Norfolk and Waveney Mental Health NHS … plan 10...Norfolk and Waveney Mental Health NHS Foundation...

Norfolk and Waveney Mental Health NHS Foundation Trust

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APR Strategy Document


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Template 1: Vision and key priorities

The Trust‟s current position is summarised as: Norfolk and Waveney Mental Health Foundation Trust has been an NHS Foundation Trust since 1 February 2008. During this time the Trust

has met all governance targets and mandatory services with a financial risk rating of 4. The Trust was awarded a “double excellent” for quality of services and use of resources in the last annual health check assessment by the Care Quality Commission. More recently the CQC awarded the Trust registration with no conditions. The Trust‟s integrated business plan approved as part of the foundation trust bid lasts until 2012/13 – the same year as the final year of this Annual Plan. The key business developments identified within the business plan have been achieved or are in the process of being achieved as demonstrated below: • Construction and opening of the new Psychiatric Intensive Care and Low Secure Unit in May 2009. • Significant CIP delivered from the management of specialist mental health placements (secondary commissioning) with better services offered locally and less need to place patients out-of-area. • Business case for Dementia Intensive Care Unit approved March 2010 • Full integration of the West Norfolk Locality (previously managed within a Primary Care Trust). • Expansion of in-house training function, including Prevention and Management of Aggression (PMA) as an income-generating centre. • Full integration of social care services for adults of a working age, with all staff TUPE transferred to the Trust in November 2008. The last two years has seen a significant increase in the Trust‟s size and turnover with income growing from £110m to more than £130m. The Trust is now facing a muc+A19h more difficult economic and perhaps competitive environment with the prospect of the NHS having to make unprecedented levels of savings over the next few years. The key challenges for the Trust over the next few years are therefore: • Continuing to provide high-class mental health services. • Addressing the impact of the downturn on NHS funding. • Delivery of 5% year-on-year CIP plans. • Implementing Payment by Results for mental health. • Expanding the range of services provided by the Trust, extending either geographically in mental health services or within current boundaries by moving into physical and community health care. • Ensuring the full engagement of staff, key stakeholders and service users. • Developing new services for patients, particularly those with dementia in response to the demographic changes expected over the next few years. • Support key service developments such as the Dementia Intensive Care Unit and clinical academy.


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The Trust‟s current position is summarised as:

During this time the Trust has had a very stable Board of Directors and senior leadership, but in recent months there have been a number of changes in the top team of the Trust. A new Chief Executive Aidan Thomas was appointed during 2009 and 2010 will see the appointment of two new Directors. The Trust is progressively realising the benefits of the freedoms that Foundation Trusts have, this for NWMHFT is evident in its work to support closer community and staff engagement and the continued innovation and improvements to the available services. In particular the engagement of Members through the Board of Governors has enabled the Trust to test out its strategic direction and continue to align it with the aspirations of local people and staff. All of these groups helped the Trust to develop its current vision. Quality Assurance As part of the Trust‟s development of the Whole Life agenda the integration between the Trust‟s Older Peoples Community Mental Health Teams (OPCMHT) in all localities and Norfolk County Council Older Peoples services has reduced the amount of times that a patient has to tell their story during the assessment process. By being open to a multi-disciplinary team, a more holistic approach to the individuals needs is evident. Social care practitioners co-located to the OPCMHTs gain a lot of experience by working with other professionals in this manner, which aids the assessment of individuals with severe and enduring mental health difficulties. Equally, health professionals have been able to gain a considerable amount of insight into the social care role, available resources and legal responsibilities. Integration minimises the need for patients to wait between the health assessment and social care assessment, services can be accessed more quickly which has aided in the prevention of some hospital and residential admissions. This approach to the delivery of services is an illustration that the Trust is able to successfully work within a partnership and encourages confidence in this approach to service delivery. The Trust has made significant changes to policy and practice due to the implementation of new Mental Health legislation. This includes the Mental Health Act, the Mental Capacity Act and the Deprivation of Liberty Regulations. Board Matters Two Directors left the Trust at the end of April 2010. The Trust has benefited greatly from the dedication and hard work of two excellent Directors and can perhaps congratulate itself for the development opportunities it has given which has enabled Directors to achieve key leadership roles within the NHS. Two new appointments have been made and the executive directors will be at full complement by the end of the Summer 2010, while an interim director has been appointed in order to ensure stability until that time. During 2010 further consideration is to be given to the recruitment process for three non-executive directors‟ whose terms of office were due to expire over the course of the autumn. The Nominations Committee of the Board of Governors has decided to conduct an open recruitment process in order to recruit replacements. Other Board changes include the retirement of another Director, which corresponds with a reduction in the number of non-executive directors, leading to a smaller Board. The Board of Governors membership has been refreshed by the Elections held in December 2009. New Governors have been welcomed and are already contributing to the work of the Trust. A great disappointment has been the problems associated with retention of Service User Governors. Work will continue in 2010 to address this.


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The Trust‟s current position is summarised as:

ICT and Finance Developments The Board of Directors has approved a new three-year strategy for its use of Information and Communications Technology (ICT), running from 2009 to 2012. This is supported by a significant investment programme to deliver a wide range of new technology, which will support the more efficient and productive delivery of services into the future. As a part of this the ICT Services have completed a major transformation of their service delivery approach. The Trust has introduced a new on-line system for understanding the costs of its activities (Abacus) this system is available to managers and senior clinicians. Much interest has been generated nationally about this project which resulted in the Trust becoming involved with projects with the Department of Health and the Audit Commission to gain a better understanding of the costs of mental health care. This system will fully support service line management and the development of Payment by Results for mental health. Environmental Matters The Trust is committed within its core values to being a good corporate citizen. In December 2009 the Board of Directors agreed an environmental strategy for the next 5 years. This strategy addresses the ten key commitment areas identified in the national NHS Carbon Reduction Strategy for England (“Saving Carbon, Improving Health”) and focuses attention on ensuring compliance with the various aspects of the Climate Change Act (2008). A Sustainable Development Committee that identifies actions and measures to demonstrate our improvement against the key performance indicators set by the NHS Sustainable Development Unit supports the implementation of this strategy. Contracts A new mental health and learning disabilities contract was issued for all services in 2009/2010. The new contract was a standard contract as required by the Department of Health. Within the contract were some new areas that in year the commissioning teams for the Trust and the two main commissioners needed to review on an ongoing basis. The contract was changed at the start of the contract term to be for one year only and this has resulted in rework for the Trust on another new contract for 2010/2011, this is now for 3 years. All of the Trust‟s services have been reviewed and the HERON website for patient and GP information will be updated in year, this has involved a collaborative approach across the Trust to ensure the services as described are correct and current. Additional work has been required around the establishment of baseline data for national and local performance schemes including not only contract monitoring but also Commissioning for Quality and Innovation (CQUIN) and Quality Accounts in which the Trust has been involved in a national pilot.


