DCHS Operational Plan 2017/18 – 2018/19

1. Introduction & Strategic Approach

In November 2016, DCHS launched its new clinical strategy, which refreshes its established Integrated Business Plan (IBP) and reflects its position as an established Foundation Trust. This strategy reflects the significant strategic developments that have led to the formulation of the Derbyshire Sustainability and Transformation plan (STP), our continued close and effective relationships with our commissioners, partners and stakeholders; and with our staff and service users.

Our strategy is built upon the foundation of high quality clinical care, as reflected in our recent Care Quality Commission (CQC) visit and the recognition of the outstanding level of caring delivered by our workforce.

This will help to guide us on our on-going journey; from good to great and to maintain our category 1 status under the new NHSI regime. This Operational Plan details our approach to the delivery of the first 2 years of this strategy and has been written in accordance with NHSI planning guidance

Our clinical strategy follows the ‘Triple Aim’, developed by the Institute for Health Improvement (IHI) which will ensure that we work together, as an organisation and with our partners in the Derbyshire Health and Care Community to close the gaps and realise the Triple Aim vision of ‘simultaneously improving the health of the population, enhancing the experience and outcomes of the patient, and reducing the per capita cost of care for the benefit of communities. To ensure that, our plan will deliver:

High quality services that our communities require now, defined around their needs and what is important to them.

Improvements to the health of our population and the resilience of our communities for the future. A sustainable health and care system where our resources are used efficiently and responsibly,

making the best use of the Derbyshire £

The financial climate within which the contract settlements, that underpin this plan, have been agreed has proved to be extremely challenging and this is reflected in section 6.3. This requires the Trust to deliver a stretched control total surplus of £5 million, and an efficiency programme of £9.8m (5.3%). This is well in excess of previous performance, and brings additional risk to the delivery of the financial plan.

The delivery of our plan will therefore require strong leadership to ensure that we are confident in our aspirations and create coherence across the organisation and wider system. We will need to work effectively with our partners in a shared environment to co-create solutions and manage out conflict whilst leading with courage and conviction. As such we understand the challenge ahead is great; but if effectively delivered the opportunities to transform care for the people of Derbyshire will more than justify the effort. To successfully address these challenges we will need to develop our leaders and our leadership behaviours; building upon the DCHS Way and the organisational models that underpin this.

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2. Strategic and Planning Context

The final version of the Derbyshire STP was submitted on the 21st October. The STP recognises the financial Challenges across the Derbyshire Health and Care system and is based upon the 5 priorities of:

This plan places significant emphasis on place based care and DCHS will work with its partners to develop the necessary services based on the investment available, which is reflected in section 4.3 below. We recognise that in delivering place based services our actions need to be universal, to address inequalities and improve outcomes, and to be delivered at a scale and with an intensity that is proportionate to the level of need.

2.1 Better Care Closer to HomeWe know that people do better mentally and physically if they can be cared for close to home by health and care staff based in the community. North Derbyshire and Hardwick Clinical Commissioning Groups launched the ‘Better Joined-Up Care Closer to Home’ consultation at the end of June. The proposals represent a collaborative approach to transforming care at a system level so that people can be supported in their own homes and communities more effectively. DCHS will work with other healthcare providers such as General Practice and Mental Health services to help implement the agreed outcomes. However no decisions about the proposals will be made until after an independent analysis, led by East Anglia University, has been concluded, and this plan reflects this position.

2.2 Closer working with Derbyshire HealthCare Foundation Trust

DCHS and the Derbyshire Healthcare Foundation Trust (DHcFT) have been looking at the opportunities for closer working that would allow us to remove any organisational barriers to providing the very best clinical care for the benefit of the citizens of Derbyshire. On 27th October 2016 the Boards approved the Strategic Outline Case (SOC) that explored options for collaboration between the organisations in response to a number of shared challenges outlined in the STP. The preferred option for both organisations has now been identified, which is for the two Trusts to pursue a merger through acquisition, with DCHS being the acquiring organisation. Work is now in hand to undertake a full business case to progress these proposals, with the outline business case to be completed by April 2017.

2.3 Erewash Vanguard

DCHS continues to work with partners in Erewash to further develop the Vanguard Multispecialty Community Provider (MCP) model. All partners have committed to an Alliance contract to deliver the best outcomes for the people of Erewash and deliver care in a seamless way. The development of On-day services, for those patients who require an urgent appointment or same day access, will be a key priority within the vanguard and DCHS will continue to develop these throughout 2017 and 2018.

3. Improving the health of the population

3.1 Public Health Organisation

Prevention and Wellbeing are at the heart of the STP and DCHS is strongly committed to the delivery of a public health approach throughout the organisation. We have the potential to impact positively on the health and wellbeing of each person every time that we come into contact with them. If we do this well it will positively improve the health of our population in the future. Because the most effective way to spend public money is on preventing ill health or on identifying illness early, we want to ensure that all opportunities are taken by adopting a systematic population-based approach to improving health which will include our work to support the development of Wellness Hubs, within the context of the STP. This will be a new way of working for many of us, through which we will pursue the objectives detailed in Table 1

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Place based Care

Prevention and Self

ManagementUrgent Care System

EfficiencySystem

Management

Table 1Public Health

AreasActions

Healthcare public health

Educate staff about maximising the use of finite commissioning resources and encourage conscious decision making from the ground up for best use of resources.Delivery of clinical and cost effective care by reviewing and applying evidence based pathways of care and minimising variation in service delivery

Improving the wider

determinants of health

Development of preventative approach to care, educating the wider workforce on what the wider determinants of public health are, the impact these can have on population health, and how adopting approaches such as Making Every Contact Count (MECC) across the organisation can improve outcomes for patients.

Health Improvement

Promote ‘brief intervention’ approaches ensuring staff are confident to take a holistic approach when discussing with the patient their health needsSupport staff wellbeing based on the findings of the staff health needs assessment (January 2017)

Health protection

Improving the vaccination and immunisation uptake ratesRefresh the Emergency Preparedness plan to reflect the potential merger with Derbyshire Healthcare Foundation Trust.Ensure future flu campaigns meet the needs of our increasingly agile workforce

3.2 Supporting Research, Innovation and Growth

The DCHS Research and Innovation Group will ensure that research expertise within the Trust is used to support services to deliver improved outcomes for their patients and to develop research competencies in front line services. We will develop strategic partnerships with research networks, universities and other NHS providers to increase our research credibility and to ensure we are better positioned to undertake research studies generated nationally by academic or commercial organisations and by our own staff. We will engage our service users so that they can choose to be part of the development of the evidence base and have access to the latest emerging treatment. Through these steps DCHS will contribute to the development of clinically effective practice.

