Forward Plan Strategy Document for 2012-13

Rotherham Doncaster and South Humber NHS foundation trust

Forward Plan for y/e 31 March 2013 (and 2014, 2015)

This document completed by (and Monitor queries to be directed to):

In signing below, the Trust is confirming that:

• The Forward Plan and appendices are an accurate reflection of the current shared vision and strategy of the Trust Board having had regard to the views of the board of governors;

• The Forward Plan and appendices have been subject to at least the same level of Trust Board scrutiny as any of the Trust’s other internal business and strategy plans;

• The Forward Plan and appendices are consistent with the Trust’s internal business plans;

• All plans discussed and any numbers quoted in the Forward Plan and appendices directly relate to the Trust’s financial template submission.

Approved on behalf of the Board of Directors by:

Name Madeleine Keyworth Chair

Signature

Name Christine Boswell Chief Executive

Signature

Name Paul Wilkin Finance Director

Signature

Name Philip Gowland

Job Title Board Secretary

e-mail address philip.gowland@rdash.nhs.uk

Tel. no. for contact 01302 798129

Date 29 May 2012

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Forward Plan

A. The Trust’s vision Rotherham Doncaster and South Humber NHS Foundation Trust (RDaSH) provides mental health, community and learning disability services across a large geographical area encompassing Rotherham, Doncaster and Northern Lincolnshire. Early Intervention in Psychosis services are also provided in Manchester. From 1 April 2012, RDaSH took over the responsibility of providing some additional services following the national Transforming Community Services (TCS) exercise. They are:

���� Doncaster Community Healthcare, which includes District Nursing and Health Visiting for the whole of Doncaster

���� Rotherham Community Health Services, which includes Primary Mental Health, Children and Young People’s Mental Health Services and Learning Disability services.

The Trust now has an income value of approximately £164m and employs around 4,300 staff, serving a population of approximately 850,000. This Annual Plan sets out the plans for 2012/13 – 2014/15 include financial forecasts for three years and sets out the Trust’s priorities, the main areas of its business and the likely risks and challenges that will be faced. Over the last few years RDaSH has made significant progress in developing and expanding the organisation to meet its Vision, Mission and key strategic goals. The recently revised Business Strategy sets out a clear direction in terms of the way in which this will continue over the coming years. The key aspects of the Business Strategy are included in this Annual Plan. The strategy for market development is underpinned by an organisational wide focus on Quality and a further development of service delivery based on a divisional model which devolves responsibility for delivery and service improvement to the lowest level, whilst retaining organisational grip and direction through a robust governance framework. Vision, Mission and Goals The Trust’s Business Strategy ensures that it is ready to seize the opportunities arising from national and local key drivers and to be a Trust that is ‘Leading the way with care’ (Trust’s Vision Statement). The Trust’s overarching Mission Statement is “Promoting health and quality of life for the people and communities we serve.” Underpinning all the work of the Trust to fulfil the Vision and deliver the Mission Statement is a set of agreed Values. These Values describe how the organisation will act while delivering its services:

• Uphold the principles of the NHS • Are user, carer focused • Enhance quality of life • Adopt the principles of recovery • Are safe, whilst promoting independence • Promote social inclusion • Are delivered in the right place at the right time by the person with the right skills • Are accessed through a single point, with clear pathways through the system • Are evidence-based and continuously developing in the light of experience • Are effective, efficient and demonstrate value for money.

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The five strategic goals in place in 2011/12 continue to be applicable and appropriate and are:

• Continuously improve service quality, safety and effectiveness for our service users and carers.

• Deliver excellent services by nurturing the talent, commitment and ideas of our staff. • Ensure value for money and increased organisational efficiency. • Adapt and deliver services to meet changing local needs delivered through enhanced local

partnerships. • Improve further our reputation for quality by maintaining excellent performance and

developing a strong market position Detailed work programmes have been developed to support these strategic goals and will form the basis of regular monitoring. In addition, the work programmes underpin the Board Assurance Framework. Overarching Approach The period covered by this Annual Plan is one where significant economic challenge continues to be faced and where the health sector landscape shifts as the implications of the new Health and Social Care Act are implemented. These will continue to impact on the Trust at a time when the Trust is continuing to deliver improved quality and fulfil its responsibilities to patients, service users and carers. During the next three years the Trust will ensure it continues to invest in services, redesign and modernise patient pathways, make the most effective use of resources and develop a culture amongst staff that provides appropriate learning, development and support to foster innovation and continuous improvement. Quality Matters is the strap line for a focused programme of quality improvement at the Trust. Across all services, through the governance framework to the Board of Directors and Council of Governors, Quality will be at the heart of everyone’s work, the focus of which is the following three key priorities that are central to all day to day contact with people who use the Trust’s services:

• Personalised Care

• Record Keeping

• Clinical Leadership

B. The Trust’s strategic position The Local Health Economy In March 2012, the Board of Directors approved its “Business Strategy 2012-2015”, which sets out the approach to strategic development over the next three years. The Business Strategy takes into account the health and social economy and the position of the Trust within it. In addition, the Business Strategy takes account of the impact that the recently published national strategic documents will have on the Trust and its local health and social care partners. The documents considered include:

• Health and Social Care Act (2012);

• The Operating Framework for the NHS in England 2012/13, Department of Health, November 2011; and the

• Developing a new NHS Provider Licence: A Framework Document, Monitor, November 2011.

