed and staffing pressure information to flow upwards and triggers appropriate interventions

Q1 19/20

Undertake a thematic / chronological review of a selection of patient records based on agreed criterion to gain a better understanding of the barriers or delays that occur within the patients’ journey.

Q2 19/20


Identify areas of variation where further exploration and improvement work can be to improve patient flow and increase bed capacity.

Q3 19/20

Increase visibility of beds and patient flow through the development of an automated approach within PARIS (Trust electronic patient record).

Q4 19/20

Quality Account Priorities

CYP to Adult Transitions Due date

Review the Healthcare Safety Investigation Branch report ‘Transition from child and adolescent mental health services to adult mental health services’ and identify any action or learning for the Trust (then report on progress on a quarterly basis)

Q1 19/20

Set improvement trajectories for the remainder of 2019/20 based on outcome of analysis carried out in 18/19 (then report on progress on a quarterly basis)

Q1 19/20

Undertake a gap analysis of numbers of transitions occurring per locality (including attendance by AMH & CAMHS staff)

Q1 19/20

Hold a joint CYP and AMH Engagement Event Q2 19/20

Report on progress against plans agreed at the CYP/AMH engagement event Q3 19/20

Evaluate the effectiveness of the panel process over 19/20 Q4 19/20

Make Care Plans More Personal Due date

Evaluate patient feedback/experience on involvement in care Q1 19/20

Involve Public Governors in future CPA Training days to provide feedback on the training and process in general

Q1 19/20

Provide further training on the CPA process to reach the target of 500 staff Q2 19/20

Test DIALOG (East London FT’s care planning process) in preparation for its full introduction

Q3 19//20

Re-audit the Trust’s application of CPA Q3 19/20

Undertake a review/evaluation of current CPA training packages Q4 19/20

Undertake a compare and contrast review of patient experience Q4 19/20

Develop a Trust Wide Approach to Dual Diagnosis Due date

Implement and then review the new reporting procedures via Datix (trust incident recording system) which enables incidents that are drug/alcohol related are flagged up

Q1 19/20

Review attendance at the Dual Diagnosis networks across the Trust and identify additional attendees to target to ensure that these networks are truly multi-agency

Q4 19/20

Report on the findings of the peer worker review to EMT and Dual Diagnosis Networks

Q4 19/20

Complete a further survey of staff dual diagnosis capabilities and skills and develop both short term and long term plans (then implement accordingly)

Q4 19/20

Work to promote MDT engagement with substance misuse services and invite to formulation/reviews/discharge planning meetings

Q4 19/20

Consider how services can provide assertive outreach approach, and produce a scoping paper

Q4 19/20

Add additional information to care plan/documentation to reflect when patients are using drugs or alcohol and identify positive messages to address/engage

Q4 19/20

Develop a process to collect key data/demographics/cause of death and how this is used and shared

Q4 19/20


Reduce the Number of Preventable Deaths Due Date

Review the Trust-wide policy in relation to Preventable Deaths and make necessary amendments

Q1 19/20

Commence circulation of new guidance booklet to families who have lost a loved one

Q1 19/20

Produce action plan from Family Conference held in Q4 18/19 and implement this Q4 19/20

Review/evaluate guidance booklet for families who have lost a loved one Q4 19/20

Participate in regional Mental Health Learning from Deaths Forum Q4 19/20

Implement any new national guidance once released Q4 19/20

Review our urgent care services and identify a future model for delivery Due Date

Ensure ambulance services can check whether any person they are called to see has a mental health crisis plan in place

Q1 19/20

Implement a new Crisis Operational model for Durham and Darlington Crisis Teams Q2 19/20

Review the current Crisis Operational Policy Q2 19/20

Develop key principles and future vision for future urgent care model Q3 19/20

Host a Trust wide Urgent Care Conference Q3 19/20

Undertake internal Trust wide mock CQC inspections in line with HTAS / TEWV standards

Q4 19/20

Agree CITO [electronic patient record] pathway/journey for crisis services Q4 19/20

Implement the agreed actions arising from the Teesside urgent care review Q4 19/20

g) Other quality issues

We recognise that we also need to address other quality issues beyond the main priorities outlined above. Examples include: Zero Suicide Ambition TEWV supports the national zero-suicide alliance initiative, and produced an inpatient zero suicide plan in March 2019. We will continue to support this initiative, working with our partners. Our preventable deaths priority (page 14) includes actions to improve our learning from deaths, both unexpected and natural deaths through our mortality review processes as well as engagement with bereaved families. Inpatient Accommodation TEWV has progressively improved our inpatient estate since we became a Foundation Trust. The only remaining dormitory accommodation is in Harrogate. We are working in partnership with the Harrogate and Rural District CCG to engage stakeholders, and expect to agree a plan to end the use of dormitory accommodation for people from Harrogate and Wetherby who require inpatient treatment during 19/20, with implementation to follow (see page 22). National Clinical Audits We will continue to participate in all relevant national clinical audits and report the findings to QuAC. We will also summarise findings in our Quality Account document. Anti-Microbial Resistance Following the success of the new medicines management assessment a bimonthly medicines optimisation assessment has now been commenced. Three of the standards in the assessment examine antimicrobial prescribing and give more timely and responsive feedback to wards on their prescribing and monitoring practices. In addition to the quality assurance groups the Infection Prevention & Control Committee (IPC) will also see progress reports.


TEWV will be adapting the Public Health England (PHE) urinary tract infection flow charts for use in the trust. The physical health group and IPC are reviewing the admission protocols in the older people’s services to incorporate a revised flow chart focusing on symptoms to guide diagnosis and a trainee will be conducting an audit on the empirical prescribing of antibiotics for suspected UTIs. In December 2018 an IPC study day was held which included training on antimicrobial stewardship and the new PHE guidance on diagnosis of urinary tract infections.

Infection prevention and control The Trust has an Infection Prevention and Control (IPC) team. There is an established Infection Prevention and Control Committee which is chaired by the Director of Nursing and Governance as the Director of Infection Prevention and Control. There is an agreed Infection prevention and control annual plan and programme. We have a continuous programme of IPC audits. We routinely report findings to the Clinical Effectiveness Group, Specialty Clinical Audit Sub Groups and to the Quality Assurance Committee.

Patient and Carer Experience and Complaints A team of dedicated complaints managers linked to each locality allows us to conclude complaints within a timely manner. We have systems in place across the Trust to gather patient experience data and have consistently been the mental health trust with the highest patient response rate for the Family and Friends test. All information is captured using an electronic system which allows us to identify themes, trends and more importantly to learn how to improve our services in response to issues raised. We are also committed to the Triangle of Care and are continuing to implement this initiative within our community services with some dedicated resource. We expect this enhanced working will allow us to further improve patient and carer satisfaction now and into the future.

Physical Health (National CQUIN) The Trust has committed to improving the physical health of its patients through the work of the National Serious Mental Illness Physical Health CQUIN target. The CQUIN not only focuses on the development of relevant pathways but also emphasises training and education around the screening of cardio metabolic risk factors that lead to premature mortality in this specific service user group. The Trust continues to work on embedding and sustaining effective physical health standards as required by the CQUIN not only for screening but also, where indicated, for providing suitable interventions to improve the quality of care we deliver to our service users.

The Trust has invested in employing a Lead Nurse in a corporate role to link with existing staff in services in a physical health role to improve the physical health for patients in the Trust. The Trust is supporting ongoing regional North East and Cumbria STP work to improve the NHS as a whole’s capability to manage the physical health of patients who are also receiving mental health treatment. The Trust also has smoking-reduction processes and support in place and we have a well-developed Weight Off Your Mind initiative in place, led by our Dietetics service.

h) TEWV Quality Improvement System (QIS) TEWV’s QIS is used to help improve the quality and value of services we provide by looking at existing ways of operating, removing waste from processes and maximising activities that add value. Processes are observed, analysed and rebuilt using the best elements to ensure high quality service delivery. Direct involvement of staff, service users, carers and other stakeholders is key, in order to capture the expertise and knowledge of those who work in the area being analysed, and also the experience and requirements of those who receive the care that the processes deliver. It is based on the Virginia Mason Production System, which adapts Toyota’s quality improvement system for use in healthcare. We have used TEWV QIS since 2007, constantly building up organisational capacity and competence in the principles and tools.