4. Improving the experience of care - Quality and Satisfaction

4.1 Approach to Quality Governance

4.1.1 Named Executive Lead

Executive leadership is provided by Carolyn White, Chief Nurse and Director of Quality, in partnership with Rick Meredith, Medical Director

4.1.2 From Good to Great – Our approach to achieving our ambition.

As a trust we are committed to our journey from ‘good to great’ and it is with this in mind that we will be using the output of our recent Care Quality Commission (CQC) inspection reported in August this year to identify and plan actions that will build on our overall ‘Good’ rating. DCHS has developed a comprehensive quality improvement and assurance framework over the last three years which has facilitated year on year improvements in the quality of our services and the underpinning governance arrangements.

Quality improvement is central to all that we do, with our patients being at the centre of all of our decisions. Through our Quality Always programme we have three components that we see as fundamental to continuous improvement:

Clinical standards across 13 domains which teams self-assess themselves against and which are peer reviewed on a regular basis, driving improvement towards overall accreditation as a Quality Always Gold accredited team.

Clinical leadership is supported through a bespoke personalised development assessment centre to equip our clinical leaders with the skills to transform and improve services

Clinical standards improvement is supported through the auspices of Safe Care Champions – individuals who are selected and trained to ensure that best practice is consistently delivered.

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Our quality plans have been developed to ensure we deliver high quality person centred care and that we ensure that our staff are able to deliver services that meet the standards defined in the NHS Constitution and the CQC. To help us on our journey we will work to ensure that our Quality Always programme assessments are aligned to the expectations and standards of the CQC so that our ‘Gold’ accreditation corresponds to the ‘Outstanding’ measure.

4.1.3 Patient Safety

DCHS is actively engaged with the national ‘Sign Up To Safety’ Campaign. We remain committed to the reduction of harm to patients through the continued delivery of high quality care and to ensure that 95% of patients receive care with no avoidable harm. To deliver this we will continue to implement our targeted reduction strategies such as those for pressure ulcers and the targeted interventions of our Safe Care Champions. Where serious harm does occur we will ensure that the Duty of Candour is exercised and that patients or their advocates are informed of any lessons learned. Our current patient safety objectives have been developed internally through the priorities and performance objectives identified through our Quality Service Committee.

4.1.4 Measures being used to demonstrate and evidence the impact of investment in quality improvement

Our Quality Always programme is led by the Chief Nurse and overseen by a programme management approach. Key performance indicators for the programme have been developed and are reviewed regularly. In addition the programme is supported by our research team who are undertaking its formal evaluation and the benefits this has realised.

In addition the trust has developed an interactive real time clinical dashboard for clinical managers to assess and monitor their own performance and compare and contrast this with similar trust services.

4.2 Quality Improvement Plan Table 2

Initiative Quality Improvement Plans

National clinical audits

The trust participates in those national audits relevant to our services which currently include: sentinel stroke, national audit of diabetic foot care, national audit of dementia, learning disability mortality and the review of Young People’s Mental Health study

The 4 priority standards for seven-day hospital services

DCHS is working with the wider health and social care community on STP plans to ensure care is delivered as close to home as possible and is provided equitably over 7 days in accordance with these standards

Safe staffing DCHS will be reviewing its safe staffing requirements in line with STP place based care proposals going forwards

Improving the quality of mortality review and Serious Incident Investigation and subsequent learning and action

All unexpected deaths are peer reviewed and all serious incidents undergo root cause analysis. We will be reviewing our processes for sharing learning going forward. Our End of Life Strategy, to be launched early in 2017 details our robust audit and assurance process. We will respond to the recommendations and actions as detailed in the CQC review into Learning, Candour and Accountability (December 2016) to ensure we deliver good practice across all areas.

Anti-microbial resistance

All inpatient antimicrobial prescribing is audited and reported through our infection prevention and control group. In the coming year we will be strengthening our systems for monitoring prescribing in the wider community

Infection prevention and control

DCHS has a strong track record for good infection prevention and control. We will continue to monitor this through regular IPC audit

Falls Our falls working group will continue to work towards reducing falls in hospital and in patients own homes and have set clear objectives to achieve this

Sepsis Sepsis education forms a key part of our staff training programme as part of our recognising the deteriorating patient. This will continue to be delivered and its impact monitored

Pressure ulcers Pressure ulcers remain our single greatest challenge and DCHS have set an ambitious 20% reduction target this year which will be achieved through greater focus on:

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Exploiting technological support solutions Improved clinical care through greater staff awareness and training Patient/carer engagement

End of Life Care Our end of life governance group reviews ensures robust audit of end of life care and we continue to implement changes from the new Derbyshire end of Life Care pathway. We will launch our new End of Life strategy in 2017 and work to implement this across the organisation and in our work with our partners.

Patient experience We will continue to engage with and learn from our patients and carers through our network of patient engagement. As we work to deliver more services in and close to home we recognise the importance of the development of social capital and person centred goals in improving the experience of care and wellbeing and avoiding social isolation. Our commitment to driving improvements is reflected in our complaints management process, by improving the timeliness and quality of our responses and ensuring that we share and act on our learning.

National CQUINS Through the implementation of our operational plan we will deliver our CQUIN targets across the following key areas: Improving Staff Health and Wellbeing, Supporting proactive and safe discharge, Preventing ill health by high risk behaviour e.g. in relation to alcohol and tobacco, Improving assessment of wounds and Personalised care and support planningThe delivery and monitoring of the actions associated with the delivery of these will be included through the on-going development and governance of our delivery plan (appendix 1)

The Trust’s measure of compliance against these standards will be monitored through the Quality Schedule which will be reported to the Quality and Performance group of the STP

4.2.1 Quality Planning – creation, assessment, governance and monitoring

Schemes for service and cost improvements are developed at an operational level and assessed for feasibility by the Executive led Plan Delivery Group. Each project plan includes a quality impact assessment (QIA), equality impact assessment, risk assessment and financial profile. Schemes deemed viable by the Plan Delivery Group are independently assessed for its potential impact on quality by a panel consisting of the Chief Nurse, Medical Director and a Non-executive Director. The process is facilitated by the Programme Management Office which also provides progress reports to the Plan Delivery Group and Quality Business Committee of the Board. Our Governance process was developed using Birmingham Children’s hospital framework illustrated as best practice in the NQB Quality Impact Assess provider Cost Improvement plan Guidance 2013. It can be summarised as follows:

4.2.2 Triangulation of quality with workforce and finance

The Board receives an integrated performance dashboard on a monthly basis which includes staffing, quality and financial metrics. In addition all clinical managers have access to a live interactive clinical dashboard which details key performance indicators for quality and staffing

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In itia te

F ea s ib ility ag ree dB en e fits id en tifie d

P la n

Q IA s ig ne d o ffP ro je ct p lan a n d risk as se ssm en t s ign e d o ff

Im p lem e n t

D e live ry a ga in s t ke y m iles to ne sM a na g em e n t o f r isksT ra ck in g o f K P Is

R e v ie w

B e ne fits a n d qu a lity re v iew a t 6 m o n th sC o n firm a tio n o f p la n s fo r fu tu re rev ie w s

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4.3 This section outlines the operational plans which are intended to ensure that our services remain sustainable whilst meeting the objectives laid out within the NHS Mandate and the Planning “Must Dos”. These plans are aligned with those of our partners and will support the effective implementation of the business cases within the STP and the effective transformation of care within Derbyshire, where resources allow. The themes reflected below will be supported by detailed operational delivery plans and clear reporting mechanisms (see appendix one) to provide assurance to our Board and its sub committees that we maintain an effective grip on delivery, timing and budget and that through this we will mitigate our Board Assurance Framework risks outlined in Appendix 2

Table 3Ref Service

AreaService Development Priorities STP

Objective1 All Work to improve the efficiency and experience of the patient journey for both patients and referrers.