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In order to meet the financial assumptions currently being planned in each locality, the Trust has a challenging efficiency target to achieve over the next three years. In addition, there is a national, local and moral imperative to continue to improve the quality of services provided. The Trust has undertaken Quality Impact Assessments on its 2012/13 efficiency plans, which will continue to be developed during the life of the Business Strategy. In addition, innovative, preventative and income generating solutions will become increasingly crucial to the success of the Trust’s QIPP programme. Significant local QIPP schemes will continue to be delivered in partnership with the Trust’s commissioners. The Trust is developing an Estates Strategy for its St. Catherine’s site, recognising the need to maximise the contribution from its estate to efficiently manage its resources. Land and buildings have been identified for development and the Trust is seeking to develop an area of the site as a community facility for the mutual benefit of the recovery of its patients and for the local community. Over the next three years, it is envisaged that the site will attract new community services from the social, voluntary, community and private sectors of the local economy. The Trust is also seeking to potentially attract income from local private sector organisations by offering specialist services, particularly to support the health and wellbeing of their employees. On 16 February 2012, the Department of Health published “Payment by Results: 2012/13 Mental Health Guidance”, which confirmed that 2012/13 is the introductory year for a shift from block contracts to payments by results, utilising cluster currencies which are associated with individual service users of adult and older people’s mental health services. The Trust continues to be an active member of the Care Pathways and Packages Consortium Pilot (comprising all Mental Health Trusts in Yorkshire, Humber and the North East of England) to support the achievement of both the national targets and the developmental aspects of the implementation of Care Pathways and Packages. During 2012/13, the Trust will be working with commissioners to refine and monitor cluster pricing in comparison to the block income and to agree care pathways for each cluster. This work is supported by a Memorandum of Understanding to manage the mutual financial risks associated with this process. This work will also support the Trust in understanding the connection between the quality of services provided to prices and thereby to the Trust’s income. Competition In July 2011, the Department of Health issued, Operational Guidance to the NHS ‘Extending Patient Choice of Provider’, July 2011. The guidance is in support of the Government’s commitment to extending patient choice, by implementing “Any Qualified Provider” (AQP) for community and mental health services. The decision by commissioners on the services which will be subject to AQP arrangements is being made on a cluster wide basis. An initial assessment of the services chosen by both the NHS South Yorkshire and Bassetlaw Cluster, and the NHS Humber Cluster for 2012/13 is that they do not present an immediate risk to services currently provided by the Trust. However, the development of AQP could present a risk to some services in future years. In addition, there may be opportunities presented from 2012/13 onwards for geographical growth. This is a developing initiative both nationally and locally. The Business Strategy 2012-15 includes a detailed competitor analysis by Business Division. The Trust will continue to closely monitor this through its Business Development Forum.

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Threats and opportunities Locally, Clinical Commissioning Groups (CCGs) are being established in Doncaster, Rotherham, North Lincolnshire, North East Lincolnshire and Manchester. They are being supported by transitional arrangements that are in place between the Primary Care Trusts, the NHS South Yorkshire and Bassetlaw Cluster, NHS Humber Cluster and NHS Greater Manchester respectively. Under the current timescales, the CCGs are aiming to be fully accredited by April 2013. The Trust is developing its relationships with commissioners, in particular GPs in a co-ordinated and structured way to support the development of services, both during the transitional period and in the longer term. An emphasis is being placed on increasing the involvement of senior clinicians in these relationships to ensure a clinical focus and engagement in service development planning. The commissioning opportunities and threats for each Business Division have been identified within the Business Strategy. Provisions within the Health and Social Care Act (2012) are also likely to increase the role of Local Authorities in the commissioning of the Trust’s services. The Trust provides the majority of its community services in partnership with and on behalf of Local Authorities. Therefore, this agenda is likely to impact on the development of Trust services, particularly in relation to substance misuse services. The partnership approach to service delivery is growing within the Trust’s Business Divisions, with the development of integrated working arrangements with Doncaster Metropolitan Borough Council for community health and social care services under the banner of One Team Working. Therefore, it is essential that staff working within Business Divisions are supported, to nurture and enhance their working relationships with partners, including providers, commissioners and other stakeholders. The Trust works in close collaboration with stakeholders across all levels and localities to ensure that effective mechanisms are maintained to support collaborative and productive relationships. Through this multi-disciplinary approach, a check and balance can be provided to those strategic decisions affecting the local population, contributing to the development of future policies, strategies and services. Overall Strategic Approach The Trust has considered the national and local policy in determining its overall strategic approach. In addition, by developing relationships with local commissioners and stakeholders the Trust has been able to identify business risks and potential opportunities that will be proactively managed and progressed over the next three years. C. The Trust’s Clinical and Quality strategy The Trust has a wide reach into numerous different services and supports many different types of patients and service users. With the employment of over 4,300 staff, there is a good opportunity to positively influence the lives and experience of many individuals, patients, staff and the public, through the work and support provided. The Clinical and Quality Strategy is set out in the Trust’s Quality Account 2011/12. There is a real desire to influence change and deliver positive and improved quality in services. In order to do this the Trust will empower staff, improve systems and processes and encourage innovation. Discussions at the Board of Directors and the outcomes from Care Quality Commission (CQC) inspections in June and September 2011 highlighted the need to reset the Trust’s quality improvement approach to one which delivers an increasingly co-ordinated solution and improves the quality improvement focus.

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In addition, the Board of Directors considered triangulated information from a variety of internal and external sources and the overall summary identified three key areas for quality improvement:

• personalised care

• record keeping

• clinical leadership As a result, key changes to the Trust’s Governance Structures were agreed and implemented by January 2012. The changes include:

• The creation of a Clinical Governance Group – a fourth formal policy and planning group reporting to the Board of Directors where there is discussion, debate and action on patient safety, patient experience and clinical effectiveness.

• The refocusing of the Performance and Assurance Group terms of reference, to focus on performance, risk and corporate assurance priorities.

• The Trust Quality Council meets quarterly and provides a clinical reference group to discuss, debate and celebrate good practice and new clinical developments within the Trust.

• The streamlining of sub-groups. This corporate realignment and use of central resources has enabled the development of a Quality Improvement Team. This team works with clinical teams in the Business Divisions to support the shift in focus, on quality being the key driver for improvement, by adopting a new quality improvement approach. The work undertaken by the Quality Improvement Team includes:

• Unannounced visits to all inpatient services and to a sample of community services. The visits focus on the three key quality improvement priorities.

• identifying the need for two interrelated work streams in each Business Division:

• Inpatient services

• Community services

• a productive leader programme for all Modern Matrons

• Commissioning an external assessment of the way in which the Trust operates within the Mental Health Act, with an associated action plan.

• A quarterly Quality Improvement Report to monitor the three domains of quality and report on performance against the key priorities, quality markers and the CQUINs. The report supports the delivery of the Trust’s Strategic Goals, Quality Account and the quarterly declaration against Monitor’s Quality Governance Framework, and the embedding of the Essential Standards of quality and safety (Care Quality Commission, 2010).

