Item 10 - Draft Annual Plan 2015/16

SUPPORTING PAPER (ACTION REPORT) BOARD OF DIRECTORS’ MEETING

Date of meeting: Thursday, 27 November 2014

Title of paper: Draft Annual Plan 2015/16

Presented by: Associate Director of Contracting, Strategy and Performance

Executive Summary: The Trust will be required to submit an Annual Plan to Monitor in

accordance with a timetable yet to be issued. Work has started on the corporate objectives and these are included in the initial draft plan together with headlines and key information for suggested plan content. The plan will be further developed with input from all business areas and the detail will be added in future iterations along with the financial plans for the Trust.

The Trust submitted a five year strategic plan in June and this has been used as the stimulus for the annual plan along with national and regional drivers. Since then the NHS Five Year Review has been published the key headlines for consideration for NEAS include:

Working more closely with CCGs;

Development of Urgent and emergency care networks and

empowering ambulance services with an enhanced paramedic role;

and

Adjustments to payment mechanisms and delivery of revised care

models.

These will be incorporated into the development of the plan alongside input from the Annual Planning Working Group and Service Line Managers. We are also still anticipating an Ambulance Service Specification as an output from the Urgent and Emergency Care Review.

The headline content of the plan reflects the challenges currently faced and the opportunities to build on the areas of relative strength.

Recommendations/and or actions required:

The Board is asked to specifically review the proposed draft corporate objectives on page 6 to provide feedback by 5th December to enable further discussion at the next Annual Planning Working Group.

Consultation and/or PPI involvement process (inc with staff): In line with NHS Constitution

Annual Planning event with senior managers and governors used to develop the draft corporate objectives. Appropriate consultation and engagement mechanisms to be considered with the Organisational Development and Communications team for future iterations of the plan.

Risks attached to this project/initiative:

Risks relate to development of draft plans in advance of guidance being available from Monitor.

Resources Required: Plan will be drafted by SBBPL with input from all of the business through the Annual Planning Working Group. Implementation of the delivery

plans will be agreed at Board level.

Legal issues:

None considered

Equality Impact Screening: Not at this time

CQC Essential Standards of Quality & Safety:

VALUES

Involvement and Information

Personalised care, treatment and support

Safeguarding and safety

Suitability of staffing

Quality and management

Suitability of management

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What NEAS strategic intention does this paper support:

STRATEGIC INTENTIONS

To lead in the provision of emergency care

To be a key partner in urgent care reform To transform our patient transport services To be a first-rate employer To have sound financial health

To be well governed and accountable

Themes: If what section of the report?

What Francis Theme(s) does this paper support?

Preventing Problems – putting the patient first &

promoting a culture of zero harm & compassionate care Throughout report as

the plan for the Trust covers all business areas and the impact thereon.

Detecting Problems Quickly – through a joined-up

system [of regulation] which collects correct information

Taking Action Promptly – when concerns or incidents

are identified

Ensuring Robust Accountability – through sanctions, regulations and systems

Ensuring Staff are Trained/Motivated – through

effective recruitment, training and support structures

Author: Nicola Thackray

Date: 20th November 2014

Operational Plan Document for 2015 to 2016

North East Ambulance Service NHS Foundation Trust

Notes for consideration:

Guidance from Monitor is not yet available – we have assumed the similar format to last year. NHS England Board papers suggest a transition year. References to operational/annual plan used – terminology will be clarified once guidance is available.

Not a lot of time has passed since the last plan was drafted – we have refreshed rather than rewritten, though incorporating national steer through Five Year Forward View etc.

Headlines and bullet points are to be expanded upon – this is an initial draft. Templates provided by business areas are to be used to flesh out the narrative.

Financial information and associated context are to be added in a later draft.