Engage our partners to ensure that we support the development of evidence based care pathways and to deliver proactive approaches to care to improve the management of long term conditions e.g. diabetes, dysphagia and musculoskeletal and to monitor their efficacy.

Identify patients who are scheduled for outpatient or primary care follow-up and would benefit from personalised care and support

P, PC, Pr

2 All Continue to focus on the prevention agenda, maximising health gains and avoiding unnecessary health care costs. Engage our patients to understand their needs and requirements and to increase their knowledge, skills and confidence to manage their health

and wellbeing. Embed this approach within all services supported by additional/further training in MECC and the support of our Health Psychology service

Pr & P

3 All Develop specific services to meet the needs of specific place population, Respond to feedback from clients and service users when developing and improving our services, such as ensuring our services are available

at different times and days (including out of hours, evening sessions and some Saturday mornings) and are delivered in local community venues with an emphasis on delivery in the most deprived areas

P

4 All Develop our medicines management function to support the reduction in antibiotic consumption. We will continue to develop our non-medical prescribing initiatives and develop robust and appropriate governance arrangements to support this.

SE

5 All Review the locations of clinical activity and services to ensure the maximised use of, and maximum value from, our estate and assets and to facilitate effective integrated working with our voluntary sector and social care partners

C&M & SE

6 All Maximise the use of technology and equipment to ensure efficient co-ordination and provision of care and to improve the monitoring of patients

Utilise telehealth opportunities to support proactive self-care at home and promote maintenance of independence in Place

Pr & SE

7 All Reduce unwarranted variation across clinical and corporate services to reduce duplication and inefficiency and embed a standardised approach to the delivery of care that optimises clinical quality, efficiency and productivity.

To reduce the delayed transfers of care and meet our target of 3.5% by September 2017

SE

8 ICS & PC

Support the appropriate use of personal budgets and personal health budgets to support person centred care and engagement to deliver individual packages of care in the most effective and efficient way.

Pr

9 HW&I & ICS

Maximise the efficiency of General Practice and Integrated community teams to support proposed inpatient rationalisation and to work collaboratively with other agencies in Place to provide quality person centred care

Develop consistent seven day services, where appropriate and in collaboration with partners. Particular areas of focus include: Community IV service - development of step up service and reviewing the current level of provision (High Peak) , development of the discharge to assess and manage service, access to same day GP appointments, the development of Personalised Care and Support Planning , delivery of the DCHS End of Life and Frailty Strategies

P

10 ICS Develop collaborative Comprehensive Geriatric Assessments that are shared across pathways, including the implementation of 'Trusted Assessments' across agencies and Improve the outcomes for those living at home with frailty

P

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11 ICS Reduce the numbers of older people with dementia being admitted into an acute mental health bed for assessment/treatment by providing this in an appropriate community setting via a specialist community multi-disciplinary team (Dementia Rapid Response Team - DRRT) and through the early recognition and treatment of delirium

HS, MH & P

12 ICS With partners in health, care and the voluntary sector develop Older People’s Mental Health services, as part of a community facing, enhanced organic pathway to improve the experience and outcomes for people with dementia, and their carers.

Pr, HS, P & MH

13 ICS Develop a Unified Community Learning Disability model to promote new approaches to care and support pathways; including the development of more personalised, efficient and effective short break respite services.

Develop our staffing model to enhance our skill mix and expertise to support the future Place based community model

LD & SE

14 ICS Develop our emergency and urgent care services to ensure patients are seen by the most appropriate person, at the right place at the right time. We will work with our partners to maximise the use and effectiveness of our urgent care services including MIUs, Step Up facilities (AVS, Falls, Care Home support & IV therapy)

P & HS

15 PC Progress the review of the portfolio of services with partner providers to ensure that the community provision meets the health needs of the population in a locally accessible and sustainable way

P, PC & HS

16 PC Continue to support and implement the recommendations from the commissioner led review of wheelchair services, to ensure high quality and sustainable service provision, in the context of increasing complexity

SC

17 PC Consolidation of our catering facilities through a more effective ‘hub and spoke’ model and to ensure that we provide a quality, nutritionally balanced and freshly cooked menu for patients, visitors and staff; and respond to patient feedback.

Pr

18 PC Develop a county wide single point of access and local triage to enable easy access for all agencies P & LD19 HW&I Improve health literacy and sexual health awareness of the target populations by offering and increasing the uptake of testing, by focusing on

increasing accessibility such as testing at home and developing walk-in servicesPr

20 HW&I Establish a wider range of self-management diabetes education programmes for people with Type 2 diabetes in partnership with our CCGs Pr & P21 HW&I Improve access initially by ensuring all practices are signed up to the Extended Hours Directed Enhanced Services and support the delivery of

the GP5YFV. Increase the use of online and telephone management and review the process for streaming patient demand. Develop a shared infrastructure between our own practices, including reviewing our skill mix to develop new roles and using existing roles

innovatively to improve efficiency and quality for all patients

P & SE

22 HW&I Influence the future development of the place based model of care to incorporate the children and young adult agenda C&M23 HW&I Respond to feedback from clients, in particular from children and young adults themselves on how we are able to ensure our services are

accessible, responsive, welcoming and inclusive to all. Work with our schools to help children and young people to make healthy life choices and to develop their emotional resilience and wellbeing.

C&M

24 HW&I Work with our county and city commissioners to continue to promote and improve the health of the population, including the reduction of childhood obesity and the continued improvement in breastfeeding sustainment rates

C&M

Service Areas: ICS – Integrated Community Services, PC – Planned Care, HW&I – Heath, Wellbeing & Inclusion

STP Objectives: P – Place, Pr – Prevention & Self Management, UC – Urgent Care, SE – System Efficiency, SM – System Management, HS – Appropriate & effective treatment at hospital sites, LD – Learning Disability, C&M – Children’s & Maternity, MH – Mental Health, PC - Planned Care, SC – Specialist Community Service

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5.4 Workforce

5.4.1 Workforce Strategy

DCHS recognises the significant risks surrounding future workforce requirements for the delivery of its plans and in response to this we have worked with each Division, our staff forums and the Workforce planning groups to refresh our Workforce strategy; ensuring this is aligned to the clinical and STP strategies across Derbyshire.