Assurance in relation to this work has been sought by the Board of Directors from the Trust’s Audit Committee, who received a range of internal audit reports during 2011/12, which included as their topics – CQC Compliance, NICE Guidance and Quality Governance – all received a ‘B’ rating from internal audit. Action plans have been agreed and there were no major risks identified in any of the audits. A number of sub-strategies will be utilised to support the Trust during the next three years to ensure that the quality improvement approach achieves a continuous improvement in the quality of services provided by the Trust. These are:

• The Clinical Governance Group will continue in its role as a forum for the discussion and debate and action on the three domains of quality. An internal audit will be completed during 2012/13 to ensure that the group is fulfilling its terms of reference.

• The Clinical Governance Group will also align closely with the Performance and Assurance Group, to support the management of clinical risk.

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• The Quality Improvement Report will be produced quarterly to provide a quality narrative of the outcomes, what difference this makes to the quality of services provided by the Trust and identify priorities for quality improvement work across all three domains of quality.

• The Professional Strategy, a cross organisation strategy for all professional staff at the Trust emphasising their individual and collective contribution to four themes – patient experience, workforce, leadership and quality.

• Development of the strategy to undertake a Quality Impact Assessment against all efficiency savings plans, ensuring that a true Quality, Innovation, Productivity and Prevention (QIPP) methodology is applied.

An example of where the Trust is influencing change, utilising a QIPP methodology, in our local communities is by developing a One Team Working approach to the delivery of our community health services in Doncaster. Since the transfer of the new services in April 2011, the Trust has been working closely, in partnership with Doncaster Metropolitan Borough Council to provide a more integrated approach to the delivery of community health and social care services in Doncaster. During 2012/13 One Team Working will continue to ensure that by March 2013 the whole of Doncaster can expect to benefit from:

• a reduction in duplicated visits by health and social care staff

• a reduction in the number of times people are passed on between services

• quicker discharges from hospital for people admitted as a result of a long term conditions e.g. Diabetes

• A joined up approach for families that need support from a variety of services. This collaborative approach with local commissioners will also be adopted in the development of new services and service developments that are undertaken over the next three years. D. Clinical and Quality priorities and milestones Quality Goals The Trust’s assessment of evidence, which is contained within the three quality domains of patient experience, patient safety and clinical effectiveness sections of the Quality Account, and also the Business Divisions self assessment, support the overall conclusions from the external regulatory assessments. This identifies the following top three risks to quality that are the Trust’s three key priorities for 2012/13 and 2013/14:

• Record keeping

• Personalised care

• Clinical leadership The priorities for 2014/15 will be informed by the work of the Quality Improvement Team, as it develops over the next two years. This will be supported by the information gained from external regulators, Business Division self-assessments, the Council of Governors, User Carer Partnership Council and the Clinical Governance Group. Quality is a regular agenda item on the Council of Governors agenda. Discussions held by the Council of Governors have resulted in the following three quality improvement priorities being identified, which also link to the Trust’s three quality priorities:

• Personalised care

• Effective, knowledgeable, personalised communication from all of our staff

• Continuously improve communication with, and feedback from people who use the service through a wide range of methods

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Quality remains a standing agenda item at the User Carer Partnership Council (UCPC) and it agreed the following quality improvement priorities for 2012/13:

• Attitudes shown by staff towards people who are diagnosed with a personality disorder;

• Service user carer involvement in staff selection and recruitment;

• 7 day follow up from discharge, support on discharge from wards;

• Embedding WRAP (Wellness and Recovery Action Plans), mapping what there is and where it is. Connecting discharge and community WRAP Groups;

• Access to services (maintaining progress on accessibility and responsiveness);

• Provide information to UCPC on analysis of complaints; trends and lessons learned;

• Increase meaningful activities on the wards. In 2012/13 the Business Divisions have identified quality markers linked to the Trust’s three key priorities and which cover patient experience, patient safety and clinical effectiveness. The quality markers are linked to both the Trust’s quality improvement priorities and through priorities identified through the Business Divisions self-assessment against the CQC Essential Standards of Quality and Safety. The quality markers have clear outcomes and measurements. An example of a Business Division’s Quality Markers for 2012/13 is shown in the table below:

Business Division - Children and Young People’s Mental Health Services

Patient Experience Patient Safety

Clinical Effectiveness

The Business Division will implement and evaluate the use of text messages to remind people of their appointment with the Children and Young People’s mental health service

The Business Division will fully implement the use of the FACE risk assessment for all children and young people

The Children and Young People’s business division will be able to respond effectively when children and young people are admitted to hospital and supported effectively through discharge and provision of community services

The Children and Young People’s Business Division will develop a range of care plans formats which will meet the needs of children and young people.

Full implementation of the on-call CAMHS service for out of hours (office hours) working across the three localities of Children and Young People’s Mental Health Services (North Lincolnshire, Doncaster and Rotherham)

Develop care pathways and packages which respond to all needs identified within the assessment process

Information will be available for children/ young people and their families/ carers about mental health issues

The Business Division will improve the quality of transition between children’s and adult services for those young people who continue to have mental health needs

Patient reported outcome measures and clinically reported outcome measures to be routinely collected

Key Quality Actions Recognising the challenges to be faced in 2012/13 and beyond, the Trust has committed additional funding to establish the Quality Improvement Team for two years and a Records Manager to support the Business Divisions and the Trust-wide quality improvement approach. The Quality Improvement Team will be jointly led by the Deputy Director of Nursing and the Chief Operating Officer. It will be managed through the Nursing and Partnerships Directorate, but work within the Business Divisions to support quality improvement and report to the Clinical Governance Group and through the quarterly Quality Improvement Report to the Board of Directors. The work of the Quality Improvement Team will focus on the three Trust priorities and support the delivery of the quality improvement programme in the quality marker schemes.

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In addition to the governance structure, the Quality Improvement Team and the Records Manager, the Business Divisions performance, including quality improvement work, is reviewed quarterly. These reviews are led by the Chief Executive and senior leadership team and outcomes reported to the Board of Directors. Where progress against the quality improvement priorities is not sufficient, improvement actions are agreed and progress towards achievement is monitored. The various committees and groups within the governance structure (detailed in the diagram) meet on a regular basis to review plans for quality improvement, challenge areas of concern and manage in year issues. Performance against key quality targets and indicators is reported to the:

• Council of Governors

• Board of Directors

• Clinical Governance Group

• Performance and Assurance Group

• Business Division Quality meetings Any areas of under performance are scrutinised and clear action plans for improvement will be monitored by these groups and committees throughout the year.