We apply this to both clinical and non-clinical processes within the Trust, and the associated observation, service redesign and review processes will be used to support aspects of many of the priorities set out in this Plan as well as day-to-day incremental improvements to services. TEWV’s QIS contributes directly to the Trust’s high levels of staff satisfaction and engagement and financial efficiency. In 2018, 875 people were involved in quality improvement events, 2,115 days were


removed from processes and there were 24 events which included service user and carer involvement. Reviews of progress one year from quality improvement events show that 107 quality defects have been sustainably eliminated In 18/19 in addition to supporting general quality improvement work across the Trust we focused on developing and implementing standard work for leaders to support quality control. This has enabled greater stability and rigour to be applied to everyday tasks. We have continued to focus on removing waste from our services and an example of this has been the drive to reduce the amount of time spent by staff inputting into our electronic clinical record. The outputs from this piece of work have already been shared across a number of teams and further focused work during 19/20 will ensure all community teams can benefit. Also following feedback from service users and carers and involvement & engagement members, we have co-designed and delivered two training workshops for this group to expand their QIS knowledge and skills so they can more effectively be engaged in the co-production agenda. Our ultimate goal would be to have staff and service users and carers working jointly on improving services. The new training format was first used in February 2019 and will be deployed again during 19/20. A training programme, specifically aimed at the leadership team members in both community and inpatient settings, is currently being developed of which QI is a key component. The programme aims to support the leadership teams to understand how compassionate and collective leadership supports a recovery oriented service, enable them to reflect on their skills and strengths, whilst working within a framework of Quality Improvement. During 19/20, we will continue to focus on developing QIS capacity and capability within TEWV but we will also support a number of key strategic areas. These include:

Bed Management/Patient Flow, Spreading new practice on real-time entry into patient record, personalised care planning, development of process to embed Dialog tool into care planning and reviews, urgent care (as part of Strategic Priority 3, Purposeful and Productive Services)

Improved “front end” to patient record, e-prescribing (as part of Strategic Priority 6, Digital Transformation)

i) Quality Impact Assessment Process

The success of TEWV QIS in identifying waste has helped the Trust to deliver cash-releasing efficiency savings (CRES) without reducing clinical quality. To ensure that CRES does not lead to unacceptable risks for patient safety, patient experience or clinical outcomes all CRES proposals are subject to a Quality Impact Analysis (QIA) process.

CRES proposals emerge from the TEWV business planning process which fully involves the Deputy Medical Directors and Heads of Nursing (Locality-based roles), Senior Clinical Directors (Trust-wide roles), the Director of Nursing and Governance and the Medical Director. Trust-wide facilitated workshops also use coaching tools to encourage innovative proposals, which are initially assessed by the Trust’s Waste Reduction Board (chaired by the Chief Executive) which can reject proposals that undermine the strategic direction of the organisation at an early stage. Leads for all CRES proposals must complete a CRES workbook (based on an NHSI tool) in order to ensure that clinical and other risks have been identified, and mitigations considered. Only if the Locality Quality Assurance Groups (QuAGs) and Locality Management and Governance Board (LMGB) – including the Director of Operations, Head of Nursing and Deputy Medical Director within that Locality agrees that the CRES proposal does not lead to unacceptable risks will the proposal is be reviewed by the Director of Nursing and Governance, Medical Director and Chief Operating Officer before they are approved for implementation. This process can lead (and has led) to proposals for CRES being revised or rejected where sign-off cannot be agreed due to an unacceptable impact on quality.


5) Strategic Goal 3 (To recruit, develop and retain a skilled, compassionate and motivated workforce)

a) Overview We recognise that the delivery of high quality, effective Mental Health and Learning Disability services is dependent upon having sufficient people with the right skills, attitudes and behaviours in the workforce. We have two strategic priorities which support this goal. Our Right Staffing strategic priority focusses on recruitment, rostering / establishments and retention, while our Making a Difference Together strategic priority focusses on how we maintain and further develop the values and behaviours that TEWV will need its staff to display if we are to promote wellbeing and recovery successfully. The section explains how we identify workforce issues, and how the two strategic priorities are governed (i.e. how risks are identified and how plans are put in place and monitored). It then goes onto identify workforce challenges and risks and explain what we are planning to address these.

b) Workforce risk-identification and planning processes The Trust’s Board of Directors receive reports that draw upon:

The Electronic Staff Record, including sickness and mandatory training compliance;

Our electronic staff roster system and temporary staffing systems ;

The annual national NHS staff survey and the three times per year staff friends and family test;

Reviewing healthcare professional vacancies as a percentage of WTE;

Progress being made by teams that are receiving intensive organisational development support;

Reports from our Freedom to Speak up Guardian and our Guardian of Safe Working;

Our Investors’ In People assessment feedback, including annual reviews.

Workforce data is also used in the Board Dashboard and Locality / Ward / Team dashboards, which are available for managers via the Integrated Information Centre. Future required changes in workforce numbers and / or skills are identified from:

Quality Impact Assessments for each proposed service change (see sections 3 and 5);

The impact of national initiatives, including the NHS Long Term Plan and relevant NICE guidance;

The service models contained in our competitive tenders for contracts and developments agreed with commissioners;

Strategies led by the Trust’s Director of HR, including the Equality Strategy and Workforce Strategy

Work on the implications of other major strategies and programmes, such as the Recovery Strategy, Trauma Informed Care programme and Purposeful and Productive Services;

Assessments by clinical and managerial leaders of future training need requirements.

Intelligence on future workforce supply is gathered from:

Intelligence on the future number of medics, allied health professionals and nurses undergoing / completing training in the North East and Yorkshire and the likely proportion who will consider working in mental health / learning disabilities;

Internal talent management conversations, including conversations about retirements and phased retirements.

c) Governance

The Trust’s Right Staffing programme board is chaired by the Executive Director of Nursing and Governance and has the Director of HR & OD and Medical Director among its members. It focusses on short and long term workforce supply and workforce deployment processes. During 2018/19 this Board developed a detailed plan for their work, taking into account the internal and external environment. There are a number of workstream groups where more detailed planning, improvement activity and monitoring take place such as:


Training and Development;

Recruitment and Retention;

Workforce Roles (this focussed on how TEWV will develop new roles such as Nursing Associates and Physician Associates).

The programme board monitors all of this work, receiving progress updates and requests to change scopes / timescales. In turn, the programme board reports out monthly to the Trust Executive team, undergoes a “deep dive” discussion session with the Executive Team twice per year, and reports on progress on business plan milestones to Trust Board each quarter.

There is a second set of workforce-related risks which refer to leadership and behaviour. These are dealt with by our Making a Difference Programme Board. These issues are important because of the impact that they have on service user recovery, appropriate clinical risk taking and staff retention. Over the past two years TEWV has invested significantly in developing a coaching culture which encourages staff to take responsibility to personally develop solutions to issues. This sustains the resulting behaviour and process changes. We have also agreed and rolled out a Participation Ladder which challenges all staff to consider the maximum level of engagement with service users, cares and other stakeholders which is achievable. TEWV also has systems in place to gather quantitative and qualitative data and intelligence about culture at team / ward level, including the Freedom to Speak Up Guardian, Guardian of Safe Working reports and the analysis of staff and patient FFT test results) and puts in place “intensive support” from the organisational development team where necessary. Programme governance is being put in place for Making a Difference Together, where the Chief Executive will chair the programme board.

d) Workforce risks Workforce related risks that we have identified, and our plans to address these are shown in the table below. Two of our strategic priorities address the risks and issues – Right Staffing and Making a Difference Together and we show these separately in the table below.

Current workforce-related issue, risk or challenge

Our Plans

Strategic Priority 3: Ensure we have the right staffing for our services now and in the future Agency Staffing During 18/19 we experienced a significant increase above our historical very low levels of temporary staffing usage. By the end of the year spend on agency staffing totalled just under £9.5m. This was higher than the £5.8m target for the Trust and was driven by an increase in inpatients requiring constant observations as well as difficulties in recruiting staff in North Yorkshire and York. Following detailed data analysis we better understand demand for temporary staffing and areas of high agency spend. The Trust’s Executive Management Team has approved a plan to reduce the use of agency workers so that our agency spend falls to £6.1m in 19/20 (below the NHSI £6.6m target for our Trust). This will positively impact on our NHSI Use of Resources rating which is currently at 3, due to the score of 4 related to agency spend.