We recognise the important contribution that the voluntary and community sector make in the delivery of care and the promotion of social value. We will continue to work with our partners in these areas, recognising their contribution to developing a sustainable workforce, developing services in partnership with them and working to explore new opportunities for them to make a difference to the wellbeing of our patients as we develop our volunteer strategy.

The implementation of this plan and the wider STP will require strong leadership to ensure that we are confident in our aspirations; create coherence across the organisations and wider system; work effectively with partners to co-create solutions and manage out conflict whilst leading with courage and conviction. Leaders will need support and development to help them rise to this challenge and this will need to be underpinned by effective communications and change management. To deliver this effectively we will also need to ensure the appropriate change management capacity is available.

5.4.2 Workforce Planning

We have a cyclical, robust, internal workforce planning methodology which triangulates service, finance and workforce requirements. We have shared this approach with our STP partners to promote a system wide methodology and we have also led workforce modelling activity, using the Strategic workforce and education planning (SWiPE) approach. 5.4.3 Workforce Efficiency Historically we have a strong track record of reducing our use of agency and locum spend though we continue to be set challenging targets. As such we are developing further innovative responses (see 6.5.1) and are engaged in regional work to address “under price cap” arrangements. We continually review our actions with the Trust Board to seek every opportunity to address our position and we are very active in the Derbyshire health economy in relation to increasing the responsiveness, and efficiency of the combined Derbyshire workforce, for example:

Chairing the Derbyshire Strategic Workforce Implementation Group Director lead on the workforce “Back office” efficiency schemes Active member of the Local Workforce Advisory Board, and Chair of Implementation Group Hosting initiatives such as the regional Return to Practice post and encouraging its expansion

beyond Nursing to Allied Health Professionals.

We generally source all of our workforce from our host community so to date have not entered into any overseas recruitment.

5.5.4 Workforce Transformation & New Models

Within the context of the financially constrained climate we recognise that there will be no workforce growth in 17/18 and potential workforce rationalisation in relation to back office efficiencies and decommissioning of service by the CCGs. Recruitment to our clinical workforce will however continue to ensure we fill our vacancies as they arise. Beyond this our workforce plans recognise the STP focus on Place and will support delivery of the emerging care models, where, we will help to create integrated and co-located teams working more efficiently to deliver care across Derbyshire. The new care models described within the STP will require:

New ways of working, such as in the integrated teams which we are already developing with our partners.

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New roles, such as the approach we have developed in relation to Advanced Clinical Practitioners and our work with care providers to increase applicants into this sector.

Review of our learning and development offer to ensure that this is specific to existing and developing roles, underpinned by a more robust approach to training needs analysis.

Increased support to our staff to enable them to work more flexibly and across different settings

Improving our understanding about current workforce risks and challenges. Supporting and learning from our partners and developing shared flexible workforce solutions.

DCHS will continue to offer clinical and non-clinical placements to promote future workforce supply, and we will maximise our offer in areas where we have a workforce challenge, such as Allied Health professionals and the registered Nursing workforce. We will also develop our approach to apprenticeships to ensure that from April we are able to deliver those requirements. In response to the changing arrangements for bursaries we have put in place schemes to both fast track existing staff to undertake registration as well as opportunities for staff to learn whilst they are also earning through Open University courses. Through our leadership within the STP and work with the Local Workforce Action Board (LWAB) we will align our workforce strategy with the needs of the local health and care system.

5.5.5 Workforce Governance

To ensure the robust governance of our workforce plans we have strengthened our internal approach to the review of emerging operational needs, the on-going position in relation to workforce supply and our agency workforce requirements. This in turn strengthens the assurance we are able to give to the Trust Board, through the Quality People Committee, regarding the delivery of our workforce plans.

5.6 Equality, Diversity & Inclusion

DCHS is currently reviewing the Equality, Diversity and Inclusion Strategy; this will reflect a longer term strategic approach to support service transformation and to manage its impact on our communities. Key actions identified to ensure the delivery of the strategy and to support our journey from good to great are detailed here:

Table 4Equality Objective Action

Consider the impact of what we do (or are planning to do) on all sections of the community / protected characteristics

Increase the completion rate of Equality Impact Assessments (EIA’s) to:− 50% of all key decisions by end March 2017,− 100% of all key decisions by March 2018

Increase and improve DCHS’ awareness and understanding of equality, diversity, inclusion and Human Rights issues – improve organisational culture

Establish an ‘Equalities Allies’ programme by end March 2017

Have 100 ‘Equalities Allies’ in place by end March 2018

Better understand, and more effectively meet, the needs of all our service users / patients

Move from 50% of services on TPP completing the Diversity Monitoring Questionnaire to:− 75% by end March 2017− 100% by end March 2018

Better understand the profile and experiences of our employees and achieve a diverse workforce

Produce and publish the 2016 Annual Workforce Profile Report and Analysis by 31 Jan 2017 and the 2017 report 31 Jan 2018

Undertake analysis by Protected Characteristic of the 2016 staff survey by end March 2017 and 2017 staff survey by end of March 2018

Progress the equalities agenda within DCHS Consolidate the ‘Achieving’ level of the Equality Delivery System 2 (EDS2) by end March 2017

Achieve the ‘Excellent’ level by end March 20186. Reducing the per capita cost of healthcare

6.1.1 Approach to Activity Planning 9

DCHS recognise the importance for the Trust to have realistic activity plans which align with commissioners plans delivered through robust demand and capacity modelling. This is essential to ensure there is sound financial and workforce planning, and that there is sufficient capacity to meet demand and ensure achievement of operational standards including A&E waits and Referral to Treatment (RTT).

A coordinated two step approach to activity planning has been taken:

Baseline activity plans have been based on agreed 2016/17 forecast out-turn. Within DCHS specific service leads have informed these baseline plans, where 2016/17 month 1 to 5 actual activity has been taken, and then forecast forward based on agreed historic activity profiles and then adjusted for full year impact of any service developments and any factors which have had a non-recurrent impact. These baseline plans have then been shared with commissioners and compared to their plans to identify and understand any significant variances, to then allow us to agree a common baseline.

Growth has then been applied to these baselines. Growth takes into account demographic and activity growth based on a consistent national methodology. This has been applied to Outpatients (First and Follow-up), Non-Electives, Electives (Inpatients and Day Cases) and A&E attendances.