Key Milestones The key milestones to achieve the quality goals stated above will be identified and set by the Clinical Governance Group by quarter one. Achievement against the milestones will be monitored and reported by the Clinical Governance Group to the Board of Directors, Council of Governors and User Carer Partnership Council.

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The Business Division Quality meetings will lead on ensuring achievement of the individual Business Division quality priorities, as identified in their Quality Markers, which will also be monitored and reported to the Clinical Governance Group. The priority for the Quality Improvement Team in 2012/13 will be to work with two of the larger Business Divisions in the Trust, which are Doncaster Community Integrated Services and the Adult Mental Health Business Division on personalised care and record management. The other Business Divisions will receive an initial core offer from the team on quality matters. The achievements of the team with all of the Business Divisions will be reported in the quarterly Quality Improvement Report. The Trust Quality Council will play a key role in recognising the quality improvement achievements during the next three years. It will provide the Business Divisions with a forum to share good practice, celebrate achievements and encourage excellence and innovation in clinical practice Plans to address existing concerns From the findings of the CQC inspections in the last twelve months and internal self assessments the Trust has identified the three key priorities, stated above, and established a support structure to deliver the quality improvements. Based on these key areas, quality markers have been agreed with the Council of Governors, the User Carer Partnership Council and the Business Divisions. In addition, CQUIN schemes have been agreed with all commissioners. The Trust is currently rated as compliant with the CQC against all the Essential Standards of Quality and Safety. The Trust is currently investigating three concerns that had been raised by individuals about Trust services, directly to the CQC. When the investigations are complete, appropriate actions plans will be developed and agreed with the CQC. The delivery of these actions will be monitored through the Clinical Governance Group. Risks to delivery The risks associated with the CQC queries and the delivery of the identified quality priorities have been recognised in the Trust’s risk management processes. Therefore, the monitoring of progress through the governance structure will be further supported by the Trust’s risk monitoring procedures. Recognising the challenges to be faced in 2012/13, and the associated capacity risks, the Trust has committed additional funding to establish a Quality Improvement Team and a Records Manager to support the Business Divisions and the Trust-wide quality improvement approach. To support the quality improvement work, Business Divisions have also planned quality developments for 2012/13. Examples of the quality developments planned for 2012/13 include:

• The Adult Mental Health Business Division is planning to invest surplus in order to deal with priority work and increase capacity within clinical services.

• The Substance Misuse Business Division is investing in external facilitation for managers and team leaders around effective leadership. The Business Division has also commissioned the production of a DVD to assist staff with care planning.

• The Psychological Therapy Business Division is developing a Talking Shop in Scunthorpe to enhance the provision of mental health services, by offering a centrally located ‘drop in’ facility for advice and information. The Talking Shop will also include access to computerised self-help interventions.

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E. The Trust’s financial strategy and goals over the next three years: The financial plan has been developed on the basis of a strategy that will deliver the following:

• Maintenance of a financial risk rating of at least 3 over the plan period

• Delivery of the efficiency savings needed to ensure financial viability while continually assessing the quality impact of any initiatives.

• Value for money

• A modest surplus target and re-investment of any generated surpluses for the benefit of patients and service users

The key assumptions relating to the financial plan are detailed below: Income and Expenditure Income assumptions The income level assumed is as per the NHS Operating Framework which equates to an overall reduction in recurrent income of -0.8% (-1.8% for tariff and a net 1% increase for CQUIN). The income assumptions that have been applied in 2013/14 and 2014/15 are a reduction of 1.5%. The income is based on the current contractual agreements for 2012/13 which were signed on the 15th March 2012. No assumptions on developments over and above the agreed contract level have been anticipated in the income position and no assumptions have been reflected for any loss of income where contracts are up for renewal during the plan period. The risks relating to these contracts have been identified in the risk register. Expenditure assumptions The overall tariff reduction on income of -1.8% offset by a 4% efficiency assumption provides for a 2.2% uplift for pay and prices. This has been included in the budgets as follows:

• Pay budgets uplifted to allow for a pay award of £250 for anyone earning less than £21,000 in 2012/13 and an uplift of 1% in 2013/14 and 2014/15.

• A 1% allowance in all pay budgets for Incremental drift under Agenda for Change in all 3 years

• Specific contractual inflationary increases funded (e.g. PFI)

• A net allowance for non pay inflation after funding the above CQUIN Income Additional CQUIN income in has been assumed in 2012/13 of 2.5% as per the NHS Operating Framework which equates to a real 1% increase from 2011/12. No additional increase in CQUIN has been assumed for 2013/14 and 2014/15. EBITDA / Surplus The breakdown below gives a summary of the Trust’s Income and Expenditure plan for 2012/13

Income and Expenditure plan for 2012/13 £m

Income 163.6 Expenditure -154.9 EBITDA 8.7 (5.3%) Other costs (depreciation / dividend etc) -7.2 Surplus before impairments 1.6 (1.0%) Impairments -1.9 Deficit after impairments -0.3

Contingent reserve – CQUIN 0.9 Contingent reserve – Other 0.8

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The table above shows that the Trust is targeting a surplus of £1.6m before impairments which equates to 1% of the forecast income base and is the minimum to maintain an overall financial risk rating of 3 and a rating of at least 3 across the individual components that make up the risk rating. The Trust’s EBITDA margin is 5.3% but this could increase if the TCS assets are transferred to the Trust, although the current guidance suggests a transfer from April 2013. The impairment assumption is £1.9m and has been estimated based on the reduction in value of unused assets and the revaluation of some capital assets after capital investment during the year. For 2013/14 and 2014/15 a similar position has been assumed with a 1% surplus per year. e) QIPP plans The financial model assumes a 4.5% CRES each year on the Trust’s total income base which equates to £7.35m per annum. Plans are now in place to deliver the target for 2012/13 and work is ongoing to develop detailed plans for 2013/14 and 2014/15. Balance sheet Capital Expenditure

2012/13 (£m)

2013/14 (£m)

2014/15 (£m)

6.6 3.5 3.5

The table above details the proposed capital expenditure over the next 3 years and includes the re-investment of some of the Trust’s accumulated surpluses. The programme includes investment in:

• The vacated Ruby Lodge facility to convert it to a Learning Disability step down forensic facility.

• Sapphire Lodge and Bungalow 2 to provide a seclusion room and an improved environment for the management of service users with differing needs. Also to provide a decanting facility to a specification suitable for future low secure services.

• Investment in Amber Lodge to split the 23 bedded unit into an 18 and 5 bedded unit to provide an improved environment for the management of service users with differing needs.