Contents

Executive Summary.................................................................................................................. 6

Short Term Challenge .............................................................................................................. 6

Quality plans ............................................................................................................................. 8

Operational requirements and capacity .................................................................................. 11

Productivity, efficiency and CIPs ............................................................................................ 12

Financial plan ......................................................................................................................... 13

Acronyms ............................................................................................................................... 15

Appendices ............................................................................................................................. 16

Update this page based on revised template & guidance Operational Plan y/e 31 March 2016 This document completed by (and Monitor queries to be directed to):

The attached Operational Plan is intended to reflect the Trust’s business plan over the next two years. Information included herein should accurately reflect the strategic and operational plans agreed by the Trust Board. In signing below, the Trust is confirming that:

The Operational Plan is an accurate reflection of the current shared vision of the Trust Board having had regard to the views of the Council of Governors and is underpinned by the strategic plan;

The Operational Plan has 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 Operational Plan is consistent with the Trust’s internal operational plans and provides a comprehensive overview of all key factors relevant to the delivery of these plans; and

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

Approved on behalf of the Board of Directors by:

Name (Chair)

Mr Ashley Winter

Signature

Approved on behalf of the Board of Directors by:

Name (Chief Executive)

Mrs Yvonne Ormston

Signature Paste in here Approved on behalf of the Board of Directors by:

Name (Finance Director)

Mr Roger French

Signature

Name Nicola Thackray

Job Title Strategic Business Planning & Performance Lead

e-mail address [email protected]

Tel. no. for contact 0191 430 2059

Date Xx

Version – initial draft (November Board) of 18

Executive Summary

Update this section based on plan content

The Operational Plan 2015 to 16 sets out a number of key developments that contribute to the achievement of our ambitions for our patients, staff and the organisation.

Proud of who we are and what we do…

Patients remain at the heart of everything …

We have a strong track record …

The plan is very much aligned to the ambitions emerging from our local health and social care economy, as well as fitting with the national direction of travel for Urgent and Emergency Care.

The work programme ahead is challenging…

Staff morale continues to be a key concern and a number of initiatives have been taken forward to improve and address…

The increasing challenge to balance quality and cost is evident in this plan – update on deficit etc.

Risk & finance stats in here…

Work with commissioners and continue to do so – expanding role as outlined in NHS Five Year Forward View.

Short Term Challenge

Short term context

Position statement from when plans were submitted last year – organisational priorities identified (ET list)

Headlines from governance review – more details below

The transformation programme requires sustained leadership and a workforce to champion through change – new CEO and managing the workforce issues

Comparison of how we compare to other services nationally

Deprivation & ill health etc. regional position - health profiles info in here (regional details)

CIP challenges

We want to transform delivery models and move care closer to home where appropriate.

Discussions underway regarding tariff and gain share arrangements.

Support for our plan

Our plan continues to support five year plans of our 12 Clinical Commissioning Groups (CCGs).

2nd year of contract – position ourselves for future contracts.

Current regional position

Update in here on current performance – all service lines

The Trust is equally focussed on the quality of care provision and performs well across a range of qualitative metrics.

Hearts and mind issues

Revised leadership roles – update on ECCM

Maintain a watching brief on region wide developments


Positive feedback relating to the front line - Ipsos mori headlines in here

Key planning assumptions

Assumptions made in the previous plan continue to be relevant and have been modified as appropriate:

The Trust will continue to provide services under contract as Commissioned by the local CCGs

The scope and volume of the work under contract will be in line with agreed forecasts

The Trust will have sufficient resources at its disposal to fulfil the requirements of such contracts; workforce pressures and implementation of the associated workforce plan will require the use of third party suppliers and agency staff as appropriate

The Trust will achieve national performance targets and working to improve local performance with Local Health Economy partners

The Trust will continue to seek new opportunities to expand its operations for the benefit of patients and its core provision given the challenges we currently face

Commissioners will commit to develop appropriate urgent care pathways and provide NEAS with access

The national direction of travel for Urgent and Emergency Care will continue to support and underpin our plan and strategic developments in line with the care closer to home agenda

There is little or no growth in CCG allocations and better care and efficiency must be borne out of redesign of services and care pathways

Setting of our corporate objectives

Mindful of the 5YFW (Five year forward view) – our plan will link directly with a number of themes identified:

Working more with CCGs – they will have more influence.