The table below details the high level 17/18 cost and volume activity plansTable 5

2017/18 Activity Plan Service Activity

National Tariff

Accident and Emergency 67,208Diagnostic Treatment Centre 47,575Diagnostic Imaging 3,625

Local Cost and Volume

Community Podiatry 153,449Physiotherapy 125,999Podiatric Surgery 15,790Pulmonary Rehab 703Speech and Language Therapy 21,598Vasectomy 391

Total 436,339

For the block contract services, growth has been applied at 2.4%. This will be applied disproportionately across service lines to ensure that service risks and pressures are addressed. To fund this growth, commissioners will apply an equivalent QIPP target. They have agreed to inform of service lines they wish to divest in by the end of January 2017.Integrated community services activity historically hasn’t been as accurate and as well understood compared to other services. This is linked to the use of block contracts and the gradual roll-out of TPP system one electronic patient information system, which commissioners now recognise and understand. Further joint detailed work with commissioners is being undertaken to agree accurate baselines for each locality, taking into account any issues with historic data and changes to information systems. This will prepare both commissioners and the Trust to prepare for the development of PLACEs across the county and to plan and monitor the impact of investments and disinvestments on activity.

To develop appropriate capacity across winter and to ensure system resilience DCHS will ensure that corporate clinical staff are able to directly support clinical services. DCHS will build on the agreement and investment it has secured via the A&E Delivery Board and System Chiefs Group to increase resources to respond to whole system pressures. This includes the provision of discharge planning and support services along with additional winter beds, a roster of corporate clinical staff who can support direct clinical service provision at times of high demand. 6.1.2 Achievement of Key Milestones

DCHS have historically performed strongly against operational standards linked to A&E and RTT. Commissioners and DCHS are committed to ensuring achievement of these operational standards

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continues. Indicative activity plans and block contracts are currently being worked through and agreed to ensure this is achievable. This includes consideration of current performance and capacity, impact of demographic growth using the national Indicative Hospital Activity Model (IHAM), and impact of transformational service changes. The impact of these activity plans will then be reflected in operational delivery plans, taking into account workforce impact and session planning.

6.1.3 Financial Planning

The financial context within which the Trust operates continues to be challenging. Although the Derbyshire system is broadly planning to achieve its control total in 2016/17, this will be delivered through significant non-recurrent measures. Therefore the contracting discussions for 2017/18 and 2018/19 have been difficult with affordability of contracts becoming a key issue for commissioners.

With affordability a key issue for the Derbyshire system, the level of financial risk taken by each organisation within their plan has grown. For DCHS, we will be required to deliver efficiencies of 4% to achieve our stretch control total, and a further 1.3% to achieve commissioner QIPP. These levels of efficiency are much greater than the Trust has previously achieved. Therefore the key financial challenge in 2017/18 will be delivery of the efficiency plan.

Moving forward, the Sustainability Transformation Plans will be the vehicle through which integrated service and financial plans of commissioners and providers will be delivered. The Trust will continue to fully participate in the development of the Derbyshire STP.

The Trust has demonstrated its financial resilience during these testing times through continuing to achieve its financial plans and targets. For 2017/18 and 2018/19, all providers have been issued with surplus control totals. The Trust has been issued with a control total of £4.923 million surplus in 2017/18 and £5.113m in 2018/19. For those providers which deliver their 2016/17 control total and accept the 2017/18 control total and associated conditions, NHS Improvement have provided flexibility for providers to set their own control total for 2018/19 within a set framework. For the Trust, as we are in surplus (before STF funding) in 2017/18, we are required to maintain a surplus at the same level as 2017/18 in 2018/19. The Trust is therefore planning for a surplus of £4.923m, and full receipt of STF funding in 2018/19.

Against this context, the Trust has developed a realistic two year financial plan which will deliver an EBITDA margin of £11.4m (6.01%) in 2017/18 and a surplus of £4.923m or 2.58% of turnover. In 2018/19 EBITDA margin is planned at £11.4m (6.02%) and a surplus of £4.923m or 2.58%

The plan is dependent on the successful delivery of an efficiency programme of £9.783m in 2017/18 and £3.8m in 2018/19.

6.1.4 Financial Forecasts and Modelling

The initial plan as presented is based on a number of key planning assumptions:-- The national efficiency requirement has been confirmed at 2.0% for 2017/18 and 2018/19.

National costs pressures are assumed at 2.1% in each year which when offset against the 2% efficiency, results in a tariff uplift on 0.1%.

- The clinical income assumptions underpinning the plan are aligned to the contract values agreed with Commissioners for 2017/18

- Revenue surplus of £4.923m in both years.- Capital Investment Plans of £5.0m each year which is in excess of the forecast depreciation

levels of £4.0m by £1.0m, the funding gap being met from internally generated resources.

Table 6 (income and expenditure) details the high level income and expenditure position planned for in 2017-18 and 2018-19. The surplus levels represent 2.58% of forecast turnover.

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Table 7 (balance sheet projections) details the current balance sheet projections. The initial cash-flow forecast shows that the Trust is planning to increase its cash reserves held from £14.3m at the end of 2016-17 to £22.3m at the end of 2018-19.The cash-flows associated with the capital programme as currently modelled are in excess of the Trust’s forecast depreciation levels by £1.0m which will be met from internally generated resources. The most significant schemes include the re-development of the Walton site, the new build on the Heanor site and the on-going investment into the Trust’s IM&T infrastructure. The Trust is currently actively marketing the surplus land on the Walton site. There is a clause within the original transfer document from the Department of Health to the Trust that states that the DH will claw back 50% of any profit on sale. It is anticipated that the likely sale proceeds will be approximately £2.44m which would represent a profit on sale of £1.0m and 50% of this or £0.5m would be returned to the DH. Therefore the Trust would receive a cash receipt of £1.9m. This has not been modelled into the Trust’s cash-flow forecasts based upon recent guidance received by NHS Improvement.

Table 6

Income and Expenditure - December Submission

Forecast Plan Plan2016-17 2017-18 2018-19

£m's £m's £m's

Clinical Income 183.0 180.4 180.6Other Income 10.9 9.8 9.8

Total Turnover 193.9 190.2 190.4

Operating Expenses -183.2 -178.8 -179.1

EBITDA 10.7 11.4 11.3EBITDA - % 5.51% 5.99% 5.93%

Depreciation -4.0 -4.1 -4.0Interest Income 0.1 -0.1 0.1

PDC Dividend Payable -2.4 -2.5 -2.5

Surplus / ( Deficit) In Year 4.4 4.9 4.9Surplus / ( Deficit) In Year - % 2.26% 2.58% 2.58%

Table 7

Forecast Plan PlanBalance Sheet - December Submission 2016-17 2017-18 2018-19

£m's £m's £m's

Non Current Assets 86.6 87.5 88.5

Current Assets 20.9 25.0 28.7

Current Liabilities -10.7 -10.7 -10.8

Net Current Assets / Liabilities 10.2 14.3 17.9

Provisions - Non Current -0.1 -0.1 -0.1

Deferred Income - Non Current 0.0 0.0 0.0

Total Assets Employed 96.7 101.7 106.3

Represented By:-

Public Divided Capital 0.2 0.2 0.2Retained Earnings 74.2 79.1 83.8Revaluation Reserve 22.3 22.3 22.3

Total Assets Employed 96.7 101.7 106.3

NHS Improvement has introduced a new Single Oversight Framework for both NHS Trusts and NHS Foundation Trusts which replaces Monitor’s Risk Assessment

Our forecast Use of Resources metric under the new Single Oversight Framework is a 1 (lowest risk). (table 8). It is important to understand the level of financial headroom available within the plan as presented here. In order to reduce the rating to a 2 there would need to be a reduction in margin of £3.1m. A further reduction of £0.8m would reduce the overall rating to a 3.