• The development of the Balby site to build on the work of Flourish Enterprise and promote anti-stigma.

• The areas identified in the revised IT strategy which will result in the more efficient use of IT resources and will benefit both clinical and non-clinical staff.

Working capital The Trust has a working capital facility of £9m in place with Nat West until the end of March 2013. Cash flow and liquidity The Trust’s projected opening cash balance for 2012/13 is £19.9m and the forecast closing balance is £14.8m. The forecast reduction is due to the fact that some of the cash reserves have been re-invested in to capital and also an assumption that there will be a reduction in deferred income during the year. The liquidity ratio which takes in to account liabilities on the balance sheet is at 22.2 days which gives an acceptable Monitor liquidity rating of 3.

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Long term borrowing The current borrowing limit agreed with Monitor for the Trust is £36.3m. At the end of the 2011/12 financial year the projected call on the loan facility was £24.2m (made up of the loan for Rotherham modernisation and PFI financing) leaving £12.1m of the loan facility available. At the end of 2012/13 the call on the loan facility is forecast to reduce to £23.4m leaving £12.9m loan facility available. No additional loans have been anticipated in the 3 year plan. Financial risk rating (FRR)

FRR Plan 2012/13

EBITDA Margin 3 (5.3%) EBITDA % Achieved 5 Financial efficiency 4 Liquidity ratio 3 (22.2 days) Overall rating 3

The table above shows the breakdown of the Trust’s forecast financial risk rating of 3. 2013/14 and 2014/15 The table below shows the key assumptions for years 2 and 3 of the Trust financial plan

FRR Plan 2013/14

FRR Plan 2014/15

EBITDA £8.8m (5.4%) £8.3m (5.2%) Surplus £1.55 (1%) £1.54 (1%) Efficiency assumption 4.5% 4.5% Tariff adjustment to income -1.5% -1.5% CQUIN No change from 2012/13

(2.5%) No change from 2012/13

(2.5%) FRR 3 3

As per 2012/13 the assumption is a modest 1% surplus to maintain a strong financial risk rating. The financial assumptions around tariff and CQUIN have been based on current intelligence and the forward plan for 2013/14 and 2014/15 will be amended as assumptions become clearer during the year.

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F. The Trust’s approach to ensuring effective leadership and adequate management

processes and structures over the next three years : The key leadership responsibilities for RDaSH relate to improving patient experience, staff engagement, public engagement and confidence within a system designed to deliver quality. The Trust has a number of key themes / priorities emerging linked to supporting the local development of higher quality, more personalised services and building on cross government, multi-agency alliances aimed at addressing patient and service user needs. Leadership framework and development programmes are used to implement the Trust’s vision, values and desired culture through the identification of current and future leaders and managers and by providing a supportive environment within which they can acquire and develop the skills required to achieve the Trust’s objectives and prepare them for future roles within the Trust. Strong clear leadership at all levels within the Trust will enable these changes to happen along with frontline staff being empowered to lead change that improves quality of care for patients through enhancing professionalism and clinical leadership. The three priority areas identified for 2012/13 all require strong commitment from staff across the Trust. The staff are the fundamental component in ensuring that the Trust delivers and improves its record keeping, personalised care and clinical leadership. Board of Directors Effectiveness In 2011/12 the effectiveness of the Board of Directors was assessed internally using 360 degree feedback from all Trust Board colleagues and a self assessment process reviewing the previous 12 months using the same evaluation tool. The criteria were based on the principles outlined in NHS Confederation publication entitled “Effective Boards in the NHS”. The feedback received was discussed in detail during the Performance Development Review (PDR) process held with each Director individually. Led by the senior independent director (SID) the other Non Executive Directors met without the chairman to evaluate the chairman’s performance, as part of a process for appraising the chair. The process for the Chairman is carried out in line with the Monitor Code of Governance A.1.3 and will continue in 2012/13. Also in 2012/13 the PDR process for individual directors will be repeated with any issues identified from the individual or collective processes in 2011/12 being followed up. It is expected that the 360 degree process will be repeated every 2 or 3 years. The Board of Directors as a team had two externally facilitated development days in 2011/12. The purpose of these sessions was to build on the work the Board had done together in previous development sessions and to provide an opportunity to

• pause and take stock as a Board

• identify key issues facing the Board of Directors and the Trust and the progress in addressing them

• Reflect on progress as a Board – what has gone well and what do we need to pay more attention to?

• Reflect on the Board’s role and its contribution to the organisation’s success. In 2011/12 two new Non Executive Directors were appointed by the Council of Governors. The externally facilitated days were used to help them get to know the other Board members better and have dedicated time outside of the formal Board meeting to discuss issues for the Trust. Interactive voting technology is used by participants to anonymously gauge views about how the Board perceived it was doing around Trust key issues. Questions from previous voting sessions, where the Board identified a need for improvement or change are re-polled along with new / additional questions linked to new or emerging areas for the Trust. Results are fed back to the Trust in a report around themes. This forum is used by the Board to think more creatively about some of the key challenges facing the organisation in the next 3-5 years.

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Council of Governors Development Under the Health and Social Care Act 2012, Governors have a greater role in monitoring effective governance in NHS foundation trusts. The Trust acknowledges that Monitor will continue to have transitional powers over all foundation trusts to maintain high standards of governance during the transition. The Trust is using this transitional period to further develop governance arrangements and has arranged an externally facilitated development process to support the Council of Governors so that it can explore how it will use its powers effectively in the best interest of patients. This will continue the on going development process with the Council of Governors which will also utilise nationally commissioned training for Governors, regional events and a range of other locally based and developed sessions. Assurance of Plans An appropriately sized, skilled, organised and motivated workforce is critical to delivering efficient, quality and safe services and as such the importance of having appropriate and robust systems in place that provide workforce assurance triangulated with finance, service and quality provision is essential. Workforce assurance in the NHS is the process of managing risk and assuring that the composition of the workforce can deliver cost effective, safe and high quality care. Assurance is needed due to the pressures and inherent risks associated with large scale workforce change from:

• Tough financial settlements – workforce expenditures represent approximately 75% of the total NHS spend and although in recent years workforce numbers have increased inline with overall spending growth, there is now a very significant productivity challenge related to achieving the overall £20 billion national QIPP target.