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Template 1: Vision and key priorities

The Trust‟s vision over the next three years is to: The Trust‟s vision is:

To be recognised as a centre of excellence in mental health care that enhances the well being of the communities it is a part of. We will do this through the delivery of services that help people to stay well and that treat, support and care for people when they are ill, to enable them to get on with living their lives. This vision was originally set out in the Integrated Business Plan in 2008 and will continue in 2010/11 to drive the Trust‟s approach to the care of its service users. However it is recognised that with the many changes, both internally and externally to the Trust, the vision will need to focus more on the Trust's Foundation Trust status and what that means in the current economic and political climates as well as the new structure that exists to manage the organisation in the next three years. In particular this means looking at providing services that are not mental health and/or not in area. With this in mind the Trust proposes to review the vision statement, values and the strategic objectives outlined in this document (priorities section) during 2010/2011. As a result some of the milestones will end during 2010/2011, but there remains a commitment strategically to ensure the provision of high quality services and a financially viable organisation. The Trust Values: • Seeing people in the context of their whole lives • Being an accessible, proactive and responsive organisation • Being a good corporate citizen • Being an employer of choice • Valuing the contribution of members and governors • Being a learning organisation • Being a provider of choice • Being an efficient, effective and viable organisation The Trust‟s strategy is to protect its position as the current market leader in Norfolk and Waveney, by bidding for and acquiring contracts for new services from current commissioners, such as the full implementation of IAPT (Improved Access to Psychological Therapies), as well as contracts to deliver appropriate services outside of its current sphere, such as provider-arm community services, or other appropriate geographical areas should they become available. Criteria have been established to test whether potential tenders that fall outside of either the expertise or geographical area of the Trust should be bid for within the context of the Trust‟s development strategy. The Trust will market itself on its ability to provide the complete care pathway (without age boundaries) and/or discrete areas of service. In order to achieve this, the strategy will also focus on securing the most talented staff and then investing in their education and training. Attention to a programme of research will equip the Trust to promote its innovative services and its approach to redesign through publishing the


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The Trust‟s vision over the next three years is to: outcomes. This will contribute to active reputation management.

The following sections set out where the Trust stands on a number of important work areas and initiatives. Quality Assurance All parts of the organisation are significantly contributing to the ongoing drive for higher quality services that improve the experience of people using NWMHFT services and their families and other carers. Many of the developments specifically relate to the improvement of service user safety and ensuring the services offered are based on what are known to be most effective in achieving the outcomes people desire. Pilots have been used to trial new ways to deliver services, for example a pilot for older people with dementia, the services are helping to put in place support arrangements for them and their families without the need for referral to secondary care. Such pilots are key to the Trust‟s strategy. The Trust continues to explore new ways to deliver services within primary care such as Intensive Support Teams with the aim of improving access to home treatment and crisis support to older adults and so avoiding admission to hospital. Other services are also being developed such as the Pharmacy website http://www.choiceandmedication.org.uk/norfolk_and_waveney/ which includes a wide range of information for service users, carers, and professionals to use in order to support them in understanding and making choices about the use of medication. Commissioning/Tenders The Norfolk and Waveney position will mirror that of many places across the country. The two local PCTs have both struggled through the current year to curb increases in non-elective activity and their financial positions have come under threat as a result. The Trust can expect to get no inflationary uplift in 2010/2011 and probably in the 2-3 years thereafter. Norfolk will see the greatest increase in the over 65 population compared to any other area in the coming few years – the implications for dementia services are huge and will present a massive pressure on service design and delivery. The PCTs have recently put forward their commissioning and financial plans for the next five years, which appear to leave mental health funding streams largely intact. There are some reductions in funding, but these are marginal and may not involve the Trust‟s services. However, these figures hide disinvestment if the inflation uplift is set at less than zero. The Trust is bidding to acquire the community services arm of NHS Great Yarmouth and Waveney and if successful would become one of the first Trusts in the country to be able to integrate mental and physical healthcare services. This would be in line with the Trust “whole life” philosophy, as well as delivering improvements in patient experience and efficiency. Marketing will play a key part in sustaining the Trust‟s strong relationships with stakeholders in the coming year, through developing greater understanding of their needs, improved communication and increased engagement. There will be a focus on communicating the Trust‟s successes and new developments clearly, enhancing the Trust‟s reputation and profile during a time of increased competitive tendering in the region. Contracting for Quality The introduction of payments linked to quality outcomes in 2009/10, the Commissioning for Quality and Innovation (CQUIN) framework, linked 0.5% of the Trust‟s NHS mental health activity income to quality outcomes. This has been increased for the year 2010/2011 by 1.0% and will be


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The Trust‟s vision over the next three years is to: reviewed annually. A programme of quality improvements (CQUIN) has been agreed with all commissioners. For NHS Norfolk and NHS Great

Yarmouth and Waveney contracts there are 6 overarching indicators included, with two sub sections representing a wide range of Trust services. For the medium and low secure contracts the CQUIN indicators have been defined nationally, the Trust welcomes the initiatives. The indicators specify the quality improvements to be achieved and a failure to do so will result in varying levels of financial penalty to the Trust. In order to ensure ongoing compliance with the CQC Essential Standards the Trust is linking the central governance role with localities. This will have the following advantages: • Local ownership by the nine locations • Release of the central resource to concentrate on strategic analysis of trends • Improving the quality of the evidence • Enabling localities to use their assurance systems to support local quality improvement There are also a number of developments related to encouraging efficiencies in service practice and reporting so that the correlation between service delivery and what is reported externally is clear in the minds of all staff. Other strategies such as data quality to ensure relevancy, accuracy and reliability of all data and Trust systems is being developed and implemented within the duration of this plan. Engagement with Staff, Governors and Members NWMHFT is committed to engaging with members in meaningful ways to shape the way it develops. The Trust is working with Governors to provide members with increasing and varied ways to engage, understand and influence, including the well attended Quality Accounts events, Meet Your Mental Health Service events and Meet Your Governor events. These will be expanded and improved in 2010/11. Further to this the Board is open to the Public and will accept actions on their behalf. The Trust has established a Board of Governors Marketing Subgroup with the specific task of recruiting members and communication Trust issues and objectives with existing members. An objective for 2010/2011 will be to increase the involvement of staff, service users, carers, governors and other local people in planning and influencing the work of the Trust. This will be possible through a wide range of new communication initiatives with staff and seminars and discussions with governors and local people on the Trust vision and values and will be released in a plan for 2011/2012. The Trust listens to its staff via the staff engagement programme „The BIG Conversation‟ and in-year a number of the staff identified outcomes have been delivered, such as a new staff magazine „Onsite‟. The first Staff Awards Ceremony in September 2009 was a great opportunity to celebrate the achievements and commitment of some highly talented and inspirational staff. This programme and the celebration will continue and be developed in the future. Over the last year the Trust invested significantly in management and leadership development, in readiness for the hardship anticipated in the coming years. This investment will continue in order to mitigate some of the challenges faced that will require effective leadership, management and staff engagement. In order to strengthen relationships with staff, the Trust will be developing and commencing implementation of a clear strategy for development, for appraisal, and for succession planning with a focus on performance at all levels. The aim in year will be to establish a development strategy


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The Trust‟s vision over the next three years is to: and to have made significant progress on all elements along with improvements in staff survey outcomes.