The plan as presented here represents the Trust’s base case and most realistic assessment of likely financial position over the next two financial years. However, in addition to the above, there are a number of key risks inherent in the Trust’s planning assumptions and therefore it is important to understand the impact that these risks could have on the Trust’s financial projections and overall financial rating.

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Table 8

Metric WeightScore Rating Score Rating Score Rating

Capital Service Capacity ( x times ) 20.00% 4.58 1.0 4.60 1.0 4.60 1.0

Liquidity ( Days) 20.00% 20.4 1.0 28.9 1.0 36.9 1.0

I&E Margin (%) 20.00% 2.35% 1.0 2.59% 1.0 2.59% 1.0

Distance from plan (%) 20.00% 0.00% 1.0 0.00% 1.0 0.00% 1.0

Agency Expenditure (%) 20.00% 2.70% 2.0 0.00 1.0 0.00 1.0

Overall Rating 1.0 1.0

Single Oversight Framework - December Submission

Forecast 2016-17 Plan 2018-19Plan 2017-18

The key sensitivities / risks that have been considered are detailed below and the table provides an analysis of the impact each of these would have on the base plan presented here. The individual

sensitivities identified whilst eroding the Trust’s margin and cash position are not sufficient in isolation to have an impact of the Trust’s overall Financial Rating of a 1. In the situation where all of the risks identified materialise this combined scenario would be sufficient to reduce the

Trust’s rating to a 2 in 2018/19. Clearly this would be the position before the implementation of the Trust’s mitigation plan. This is shown in the table 9

6.2 Efficiency Savings for 2017/18 to 2018/19

Table 10 shows the level of efficiencies that the Trust will be required to deliver over the two year planning period. This is a combination of the national efficiency target for all providers of 2% plus unfunded cost pressures and the additional transformational efficiencies identified by commissioners. At the time of submission, there remains £1m of the Trust’s internal efficiency programme which is unidentified. The Trust will work over the final quarter of the current year to identify further schemes to close the current gap in the programme. The Commissioner QIPP is also currently unidentified. A deadline of the end of January 2017 has been set to agree the schemes which will deliver this additional efficiency. As a result the level of efficiencies to be delivered in 2017/18 is significantly greater than previous years which brings additional risk to the plan.

6.3 Capital Planning

Capital Investment Plan

The plan assumes capital investment of £5m pa. The major areas planned for investment are the redevelopment of the Walton and Heanor sites, continued investment in the Trust’s IM&T infrastructure and routine backlog maintenance. This level of investment is in excess of the forecast annual depreciation of £4.0m The Trust is not seeking external financing and therefore the balance will be funded from internal cash resources. The Trust is anticipating a capital receipt during 2017/18 in relation to the sale of surplus land on the Walton site which will assist in maintaining a good level of liquidity.

6.4 Estates Management

Within Derbyshire estates costs are projected to increase by £25m over the course of the next 5 years. We recognise the inefficiencies in our current estate and have, with our partners, identified a range of opportunities that will be key to delivering our service developments and aspirations as well as delivering improvements in efficiency and utilisation. The outcome of the public Better Care Closer to Home consultation will have a major impact on how our services are delivered in the future, and as such determine the capital/estates priorities and work schedule for the coming years. In addition we will work to deliver the ‘One Public Estate’ initiative to maximise the utilisation of NHS and Public sector buildings and estates and to facilitate integrated and collaborative working, such as the development of an integrated hub in Buxton. The table 11 captures the STP estates priorities for DCHS

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Table 9

Sensitivity - Combined Surplus Cash Surplus Cash£000's £000's £000's £000's 2017/18 2018/19

Trust Base Case Plan 4,923 18,318 4,923 22,241 1 1

Combined -2,448 -2,448 -3,248 -5,696

Revised Position 2,954 16,329 1,362 18,707 1 2

2017/18 2018/19Rating

Table 10

2017-18 2018-19% %

Pay & Prices 2.1% 2.1%Tariff Inflation 0.1% 0.1%

National Efficiency -2.0% -2.0%

Techncial Efficiency - £000's7,238 3,800Techncial Efficiency - % 3.95% 2.08%

CCG QIPP 2,545CCG QIPP 1.37%

Total Efficiency 9,783 3,800Total Efficiency 5.32% 2.08%

Table 11Transactional Schemes Transformational SchemesRevaluation of estate – awaiting outcome Better Care Closer to Home Consultation outcome actionsMaximise utilisation of LIFT buildings (St Oswalds)

Site utilisation and accommodation– London Road Community Hospital, Belper,

Heanor, Walton & WheatbridgeRent reductions (NHSPS – Babington) Closer working with DHcFT

6.5 System Efficiency

The Trust will be working with Lord Carter, NHS Improvement and other providers to develop the efficiency workstream for community and mental health trust providers in 2017/18. We are already well advanced on this work and we are progressing in the following areas:

6.5.1 Agency Rules

DCHS has been identified by the Lord Carter case study as a best practice example for temporary staffing solutions. We have undertaken further work to reduce our Agency spend whilst continuing to make patient safety our absolute priority. This includes:

Successfully recruiting additional team members to our Responsive Workforce team. Identifying additional actions to increase the bank fill rate; including enhanced rates and

opportunities to implement a weekly payroll Recruiting additional posts to our bank, especially in workforce groups where we have known

challenge, such as around Allied Health Professional recruitment Large-scale recruitment campaign which aims to not only fill current clinical vacancies but

also anticipates where we might need extra staff or where vacancies might arise. Where ‘hard to fill’ areas have been identified we will explore targeted recruitment incentives

to secure a permanent workforce more easily. Introducing a central daily ‘staffing monitoring’ service within People & Organisational

Effectiveness, to find solutions to gaps and is reducing shifts sent to bank/agency. Scrutinising agency spend line by line to remove any unnecessary expenditure, only

permitting use in Clinical services to ensure that patient safety is not compromised Engaging with our existing Advanced Nurse Practioner workforce to see who is prepared to

work extra hours within our GP practices and also liaising with a framework agency to support ANP work to reduce GP locum spend.