• Increasing demands for services During 2011/12 the Trust developed a Quality Impact Assessment process which was completed for all workforce changes linked to QIPP plans. In 2012/13 the Trust will review and pilot the Workforce Assurance Tool developed by the Department of Health and Deloitte. The Workforce Assurance Tool (WAT) provides a method for achieving system assurance that the planned and available workforce can deliver safe and quality services. The tool adopted will provide the self assurance to improve outcomes, enable pre-emptive responses to concerns and support the Trust’s ability to provide external assurance. The WAT provides a means to identify both current workforce issues and provides an early warning system when reviewing projected workforce changes. Factors affecting the forward plan The Trust has had a number of significant TUPE transfers into the organisation as a result of the Transforming Community Services agenda, and also smaller transfers both into and out of the organisation as a result of other changes. Following integration development activities, the Trust will be undertaking focussed activity linked to the outcomes of a culture audit. The Trust agreed a plan to respond to the current economic plan in 2009 and has maintained the direction originally intended of a 2.5% - 3% decrease over a 3 to 4 year period. The main changes to the planned reductions have occurred as a result of previously unknown / unscheduled transfers or new business opportunities. The Trust has undertaken an assurance process which has consisted of each Business Division submitting their QIPP plans to the Senior Leadership Team for review and quality assessment. The mechanism involved an assessment of “traffic lighting” (red, amber or green) the proposed plans. Any plan considered to be amber / red was returned to the Business Division to ensure an action plan was in place to mitigate the area of concern or the plan revised. This process has resulted in the revision of some of the initial plans. The resulting plans were assessed by the Board of Directors and agreement reached to confirm the proposed plans.

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On completion of the workforce assurance process the Deputy Chief Executive / Director of Nursing and Partnerships, Chief Operating Officer and the Director of Workforce and Organisational Development agreed the workforce information data. Managing Attendance The level of sickness absence has been incrementally decreasing over the last two years however it is recognised that it remains above average, in comparison to other similar sized Mental Health / Learning Disability / Community providers. As a consequence the Trust has invested additional resources and recruited a fixed term project officer. A robust policy is in place together with regular monitoring at a senior level of the organisation. Health and wellbeing initiatives are being identified, developed and put in place and involve the Trust taking forward an initiative to provide a supportive mental health pathway for the workforce (as this is one of our highest reasons for absence). Sickness absence data is reported and discussed each month at the Human Resources and Organisation Development Policy and Planning group. Sickness absence predictions are based on previously recorded trends factoring in the expectations surrounding targets and the work being undertaken to reduce sickness absence. Agency / Bank Costs / Forecast The Trust has been working towards reducing agency costs over a number of years.

• Between 2008/9 and 2009/10 the overall costs were reduced by 11%

• Between 2009/10 and 2010/11 the overall costs were reduced by 43%

• Between 2010/11 and 2011/12 the overall costs were reduced by 30% Given the reductions achieved and the potential impact of QIPP savings it is anticipated that agency expenditure will remain at similar levels to 2011/12 in non medical categories, but could increase in relation to medical staff. In terms of bank staff usage the Trust has introduced a successful internally run administration “bank”. The Trust will explore making staff available to other NHS providers as a means of generating income. Mutually Agreed Resignation Scheme During 2011/12 the Trust ran a Mutually Agreed Resignation Scheme (MARS). MARS is a national scheme which offered a severance payment to an employee to leave their employment voluntarily. The scheme was used to assist the Trust in creating capacity through vacancies which could be filled by redeployed staff from other areas within the Trust and / or as a suitable alternative for some of those staff facing redundancy. This process was carried out so that the financial savings required for the Trust QIPP plans for 2012/13 and associated reduction in workforce numbers were enacted from 1 April to enable the Trust to benefit from the full year effect of the reductions achieved. The Quality Impact Assessment described earlier was undertaken on these workforce reductions. Further use of a Mutually Agreed Resignation Scheme during 2012/13 and 2013/14 will be considered by the Trust Board of Directors and Executive Management Group. Staff Groups Affected by the QIPP plans The main staff groups affected by the reductions in staffing numbers have been across all Business Divisions and Corporate Services and include qualified nursing, allied health professionals and therapeutic posts, unqualified support staff, in both clinical and non clinical areas, managerial and administrative functions. There has been a significant shift in resources from inpatient services to community developments which have off set the reductions and allowed for the redeployment of staff otherwise at risk.

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These developments, together with a number of further TUPE transfers into the organisation from other health organisations, voluntary sector and the Local Authorities demonstrate an increase in some staff categories and off set the reductions achieved through the QIPP plans. Hence, overall staff numbers are broadly the same. The additional services have brought additional income to the Trust. Service Developments with workforce implications

• Learning Disability Services will be undergoing significant service development changes associated with a review of Learning Disability Services in Rotherham and the potential impact of Local Authority tendering exercise(s) in Doncaster

• Support associated with the outcome of the review of the Adult Mental Health Service Model.

• Development of a Forensic Step Down Facility

• Development / increase in District Nursing numbers in Community Services as a result of the Clinical Services Review in Doncaster

• Increase in Health Visiting.

• Doncaster Clinical Services Review will have an impact on the associated ancillary workforce within the Trust.

• Potential developments are being considered in relation to Children and Young People’s Mental Health Services

Training Needs Analysis and Leadership Development The Trust has developed a robust training needs analysis process which is reviewed regularly by business divisions and corporate service areas. This mechanism is used in conjunction with the Personal Development Review (PDR) process. All learning needs are identified from the information gathered at the Learning Forum where issues linked to the strategic direction and priorities are discussed. The group comprises of Operational Assistant Directors and Corporate Service Heads of Service and it uses data gathered via the PDR process. This means that intelligence is gained using both a top down and bottom up approach and those emergent needs for the organisation and individuals are also picked up and dealt with in a timely manner. The Trust has a leadership and management development framework, which outlines how leaders and managers will be developed to enable the Trust to achieve its objectives and sustain a high level of success. The framework is underpinned by the importance of employee engagement and involvement as a route to superior organisational performance, individual job satisfaction, commitment and reduced stress. In line with the framework the Trust is currently running leadership programmes aimed at established leaders. The participants on this programme also use an in house 360 degree assessment tool to identify individual development needs, based on the management standards competencies referred to in the framework. This programme will continue to be run over the next few years. Further programmes are being developed aimed at developing leaders and this programme will be combined with participation in Personal Development Reviews including Managing Performance and Managing attendance workshops to provide basic training for developing leaders. Accreditation via Coventry University for the internal programmes is being considered.