Partnerships and consultation with stakeholders The Trust is committed to partnering with other appropriate local organisations to bid for services. The Trust recognises the need to achieve pluralism of delivery, and will act to ensure that a range of organisations can contribute to the successful outcomes of new services for which it becomes responsible. The productive partnerships with Norfolk and Suffolk County Councils, to which the Trust is committed, will become continually more important to the effective delivery of integrated health and social care. The Trust is working with Suffolk Mental Health Partnership to investigate ways in which efficiency savings could be made by working collaboratively. Should this lead to any formal partnership the appropriate regulatory process will be followed. No public consultations outside of the ongoing interaction with partners, service users, carers, members and the LINk are currently planned, but in the event that contracts are acquired, or relevant formal partnerships developed during the year that have a significant impact on the shape of service delivery, the Trust will undertake appropriate consultation. HIEC and research The Trust is committed to establishing a strong research base (academic and practical), building on the Health Innovation and Education Cluster (HIEC), and DeNDRoN, and supporting NIHR participants. In 2010 the Trust will establish a HIEC, and establish a clear plan for working with the University of East Anglia (UEA). The Trust is working with the UEA and other health partners to try and maximise the amount of funding that can be used to develop clinical academic posts and thus further boost the research credentials of the Trust. Improving Access to Psychological Therapies (IAPT) The Trust is working closely with NHS Norfolk and NHS Great Yarmouth and Waveney to develop Improving Access to Psychological Therapies which is an ongoing new service development from 2008/2009. NHS Norfolk has been allocated approximately £1.5m for IAPT in 2010/11 and has also committed local funding. NHS Great Yarmouth and Waveney has been allocated approximately £480,000 and has similarly committed additional local funding to this development. Plans for 2010/2011 include working with partner organisations to submit bids in response to request to tender for the full IAPT services, to continue with recruitment and training of new staff, to develop care pathways working with the multiplicity of services available and service providers to ensure cooperative and efficient use of all our local resources and in particular to develop strong working relationships with employment services. Dementia Strategy, the Dementia Intensive Care Unit (DICU) and the Norfolk Clinical Academy for Dementia The key policy for the Trust is undoubtedly the national Dementia Strategy, and there will be a real challenge in Norfolk to address the growing problems of dementia, alongside the financial downturn and an increasingly elderly population. The new provision for the Older Peoples` continuing care wards and the building of a new 36 bedded Dementia Intensive Care Unit was approved in 2009. Work will start in late 2010, as planned, with completion of the £13.7m state of the art building scheduled for Spring 2012.


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The Trust‟s vision over the next three years is to: The DICU replaces the 28-bedded wards at Hellesdon Hospital and is positioned to the rear of the Julian Hospital, in close proximity to existing

older people in-patient areas on the site. Service users, carers and staff have contributed to the building design. Within the Hellesdon Dementia Unit considerable efforts are being made to prepare the workforce for the move to the DICU and their place within the new Norfolk Clinical Academy for Dementia. This involves additional education programmes and the development of new ways of working including embedding dementia care mapping and extending initiatives with a focus on person-centred care. The academy aims to become a nationally recognised centre of excellence for dementia. The centre of excellence concept draws together best clinical practice approaches, research and education and training under one roof. This allows our strong research and education base to be linked to clinical care in a dynamic and unique way giving the Trust an opportunity to lead on the changes that are being implemented through the National Dementia Strategy. Finance A key objective for 2010/2011 will be to ensure the Trust produces and delivers a long-term plan for the financial down turn faced by the NHS, and delivers its financial plan for 2010-2011. This will be achieved through the delivery of a 4 year Plan by June and a financial plan delivered by April 2011. Further to this the Trust will look to implement a local tariff (payment by results) for the majority of our Mental Health Services by April 2011 as required by Department of Health Guidance, to this effect a tariff is to be in place for April 2011 Estates and Facilities – Environment strategy key plans and developments In 2010/2011 the Trust will develop and implement the estates strategy. The strategy covers all major sites managed and by April 2011 the aim is to have an agreed plan for futu+A14re development of Northgate, Kings Lynn, 80 St Stephens and the Hellesdon site. ICT strategy and SHAPE key plans and developments In the coming years the Trust has committed to develop its information infrastructure and systems to support the visions. This will be achieved according to the detail in the ICT Strategy and in addition the specific commitment to a new patient and clinical recording system will be delivered against agreed milestones for the year as defined in the SHAPE programme. NHS Constitution The Trust believes in the principles of the NHS Constitution and has already committed to ensuring adherence to these principles. In order to reflect this all papers for the Board of Governors and the Board of Directors will have a cross reference to show compliance to the Constitution criteria. CIP The Trust is completing a detailed plan to achieve net cost improvement over the next four years of 20% in response to the economic downturn. These plans are focussed on several initiatives: • Significant reductions in overhead and support function costs including improved productivity schemes for these areas and also the sharing of some functions with other areas such as Suffolk Mental Health Trust and Local Government. • Standardisation of clinical services across localities utilising the most cost effective models


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The Trust‟s vision over the next three years is to: • Reductions in the provision of some services in agreement with commissioners

• Significant remodelling of some services to enable the provision of more cost effective service models • Rationalisation of Estate • Reduction in Community infrastructure costs through the introduction of improved ICT systems


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Template 1: Vision and key priorities - Key priorities for the Trust which must be achieved in the three years of the annual plan to

underpin the delivery of the Trust's vision

Key priority (and timescales) How this priority underpins the strategic vision

Key milestones (2010/11)



To increase the market share of the Trust

Key to the strategy. Public health data and service user feedback will be used to challenge and shape the trusts services to ensure that the programme of services are efficient and effective and meeting the needs of existing and potentially future service users in the region with the aim of offering real choice

IAPT tender process completed Suffolk Mental Health Trust partnership working discussions and implementation plans and protocols The Trust is bidding to acquire the community services arm of NHS Great Yarmouth and Waveney

Annual Planning process In year tenders (not yet known) although Trust expectation is that Substance Misuse services will be open to tender this year.

Annual Planning process In year tenders (not yet known).

To be the market leader for the provision of mental health services in the Eastern region with an international reputation for excellence, innovation and choice.

Supports the trust vision of being a centre of excellence, innovation and choice. The Trust aims to expand its research profile and is looking to work more closely with the UEA to develop additional clinical academic roles.

DICU work commences according to project plans HIEC early implementation roll out within the region

DICU project completion HIEC operational plan fully established and operating.

DICU admissions and successful implementation of the care pathway HIEC is self funding.

To attract the very best staff, retain them by rewarding them well in ways that motivate them further, and provide every opportunity for them to develop to their fullest potential.

In order to achieve its vision the trust will need to employ and retain the best staff, only by investing in them will the vision be possible.

Talent management strategy implemented. Wellbeing strategy implemented.

Total reward strategy implemented. Increased flexibility demonstrable within the workforce

Ongoing review of staffing requirements and success of strategies implemented


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Reduced sickness absence. Greater motivation reported via staff survey.

in response to unplanned and planned demands and development needs.

To have a workforce that is fit for purpose and delivers first time, every time.

By ensuring that staff skills remain current and in line with the requirements of their roles staff can perform to the best of their ability.

Organisational development strategy implemented. Engagement strategy implemented Review of staff engagement in Staff Survey. Staff survey action plan implemented and improved responses identified Increase in completed appraisals ILM and Good to Great programmes running

Continuation of 2010 milestones and additionally Annual organisational culture surveys undertaken and year on year improvements demonstrated. Continuing improvements in staff survey results and high levels of satisfaction identified in patient surveys.

Continuation of strategy with ongoing review and development as required and identified in annual plan.

To ensure the Trust makes the best use of existing resources and constantly explores opportunities for increasing income and generating surplus, which can be used to underpin innovation, research and development.

With the programme of service line reporting, all services will be tested for efficiency of services and service models. This will be an opportunity to learn from developments and ensure that innovation is encouraged, the investment of profit will support this approach.

PbR work with DoH and EoE SHA, and PCTs Service line reporting via SLR Programme Board CIP implementation

PbR work with DoH and EoE SHA, and PCTs Service line reporting via SLR Programme Board CIP implementation

Local PbR system in operation from April 2011. CIP implementation. HIEC is self funding.