Public engagement and understanding – they will know when and how to access our services.

Multispecialty Community Providers - Future models expanding leadership to include community based professionals. This could include paramedics.

Primary and Acute Care Systems – expansion of primary care into a hospital environment. There may be a link to GPs in a hospital environment.

Urgent and emergency care networks – organise and simplify the system with ambulance services being more empowered to make decisions and treat patients and make referrals. This is directly relevant to our strategy and care closer to home agenda.

Hospital patients access to 7 day services – implications for PTS.

Adjustments needed to payment regime – may help inform discussions regarding gain share and tariff.

Enhanced health in care homes – potential role for the paramedics, mobile diagnostics and point of care testing.

Pump priming and fast track a selection of new care models – this might be something the Trust would like to be involved in

Operational research e.g. evolving GP Out of Hours and 111 to improve patient understanding of where and when to seek care, most appropriate use of ambulances and A&E. Again, something we may want to be involved in based on existing role.


Five year strategic plan submitted in June is built around the four strategic goals of the Trust. Corporate objectives are linked to these strategic goals. Given the short term challenge outlined above and the arrival of a new Chief Executive, the immediate focus will be the core business of the Trust and the workforce rather than strategic development in the short to medium term. Our corporate objectives for the coming year are as follows: Update – drafted based on outputs from annual planning event and can be refined and made smarter. More detail to help develop sub-objectives is included in appendix.

1) To develop an appropriately skilled workforce to achieve full establishment levels by September 2016.

2) To deliver a programme of cultural change that generates an improvement in staff morale evidenced through an improved FFT score and the cultural barometer, by March 2016.

3) To improve the level of core income to ensure a sustainable future for NEAS, working with Monitor and our Commissioners to have an established funding structure that incentivises NEAS to appropriately reduce hospital conveyances, to operate from 1 April 2016.

4) To develop a comprehensive evidence base for a single operational model through the Integrated Care and Transport pilot that would support full roll out of the model from April 2016.

5) To establish a quality cultural base that sets to improve performance for all of our Ambulance Quality Indicators beyond national benchmarks on a consistent basis

6) To have fully embedded user-friendly information systems by June 2015 that provide quick access to business intelligence to drive performance improvement activity

7) To achieve recurrent cost improvement targets through waste reduction and application of lean methodology to reduce the impact on the 2016/17 target.

In addition to the corporate objectives, some of the Trust’s specific plans include:

Ongoing achievement of the national performance response targets to include performance improvement in our most rural locations

Review of strategic engagement

Brand development for the Trust

Implementation of recommendation from the ECIST review to maximise performance and effectiveness of the 111 service

To embed all year resilience planning and activity that is not solely focussed on addressing winter pressures

Quality plans

National and local commissioning priorities

Reiteration of care closer to home etc. & pressure on A&E, urgent care

Integrated services and links between health and social care


Handovers – working with hospitals to improve at target hospitals using best practice from others

Working collaboratively to put in place a well understood and whole system supporting divert and escalation policy

Use of research to influence service developments

Quality goals and priorities

Update based on content of quality strategy and updates from the clinical team

Update with quality priorities for inclusion in the Quality Report when work on Quality Report underway

Current quality concerns

The Trust constantly learns from complaints, incident reporting, auditing and surveying (and many others). The current areas of work include:

Implementation of a more streamlined complaints reporting process with staged action plans

Trends and themes are considered at Board level

Regular meetings to consider training needs

Update in here with specific actions taken as a result of improved process

Key quality risks inherent in this plan

1. Staffing levels and skills mix are not appropriate to deliver the best service to patients.

2. Cost improvement requirements reduce our ability to invest in the front-line, placing national Emergency Care response targets at risk.

3. Unable to dampen acuity of growth in relation to the Trust’s red rate, leading to pressures affecting performance of back-up transport, GP Urgent requirements and our low priority work (as emergency resource is deployed to higher priority emergency activity).