The Trust will commence and complete formalised and structured establishment reviews (Q4 19/20), and this will be an ongoing commitment for 6 monthly establishment reviews thereafter;

Pilot a zonal engagement inpatient approach from 19/20 Q1. (This aims to promote effective and meaningful engagement, whilst providing safe levels of observation for all service users on a ward without the specific necessity to use 1:1 supportive engagement. Merseycare and Lancashire NHS trusts have observed reductions in the use of restraint, physical violence and falls along with improved staff wellbeing and morale when using this approach);

Implement the 38 actions agreed by TEWV’s Executive Management Team in March 2019 including increased recruitment to Nursing Bank, weekly pay for Bank staff, improved rostering practice, moving from neutral vendor model to direct Trust management and procurement of agency staffing, development of Admin and AHP Banks or peripatetic posts, further efforts to recruit into vacant posts; review of policy, development of improved processes for oversight and monitoring/reporting of agency usage across all staff groups, develop plan to reduce Medical agency spend.


Recruitment and Retention TEWV’s labour turnover rate is relatively high in Children’s services AMH 11.0%; MHSOP 11.1% CYP = 16.7%; ALD =10.4% Forensic and Offender Health– 7.4% -

Our vacancy fill rates show that Adult and CYP services have the most difficulties in filling vacant posts, but that nevertheless recruitment is successful almost 9 times out of 10: AMH: 88.3%; MHSOP 93.2%; CYP 89.2%; ALD 97.1%, Forensics & Offender Health 93.8%

The posts that are hardest to recruit to are generally registered nurses, psychologists allied health professional roles (e.g. speech and language therapists, dieticians, physiotherapists and IAPT psychological wellbeing practitioners and employment advisors. There are currently 33 vacancies for medical consultants in the Trust, 16 of which are currently filled with agency medical consultants.

Our analysis is that the issues are more related to geography than to the particular service or job role. There are particular difficulties experienced in North Yorkshire and York where labour turnover and vacancies significantly higher than the Trust average. In our Durham, Tees and Forensics services, vacancy levels are lower than the national norm, and turnover is around 5-6%. Medical (including Consultant) recruitment can be challenging across the whole Trust.

Use social media to proactively market posts and review materials describing wider marketing information i.e. housing, schools etc. (Q4 19/20);

Continue to collaboratively work with Universities to influence their recruitment processes to ensure alignment with the NHS and Trust Values (Q4 19/20);

Explore the feasibility of implementing talent management spotting opportunities for students to increase the number of placement opportunities to students attending universities (Q4 19/20);

Develop a York focussed nursing bank (Q1 19/20); Continue focussed recruitment activities in York and

North Yorkshire (ongoing).

Staff Retention TEWV, in common with other Mental Health trusts faces challenges of retaining clinical staff, including those who have reached retirement age. These are particularly acute in North Yorkshire and York. The Trust is participating in a national collaborative programme, the aim of which is to increase the retention of clinical staff, in particular registered nurses, led by NHSI. We submitted an action plan in July 2018 which runs to June 2019.

To date we have:

Reviewed our retire and return scheme

Carried out turnover / leaver analysis

Increased the notice period for AfC bands 1-5 in order to reduce the length of time a post is vacant.

Started paying bank staff on a weekly basis

Developed a standardised student information pack to share with students when they are on placement and moving into employment which describes the Trust values and behaviours

Reviewed the Values Based Questions used in our recruitment interviews

Focus our retention action plan implementation work on improving internal support, well-being, internal development routes and offering career options which increase the likelihood of retaining staff (Q4 19/20);

Develop clearly defined career pathways for all staff (Q4 19/20);

Design, develop and consult on the introduction of daily wellbeing checks (Q4 19/20);

Better understand the possible opportunities and barriers to offer improved flexible working opportunities in clinical services (Q4 19/20);

Reduce the numbers of staff who wish to move sideways through the introduction of an Internal Transfer Scheme (Q2 2020/21);

Consider the value of developing a process to support opportunities for a temporary job swap to allow staff to build up experience in an alternative speciality. (Q3 2020/21);

Staffing Escalation Procedures in inpatient and community service developed, monitored and reported against (Q1 19/20);

Agree a framework for how services can utilise the newly defined workforce roles of Nursing Associates, Physical Associates, Advanced Clinical Practitioners and Multi Professional Approved Clinicians (Q1 19/20).


Training the workforce of the future: There are significant geographical areas served by the Trust with no local access to mental health / learning disability nursing training (e.g. Scarborough). In the past, the only nurse training provider in the area served by the Trust was Teesside University, but Sunderland University (which is just outside the northern boundary of the area served by the Trust) has recently commenced nursing and medic training.

Further develop strong partnership working with all the local HEIs and the Open University (ongoing);

Develop pre-registration training courses at Sunderland University, and Coventry University at Scarborough (Q3 19/20).

Staff health and wellbeing: Our sickness rate is stable. By service our 18/19 outturn was: AMH: 4.97%; MHSOP 5.39%; CYP 4.34%; ALD 4.79%; Forensic and Offender Health 6.45% Our latest staff survey shows stress levels may be improving. The major reasons for sick leave remain mental health, musculoskeletal and gastro intestinal related. The number of people on long term sick increased compared to the past, but the average length of sickness has reduced.

Retender our Occupational Health contract (19/20)

Update our Sickness Management Procedure (19/20);

Promote health and wellbeing activity at team level (19/20 and ongoing);

Ensure that staff health related risks are considered at times of organisational change (ongoing).

Shift Patterns and Staffing establishments Most TEWV inpatient units introduced 12 hour shifts in the middle part of this decade. Independent research by York University on the impact of these shifts, increasing inpatient acuity and instances of staff being unable to take breaks has taken place to identify whether there have been unacceptable implications in terms of staff wellbeing and quality of service from 12 hour shifts. The findings were reported to the Trust in February 2019. The Trust is also reviewing inpatient staffing to ensure that we have establishment levels appropriate to ward acuity / occupancy, and has increased the establishment on our two 20 bedded adult mental health wards in Durham.

Develop plans based upon the outcomes of the York University research (Q2 19/20);

Review of rostering and embedding of revised process (Q4 19/20) – this will ensure we have the have the right number of staff to meet the clinical demands of each ward;

Review rest break policy (with staff side) (19/20);

Developing our approach to employing older workers, which will take into account the physical demands of some inpatient work (Q4 19/20 Q4);

Roster dashboards and Safe Staffing dashboards added to IIC (Q3 19/20);

Valid approved evidence tool available for establishment reviews (Q4 19/20);

Check and challenge meetings embedded and standardised (Q4 19/20);

Roster review process embedded (19/20 Q4).

Competencies and Skills: There are particular barriers to maintaining the required levels of clinical skills and knowledge caused by the geographical size of TEWV and the operational barriers to releasing scarce staff resources to undertake training. However, we are among the top 10 Trusts in the NHS for use of e-learning, which has been our response to our geographical size.

Increase the number of locations where training is delivered from to reduce travel time for staff (ongoing);

Continue to encourage the use of e-learning (ongoing);

Support the NE&C Streamlining Programme, which will include mutual recognition of mandatory training for staff who transfer between Trusts (ongoing);

Improve the planning of training course to coincide with staff competence expiry (Q1 19/20).

Apprenticeship Levy: There is a financial risk for the Trust arising from the apprenticeship levy – however, the Trust views this as an opportunity given the incentive to develop new forms of training. We have already funded several Health Care Assistant and admin staff are being funded by the Trust to undertake mental health or learning disability nursing associate or nursing courses.

Maximise the amount of funding we can reinvest in TEWV. Investment will take place in leadership development, healthcare assistance training, training HCAs to become nursing associates and nurses. We intend to reclaim the whole levy amount to reinvest. (19/20 and ongoing).


Brexit – this is a much smaller risk for TEWV than for most providers because TEWV has only 74 out of 6,700 staff who are non UK, EU citizens. The highest proportion of EU staff is in our medical workforce. So far there has been no indication that these staff intend to leave, but clearly there may be further risks including the behaviour of other staff and service users at and around the time that the UK leaves the EU.

To minimise the Brexit related workforce risks, the Trust is committed to giving support to staff applying for settled status in the UK and will monitor any emerging risks in this area.

Priority 4: Make a Difference together by embedding TEWV’s values and behaviours throughout the organisation

Current workforce-related issue, risk or challenge

Our Plans

Current status of values and behaviours: Variable application of the Trust’s values and behaviours has been observed. This variation can also be seen in differential take-up of managerial processes such as daily huddles and coaching.