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These programmes provide a starting point for further activity to develop management and leadership and use development to positively influence the culture of the organisation, by providing a clear link to the organisational context. Leadership & Management training alone is not enough to deliver long term behaviour change as the learning from these programmes needs to be embedded, reinforced and consistently and visibly supported across the organisation. Reinforcement activity is initiated in the following areas: Clarifying Expectations The Trust is working with leaders to make it very clear, in terms of roles and responsibilities, what is expected of them as leaders and managers. The clear articulation of these expectations provides a starting point for monitoring and holding leaders and managers to account for their performance. The RDaSH Competencies identify these responsibilities and provide a detailed description of expectations at a variety of levels, including team contributor, developing leaders and specialists/ established leaders/specialists and strategic leaders/specialists. These were developed through involving staff and colleagues.

RDaSH Competency Areas Meeting the needs of our patients / service users

Managing our Performance Communicating & Influencing

Business Thinking Supporting Each Other

Shaping our Future Learning & Improving

Senior Level Buy In & Role Modelling – Individual Emerging and established leaders need to be empowered to embed and implement their objectives by their managers and leaders in the work place and feel sufficiently engaged with their work and their organisation to make the extra effort required to do so. The Trust recognises the importance for all senior leaders across the organisation sharing accountability as leaders and managers. The Executive Management Group (EMG) which involves the Chief Executive, Executive Directors, Chief Operating Officer and the Assistant Directors meet to review, shape and determine the appropriate support required to deliver the strategic direction. Personal Development Reviews (PDR) At an individual level leaders and managers are engaged in a process of continuous professional development. This is demonstrated through a review of their own capabilities against expectations as a basis for personal development action planning and role modelling. The use of a 360 degree questionnaire based on the RDaSH competencies for strategic leaders provides the opportunity to overtly demonstrate this activity. Emerging and established leaders are empowered to fulfil their roles and responsibilities through embedding and implementing their objectives which are aligned to the Trust’s strategic objectives. Revalidation The Trust has been involved as a pilot site for introducing a revalidation system for doctors. Revalidation of doctors helps to assure RDaSH that the doctors practising in the Trust are up to date and fit to practice. It complements other systems that already exist for achieving high quality care and recognising and responding to concerns about doctors’ practice. Revalidation is based on a local evaluation of doctors’ practice through regular appraisal. To support revalidation, the Trust has introduced:

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• Systems to support the Responsible Officer in their role • An up to date appraisal system that reflects the GMC's core guidance for doctors, Good

Medical Practice, and ensures every licensed doctor is having a regular appraisal • A sufficient number of trained appraisers in post • Clinical governance systems that can provide doctors with the supporting information they

need for appraisal and revalidation • Policies and systems in place for identifying and responding to concerns about doctors • Robust links with the other organisations where doctors may also be working, so information

about their practice and any concerns about them can be shared. Doctors will be revalidated via the GMC, usually every five years, based on a recommendation that they receive from the Trust’s Responsible Officer. The GMC are planning to introduce revalidation at the end of 2012. Once the legislation to support revalidation is in place, the GMC expects every responsible officer to begin making recommendations about doctors from this point onwards. Methods/activities to support our leaders and managers include:

• Coaching and mentoring are widely recognised as practical and cost effective ways to boost staff performance. NHS North of England via Yorkshire & Humber Strategic Health Authority provide access to a network of NHS mentors via a website (mentoring for success) which may offer a valuable resource for some of our staff as well as access to our internal mentors and coaches in the Trust.

• Action learning sets

• 360 degree feedback

• Continuous learning via updates, action learning sets, sharing best practice

• Leading the Way with Quality workshops

• Myers Briggs Type Indicator (MBTI) - MBTI results be used with individuals and teams. G. The Trust’s other strategic and operational plans over the next three years: The Trust’s quality and financial strategies as described in earlier sections of this plan set out the key strategic and operational priorities for the next three years. To support these strategies, the Trust’s Board Assurance Framework sets out the key operational work programmes which will be delivered each year to delivery the five strategic goals. In 2012/13 the Trust has identified 21 key work programmes which cover finance, quality, service modernisation and redesign, workforce and performance. The delivery of the work programmes is monitored by the Performance and Assurance Group, Audit Committee and the Board of Directors during the year on a regular basis. During 2012/3, the Trust will also be focusing on the delivery of its Estates Strategy and Information Technology Strategy. Both strategies will be supported by detailed operational plans to deliver key milestones during the year. A summary of the key priorities within these strategies is below: Information Technology (IT) Strategy – the Trust has developed a high level IT strategy for 2012-2017 which outlines the vision for ICT and business intelligence in the Trust, maps current context and maturity of ICT and business intelligence and identifies areas of focus and priorities for development based on need. Key activities required over the next 5 years are identified in a roadmap and operational plans are currently being delivered to support this plan. This is a key enabling strategy for the Trust to support the delivery of the financial and quality strategies and Trust strategic objectives. The final strategy will be signed off by the Board of Directors in May 2012.

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Estates Strategy – The Trust is currently in the process of reviewing its estates strategy with particular reference to the Balby site in Doncaster where there is land and buildings for development due to a number clinical changes and initiatives. During 2011/12 the Trust commissioned an external feasibility study to look at the options for future use in relation to some of the Balby site. The next stage, following Board of Directors approval in April 2012, will be the development of an Outline Business Case to take forward the preferred option:

• An option appraisal on the disposal of some land and property to generate additional capital funds to provide capital investment for the development of the rest of the Estates Strategy.

• Capital investment in part of the site to develop community facilities to open the site up to the public and third sector

• Investment in the listed building, stables and the walled garden to develop a commercial area which will generate income for the Trust and also provide opportunities to bring service users back into employment.

The Trust’s capital programme in the financial plan does not anticipate any capital receipts at this stage but does include a £2m contingency to develop the estate and IT strategies when they are agreed by the board.