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HIEC roll out in year and other Trust supported research programmes. Increase in the number of NIHR portfolio studies. Review of existing SLAs to ensure fit for purpose. Implementation of a new financial system and financial services provider.

HIEC operational plan fully established and operating.


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Template 1: Vision and key priorities - Key priorities for the Trust which must be achieved in the three years of the annual plan to

underpin the delivery of the Trust's vision (cont.)





To improve the mental health of the local communities by providing accessible, timely and effective services that are diverse and culturally sensitive.

The trust has a good reputation for the delivery of innovative services this would not be possible without a conscious approach to understand the community that it serves. By engaging with service users, carers and the wider community the trust will ensure that when it does expand it continues to deliver services that the community requires and deserves.

Continue to commit to the provision of national data for ethnicity, housing and employment etc and surveys such as the Count Me In Census, Childrens Service Mapping or their replacements. Engage with cultural competency assessments locally and regionally. support the CAMHS needs assessment review in Norfolk. Engage with members, service users and carers to understand their needs and inform service redesign

To be reviewed in line with contract requirements and review of changes

implemented through a change in government using lessons learnt from

2010/2011. Develop 2012 priorities and milestones.

Working with PCTs

and partners to implement the

Dementia Strategy

To be planned in 2011 Annual

Planning process


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To have a quality mental health service that protects and instils confidence for patients, the public and staff through well-governed systems and processes.

The trust will develop and expand its services only if its reputation is for high quality health care. This reputation will require evidence, the internal systems in place ensure that clinical governance and quality are ensured.

CQC Registration requirements. Contract and Monitor requirements - CQUIN, Quality accounts. Member and Governor events

CQC Registration requirements. Contract and

Monitor requirements - CQUIN, Quality

accounts. Member and Governor

events

CQC Registration requirements. Contract and

Monitor requirements - CQUIN, Quality

accounts. Member and Governor

events

To contribute to collaborative working arrangements in order to improve the experience of people using or referring to the services; e.g. children‟s trusts, strategic alliances, local strategic partnerships, crime reduction partnerships and joint ventures.

The trust aims to market itself as a provider of the complete care pathway without age boundaries and working collaboratively when the opportunity is available.

Annual patient survey, Annual Report will highlight collaborative arrangements. Review of CAMHS reporting for LD, IST and LAAC to ensure that collaborative working is reported effectively to commissioners and areas of difficulty addressed.

To be reviewed in line with contract requirements and review of changes implemented during 2010/2011 and SLR and CIP outcomes. Develop 2012 priorities and milestones.

To be planned in 2011 Annual Planning process


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Template 2: Key external impacts

Key external impact Risk to the plan Mitigating actions and residual risk Overall expected outcome

Measures of progress and accountability

Competition comes from the independent sector or third sector for tenders

Failure to win tenders specifically Substance Misuse Tender

Creating collaborative “consortia” with third and independent sector subcontractors. Develop strengths of tendering team and ensure that developments remain in the best interests of the Trust. Continue to create a team to support the tenders that have the skill set to best inform decision making. Continue with Board level accountability to members and governors on any new proposed tender.

Success of previous collaborative ventures suggests that this will be a successful approach to developing new and extending existing services

Review of what went wrong with tenders that have been unsuccessful. Commercial Developments Director

Change of policy due to change in Government

Change in policy towards NHS and MH specifically. Most likely to be a reduction in income, structural changes and PBCs

Timescales to implement changes will allow for service re-development as necessary. Existing projects have funding in place and cost efficiencies are already under way. It is unlikely that any of the Trust's planned projects would be at risk following the change in Government, other than ICT (see separate impact assessment). The Trust might need to re-phase

Trust will need to respond and adapt, experience leadership team will drive through current CIP and will ensure that staff have the skills and competencies so that service user or their carers are not impacted upon adversely.

Projects are monitored at Programme Board level. Financial accountability via Monitor and governance through CQC will ensure that the political changes do not impact adversely on existing client groups. The Finance Committee and Investment Committee oversee delivery of CIP programme and Capital Investment programme


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projects to live within reduced means or press more quickly on savings programme.

respectively.

Competitive threats those that threaten existing business

Loss of existing contracts Working closely in partnership with commissioners to help ensure that the services continue to mirror their needs and best practice. By raising and maintaining the Trust profile as the local leader in mental health. Ensuring pricing is competitive and costs are controlled. The Trust is developing alliances with both private sector and voluntary sector organisations to help identify more effective and efficient ways in which services could be delivered.

The Trust has developed a good working relationship with commissioners and is developing relationships with new members of the commissioning teams. The intention would be that this is an event that would have had prior discussions.

Plans would be developed should discussions between all parties lead to a notification to terminate contracts. Finance Director

Competitive threats - those that are competition for new business

Failure to win new business will impact on expansion plans

Developing and exploiting existing networks, contacts and relationships to identify opportunities and put longer-term building blocks in place. Sharing ideas and opportunities with commissioners and other

The Trust at this point in time does not identify major threats to its existing core services. New tenders will be monitored and discussed in relation to existing contracts with commissioners.

Commercial Developments Director


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partners, engaging in consultation and instigating service development initiatives.

New CQC standards being introduced

Failure to achieve the required standards would impact on authorisation

Service performance and compliance with known national and locally determined targets and standards is monitored through the Business Performance Report, received by the Board of Directors and the Executive Operational Team. Any potential lapses are identified and action plans are put in place to achieve compliance

Unlikely to be a risk to the Trust based on recent authorisation process.

Continued reporting should illustrate issues and allow for implementation of action plans to any challenge to standards.


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Template 2: Key external impacts (cont.)



National Programme For IT Failure of the programme or discontinuation of the programme could impact on the Trust commitment to implement new patient and clinical systems

N3 network could be at risk if a national provider is removed. Trust plans currently to use N3 as part of future developments. To replace would have a cost impact. Removal of networks would require time to plan and implement alternative provision. CSCA withdraws from the LSP contract or has its contract terminated or restructured due to not meeting contractual obligations, changing the cost implications or requiring additional procurement

Trust perspective is that N3SP removal is an unlikely outcome. Trust view on CSC contract is that timeframes are delayed and that NWMHFT should continue to monitor the new governments commitment to sign a renewed contract with CSC.

Commercial Developments Director to monitor with Head of ICT and SHAPE Programme Board

Implementation of PbR Financial impact of applying care pathways

The Trust is working with PCTs, SHA and DoH on initial pilots on how this will look for MH. Current position is that the Trust has a good understanding of the implications of the implementation of PbR and is involved in prework to ensure risks are limited.

Trust feels well placed to inform discussions based on evidence on its own implementation

Medical Director leads the Programme Board. Contract Management meetings with Commissioners involve updates on regional and national meetings


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A joint project Board will be established with PCT and County Council representatives to ensure health system understands impact and performance management implications of a move to PbR.

Increase in elderly population and impact on services

Increased numbers of patients in treatment or in contact with the services and increasing costs of service delivery may impact on other MH services

Development and implementation of a dementia strategy in association with PCTs, acute Trusts, voluntary sector and social services. Monitoring through PbR and other reporting mechanismsto gauge impact on services. When necessary contract negotiations will be used to ensure there is no detrimental impact on service delivery. Development of the DICU and clinical academy.

2010/2011 contract negotiations have resulted in General Pressures Funding from NHS Norfolk and NHS Great Yarmouth & Waveney, however this will remain an area to monitor in coming years.