Develop and implement a new leadership programme with a strong values component (19/20);

Further increase the number of Trust coaches and master-coaches (ongoing);

Review all recruitment and promotional materials to ensure all aligned to the values of the Trust (Q4 19/20);

Continue to collaboratively work with Universities to influence their recruitment processes to ensure alignment with the NHS and Trust Values (ongoing);

Promote service user involvement in the recruitment process (ongoing);

Provide values based local induction programmes and preceptorship arrangements where relevant (Q4 2020/21);

Develop a new communications framework (Q4 19/20)

There are also a number of risks for TEWV connected to Equality and Diversity. Data for TEWV shows that shortlisted ethnic minority job candidates are less likely to be appointed than white candidates and our staff from minority ethnic backgrounds are also more likely to enter our disciplinary systems. Our staff survey results also indicate that bullying and harassment of ethnic minority and disabled staff by patients and members of the public is more widespread than for our white British staff. We provide “unconscious bias” training for the Board and Trust managers. As part of the Workforce Race Equality Standard action plan we have been gathering high quality information from our BAME staff to inform future actions including the provision of more robust organisational responses when staff are the subject of abuse by patients and members of the public. Similar approaches are to be adopted in respect of disabled staff also. We have become a member of the Business Disability Forum.

Improve the experience of disabled staff working within the trust by developing an Workforce Disability Equality Standard action plan (Q3 19/20);

Further develop our links with the Business Disability Forum, making use of their knowledge of best practice (Q4 19/20);

Review and amend current disability-related policies and procedures (Q1 19/20);

Implement our Race Equality Standard Action Plan (ongoing, including refreshed plan by Q3 19/20);

Establish a network of Dignity Champions (who will also support the Freedom to Speak up Guardian) (Q1 19/20).


6) Strategic Goal 4 (To have effective partnerships with local, national and international organisations for the benefit of the communities we serve)

a) Overview This strategic goal is not directly supported by any Trust Strategic Priorities. This is because much of the work to support this goal involves developing stronger relationships with partners and stakeholders, which allow TEWV to both influence others, and also to understand and support partners’ priorities too. Our ongoing day to day work delivering New Care Models (Adult Secure and Children’s) in partnership with NHS England, and our commissioning partnerships are also progressing this agenda. All of the priorities in this document rely on partnership working to some extent. However, there are a number of operational priorities in which partnership working is particularly significant, and these are shown in the tables below.

Operational Priorities

Implement the Transforming Care agenda in Learning Disability Services

Current Position Plans for 19/20 to 21/22

Durham and Darlington

Trajectory to achieve target bed numbers has been achieved

Continue to further develop the enhanced community services to support people to remain in their ‘home’ (ongoing)

To consider how we can improve the inpatient environment to be able to offer individualised care when appropriate (Q1 20/21)

Teesside

Trajectory to achieve target bed numbers has been achieved

Support the implementation of the Trust wide service model for any required admissions (ongoing)


Inpatients are currently cared for at Oak Rise in York and at Bankfields Court, which is located in Redcar & Cleveland.

Review the inpatient reconfiguration and develop a proposal for the enhanced community service and appropriate alternatives to MH admissions (19/20 with implementation likely by Q1 20/21)

Forensic Learning Disability

Trajectory to achieve target bed numbers has been achieved to date

Kestrel/Kite reduce from 16 to 12 beds Q1 19/20;

Harrier/Hawk reduce from 10 to 6 beds Q1 19/20;

Northdale - contracted beds reduced from 12 to 6: Q1 19/20;

Kestrel/Kite to reduce by a further 3 beds: Q4 19/20

Implement the agreed future delivery model for people living in Harrogate and Rural District and Wetherby who require our services Revised Service Model approved by TEWV Board

and HaRD CCG;

Agreement given by NHSE for preferred option.

New Service Model will be implemented by Q2 20/21 (subject to outcome of CCG-led consultation process)

Implement the 10 Year NHS Plan as agreed with each of our commissioners

Service Current position Plans for 2019/20 to 2021/22

Children and Young People (CYP) – increasing % of YP treated

Durham and Darlington We are currently treating 46% of children with a clinical need in County Durham and 38% in Darlington. This is above the national average but is still someway from the 10 year aspiration for 100% of CYP with a clinical need to receive treatment

Respond to future rounds of CYP Trailblazer bids to improve MH support in schools (timing to be confirmed depending on NHSE timescales)

Respond to NHSE waiting list initiatives to enable waiting times to improve (timing to be confirmed depending on NHSE timescales)


Teesside We are currently treating 41% of children with a clinical need in Hartlepool / Stockton and 55% in South Tees. This is above the national average but is still someway from the 10 year aspiration for 100% of CYP with a clinical need to receive treatment

Improve Mental Health support to schools (Q3 19/20)

North Yorkshire and York We are currently treating 34% of children with a clinical need in the Vale of York, and between 20% and 24% across North Yorkshire. The North Yorkshire figures are below the NHS’ expectations for 2023/24 and there is a significant gap between current capacity and the NHS Long Term Plan’s aspiration for 100% of CYP with a clinical need to receive treatment

Explore options to develop CAMHS access model by Q3 19/20 (dependant on secured funding)


CYP Intensive Home Treatment (IHT) Services and Crisis Services

Durham and Darlington 24/7 service in place Work with Commissioners to ensure workforce

capacity meets need ( in particular overnight) and has dedicated management support

Teesside 24/7 service in place

North Yorkshire and York A CYP crisis service is in place but this does not operate 24/7 in York, Scarborough or Harrogate

Implement a 24/7 Crisis Service model across the whole of North Yorkshire and York: Q1 19/20


CYP Comm-unity Eating Disorders

Durham and Darlington Children’s Eating Disorder Service in place

Teesside Children’s Eating Disorder Service in place

Development of enhanced community eating disorders service Q2 19/20

North Yorkshire and York & Selby Currently only able to offer an enhanced service and not a specialist service

Explore funding opportunities to develop a specialist service by Q1 20/21

Service Current position Plans for 2019/20 - 2021/22

Perinatal Durham and Darlington Service went live in Q3 18/19, funded by wave 2 national transformation resources

Evaluate service and provide a report to Commissioners to secure recurring funding (Q1 19/20)

Continue to develop service in line with agreed trajectory (Q4 19/20)

Teesside The service that was already in place has been further enhanced following wave 2 national transformation funding


North Yorkshire and York Service went live in Q3 18/19, funded by wave 2 national transformation resources


Continue to develop service in line with agreed trajectory (Q4 19/20)


Acute Liaison


Core 24 service in place Review service and commence implementation of actions (Q2 19/20)

Teesside The current service is 24/7 but funding to ensure Core 24 compliance has not been agreed with commissioners

Maintain core 24 compliance if sustainable funding can be put into place. This could include bidding for any future “wave” of national funding (19/20)

North Yorkshire and York There is a service in place in Harrogate, York, Northallerton and Scarborough but this is not Core 24 compliant.

Bid for future “wave” of national funding (19/20 – date dependent upon NHSE)


IAPT

Durham & Darlington

We are awaiting the outcome of a competitive procurement carried out by the Durham, Darlington and Tees CCGs

Implement the outcome of the procurement exercise


Our current IAPT service is achieving 10-15% (depending on CCG) on the indicator which measures the proportion of people that enter treatment against the level of need in the general population. This is below national targets and is partly due to the level of investment / staffing being insufficient to achieve this target. There is also an issue around staff training / accreditation for low-intensity work The service is achieving between 52% and 61% (depending on CCG) on the indicator which measures the proportion of people who complete treatment who are moving to recovery. This is above the national target Achieving 99% of people referred to IAPT commence treatment within 18 weeks (above the national target)

Plans and trajectories are being developed to improve performance in tandem with potential increased investment for some teams

Managing an increase in the number of direct self-referrals via the development of a dedicated website.

Focus on increasing access for older adults within the NY locality



Individual Placement and Support (IPS)

IPS workers currently aligned to EIP Teams. STP wide bid for Wave 2 funding has been submitted

Should Wave 2 National application be successful, implementation of model

Teesside IPS workers currently aligned to EIP Teams. STP wide bid for Wave 2 funding has been submitted


North Yorkshire and York STP wide bid for Wave 2 funding has been submitted



Service Current position Plans for 201/20 - 2021/21


Criminal Justice Liaison and Diversion

Currently provide service within Durham Police Force area. Responded to procurement and TEWV successful.

Contract commencement 1st April 2019

Teesside

Currently provide service within Cleveland Police Force area. Responded to procurement and TEWV successful.