Implementation of an additional senior clinical on-call rota to ensure that clinical judgments relating to staffing can be swiftly made to prevent the need for agency cover

6.5.2 Back Office

DCHS is working collaboratively with its STP partners to identify system wide efficiencies such as those that have been identified in relation to utilities, food and waste management costs. We are also working closely with colleagues at DHcFT and have identified significant efficiencies in relation to closer working across IM&T, People & Organisational Effectiveness, Estates, Facilities Management and Procurement. Project management support will be provided to enable the implementation of these initiatives.

6.5.3 Procurement

The Trust has developed its procurement strategy which applies to all its procurement activity and which commits it to take action on all areas of non-pay expenditure by applying good practice in selection, purchasing, prices, stockholding and usage to achieve value for money and appropriate quality.

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In line with the Carter Report, we have developed a Procurement Transformation Plan. This sets out the key changes and actions required to improve our performance against the key Carter metrics. In addition, the procurement department are working with clinical services to support the delivery of non pay efficiencies, as well as working with partner organisations to drive further savings through collaborative procurement.

6.5.4 Reducing unwarranted variation

As part of our approach to delivering the Carter principles DCHS is committed to reducing unwarranted variation and improving efficiency across all services. Work on our business intelligence system continues to support these developments. We will continually review the quality, effectiveness and productivity of our community therapy, nursing and specialist service provision across the city and county. By following this approach we will reduce duplication and inefficiency, embed a standardised approach to the delivery of care to ensure that will optimise clinical quality, efficiency and productivity and ensure that we deliver appropriate and measurable outcomes.

6.5.5 Commercial Developments

We continue to monitor commercial development opportunities in line with our commercial development strategy and work closely with our public health commissioner in relation to the delivery of these contracts. This will require us to evaluate the future tender arrangements for our public health contracts and work to further align all these contracts with the key priorities within the STP. We have revised our Business Development Framework and adopted a benefits realisation approach to all commercial investments which is monitored through the Quality Business Committee

6.5.6 Informatics and Technological Transformation

We will continue to exploit both our existing and new technologies to provide increasingly high quality and efficient care and support our clinicians to exploit that technology to its fullest extent to deliver better quality outcomes to the people of Derbyshire. DCHS is a key member of the Derbyshire Information Delivery Board (DIDB) which has agreed a Derbyshire Local Delivery Roadmap. This sets out our IM&T objectives, which are shown in Appendix 3, in relation to the STP priority areas.

6.5.7 Business Continuity

The Trust has in place a Major Incident & Business Continuity Plan and maintains and develops business continuity arrangements in line with national guidance and BS25999. In 2014-15, following a peer review from the lead CCG, the Trust received 'full assurance' against the wider Emergency Preparedness, Resilience and Response (EPRR) work programme.

7. Governance and Assurance

7.1 Governor Elections, Training and Development

9 new Public and 5 new Staff Governors commenced their tenure with DCHS on 1 November 2016.

Governor training, development and activities to facilitate future engagement and recruitment will include:

Election “drop in” sessions at locations and DCHS services across the county An induction programme for new Governors Articles in members’ newspaper and staff magazine; press releases: social media messages;

internet and intranet web content;  emails to members; posters; electoral agent electronic election platform;  video interviews with Governors

Provision of a “buddy” to ensure the successful integration to the Council Continued support to Governor groups covering Strategy, Quality, Governance and

Engagement   Strategic development workshops and membership engagement activity Visits to sites and services including the national Governor conference

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Governor involvement with community groups such as Patient Participation Groups Partnership working through joint meetings with Governors and Directors from key

organisations across the system, including Derbyshire Healthcare Foundation Trust

As we work closer with our colleagues in Derbyshire Healthcare NHSFT, we will work to explore the actions required to develop a Council of Governors following the anticipated merger by acquisition.

7.2 Membership Strategy

As part of the review of the Trust’s Strategy members were consulted directly to obtain their views on the priorities for the Trust and to understand what could be improved upon. As a result of this we will continue to develop our membership strategy by:

Developing a member survey asking their opinions on activities and engagement for the coming year.

The Trusts Communication and Engagement Team supporting the Patient Experience Team (PET) to engage members in defined protected characteristics projects

Providing a varied programme of quality visits (PLACE) and educational training sessions for our members on popular health-related topics (such as Heartstart)

Regularly contacting members about health events in their area Strengthening links with a wide range of community and voluntary groups to build a diverse

membership Reviewing members’ engagement in the public session of the Trust Board, supporting the

Trust Secretary and Chair to maximise engagement and transparent operation of the Board.

To engage with the wider public we will:

Actively promote the Board meeting to members and public; including the open question and answer session that precedes the Board

Actively promote the Governor elections as and when they arise – through press releases, promotional materials, social media communications and our website. We will additionally actively recruit new members and promote the benefits of trust membership during this time.

7.3 Governance of the Plan

7.3.1 Risks to plan delivery

Our plans over the next 2 years are both transformational and challenging so we recognise that there are significant risks associated with their delivery. In 2016 we reviewed our BAF risks to ensure these appropriately reflect the challenges we face. Appendix 2 details how the actions contained within the operational plan, along with the objective and priorities of our Derbyshire STP, come together to mitigate these BAF risks and to provide assurance on the continued delivery of the Trusts strategic objectives and therefore the overarching vision and values of the Trust.

The challenging financial context means that the effective governance of the delivery of the plan is extremely important and therefore the plan has been structured to reflect the way this will be implemented through the Board’s Quality Service, People and Business committees taking account the key aims of service sustainability, viability, public accountability and transparency.

The monitoring plan, shown in appendix 1, details arrangements for ensuring delivery and ensures that our actions are aligned to our strategic objectives and address any associated BAF risks.

Whilst this plan sets out the DCHS operational priorities within the context of the STP it is significantly reliant on the plans of our partners and their commitment to an integrated delivery and risk sharing approach. We will therefore continue to work hard to support system delivery and work closely with our partners to achieve our joint aims whilst promoting the continued provision of our own high quality care delivered by our own high quality workforce.