Ongoing monitoring - Finance Director

Economic downturn and impact on resource availability

Reduced income from 2010/11 onwards may result in the need for further efficiencies than currently planned.

The Trust has significant engagement with clinicians, Trust CIP plans are recurrent. The Trust's CIP plans are based on 5.7% in 2010/11, and 5% each year thereafter. Additional CIP

The Trust anticipates that it will maintain the Financial Risk Rating of 3.

Director of Finance, maintain Financial Risk Rating.


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plans could be worked up including local negotiation around terms and conditions and opportunities from QIPP initiatives. The Trust has secured additional funding in 2010/11 to reflect general cost and activity pressures from its commissioning PCTs.

National Pay agreements If agreed payment is high this will have a negative long term impact on trust finances.

Trust survey to gain understanding of staff views on pay and benefits.Review of survey findings will inform any action that the Board feels is necessary to ensure that services are protected and staff remain in post. Current forecasts are cautious. If national pay agreements are viewed as higher than anticipated in this plan action would be considered to reduce the local agreements rather than reduce posts.

Trust plans currently accommodate 3.5% per annum over the 3 years. The Trust is confident any additional pay inflation can be absorbed via additional CIPs. If pay is limited through national negotiations then the Trust has significant scope for saving against the 3.5% included.

Director of Finance and Head of Human Resources. Ongoing monitoring of national pay agreements and review of workforce strategy accordingly.


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Template 3: Clinical quality

Clinical quality priorities Contribution to the overall vision

Key actions and delivery risk

Performance in 2009/10 3 year targets / measures 2010/11 2011/12 2012/13

Improved access to services for people with a dual diagnosis of learning difficulties and mental health. (Quality Accounts)

Seeing people in the context of their whole lives National priority

Implement action plan in line with CQC national priority „Access to health care for people with a learning disability‟ Failure to deliver this national priority may result in a visit from CQC inspectors or ultimately change of registration status and enforcement action.

The Trust has reported to the CQC in 2009 and May 2010, demonstrating progress on the implementation of the action plan to meet the indicators.

In 2010/11 and ongoing. The Trust will continue to implement the action plan across the trust until full compliance is achieved.

Expand the ways of capturing service user and carer experience in all age groups to inform service improvement (CQUIN And Quality Accounts)

Being an accessible, proactive and responsive organisation

Explore options for capturing service user and carer experience in conjunction with appropriate groups, to complement the mandatory National patient survey. Agree patient and user experience methodology and sample. Plan for the implementation of agreed methods. Implement Review results and prepare action plan based on results. Financial risk to the Trust as

The Trust actively seeks the feedback of service users and carers utilising a number of methods:- National patient survey. Patient experience tracker (PET) Compliments/complaints. Service User representation

n 2010/11 The Trust aims to achieve the key actions as stated. 2011/12 The trust will utilise the results of the feedback to plan service improvements. 2012/13 The Trust will continue to review feedback and develop action plans to


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this is a CQUIN target. Risk to the reputation of the Trust as perceived by service users and carers.

implement further improvements in conjunction with users and carers.

Improve healthcare of the local population through increasing opportunities to access smoking cessation (CQUIN)

Rates of smoking are 2-4 times higher among people with psychiatric disorders and substance use disorders. Seeing people in the context of their whole lives.

Ensure that at least one member of the Trust‟s Assertive Outreach or community recovery teams for people of working age and older adults receive (L1) training in very brief anti-smoking interventions, to improve delivery of effective stop smoking advice to smokers. Brief advice can consist of three simple steps - Ask, Advise and Act. Financial risk to the Trust as this is a CQUIN target.

During 2009/10 the Trust has increased the availability of smoking cessation assessments to in patients. This has resulted in an increase from 13% to 36% of service users receiving assessments, advice and help to stop smoking.

2010/11 To achieve the key actions as stated. 2011/12 To review and revise the action plan as appropriate. 2012/13 The Trust will continue to review its obligations to meet public health targets with the commissioners and take action as appropriate.

To improve the inpatient experience, particularly in relation to discharge through use of recovery folders (CQUIN)

Mental Health Act monitoring report recommendation. Introduction of the recovery folders will improve the inpatient experience by providing a range of information to each service user. Seeing people in the context of their whole lives and

To develop and plan for the implementation of recovery folders in conjunction with patients and carers in two specified sites (TBA) To implement the use of recovery folders within 2 pilot sites (TBA) Undertake audit of Q2 and provide report by 31st October 2010

Recovery folders have been developed in conjunction with new CPA. Additionally, recovery folders have been developed differently in different areas of the Trust to meet individual service requirements

2010/2011 To achieve targets as set out. To consolidate the work already undertaken. 2011/12 To ensure full implementation of recovery folders across the Trust and that they are updated regularly. 2012/13 The Trust will review the use of recovery


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being a provider of choice. Undertake audit of Q3 and review progress. Review folders and plan further implementation as appropriate in light of the audit results. Report of findings required by 31st January 2011 Failure to implement the above action will result in financial penalty for the Trust. There is also a risk to the reputation of the Trust if service users are not engaged or feel that the folders are not helpful.

folders and continue to build on good practice to identify future developments.

Improve medicines reconciliation on admission (CQUIN)

NPSA/NICE guidance 2007 guidance to improve medicines reconciliation CQC standard. Seeing people in the context of their whole lives, being an accessible, proactive and responsive organisation and being a provider of choice.

Audit to inform baseline. Develop monitoring system and plan implementation. Report required by 30th April 2010 Implementation. Progress report required by 31st October 2010 Audit of patients who have had medicines reconciliation within the 72 hour period. Report required by 31st January 2011 Risk to the Trust rating if

Throughout 2009/10, medicines reconciliation has been a component part of admission procedure and recorded on the new CPA paperwork.

2010/2011 To achieve the key actions as stated. To raise awareness of the guidance and importance of recording reconciliation activity. 2011/12 To consolidate improvements made in 2010/11. 2012/13 The Trust will continue to review NICE guidance and implement any required changes as well as building on


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adherence to NICE/NPSA guidance is not adhered to. Financial risk to the Trust as this is a CQUIN target.

improvements made.

Improve access to consultant advice in primary care to reduce the necessity for referral to secondary care. (CQUIN)

To ensure that patients receive timely appropriate intervention To improve cost effectiveness. Being an efficient, effective and viable organisation

Review data in South locality and identify changes in referral patterns Implementation in North and Great Yarmouth localities Review the reduction of direct referrals to secondary care and identification of changes in referral patterns. Review targets and actions for 2011/12 Financial risk to the Trust as this is a CQUIN target. Financial risk to the Trust in light of the current financial climate.

The appointment of a consultant in one locality has demonstrated a reduction in complaints from GP‟s and a reduction in the number of referrals made to secondary care.

2010/11 To achieve the key actions as stated 2011/12 To review and revise the action plan as appropriate. 2012/13 The Trust will continue to review its obligations to meet public health targets with the commissioners and take action as appropriate.


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Template 3: Clinical quality (cont.)




Holding a service-user led health, happiness and wellbeing event addressing health promotion, with user-defined outcomes (CQUIN and Quality Accounts)

Seeing people in the context of their whole lives Being an accessible, proactive and responsive organisation. Valuing the contribution of members and governors. Being a learning organisation. Being a provider of choice. Being an efficient, effective and viable organisation

Identify resource and planning. Arrange and publicise event Hold event and assimilate feedback. Identify potential developments for 2011-2012 Financial risk to the Trust as this is a CQUIN target. Risk to the reputation of the Trust as perceived by service users and carers.