No current provision. Responded to procurement and TEWV successful. Mobilisation has commenced and it is expected that a full team will be in place for 1

st April, ready to implement the

service model


Offender Health

North East Currently provide MH services across the 7 North East Prisons

Respond to commissioner procurement anticipated Q1 2019/20

Cumbria and Lancashire

Currently provide MH services to HMPs Preston, Kirkham and Lancaster Farms in Lancashire and HMP Haverigg in Cumbria

Respond to commissioner procurement for HMP Haverigg anticipated Q1 19/20

7) Strategic Goal 5 – Sustainable Organisation (including Information Technology and Finance)

a) Overview The Trust maintains a number of corporate support services which work across the Trust’s area, supporting our clinical services. This strategic goal is supported by two strategic priorities: Deliver our Digital Transformation Strategy; and Identify and Reduce Waste.

b) Information Our digital transformation priority is helping our clinicians work more efficiently and effectively, freeing up time for them to spend in interacting with and supporting service users. During 18/19 we have already:

Carried out a large scale pilot which enabled clinicians to enter into the clinical record during their meetings at service users’ houses;

Introduced skype for business to reduce the number amount of travel undertaken by managers and corporate staff – we are currently piloting the use of skype for clinicians;

Put in place multi-functional printing / scanning devices across the Trust so that all members of staff can print at any site, while also giving each member of staff a running total of their printing spend to discourage unnecessary printing;

Replaced our website infrastructure, and procured a replacement intranet;

Obtained external funding to upgrade community teams’ IT hardware to provide mobile working opportunities for clinical staff;

Enabled digital communication with pathology laboratories;

Held “discovery workshops” to help the CITO developers fully understand our needs;

Upgraded our infrastructure to support the development of CITO;

Undertaken security upgrades to the Trust network to provide safe and secure platforms for our clinical systems to operate and to reduce the risks of cyber security attacks.


The most significant element of our plans for the future (see table below) is the introduction of CITO. This will make it easier for clinicians to enter and retrieve data from the Trust’s electronic patient record. It will also enable service users to have access to their own records and facilitates interoperability (computer to computer communication) with other systems such as GPs, ambulance services and social care. In the longer term we want to implement the vision set out in the NHS Long Term Plan of artificial intelligence improving patient safety and outcomes.

Strategic Priority 5 – Deliver our Digital Transformation Strategy Due Date

CITO being tested "live" by MHSOP teams Q1 19/20

All MHSOP teams using CITO for all day-to-day clinical work Q3 19/20

CITO development and "live" testing for all key agreed Adult mental health (AMH) pathways / processes commenced

Q1 19/20

All AMH teams using CITO for all day to day clinical work Q4 19/20

CITO development and "live" testing for all key agreed CYP pathways / processes commenced

Q1 20/21

Crisis Dashboard in place Q3 19/20

Digital mailroom pilot commences Q1 19/20

All eligible teams / wards / services using digital mailroom Q2 19/20

e-prescribing system pilot commenced Q2 19/20

e-prescribing system pilot complete Q4 19/20

All wards and teams solely using e-prescribing Q4 20/21

Integrated Information Centre (IIC) real-time datix dashboard in place Q1 19/20

Replacement intranet in use Q1 19/20

Public access to wi-fi in place at all TEWV clinical sites Q2 19/20

Windows 10 installed on all TEWV laptops and desktop computers Q3 19/20

All Trust smartphones meet agreed future operating and security standards Q3 19/20

TEWV fully compliant with national network connectivity standards Q4 20/21

Patient portal pilot commenced (this is to allow service user access to own records) Q3 19/20

Patient portal pilot complete Q4 19/20

Patient portal roll out to all services commences Q4 19/20

Automatic diary linking between clinical record and Outlook (email programme) in place for all clinical staff

Q1 19/20

c) Waste Reduction

Our approach to eliminating waste through the use of our quality improvement system methodology is set out on page 17. Our new waste reduction board, chaired by our Chief Executive emphasises the importance of identifying and removing waste for all services. It has encouraged the production of a wide range of waste-reduction ideas from across the whole organisation, and selected some of these for further investigation and development by particular Localities or services. The Board has a particular role in making sure that some cross-cutting proposals are fully investigated and implemented, and these are set out in the table below. This Board also monitors the achievement of waste reduction plans by each Locality and corporate service.

Strategic Priority 6 – Identify and Reduce Waste Due Date

Reporting functions centralised and cost-savings realised 19/20 Q4

Centralised asset management of IT hardware introduced 19/20 Q3

Introduce new venue and travel booking system Trust-wide (subject to pilot) 19/20 Q3

d) Financial Planning

NHS operational planning and contracting guidance 2019/20 established the clear expectation that all providers will be expected to plan for and deliver against rebased control totals for 2019/20, to contribute to delivering financial balance across the NHS. Delivery of this expectation will require TEWV plans to be stretching from a financial perspective, implementing transformational change


through the STPs, and to take full advantage of efficiency opportunities to ensure the control totals for 2019/20 can be delivered.

As part of the NHS operational planning and contracting guidance 2019/20 there is a requirement for all NHS Trusts to deliver a minimum annual cost efficiency saving of 1.1%. TEWV has identified that cash releasing efficiency savings (CRES) of £5.2m must be delivered in 2019/20 financial year. These savings are estimated to be sufficient to meet future cost pressures, provide a strategic change fund, and ensure medium term financial stability.

The Trust’s CRES schemes are developed through our integrated business planning process and evaluated both financially and clinically with a Quality Impact Assessment process undertaken by the Executive Management Team. This process led by the Director of Nursing & Governance and Medical Director (see section 4) provides assurance from each lead Director that efficiency plans do not have an unacceptable impact upon the quality of patient care. TEWV’s Quality Improvement System (see section 4) is a key enabler that helps us identify sustainable cost improvements.

As per the NHS Operational Planning and Contracting Guidance financial framework, our financial plans and NHS Contracts include a 3.8% uplift for inflation and pressures and a 1.1% efficiency requirement. This results in a net cash increase of 2.7%, before known and agreed contract variations. The Trust’s rebased control total for 2019/20 includes the distributional impact of Agenda for Change cost increases relative to the contract uplift.

e) Financial Forecasts and Modelling Statement of Comprehensive Income

The following table shows the planned Statement of Comprehensive Income for 2019/20. This is based on the latest agreed position for commissioner contracts and other income assumptions and is reflective of the current economic position and inflationary pressures.

2019/20 £m Clinical Income - NHS 335.21 Clinical Income - Non NHS 4.09 Other income:

Education and Training 7.80 Research and Development 0.70 Other income 5.05 Provider Sustainability Funding 2.83

Total income 355.68

Pay Costs -276.73 Drug costs -4.22 Clinical supplies and services -2.04 Purchase of healthcare -8.42 Education and Training -1.76 PFI Operating Expenses -0.38 Other Costs -47.75 Total costs -341.30 EBITDA (4.0%) 14.38 Depreciation -3.79 Interest receivable 0.20 Interest (payable) -1.07 PDC Dividend -4.23 Net Surplus 5.49


Key points to note are:

The Trust’s income and expenditure baseline increases by £5.8m in 2019/20 as a result of commissioner investment in services such as Perinatal, Secure Outreach and Autism Spectrum Disorder as well as a number of smaller investments in learning disabilities;

Pay costs rise in 2019/20 largely as a result of pay awards. Other movements are in line with the Trust’s CRES programme and changes in non-recurrent investment in the Trust’s strategic change enabling schemes;

Planned non-recurrent investment in strategic change is £8.6m in 2019/20;

The Trust also anticipates £2m of non-recurrent enabling costs to support the capital programme;

The Trust has been notified of, and included, £2.8m Provider Sustainability Funding in 2019/20.

The technical assumptions included in the table are as follows:

2019/20

Inflation National Tariff - Cost Uplift 3.80%

National Tariff - Efficiency requirement -1.10%

Pay Inflation 4.60%

Drug Inflation 0.60%

Clinical Supplies 2.20%

Non-Clinical Supplies 2.20%

Cost of capital varies linked to investment

Keys points to note are:

Income inflation is in line with the latest position negotiated with commissioner contracts at 2.7%;

Pay inflation is estimated at 4.6% of the total recurrent pay bill and takes account of the recurrent pay award set for 2018/19 (funded non-recurrently in 2018/19) and 2019/20 as well restructuring of increments and the non-consolidated pay award due to those staff at the top of their grade in April 2019. Incremental drift is assumed to be offset by staff turnover;

Non-pay inflation has been assessed and profiled in accordance with the latest estimates for the economy;

Cost of Capital links to planned investment; which is significant in 2019/20.