4. Pressures throughout the system continue and reduce our resource availability which can contribute to an increase in the number and severity of serious incidents.

5. Continued use of poor quality and differing care plans making it difficult to extract key information to facilitate provide better tailored care for patients, either at the point of call, or on face to face contact.

6. Unable to meet the growing needs for non-urgent patient transport without strong intervention by Commissioners to reduce demand, or without additional funding.

How we assure quality and safeguard patients

There are several layers within the Trust that enables the Board to be assured on quality and to safeguard patients:

Robust monitoring is in place across key metrics; including early warning indicators such as near misses and complaints received

Additional developments have been made to the incident reporting system to improve monitoring of themes and trends

A comprehensive clinical audit programme is in place and reviewed annually. Ad-hoc assurance audits are undertaken to validate key metrics such as re-contact rate

There is routine review and clinical audit of long responses to emergency incidents

Effective contract management, including management of sub-contracts


Our Experience, Complaints, Litigation, Incidents and PALS (ECLIPS) group meets routinely to triangulate all reporting and metrics and ensure lessons learned are acted upon

Quality governance arrangements have been reviewed and will be further refined and streamlined in light of the Trust governance review to further improve effectiveness

Update – FFT for patients by March 2015.

We will continue to gain assurance through:

Our internal audit programme

Existing counter fraud arrangements

ISO (Internal Organisation for Standardisation) Quality Assurance system as certified by Worldwide Quality Assurance

Staff surveys and our Health and Well Being assessments

The updated Francis Action Plan in light of Hard Truths.

QGARD Benchmarking with the National Ambulance Quality Group

The ongoing development of the Board Assurance Framework, monitoring and rectifying gaps in control and assurance

Robust risk management and use of effective management and treatment plans to mitigate risk

Business continuity management.

Update - findings/recommendations from governance review

Our quality plans and the workforce

Update this entire section based on revised workforce plans which support the delivery of performance and the care closer to home agenda i.e. ICaT, Enhanced CARe, specialist roles, ECCM implementation etc.

The workforce planning group is improving the planning, recruitment and development processes and has set a target date to recruit to achieve full establishment levels by September 2016.

The workforce plan is constantly being refined and the establishment and skill mix will adjust to reflect commissioner requirements, successful commercial bids and other external factors.

The commitment to transform the Trust’s operational delivery model has also enabled permanent introduction of a Clinical Support Desk and a restructure of the dispatch function to support the ICaT delivery model.

The delivery of the Organisational Development strategy is pivotal to the success of this operational plan and also the longer term strategy for the Trust.

Non recurrent monies allow additional staff resources to be drawn into the Trust to improve system resilience and help achieve performance during the winter months. The Trust will work closely with Commissioners to consider how this process can be used to help inform all year round resilience, not only in the winter months.

Update draw on national strategies and regional drivers to develop the training and recruitment plans for the organisation. Include filling the gaps in the paramedic workforce and the introduction of the three year BSc and clinical skills enhancement.

Human factors training has already been introduced into the Contact Centre as stand-alone training, and is now being embedded into the training programme for Contact Centre new starters. Refresher training is also being made available to existing staff as required.

Risks to plan delivery

Update this section based on agreement of corporate objectives and expanded narrative.


The following risks have been identified.

1. Ongoing pressures without appropriate funding to maintain adequate capacity and maintain overall achievement of national response performance targets.

2. Use of cash reserves to invest recurrently in staffing-related quality issues i.e. leadership, new role development.

3. Ability to identify new cost improvements and achieving delivery of them

4. Staff morale and motivation is low at a time of further change

5. Unproductive partnership development with staff groups and their representatives.

6. Limited leadership at the front-line

7. Pace of financial incentive development is too slow to deliver the desired transformation of the health economy

8. NHS 111 promotional campaigns induces demand at a rate not commensurate with resource increases

9. Ongoing reliance on cash reserves which is not wisely invested leading to further financial deficit.

Plan contingency

The Trust will continue to utilise third party support at the front-line to protect Emergency Care response performance targets, whilst recruiting and training staff to achieve establishment levels.