The Trust has actively engaged in service user feedback to identify this as a priority.

In 2010/11 The Trust aims to achieve the key actions as stated. 2011/12 The trust will utilise the results of the feedback to plan service developments. 2012/13 The Trust will review developments with service users and implement appropriate developments.

Improve care of patients with Dementia. (CQUIN)

To improve dementia patients‟ experience by ensuring that safe and effective care is given, communication channels are clear, and cross boundary working is achieved across mental health, community and acute sectors, resulting in a better quality of life for both inpatients and outpatients under the care of the local health economy.

a) Participation at a senior level from clinical and management staff at all multi-sector steering group meetings led by the pct b) The trust will develop an implementation plan for those elements of the pathway the trust is commissioned to provide. This will include appropriate targets and deadlines against which progress will be monitored.

Throughout 2009/10, key Trust staff at all levels have participated in meetings and events to review the Dementia Strategy and inform commissioning intentions. Where appropriate, changes within practice have been made in line with the Strategy.

2010/11 To achieve the key actions as stated. 2011/12 targets will be driven by the PCT‟s commissioning intentions and the action plans agreed in the 2010/11 year. 2012/13 As above


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Seeing people in the context of their whole lives, being a provider of choice and being an efficient, effective and viable organisation.

c) Piloting of the pathway with adjustments made where indicated. d) Demonstrate that patients with dementia in the Trust are following the pathway, and care is given according to the pathway e) Dementia awareness training commissioned and commenced as part of the pathway development f) Failure to commission the agreed pathway or failure within the group to agree a pathway will pose a significant risk to the development of improved services.

Improve data collection in line with DICU and dementia strategy (CQUIN)

Data collection improvement to inform and enable future monitoring of implementation of the dementia strategy and support the development of the Norfolk Clinical Academy for Dementia. Being an accessible, proactive and responsive organisation, being a learning organisation and

Number of service users allocated to a care cluster related to HONOS PbR assessment. There will be a potential financial risk to the trust if the correct clusters are not attributed to service users, accurately reflecting the cost of care.

The HONOS PbR system has been rolled out throughout 2009/10 with active involvement of staff in developing care pathways. The Trust is at the forefront of this work prior to the mandatory use of care clusters in 2012/13.

2010/11 To achieve 60% data collection by Q3 January 2011. 2011/12 The data will be used to inform future strategy 2012/13 As above. Mandatory use of care clusters


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being an efficient, effective and viable organisation.


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Template 4: Service development strategy

Service development priorities Contribution to the overall vision


Key resource requirements

Measures of progress 2010/11 2011/12 2012/13

Organic / innovation:

DICU A significant development for the Trust in the form of a new building that will be accommodation for dementia patients as well as a centre for excellence and the Norfolk Clinical Academy for Dementia. This is an obvious illustration of the Trust's commitment to the provision of high quality care and reflects all of the Trust's values.

Building development on existing site. Workforce development. Normal construction time and costs may overrun. Currently beds need to be contracted

Staffing Financial

Building works to commence end 2010 due for completion April 2012. Training programmes developed and implemented 2010/2012

Service Standardisation Removal of inequalities across service provision. Service standardisation will help the Trust to deliver on it's CIP plans by remodelling services to deliver in recognised cost effective ways. This will contribute to the Trust's value of being an efficient, effective and viable organisation whilst also seeing people in the

Services will be remodelled affecting staff and the way that services are delivered.

Clinical engagement. Programme Management. Finance and HR support.

Services models released during 2010/2011. Benefits realised in subsequent years.


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Service development priorities Contribution to the overall vision


Key resource requirements

Measures of progress 2010/11 2011/12 2012/13

context of their whole lives

Acquisition etc:

IAPT IAPT will be available for tender. The successful implementation of IAPT services through out the Trust would support the Trust's aims of working cooperatively with local service providers, engaging with GPs and further developing community services

The Trust would hope that the coworking that has been implemented to date illustrates the success of IAPT and of the Trust as the provider. Possible risks are around staff should the tender not be successful and the issue of this being a relatively new care pathway.

Recruitment to new posts Funding committed for 2010/2011 but open to tender during this period. Trust would aim to successfully bid for the tender for both NHS Great Yarmouth & Waveney PCT and NHS Norfolk.

Transferred / discontinued activity:

Prison Services This service will be removed from the Trust provision due to a failed bid to deliver the services collaboratively with a private provider

Trust staff will be transferred to the new provider within regulatory protocols.

Trust provision of the service will end during 2010.


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Template 5: Workforce strategy

Key workforce priorities

Contribution to the plan

Key actions and delivery risk Key resource requirements Measures of progress2010/112011/122012/13

Delivering a quality cost effective workforce (the financial impact of our workforce)

Ensuring that the workforce is financially affordable

Localities and services (clinical and non clinical) to review their workforce structures and roles to ensure that they are fit for purpose, affordable (taking account of required cost reductions) and that services are standardised across the Trust in order to deliver equity of service provision. Opportunities for shared services/partnership working explored. To reduce temporary staffing costs through the management of demand and increased bank: agency ratios. To proactively manage and reduce sickness absence. To review aspects of terms and conditions of employment that can be negotiated locally with a view to reducing costs. Note - the Trust's workforce plan is based on Establishment figures, with unfilled posts funding the cost of temporary

Management, HR and finance capacity is required in order to undertake the workforce reviews, to develop the strategies and to implement in an appropriate and timely way. Resource issues are being configured into the programme schedule for the various streams of work arising from the standardisation and cost improvement programme. Data on temporary staffing spend is included on the monthly finance reports to the Executive Operational Team (EOT) and the Board. A Programme Board meets regularly to review the temporary staffing strategy, governance issues and relationship with the provider. Updates are provided to the EOT. Fortnightly management information meetings are held with staff. Management plans are in place for the reduction/removal of all locum doctor cover. Training in managing sickness absence is provided to managers to support them in effectively and

2010 Workforce redesign proposals developed and approved. Supporting workforce strategy developed and approved. Programme of implementation commenced and, in some areas, completed. Business plans for cross-organisational partnership/shared service/outsource arrangements developed where appropriate (particularly regarding corporate services) and implemented/working towards implementation. Reported reduction in temporary staffing costs. Increased ratio of bank: agency spend. Reduction in vacancies (although some vacancies may be managed for redeployment purposes) and reduction in workforce numbers (managed as far as possible through natural turnover). Reduction in sickness absence


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pay. proactively managing absence. To make a greater impact in this area, additional HR resource would require to be invested. A Wellbeing Strategy is currently being developed. Negotiations are being held with recognised trade unions regarding such as reviewing the pay protection arrangements. Should, as one potential option, the Trust decide to move away from Agenda for Change terms and conditions of service at any stage, this will require quite significant people resource to consult, negotiate and implement.

rate with associated reduction in temporary staffing costs. Reduced pay protection arrangements. 2011 and 2012 As above but further on.

Creating a culture that secures the success of the organisation and delivers high quality patient care through our workforce (The behaviour and culture of the workforce)

In order to stimulate innovation, increase productivity and ensure high quality services are provided to our patients, we recognise the importance of a high quality workforce that is committed, engaged, trained and supported

To implement an organisational development strategy. To embed staff engagement into 'normal business' to ensure that staff are consulted and genuinely involved in issues that affect them and are able to proactively contribute to service and workforce improvements. To learn from the Staff Survey and deliver improvements, particularly in respect of appraisal rates and quality.