Cash Releasing Efficiency Savings (CRES) Given the current economic climate and in order to operate within the national and local financial frameworks, the Trust is planning to deliver cash releasing efficiency savings (CRES) of £5.2m, plus £4.6m carry forward from 2017/18 (total requirement of £9.8m) in 2019/20. The following table summarises the CRES programme targets for the Trust:

Scheme 2019/20

£000

Community Productivity 644

Skill mix Review 753

Review of Management and Corporate Structures 375

Review of Management and Corporate Structures - North Yorkshire & York locality

531

Service Review / Redesign 3,150

Non pay contract and procurement 1,093

Net PFI contract savings 2,091

Estates masterplan 1,135

Total CRES required and Identified 9,772


Statement of Financial Position A summary of the Trust’s Statement of Financial Position is shown below. The main movement in cash is as a result of investment in the capital programme and Independent Trust Finance Facility (ITFF) borrowings.

2019/20

£m

Intangible Assets 1.49

Property Plant and Equipment 178.32

Other Non-Current Assets 0.04

Current Assets 14.76

Cash at bank and in hand 13.38

Current Liabilities -31.91

Non-Current Liabilities -2.27

PFI Finance Lease < 1 year -0.58

PFI Finance Lease > 1 year -12.71

Total assets employed 160.52

Taxpayers Equity

Public Dividend Capital 145.39

Retained Earnings 11.16

Revaluation Reserve 3.97

Total assets employed 160.52

Finance and Use of Resources Metrics The following table summarises the planned Finance and Use of Resources metrics for the Trust:

Ratings 2019/20

Capital Service Cover rating 3 Liquidity rating 2 I&E Margin rating 1 Variance From Control total rating 1 Agency rating 1 Overall Plan Risk Ratings 2

The overall Trust financial plan delivers a Use of Resources rating of 2 in 2019/20.

The following table summarises the margins within the rating:

2019/20

Margins within Use of Resources ratings

To Increase Rating

To Reduce Rating

Capital service cover (change to surplus £000's) 891 -3,528

Liquidity (change to cash level £000's) 3,785 -1,234

I&E margin (change to surplus level £000's) n/a -1,828

I&E variance from plan (change to surplus level £000's) n/a n/a

Agency (increase in agency costs £000's) n/a -1

The current planned results demonstrate that the Trust Finance Use of Resources rating will not drop below a 2 at the end of the next financial year.


f) Anticipated Workforce Change

The following table summarises the anticipated changes in workforce March 2019 to March 2020:

2019/20

Opening Average WTE * 6,512

CRES -127

Other ** 219

Reduction in bank / agency -31

Closing Average WTE * 6,573

* This represents worked WTEs and not contracted therefore includes bank nurses and an estimate for agency and locums ** FM Services at Roseberry Park brought in-house, recurrent strategic change initiatives (including Nurse Associates, Nurse Apprenticeships, and Bank expansion), non-recurrent strategic initiatives (CYP IAPT child therapists) and contract variations (including North Yorkshire Liaison and Diversion and Perinatal services).

g) Agency Rules

The Trust’s notified agency ceiling for 2019/20 is £6.6m and represents a 25% reduction in actual expenditure against that incurred in 2018/19. Whilst the agency ceiling is a challenging target to achieve in its financial plan the Trust has anticipated containing expenditure within this annual ceiling. The cost reduction will largely be achieved within nursing as a result of a number of initiatives introduced in quarter 4 2018/19; which should result in more staff directly engaged in a substantive or bank role within the Trust. Medical recruitment continues to be a concern but the Trust has made positive steps to appoint Trust locums as an alternative to agency and has a number of permanent posts due to commence in quarter 1 of 2019/20.

h) Capital Expenditure The following table summarises the Trust’s capital expenditure plans for 2019-24:

Description of Scheme 2019/20 2020/21 2021/22 2022/23 2023/24 Total

£000 £000 £000 £000 £000 £000

Roseberry Park Rectification Programme 17,734 16,234 13,623 11,261 9,307 68,159

York and Selby In Patient facility 22,097 2,444 3,477 28,018

York and Selby Community Mental Health team bases 3,939 1,605

5,544

North Yorkshire Community Mental Health team bases 698 6,218 5,520

12,436

Teesside Community Mental Health team bases 350

350

Trustwide CAMHS reconfiguration 1,000 1,000

Middlesbrough Crisis Assessment Suite 774 774

PFI and Contract Life Cycle 454 217 351 373 645 2,040

Trust Life Cycle 1,116 1,181 1,203 1,003 1,352 5,855

Estates Rationalisation 1,250 1,250 1,250 1,250 1,250 6,250

Equipment Purchases 100 500 100 100 850 1,650

Other 270 275 280 285 290 1,400

Total Schemes 49,782 29,924 25,804 14,272 13,694 133,476


The capital expenditure profile remains significant and as such will be regularly reviewed to ensure ongoing affordability in the short to medium term.

Capital expenditure, excluding Roseberry Park rectification programme, will be funded through depreciation, cash reserves and asset disposals.

On 27 September 2018 the PFI contract for Roseberry Park Hospital in Middlesbrough was terminated and a programme of works was commenced on addressing the issues found. The Trust will need to explore sources of funding throughout 2019/20 to complete the works.

8) Governors and Members

As a Foundation Trust, our membership and Council of Governors are an important element of our accountability to and engagement with the communities that we serve.

a) Council of Governors TEWV’s Council of Governors is made up of 54 Governors:

33 Public Governors (many of which are service users or carers)

5 Staff Governors

16 Appointed Governors

b) Governor Elections The Trust held its planned ordinary election on 21 June 2018 to fill 7 Public Governor vacancies and 2 Staff Governors vacancies as a result of tenures of Governors coming to an end and casual vacancies that had arisen or had remained vacant during the year. 1 Public Governor was elected uncontested; 3 Public Governors were elected following contest; 3 vacancies remained unfilled. The 2 Staff Governor vacancies remained unfilled.

An additional election was held on 29 November 2018 to fill 3 Public Governor positions. 2 vacancies were filled uncontested and 1 remained vacant. All elections were administered by Electoral Reform Services. The next ordinary election, for 13 Public Governors and 1 Staff Governors is planned for June 2019.

c) Governor Engagement To ensure that all members of the Council of Governors have the skills and knowledge to undertake their role we will continue to undertake the following:

An annual review of training and development: - o Local training and briefing events on areas such as Safeguarding, Equality, Diversity and

Human Rights and Mental Health Legislation for which a number of sessions are mandatory requirements for Governors (this includes national Governwell training);

o 4 Governor Development Days on topics identified by Governors. Recent topics have included briefings and discussions on local and national initiatives nurse recruitment and safe staffing, Care Quality Commission, Freedom to Speak Up Guardian, Patient Experience, Patient Safety, staff survey outcomes and;

o Ad hoc briefings as and when required.

Public engagement events. This includes: - o Drop in sessions for potential Governors; o Information showcase events; o Annual General and Members Meeting;

A wide variety of conferences, public consultations and general publicity events including member recruitment have been attended by representatives of the Council of Governors.

As a minimum, every 6 months, Governors are invited to meet with their local Director of Operations to discuss progress on business priorities and share any views on feedback on services. In addition, the Chairman holds regular meeting/ feedback sessions with the different Governor categories and within individual localities.


During 2018 Governors concluded a Task and Finish Group to review the involvement of service users and carers within the Trust. Development of the resultant action plan is underway.

Representatives of the Council of Governors regularly attend meetings of the Board of Directors and accompany Directors on visits to services to gain an understanding of services and how service delivery is being achieved.

d) Member Recruitment The Council of Governors approved an Involvement and Engagement Framework in November 2015, incorporating elements of the previous Membership Strategy and the Trust’s work on patient and public involvement. The target for the Trust was to recruit 250 public members (nett) each year. The introduction of the General Data Protection Regulations (GDPR) required the introduction of a new Privacy Notice for members of the Trust and due to the requirement to communicate the new duties; there have been a number of member resignations alongside a wider data cleanse exercise. During 2018/19 overall membership has decreased by 46 members (0.5%). This decrease was due, in the main to the implementation of the General Data Protection Regulations. On 31st March 2019 our total membership was 16,232 consisting of 9,485 public members and 6,747 staff.

During 2019/20 recruitment will continue to focus on those under-represented Constituencies of North Yorkshire and York and Durham. All recruitment activity undertaken focusses on inclusion rather than exclusion of all demographics, age and ethnicity.