Existing framework agreements are being utilised to get third party staff into the Trust and the Crown Commercial Services contract is also being used to obtain qualified paramedic resource on a short term basis.

Commissioners have committed to working collaboratively to realise the desired transformations of our service and recognise that timescales are long term.

Operational requirements and capacity

Activity forecasts

Update

Activity to be remodelled based on 14/15 outturn to date.

Tariff review discussions as part of Monitor pathfinder approach

Introduction of PTS eligibility criteria and impact on bookings, journeys and associated resources

Workforce plans

Emergency care

General overview of updates to workforce plan

Corporate Bank to be taken forward as part of workforce planning

ECCM role implementation

Enhanced CARe training and resource allocation

Workforce Management System

Over training of workforce proposed in previous plan not taken forward

Removal of requirement for C1 driving licence which was a barrier to entry


Patient Transport Services

Workforce planning & resourcing

Contact Centre

Update in here re resourcing including use of agencies

Interactive Voice Response (IVR) message to divert calls appropriately and optimise resource usage

Organisational Development

Update in here re implementation of the strategy and progress made to date

Workforce related issues and management of the same

Using the unions as an enabler

Hearts and minds of staff in challenging times

Working through change

Other enabling plans

Information Management and Technology (IM&T)

Update in here needed

Estates plans

Innovation through co-location of emergency services in Barnard castle as part of agreed bid with fire, police and mountain rescue. Similar opportunities will be considered as they arise.

Scotswood lease expires in January 2016. Currently looking at options including how the existing estate can be used more effectively.

Performance management

Performance Management Strategy to reflect the Delivering Consistently approach that is now in place.

Service Line Management

Decision re progression with SLM

Productivity, efficiency and CIPs

NB – content of plan related to finance to all be updated

CIP expectations and achievements

Traditional CIP and income generation schemes

Scheme Description 2014/15 £000

2015/16 £000

WTE reduction

Quality Impact Assessment (QIA)

Sponsor

Income/commercial update

Transformational CIP update

Initiative Detail Stage of development

1. xxx Xxx

Likely impact: xxx


Financial plan Reference in here to comments from Monitor letter

Revenue income

xx

The following table shows our NHS clinical revenue forecasts for the next two years.

Income 2015/16

£’000

2016/17

£’000

Cost & Volume

xxx

Block Contract

xxx

Other operating income in 2014-15 includes xxx

Planned costs

Pay expense budgets

The Trust’s pay budget for 2015-16 after CIPs is xxx - expand

Non-pay budgets

The total non-pay expense cost for 2015-16 is xxx - expand

Service developments

There are two planned service developments:

Update on agile and ECCM role

Capital Plan

The Trust’s Capital Plan is summarised below.

Area of expenditure Description 2015/16

£’000

2016/17

£’000

xx xx

Total

The main source of funding is xxx

Anything of relevance this year regarding property disposal

Liquidity

xx

Risk rating

xx

Financial risks

The key financial risks to this plan are:

1. xx

2.

3.


Update section re modelled downside scenarios and mitigation.

2015-16 (£000)

2016-17 (£000)

Recurrent impact (£000)

Recurrent

Non-Recurrent

Totals


Glossary of terms - update based on terminology used

Term

Definition

Agile working Working from different locations by utilising mobile technology, in the Trust this will include home working where appropriate

Better Care Fund The Better Care Fund (BCF) is a single pooled budget to support health and social care services to work more closely together in local areas

Blue light services Police, Fire and Ambulance services

Enhanced CARe Building up the specific skills of Paramedics to treat an increased range of symptoms at the scene to help reduce the demand on Emergency Departments

Ischaemic limbs Lack of blood flow to the limbs

NHS 111 National urgent care access service, provided by NEAS in the North East of England

Telehealth Using technology to monitor health in a patient’s own home and transmit information to health professionals