The training and development of our leaders is critical to the success of the organisation but requires ongoing financial investment. Nurturing and developing the appropriate skills, behaviours and confidence as a leader and unleashing innovation will support the deliver of the Trust's vision and objectives.

2010 Organisational development strategy implemented. Engagement strategy implemented. 'Big' and 'Little' conversations are part of the norm of what we do. Outcomes are clearly communicated back to the workforce. Staff report to be more 'engaged' in the 2010 staff survey. Appraisal rates are increased significantly. Appraisal process reviewed and new process implemented. Staff survey action plan implemented and improved


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and that is aligned to our vision, objectives and values.

To continue to develop leadership and management capability and behaviours through the 'Good to Great' and Institute of Leadership and Management programmes, action learning and coaching, psychometric assessments and talent strategy.

responses identified in 2010 survey for areas identified for development (including appraisals). 'Good to Great', 'ILM', action learning and coaching programme run. 2011-12 As above, but further on, including: Annual organisational culture surveys undertaken and year on year improvements demonstrated. Continuing improvements in staff survey results and high levels of satisfaction identified in patient surveys.

To attract, retain and effectively deploy the best possible staff (Being a model employer/ employer of choice)

In order to deliver high quality services, we require high quality staff who want to work for us and, once here, are engaged and motivated to work for us, and are productive.

Many of the actions listed under 'behaviour and culture' above are equally relevant here. In addition: To implement a succession and talent management strategy. To review our reward strategy, particularly in relation to non-monetary rewards.

Some aspects of the wellbeing strategy may require some financial investment in order to procure greater savings in terms of reduced sickness absence and stress and its associated financial and non financial costs.

2010 Talent management strategy implemented. Wellbeing strategy implemented. Reduced sickness absence. Greater motivation reported via staff survey.


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To promote health and wellbeing and effectively prevent and reduce incidences of stress.

2011 Total reward strategy implemented. Increased flexibility demonstrable within the workforce in response to unplanned and planned demands and development needs.

To review the HR function to ensure it remains strategically aligned to the needs of the organisation providing effective change consultancy and business support (The value added by a high performing HR function)

HR has a significant leadership role to play in, essentially, delivering the best in HR practice and business support to ensure the best possible services for our patients.

To review the HR function to ensure this continues to meet business needs and to deliver required cost reductions. To review the Workforce Strategy.

In order to enable the delivery of the significant workforce agenda, in particular relating to service redesign, some additional HR resource, at the right level and at the right time, will be required to ensure quality and timely delivery.

2010 HR function reviewed and plans identified for any changes in structure or function over the next four years. 2011/12 Five year workforce strategy reviewed with view to new strategy being delivered in 2012.


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Template 6: Capital programmes (including estates strategy)

Key capital expenditure priorities Amounts and timing Contribution to the plan (including service delivery)


Development:

Dementia Intensive Care Unit (DICU), Julian Hospital, Norwich

Opening April 2012 - total budget £13.730m: 2009/10 - £0.259m; 2010/11 - £2.635m; 2011/12 - £9.836m; 2012/13 - £1.000m.

The re-provision of the current Hellesdon Dementia unit has formed part of the Trust's long-term Older People's Strategy for several years. The current accommodation is no longer fit for purpose. The development of the DICU will create a specialist dementia service, which can become a Centre of Excellence with dementia care mapping at is foundation along with the Norfolk Clinical Academy for Dementia. Rising demographics and the potential for income generation allows the DICU to be built to accommodate 36 patients but initially staffed for 30 beds.

Demolition and Site Clearance completed May 2010; Detailed Design & Procurement ongoing in 2010; Contractor appointed Aug 2010; Design & Specification complete by Aug 2010; Contract due to be signed Nov 2010' Site mobilisation Dec 2010; Construction from Jan 2011 to Feb 2012; Fitting Out Mar 2012 Delivery Risk - is normal construction and cost & time overruns The FTFF has approved a £5.2m loan towards the cost of the DICU. If the FTFF is unable to advance the loan the Trust will review commercial options for funding or fund from retained surplus.

Maintenance:

Capital Asset Repairs & Minor Refurbishment

2010/11 - £0.650m; 2011/12 - £0.500m; 2012/12 - £0.500m

Addressing Compliance issues, improvements to clinical environments

All actions across 3 years include: - Works to address disabled access; - Energy efficiency improvements; - Continuous Improvements to clinical environments; - Highway and Parking improvements (Health & Safety and


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quality); - Major plant and services replacements (Boiler, pipeworks, electrical installations); - Significant Building Fabric Repairs; - Leasehold Delapidations.

Other capital expenditure:

Implementation of ICT Strategy 2010/11 - £1.973m; 2011/12 - £1.429m; 2012/13 - £0.598m

Access to and sharing of timely and trusted information. This will be achieved through an array of best value systems for communication over a robust infrastructure. This will support the Trust value of being a market leader in the provision of mental health services

The risks are identified in part under the external impact of the National Programme for IT. The Trust is committed to using N3 and is looking to implement the national solution for its clinical and patient administration systems. Once national plans are clear the Trust will be better placed to confirm its plans however commitment is currently to the national programme. Additional risks include procurement delays and normal cost and time overruns.

Other estates strategy:

West Norfolk Estate Rationalisation Due to be completed Q1 2011/12 - £0.936m in total.

Rationalisation of Estate utilisation. Providing S136 Assessment Suite and out of hours assessment room enabling 24/7 admittance for Queen Elizabeth Hospital A&E patients. Reconfiguration of accommodation in Chatterton House to enable co-location of all community services

Procurement of contractor due in July 2010; Programme of construction through to April 2011; Demolition of existing building in June 2011. Risk of delay due to relocation of NHS tenant, together with normal risk of time and cost overruns.


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and deliver CIP from management and admin reductions and Estate savings.

Other Accommodation Improvements

To be allocated but to support CIP / Service Standardisation programme and implementation / development of Estates Strategy. Includes reconfiguration of Forensic Services, Remodelling of patient areas for CRHT and Acute wards - and other service changes.

Support Service Standardisation - Revenue cost improvements of: 2010/11 - £1.760m; 2011/12 - £3.608m; 2012/13 - £3.202m.

Risk of delay due to business case development time, procurement and normal time and cost overruns


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Template 7: Operational / financial effectiveness

Key operating efficiency programmes

Amounts and timing



Resource requirements

Milestones2010/112011/122012/13

Service Standardisation (Cost Improvement Programme)

2010/11 - £1.760m; 2011/12 - £3.608m; 2012/13 - £3.202m. All recurrent savings - PCIPs 4,5,6,7,8,9,10. MiscCIPs 6,7,8,9,10

Reduce inequalities and identify best practice and outcomes across localities ensuring standardisation of job descriptions, pay banding, whilst ensuring sustainable, high quality services delivering productivity improvements.

Establishment of clinical cabinet including medical director, chief pharmacist and other senior clinicians (OT, psychologist and social care) to provide clinical lead for process. Benchmarking of services across localities, financial and qualitative, using service line reporting methodologies and outcome measures. Development of HR policies and consistent job descriptions, processes to enable the disestablishment of posts, redeployment of staff in to new posts, possible redundancy and improvement in workforce strategies generally. Significant communications plan to be put in place across the Trust and within services.