9) Implementation and Performance Management of the Plan This Business Plan shows clearly that:

TEWV considers operational requirements, quality, workforce and finance together within our integrated planning process;

TEWV has a clear plan in place to further improve our services during 19/20 retaining financial balance and addressing national policy priorities, and that there are strong foundations in place for 20/21 and 21/22 which will be further developed during the annual planning process that will take place between May 2019 and March 2020.

TEWV’s planning framework ensures that there is ownership by clinicians and managers from across the organisation, but we recognise the need to have effective tools to implement change and to monitor the completion of the actions within our plans.

Implementation will be achieved by use of the:

TEWV Quality Improvement System;

TEWV Project Management and Programme Management Frameworks;

TEWV Performance Management Framework;

Operational management.

The Trust’s Board of Directors will receive updates on progress made on delivering all of the priorities within the Business Plan through its quarterly Trust Strategic Direction performance report. This gives the Board assurance on whether proposed change actions have been, or are likely to be completed on time, and the level of risk of non-achievement for future milestones. It also enables the Board to agree additions and changes to the Plan to take account of emerging issues.

In addition, the Board also receives a monthly:

Trust Dashboard report, which gives the Board assurance on the key indicators of operational performance;

Finance Report, which shows the actual financial position compared to the planned position.

Other sources of assurance on performance against the Plan include:

Programme Governance arrangements, which ensure that benefits realisation and project / workstream delivery of plans are monitored on a regular basis, and changes made (or escalated to EMT and Trust Board) as appropriate


Executive Management Team’s (EMT) monthly Strategic Change Oversight Board meetings,

Quarterly workforce reports considered by the Resources Committee and Board of Directors.

Report outs from TEWV QIS events, Trust and Locality Report-Out events. There is also a weekly QIS report out to EMT

Contract monitoring and other associated processes;

Locality Management and Governance boards’ monitoring of business plan progress;

The various reports provided to sub-committees of the Board, e.g. Quality Assurance Committee, Resources Committee.


Appendix A: Glossary

Term Description

24/7 24 hours, 7 days a week

AMH Adult Mental Health Services (i.e. services for people aged 18 to 64)

Better Care Fund (BCF)

A proportion of CCG commissioning budgets that the government has assigned to the BCF from April 2015. The Local Authority and CCG both need to approve how the BCF will be spent, and the resource is designed to support integration of health and social care services.

CAMHS Child and Adolescent Mental Health Services

CCG Clinical Commissioning Group

CDDFT County Durham and Darlington NHS Foundation Trust

CITO An IT system which TEWV is introducing to make it easier to input information into and extract information from our electronic patient record (PARIS)

CLD Child Learning Disability services

CLiP Clinical Link Pathway

COO Chief Operating Officer

CQC Care Quality Commission – body that regulates quality for NHS healthcare providers, including Mental Health Act inspections.

CQUIN Commissioning for Quality and Improvement (targets within the Trust’s contracts with CCGs where the Trust is financially rewarded for achieving those targets).

CRES Cash Releasing Efficiency Saving

Crowdsourcing Obtaining information or input into a task or project by enlisting the services of a large number of people, typically via the Internet

Currency and tariff

A new description for the national initiative previously known as mental health “PBR” (payment by results). It seeks to calculate payments to mental health providers based on outcomes achieved as well as the number of patients treated (activity)

CYP Children and young people (birth to 18th birthday)

D&D Durham and Darlington

DDES CCG Durham Dales, Easington and Sedgefield CCG

DDT Durham, Darlington and Teesside

DIALOG A process for developing and reviewing care plans developed by East London Foundation Trust which promotes “co-production” with service users


Term Description

Do(….) Director of…. (e.g. DoN&G = Director of Nursing and Governance, DoO = Director of Operations)

Dual Diagnosis A pattern of psychoactive substance use (including illegal drugs, alcohol, smoking and misuse of prescription drugs) that is causing damage to mental health or has adverse social consequences. Substances can be misused on a regular or intermittent basis (e.g. binge drinking).

EFM Estates and Facilities Management

EIP or EiP Early Intervention in Psychosis team / service

ePR or EPR Electronic Patient Record (the current TEWV ePR system is PARIS)

ESR Electronic Staff Record

GP General Practitioner – the “family doctor” who is usually the first contact with the NHS when a patient becomes ill.

Foundation Trust (FT)

A group of hospitals and / or community health services that is allowed to re-invest any financial surpluses made and has a high degree of independence from the Department of Health. FTs are accountable to their local populations through their Membership and Council of Governors. They are regulated by NHS Improvement and the Care Quality Commission (CQC) TEWV is an FT.

HaRD CCG Harrogate and Rural District CCG

Health and Well Being Boards (H&WBBs)

A body consisting of Local Authority and CCG representatives. In most H&WBBs major NHS providers such as TEWV are either members of the Board or a sub-group of it.

HRW CCG Hambleton, Richmondshire and Whitby CCG

IAPT Improving Access to Psychological Therapies – a national programme to make “talking therapies” available to people with milder forms of mental illness to reduce the proportion who go onto develop serious mental illness.

IHT or IHTT Intensive Home Treatment / Intensive Home Treatment Team

IIC Integrated Information Centre – The Trust’s data repository which provides data for a variety of internal and external reporting.

Inpatient service / inpatients

Our services provided for patients who require treatment in a hospital for a period of time rather than treatment in the community.

IPS Individual Placement and Support – this is an approach which seeks to aid service users’ recovery by placing them directly into paid work. This involves work with potential employers as well as service users.

JSNA Joint Strategic Needs Assessment – a document produced by the Health and Well Being Board in each “upper tier” local authority area which sets out the health needs of that community and informs the development of Health and Well-Being strategies for that area, which contain strategic priorities for commissioners to consider as they develop their commissioning intentions.


Term Description

Kaizen This is the Japanese word for "improvement" or "change for the better". It refers to philosophy or practices that focus upon continuous improvement of processes. This philosophy of improvement has spread from the Japanese car industry to UK manufacturing and more recently into other sectors that rely on processes to deliver their work (Kaizen improvement techniques can often be known as “Lean”” methodology).

KPO Kaizen Production Office (TEWV’s specialist Quality Improvement team)

Learning Disability (LD)

People with an IQ below 70 are generally regarded as having a learning disability. People in this group are more likely to have a mental illness than other people.

Local Authority An elected body which commissions social care, public health and other services for a geographical area. Often also referred to as a Council.

Locality TEWV has 3 geographic Localities –North Yorkshire & York, Durham & Darlington; and Tees. The Forensics and Offender Health service is usually considered to be a “Locality” in management terms although it serves patients from across the north of England. All are managed by a Director of Operations reporting to the Chief Operating Officer.

MHSOP Mental Health Services for Older People (generally 65 years or older, although MHSOP services can cover younger people with early onset dementia).

MUPS Medically Unexplained Physical Symptoms

N&G Nursing and Governance Directorate

New Care Models In recent years, NHSE have promoted “new care models”. These generally involve forms of integration of providers or of commissioning and provision over a defined geographical area. There is a specific NHSE programme under which the Trust is working with partners to use NHSE resources differently in CYP and Forensic services to improve community services and reduce admissions to hospitals.

NHSE NHS England

NHSI NHS Improvement. This is the regulator for foundation trusts, and it incorporates the functions that used to be carried out by Monitor.

NY&Y North Yorkshire and York (please note that this is not coterminous with the boundaries of North Yorkshire County Council because this TEWV Locality covers the City of York, Pocklington (East Yorkshire) and Wetherby (Leeds) areas, and it does not cover Craven District. Services to that part of North Yorkshire are provided by Bradford District Care Trust).

PARIS TEWV’s electronic patient and clinical activity (ePR) record system, from which operational data is also drawn for use in the Integrated Information Centre (IIC).


Term Description

Pathway A standard “route” through treatment for all patients with the same diagnosis. This can include choices of alternative evidence based treatments at appropriate points in the pathway.

Program or Programme

A long-term initiative that focuses on designing and embedding significant changes that will lead to benefits. A program consists of several projects or workstreams and is governed by a programme board.

Project plan A plan that sets out how a one-off change is going to be delivered, including deadlines for key actions (also known as “milestones.”)

Q This stands for “quarter” of a year – Quarter 1 ends on 30th June; Quarter 2 on 30th September, Quarter 3 on 31st December and Quarter 4 on 30th April.