Troponin Tests used to evaluate if somebody has had a heart attack or some other damage to their heart

Acronyms Update based on those used

Abbreviation Definition

CCG Clinical Commissioning Group

CIP Cost Improvement Programme

CQC Care Quality Commission

CQUIN Commissioning for Quality and Innovation payment framework

EC Emergency Care

e-PCR Electronic Patient Care Record

FFT Friends and Family Test

IM&T Information Management & Technology

ISO International Organisation for Standardisation

NEAS North East Ambulance Service

PMO Programme Management Office

PTS Patient Transport Services

QIA Quality Impact Assessment

WFM Workforce Management System

WTE Whole Time Equivalent


Appendices Commercial or other confidential matters (NOT FOR PUBLICATION)

Update based on list from last year and appetite for commercial expansion

Plan on a page

Delivery plan and quarterly milestones

Ensure winter planning is captured in the milestones

Use system to set and track milestones

Reporting metrics

Include comms and engagement

Update - sub objectives to be developed from tables below that are the outputs from the Annual Planning event.

Strategic Goal: We want to deliver safe, effective, caring, responsive and well-led services

OBJECTIVES Workforce to full establishment by 2016 with appropriate skill mix - Reduce late finishes/meal break issues - Reduce need for overtime/3rd parties - Improve staff morale - Increase performance Leadership – ECCM in Post by 2015 - Build on corporate management training

100% attendance - Encourage more attendance at NELA. Enterprise information system continues to develop - Improved reporting/challenge current practice - Evidence for performance management - Identify efficiencies - Better patient care - Automation of processes - £££

RISKS

Fleet/Vehicles/Equipment Union engagement Weakness at any level Data Quality SILO systems/lack of integration Lack of buy in

Strategic Goal: We want to provide safe alternatives to hospital

OBJECTIVES

To work with Commissioners to agree a framework for alternative care pathways with an appropriate funding structure to enable phased delivery from April 2016

RISKS

Commissioner engagement General Election


Identify collaborative partnerships both within NHS and wider commercial sector to deliver alternatives to hospital care from April 2016.

Acute sector buy in/resistance Internal capacity Timescales for ROI Inappropriate funding structure

Post event input from Peter – recruitment value based and safe and directors to be on local transformation boards Strategic Goal: We want to move to a single operational model across emergency, urgent and planned activity.

OBJECTIVES

Develop a comprehensive evidence base through pilot roll out/testing phase/user satisfaction/staff news/focus group/efficiencies gained/standards/KPI’s Develop a supporting costing model to inform future proposal to Commissioners for 16/17 contracting round (payment reform) Target operating model (TOM) Optimal – Resources, staff, estate support, vehicles. - Planning for 7 day working - Matching resource to demand - Use the unions as enablers

RISKS Failure to implement/roll out pilot/recruitment Benefits not realised - productivity - standards/performance Election Change/Disruption Tariff/Monitors payment reform does not match our model Persuading 12 CCGs + 8 SRGs to move money and invest in NEAS Performance Equity not achieved through model Project stalls – other priorities

Post event input from Peter - get CCGs into NEAS, influence them and Monitor hub & spoke? Strategic Goal: We want to have sound financial health and grow our commercial revenue streams

OBJECTIVES

Reduce waste by applying lean methods to change the way we do things Diversify fleet and logistics using current skills to offer new services not just healthcare Work with commissioners over tariffs incentivised to leave patients at homes Wider engagement with staff in developing Cost Improvement Plans

RISKS

Effort vs gain Buy in from those involved Impact on core service Commissioners don’t agree National Ambulance resistance Lack of staff engagement/interest


Post event input from Peter

Procurement and e-procurement efficiencies – positive impact on CIP?

National commissioning discussions and work with acutes to commission NEAS directly – “Encourage a thorough review of ambulance commissioning involving all interested parties including acute trusts, from both the local and national standpoint”.

Item 10 - Draft Annual Plan 2015/16

Documents

Transcript of Item 10 - Draft Annual Plan 2015/16