Foundation Trust Membership – Although over the last 12 months the focus on our membership has shifted towards improved communication and engagement, rather than recruitment of new members, we understand that this is still an important factor and opportunities have been exploited wherever possible to highlight the benefits of membership to potential members. We have continued to build a representative and meaningful membership and improve communication and engagement with existing members. New employees have the advantage of automatically becoming members of the Foundation Trust. As with all members, they can influence plans for the Trust and its services for the benefit of service users and carers. They can elect to the Council of Governors and stand for election themselves. Staff are encouraged to be actively involved as members of the Trust and to spread the word, highlighting the benefits of membership. Over the last 12 months we have carried out a number of actions in order to increase engagement and communication with our staff members, informing them of what membership could mean for them, for example:

• Foundation Trust Office/Chair attendance at Trust induction, which provides us with an opportunity to inform staff at the outset that they are members and what this could potentially mean for them.

• Joint publication for staff and members available 3 times a year keeping staff updated on membership matters.

• Providing staff with the opportunities to be involved in members events, not only acting as representatives of the Trust but as members themselves.

• Communication with staff highlighting the recent elections, encouraging staff to nominate themselves as Governors and staff to vote. An additional Governor seat was created from April 2011 to recognise the Community Nursing staff transferring to the staff – this increased the number of Staff Governor seats to six.

In terms of improving engagement with our members in the wider community (patients, service users, carers and public), we have achieved this over the past 12 months through some of the following initiatives:

• Election Information Events • The Annual Members’ Meeting

• Governor Drop-In • Participation in consultations

• Members’ Information Events • Trust website

• Public Council of Governors Meetings • Members’ Newsletter

• Public Board of Directors Meetings • Members’ Updates

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Membership size and movements On April 1 2011, the Trust had a total membership of 10,295. At the end of March 2012, the membership stood at 10,425. This represents a net gain of 130 although 690 new members were recruited in the year. Whilst wanting to maintain membership levels in the year a greater focus was provided to engagement and better understanding the composition of the membership. Our public membership provides us with an indication of how representative our membership is. The key points to consider are as follows:

• The membership is geographically focused in Rotherham and Doncaster in line with the range of services provided in these locations in comparison with those in North and North East Lincolnshire.

• Ethnicity profile shows membership to be well represented in the black and minority ethnic groupings.

• The gender ratio is weighted towards females whereas the eligible membership is more equally balanced.

On analysing our patient constituencies it is evident that there is a need to focus our efforts of recruitment on the specialist services and community services areas to ensure service users, patients and carers have a voice and that we have benefit from their experience and knowledge. Membership 2012/13 In order to develop our membership base further to reflect the diversity of services provided by the Trust and to ensure it is representative of the population we serve including patients/service users, carers and members of the public, we will continue to recruit new members through some of the successful initiatives undertaken previously, particularly attending local Trust events and local community events organised externally. Business Divisions will play an increasing part in the recruitment and engagement of Foundation Trust Members and therefore have some ‘ownership’ for members within their own areas; utilising this resource in terms of ensuring that individuals within these areas are offered the opportunity of becoming members and encouraging engagement from those who are already members. Although opportunities for recruitment should be taken wherever possible, over the next 12 months we will focus on areas where membership is deemed to be less representative of the areas served, for example Specialist Services and Community Services. As the Trust continues to develop and improve the services it provides, it will encourage staff, service users, carers and members of the local communities to become involved as members of the Foundation Trust. The Trust will also seek to make membership more meaningful through involvement, collaboration and empowerment. To achieve this, our plans will include:

• Membership application leaflets available in Trust reception areas;

• Continued use of partnership working with minority ethnic, special interest, community and faith groups to contact the hard to reach groups and individuals

• Use of public meetings, e.g. health fairs / Annual General Meeting

• Targeting new and existing volunteers

• Specific focussed recruitment campaigns

• Trust Matters membership newsletter

• Weekly Bulletin (for Staff members)

• Membership recruitment information Free phone telephone line (0800 015 0370)

• HealthWatch

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• Voluntary sector involvement – direct contact with all stakeholder / support groups

• Direct contact with established user and carer groups

• User Carer Partnership Council involvement

• Information campaigns

• Patient Advice and Liaison Service involvement

• Use of the Trust’s website

• Membership information is provided at Staff Induction Events

• A dedicated section on membership available on the Intranet and public website.

• Displays placed in public areas of the Trust.

• Targeted use of local papers (advertising, inserts and editorials)

• Local radio

• Encouraging staff to recruit friends and family.

• Encouraging staff to make aware to service users and carers the benefits of membership.

• The promotion of membership across all constituencies by Governors within their respective constituencies

Two further matters that will be considered in the year are:

• Increasing the public catchment area beyond the current boundaries. There is a large population immediately beyond those boundaries and with the service provision potentially widening geographically, the Trust will consider if there is scope to widen the public membership boundary.

• Lowering the minimum age for membership or introducing a shadow membership forum for those individuals interested in the Trust and its services who are not 16. The Trust provides a range of services to children and wishes to identify the best way of engaging with them.

Our plans for membership and recruitment over the next 12 months will include considerable input from the Council of Governors. Governors are able to contribute a wealth of knowledge and experience, which in turn can be used as tool to encourage and engage with new members. Their established involvement in community and voluntary organisations provides an ideal opportunity to reach out to potential members by highlighting the benefits of membership.

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H. The Views of the Trust Governors : Discussions with the Governors regarding the Annual Plan commenced in November 2011 when, at the meeting of the Council of Governors, Governors participated in table top discussions led by Executive Directors on the topic of the Trust’s Forward Strategy. The Trust sought the Governors views on the following:

• Size of Trust – income levels

• Growth – within our geographical boundary, existing services

• Growth – outside our geographical boundary, existing services

• Diversification – new services, not currently provided At the next meeting of the CoG in February, Governors were again involved in table top discussions with four key areas discussed:

• Service Development

• Finance

• Quality improvement

• Workforce They were also presented with the related timescales regarding the submission of the Annual Plan to Monitor. A further request for comments and thoughts from individual Governors was made in March 2012 in the Governor Update newsletter, when the membership Plan for 2012/13 was included for comment too. Throughout 2012 a Governor representative has been part of the team developing g the Quality Account 2012. Whist in the main a retrospective document looking at past performance it also has a look forward to the current and future work at the Trust aimed at improving quality and hence links closely with the identification of quality risks and the forward plans in this area. At the May 2012 Council of Governors meeting, the previous engagement with Governors was reiterated and an overview of the draft Annual Plan was presented to the Governors. The Governors provided their support for the Annual Plan at the meeting. The Board of Directors is therefore able to confirm that the views of the Governors have been sought and considered in the development of this Annual Plan.