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Appendix 1 – Draft Monitoring Plan

Objective Action Division or Corporate Area

Responsible Lead

STP ObjectiveCQUIN

Carter Metric

KPI/Measure Milestones Reporting Structure/Overseeing Committee

Frequency of Reporting

Status

Strategic Objective

Specific actions should be included

The accountable person(s) for delivery of the action and addressing any adverse performance

What we expect to achieve following completion of the action eg the achievement of a specific target, standard or outcome which should be measurable

Dates when the actions should be progressed and completed

Will the delivery of the action be formally monitored by a sub-committee or Q Committee? If not - report to PDG

RAG rating - either as at present or as forecast for year end/achievement of milestones

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Appendix 2 – Board Assurance Framework Risks (2016/17 – as at 30th November 2016)

BAF Reference

Risk Description 17/18 – 18/19 Operational Plan Action Reference

Quality Service1.1 There is a risk to management capacity and overall service continuity from the process of bidding for and acquiring new

services and/or the requirement to retender for existing servicesSection 6.6.6 (Commercial Developments)

1.2 There is a risk to comprehensive patient information due to discontinuity between systems employed 6, 9, 10, 11, 12, 181.3 There is a risk to the provision of safe, effective elective care due to lack of

consistent clinical leadership and expertise15, Section 5.4 (Workforce)

1.4 There is a risk that DCHS does not provide patient centred care due to a lack of engagement and involvement of service users and stakeholders

1, 2, 3, 5, 6, 8, 9, 10, 11, 12, 13, 14, 15, 17, 18, 19, 20, 22, 23, 24

1.5 There is a risk that our Clinical Governance initiatives do not deliver the outcomes necessary to support our Strategyfor high quality care

1, 4, 15 Section 7 (Governance of the Plan)

1.6 There is a risk to the provision of safe, effective care due to a lack of consistent employment of the trust’s quality improvement and assurance framework

Section 4.2 (Quality Plans), Section 7.4 (Governance of the plan)

1.7 There is a risk to the provision of effective care due to a failure to learn and share lessons and implement change resulting from audit and feedback

Section 4.2 (Quality Plans)

1.8 There is an overarching risk to patient quality and safety during periods of major system change and employment of new governance systems and processes related to PLACE based care.

3, 6, 9, 13, 14, 22, Section 4.1.3 (Safety),Section 4.2 (Quality Plans), Section 5.4 (Workforce)

Quality People2.1 There is a risk of our staff not being able to provide high quality care due to national and local workforce supply shortages

and the challenges of developing the workforce to have the appropriate skills and competencies to provide the future model of care resulting in poor patient outcomes

2, 4, 5, 6, 7, 9, 10, 11, 12, 13, 14, 20, 21, Section 5.4 (Workforce)

2.2 There is a risk to patients, service-users and employees due to staff performance and behaviours not being monitored and improved resulting in an adverse impact on the provision of high quality care and organisational reputation

Section 5.4 (Workforce)

2.3 There is a risk that the Trust fails to develop a proactive Health and Safety culture across the organisation, resulting in the trust not achieving zero harm to staff, visitors, contractors and members of the public

Section 4.1.3 (Safety)Section 4.2 (Quality Plans)

2.4 There is a risk to organisational performance due to the high volume of organisational and health system change, which is likely to continue to be a feature of our health economy for several years

Section 5.4 (Workforce), Section 6 (Reducing the per capita cost of healthcare)

2.5 There is a risk to service users, staff and DCHS’ reputation due to staff not adhering to the principles of an equal, diverse and inclusive culture, resulting in discriminatory and non-inclusive behaviours, non-compliance with Equality Act and potential legal costs

2, 3, 5, 8, 9, 10, 11, 12, 13, 15, 16, 17, 18, 19, 22

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2.6 There is a risk to the personal engagement, morale, and health and wellbeing of our staff due to the uncertain operating environment DCHS is working in

Section 1 (Introduction and Strategic Approach), Section 3.1 (Public Health Organisation), Section 4.2 (Quality Improvement Plan), Section 7.2 (Membership Strategy)

Quality Business3.1 There is a risk to the organisation achieving strategic objectives due to inconsistent implementation / organisational

support of the Sustainability and Transformation Plan resulting in poor outcomes for patients and poor use of resources1, 2, 5, 6, 7, 9, 10, 11, 12, 14, 15, 16, 18, 21, 22, 23,

3.2 There is a risk to the organisation of delivering public health contracts due to local authority price cuts resulting in poor outcomes for patients and poor use of resources

15, 22, 24, Section 6.6.6 (Commercial Developments)

3.3 There is a risk to future sustainability due to change in national policy for out of hospital care and commissioner priorities 1, 2, 3, 8, 9, 15, 16, 20, 21, 24

3.4 There is a risk to the effective and efficient provision of DCHS services due to the impact of funding cuts within Local Authorities resulting in greater activity being directed towards health services and flow of patients being disrupted

3, 7, 9, 19, 22, 24

3.5 There is a risk to the organisation due to capital controls leading to poor estate impacting upon patient care resulting in poor outcomes

3, 5, 7, 15, Section 6.4 (Estate Management)

3.6 There is a risk to the organisation regarding the efficient use of resources constrained by Health Economy Plans 2, 3, 5, 7, 8, 9, 11, 13, 14, 15, 16, 19, 20, 21, 23, 24, Section 6 (Reducing the per capita cost of healthcare)

3.7 There is a risk to the financial stability of the organisation of not meeting future Sustainable Quality Improvement Programme over the next two years (2016/17 and 2017/18)

1, 5, 6, 9, 11, 12, 13, 14, 15, 17, Section 6.2 (Efficiency Savings)

3.8 There is a risk to the organisation that activity levels will exceed contractual activity and capacity plans, resulting in financial risk and / or increased waiting times

1, 6, 7, 9, 14, 15, 16, 19, 21, 24, Section 6.1.1 (Activity Planning)

3.9 There is a risk to the organisation due to non-delivery of elements of the IM&T strategy, resulting in financial risk benefits not being realised and impact on patient care

6, Section 6.5.6 (Informatics & Technological Transformation)

3.10 There is a risk to the organisation due to lack of comprehensive financial data quality systems resulting in poor decisions that could affect outcomes and financial loss

6, 7, 9, 24Section 6 (Reducing the per capita cost of healthcare)

3.11 There is a risk to the Trust’s resilience, due to an emergency or severe disruption, resulting in an impact on patient care, inability to meet targets, loss of revenue

1, 5, 9, 11, 14, 15, 21, Section 6.5.7 (Business Continuity)

3.12 There is a risk to the organisation, due to failure to align and influence stakeholders resulting in poor relationships that 1, 3, 5, 9, 10, 11, 12, 14, 15, 16,

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impact on patient care 18, 19, 21, 23, 24Quality Governance4.1 There is a risk to the organisation due to not having strong corporate governance systems in place resulting in Trust vision

not being deliveredSection 7.4 (Governance of the plan)

4.2 There is a risk to the organisation due to not meeting regulatory, contractual or legal obligations resulting in sanctions 11, 12, 13, 15, 164.3 There is a risk to the organisation due to not having strong risk management controls in place resulting in failure to put

effective mitigation plans in place promptlySection 7.4 (Governance of the plan)Appendix 1

4.4 There is a risk to the organisation due to not having strong risk management controls in place resulting in failure to put effective mitigation plans in place promptly

7, 11, 12, 15, Section 7.4 (Governance of the plan)

4.5 There is a risk to the organisation due to lack of comprehensive data quality systems resulting in poor decisions that could affect outcomes and financial loss

6, Section 6.5.6 (Informatics & Technological Transformation)

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Appendix 3 Derbyshire Local Delivery Roadmap

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