QIS Quality Improvement System. Can be referred to as TQIS (TEWV QIS)

QUAC or QuAC Quality Assurance Committee

RIDDOR Accidents that have to be notified to the Health and Safety Executive.

Speciality TEWV has 5 Specialities which are Forensics, Adult Mental Health, Mental Health Services for Older People, Child and Adolescent Mental Health Services and Learning Disabilities. There are regular Trust-wide Speciality Development Group meetings for the relevant Clinical Directors working in that speciality.

Tiers 1-4 Many services operate within a 4 Tier model, where Tier 4 represents the most serious conditions that require inpatient treatment. Tier 3 refers to levels of need that require specialist input, but usually in a community setting. Tier 2, and Tier 1 interventions are often delivered by agencies other than TEWV including the voluntary sector, schools and GPs, though TEWV may have a role in supporting and training for Tier 2 and Tier 1 delivery. The “Tiers” model is likely to be used less in future, particularly in CAMHS services.

Tees / Teesside Geographical area including the boroughs of Hartlepool, Stockton, Middlesbrough and Redcar & Cleveland.

Vale of York

(VoY)

This is the area covered by the Vale of York CCG. This includes the City of York, the Selby district of North Yorkshire and also the GP practices running from Easingwold south to the York City boundary, the western part of Ryedale District and Pocklington in East Yorkshire.

VMPS Virginia Mason Production System: a quality improvement system based on the Toyota Production System developed by Virginia Mason Healthcare Organisation, Seattle, USA.


Appendix B – This Means That Statements Strategic Goal 1: To improve the quality of life of service users and their carers by working with them to provide excellent services This means that we work in partnership with service users, and their carers to make a positive difference by:

a. Supporting individuals to identify and achieve their personal recovery goals b. Fully involving service users and their carers in the development and delivery of their care plan c. Providing personalised care and treatment d. Delivering accessible, effective and safe care e. Ensuring service users, and their carers have a positive experience of our services f. Providing accessible, high quality information

Strategic Goal 2: To continuously improve the quality and value of our work This means that we only do things that add value to our customers by:

a. Empowering service users, and their carers to get involved in helping us improve services b. Learning from and responding to service user, carer and other stakeholders’ feedback c. Taking part in relevant, innovative research and development d. Using our quality improvement method to continuously improve quality and value e. Using information to show the impact of the changes we make

Strategic Goal 3: To recruit , develop and retain and skilled, compassionate and motivated workforce This means that we are an excellent employer by:

a. Developing a culture where all our staff feel valued b. Ensuring we have the right staff, in the right place at the right time to provide safe, effective,

recovery focussed services c. Providing appropriate education, training, development and leadership opportunities for all

trainees, staff and volunteers d. Identifying and removing unnecessary barriers that prevent staff being the best they can be e. Developing existing and new professional roles f. Ensuring we have effective leadership and management throughout the organisation g. Supporting staff to maintain or improve their health and wellbeing h. Building the right culture where staff demonstrate the Trust’s values through their everyday

behaviour

Strategic Goal 4: To have effective partnerships with local, national and international organisations for the benefit of the communities we serve

This means that we actively engage partners to improve the health and wellbeing of the people we serve, by:

a. Influencing the development of regional and national strategies and plans b. Collaborating with CCGs, NHSE and other partners to implement national and local

mental health and learning disability priorities c. Working closely with GPs, local authorities, the voluntary sector and other service

providers to provide effective prevention and personalised care d. Working with partners, including higher education, to develop and test innovations


Strategic Goal 5: To be recognised as an excellent and well governed Foundation Trust that makes best use of its resources for the benefits of the communities we serve. This means that This means that we demonstrate we are a successful and sustainable organisation by: a. Actively involving governors, members and staff in the work of the Trust b. Having effective governance arrangements which are recognised as outstanding c. Being well managed and generating a financial surplus so we can improve services d. Spreading best practice across the Trust’s services e. Having a good reputation with the public, commissioners and partners f. Minimising our environmental impact


Appendix C – Summary of the Trust’s Business Plan priorities

No Title Lead To conclude by Strategic

Goals

OVERARCHING PRIORITIES

O Implement a recovery-focussed approach across all services

Medical Director 21/22 Q4 1

STRATEGIC PRIORITIES

1 Develop and implement a trauma-informed care approach across our services

Medical Director 21/22 Q4 1

2 Right Care: Right Place Chief Operating Officer

21/22 Q4 2

3 Ensure we have the right staffing for our services now and in the future

Director of Nursing and Governance

21/22 Q4 3

4 Make a Difference Together by embedding TEWV’s values and behaviours throughout the organisation

Chief Executive 21/22 Q4 3

5 Deliver our Digital Transformation Strategy Director of Finance and Information

21/22 Q4 5

6 Identify and reduce waste Chief Executive 21/22 Q4 5

OPERATIONAL PRIORITIES

7 Implement the Transforming Care agenda Chief Operating Officer

19/20 Q4 4

8 Develop and implement a Trust-wide approach to enabling people who have autism to access mental health services

Chief Operating Officer

19/20 Q4 1

9 Complete the transformation of our York and Selby services


21/22 Q2 1

10 Implement the agreed future delivery model for people living in Harrogate and Rural District and Wetherby who require our services


20/21 Q2 1

11 Implement the agreed delivery model for people living in Hambleton and Richmondshire who require our services


20/21 Q4 1

12 Improve the physical environment at Roseberry Park Hospital


24/25 Q1 5

13 Implement the NHS Long Term Plan for Mental Health as agreed with each of our commissioners


21/22 Q4 4

QUALITY ACCOUNT PRIORITIES

14 Further Improve the clinical effectiveness and patient experience at times of transition from CYP to AMH services

Director of Nursing and Governance

19/20 Q4 2

15 Make Care Plans more Personal Director of Nursing and Governance

19/20 Q4 2

16

Develop a Trust-wide approach to dual diagnosis which ensures that people with substance misuse issues can access appropriate and effective mental health services

DoO Durham and Darlington

19/20 Q4 2

17 Reduce the number of preventable deaths Director of Quality Governance

19/20 Q4 2

18 Review our Urgent Care services and identify a future model for delivery


19/20 Q4 2


Appendix D: Trust Dashboard 2019/20 Trust Dashboard Key Performance Indicators 19/20

No KPI Comments

1 Percentage of patients who were seen within 4 weeks for a first appointment following an external referral

No change from 18/19

2 Percentage of patients starting “treatment” within 6 weeks of external referral


3 The total number of inappropriate OAP days over the reporting period (Rolling 3 months)


4 Percentage of patients surveyed reporting their overall experience as excellent or good


5

New The percentage of Serious Incidents which are found to have a root cause or contributory finding

This KPI has been revised following feedback (previously “Number of unexpected deaths classed as a serious incident

per 10,000 open cases”)

6 The % teams achieving the agreed improvement benchmarks for HoNOS total score


7 The % teams achieving the agreed improvement benchmarks for SWEMWBS


8 Number of new unique patients referred No change from 18/19

9

New The percentage of new unique patients referred with an assessment completed (month behind)

This KPI was revised following feedback (previously “Number of new unique patients referred

with an assessment completed”)

10

New The percentage of new unique patients referred taken on for treatment (2 months behind)

This KPI was revised following feedback (previously “Number of new unique patients referred

and taken on for treatment”)

11 Number unique patients referred who received treatment and were discharged



No KPI Comments

12 Bed Occupancy (AMH & MHSOP A & T Wards) No change from 18/19

13 Number of patients occupying a bed with a length of stay (from admission) greater than 90 days (AMH & MHSOP A&T Wards (Snapshot)


14 Percentage of patients re-admitted to Assessment & Treatment wards within 30 days (AMH & MHSOP)


15 New Vacancy Rate

This KPI was revised following feedback (previously “Actual number of workforce in month and Vacancy fill rate”)

16 Percentage of staff in post more than 12 months with a current appraisal


17 Percentage compliance with ALL mandatory and statutory training


18 Percentage Sickness Absence Rate No change from 18/19

19 Delivery of our financial plan (I&E) No change from 18/19

20 CRES delivery No change from 18/19

21 Cash against plan No change from 18/19

N/A Percentage of Cancelled appointments by Trust (community and clinic appointments)

To investigate the feasibility of reporting this metric –

confirmed for 20/21 delivery

.

Documents

Business Plan 2019/20-2021/22 - TEWV...Tees, Esk and Wear Valleys NHS Foundation Trust – Business Plan 2019/20 – 2021/22 – NHSI 4/4/19 1 Preface This Business Plan sets out the