Significant finance, HR and communications support required to enable managers and clinicians to implement changes. Programme management office established April 2010 to drive delivery of CIP savings. Funds to deal with pay protection and possible severance costs maybe required.

Deliver CIP savings across 3 years - at least full year effect.


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Amounts and timing




Milestones2010/112011/122012/13

Specialist Mental Health Placements

Savings2010/11 - £1.210m;2011/12 - £0.455m.OCIP1

Reduce secondary commissioning costs by improved clinical controls

Establishment of a central clinically-led panel to review process of making specialist mental health placements - both in to Trust and out of county facilities (secondary commissioning). Trends and case management monitoring. Establish local panels across 6 localities to ensure that clinical and financial decisions are joined up and pathways are aligned. Governance reviewed by Finance Committee and Medical Advisory Committee. Delivery risk: potential increase in placements as a consequence of reduced mental health spending across local health economy.Increased trends for eating disorder and adolescent placements.

Schedule panel meetings and obtain accurate and timely management information from specialist commissioners.

Achieve CIP 2010-11, 2011-12

Clinical and Patient Administration System

Two years to implement: 2010/11 - £0.820m;

To create a complete, electronic clinical record allowing easier access to

The risks are identified in part under the impact of the National Programme for IT. Further delay to agreeing contract with CSC may add

Two year non-recurrent investment is largely backfill costs for clinical

Agreement of national contract, formal confirmation that system delivers planned functionality.


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Amounts and timing




Milestones2010/112011/122012/13

2011/12 - £0.987m. From 2012/13 savings and cash-releasing benefits from the new system are expected to contribute £0.200m annually to the Trust's CIP.PCIP13 and MiscCIP11.

and sharing of patient information, both within the organisation and external to the Trust; To improve the management of clinical safety throughout the Trust; To significantly improve the completeness and quality of performance and management information; To significantly improve the efficiency of the Trust workforce; To reduce costs relating to Clinical and Patient Administration systems over the long term.

additional cost and delay to business case. Current arrangements to centrally fund software, licensing and provider implementation costs may be changed. Benefits realisation from 2012/13 onwards may be impacted by existing CIP schemes.

staff released to manage project implementation.


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Amounts and timing




Milestones2010/112011/122012/13

Norfolk and Waveney Health Innovation and Education Cluster (HIEC)

2010/11 - £0.513m; 2011/12 - £0.545m.

The HIEC's mission is to deliver Innovation for the Quality, Improvement Productivity and Presentation in the Provision of health and care services for elderly people in the East of England.

Development of Information Centre - Create an information centre for all information about the care of older people in East Anglia, including innovations that are already under way, assistive technologies and what we can learn about new approaches and best practice from initiatives elsewhere in UK and overseas; Problem Solving - Bring fresh thinking, expert knowledge and change facilitation to problems which care providers are experiencing which act as barriers to achieving excellent services; Strategic Guidance - Bring collaborative wisdom and advice of leaders from across the whole "older people's economy".

The HIEC will receive £0.600m of DH funding over two years, with the balance met by nine core partners from NHS, Further Education and Local Media. The HIEC is hosted by the Trust. From 2012/13 the HIEC is planned to be self-financing.The HIEC is hosted by NWMHFT who will provide some admin and logistics support.

To demonstrate delivery of key actions and report progress against agreed key performance indicators: - volume of people provided with new forms of educational service; public satisfaction with services (before and after innovation; Developing ways of measuring social return on investment;and from 2012/13 to be self-financing.


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Template 8: Leadership and governance

Key leadership and governance priorities

Key risks (and gaps) Actions to rectify / mitigate Milestones2010/112011/122012/13

Board Development Whole board self-assessment during April 2010 and a 360 degree appraisal of board performance may identify a skills gap. (All of the competencies being assessed are based on the “The Healthy NHS Board – principles for good governance” published by the NHS National Leadership Council

The Board is undertaking a skills audit of both Executive and Non executive directors. April 2010 Trust Board the meeting carefully considered the Francis Report. A number of actions have arisen from the Trust's response to the report, one of which is to appoint a clinical NED. This is to provide robust challenge and clinical thinking to major decisions and apply clinical implications for service delivery of all Board business.

The Nominations Committee of the Board of Governors will use this information to support them in drawing up person specifications for 3 Non executive appointments that will be made towards the end of this 2011. Intelligence from both the Board development session, and the self and 360 appraisals will form the basis on Board development sessions throughout the duration of the plan.

Board Changes Potential risk to the stability of the Board. In the past 12 months a number of changes including a new Chief Executive Officer, resignation of two Directors and the retirement of another have resulted in a reduction in two Board of Director posts (one executive, one non executive).

To maintain stability all non-executive directors terms have been extended by six months at the approval of the Nominations Committee, these will be subject to re-appointment in 2010. Executive Director posts have been recruited.

Interim Executive appointment in place May 2010. New Executive team is fully recruited to and operational August 2010. Recruitment of Non Executive Directors commences Autumn 2010.

Structure and function of the senior operational team (Associate or Deputy Director level)

A review is seen as necessary to ensure that the trust has the capacity, capability and flexibility to meet future challenges. This will ensure that sufficient capacity to

Review of the structure. Management development and leadership programme in place. Further development of management and leadership

2010 – Roll out of further leadership and management development courses for first line and more senior managers. Roll out of coaching and action learning for deputy


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Key leadership and governance priorities

Key risks (and gaps) Actions to rectify / mitigate Milestones2010/112011/122012/13

deliver the plan is in place in the face of changes in organisational shape and design.

development; talent management and succession planning programme planned

Locality/Service level posts. Talent management /succession strategy to be launched summer 2010.

Implementation of service line management

To identify a clearer mechanism for understanding the trust services and produce a clearer reporting structure to support costing and the development of future services.

Definition of service line leader roles and competencies.

Implementation will occur over a two year period according to the service Line Management Road Map with expected full implementation in April 2012.

Development of a programme team to bring new business, through tendering or acquisition, to the Trust whilst ensuring the integrity of current service provision

Ensure the integrity and safety of services are maintained. Maintain service governance. Not realising the full clinical or financial benefits of a large acquisition Insufficient capacity to deliver a large acquisition successfully

Establish a programme structure for acquisition / tender work that focuses on benefits realisation. Allocate a lead executive director with clinical and corporate support. Resources identified within 2010-11 financial plan to support a tendering team. Management and leadership development programme ensures capability of backfill arrangements. Use of external advisors at key points in decision making.

2010-11 Achieve one large tender / acquisition. 2011-12 In year tenders and benefits realisation. 2012-13 Business as usual and in year tenders


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Template 9: Regulatory

Key regulatory risks Nature of risk Actions to rectify / mitigate and responsibilities

Measures2010/112011/122012/13

Failure to implement Cost Improvement Programme (CIP)

Financial. Potential impact on the Financial Risk rating of the Trust taking it below "3". May also impact on the provision of mandatory services if Trust is unable to deliver on programme redesign that is required to meet the future reductions in resources.

CIP plan development is to deliver 20% savings over 4 years. The Trust has set up a Programme Management Office to manage the delivery of CIP. The Programme Manager is accountable to the Executive Team while the Finance Committee exercises Board. control over the CIP Programme. 70% of the CIP for 2010/11 has already been delivered as a result of actions already taken, and detailed plans are in place to deliver the remainder. The Trust has contingency funding of £1.23m and has recently secured additional funding for general activity and cost pressures of £0.7m from PCTs, which provides mitigation against non-delivery of CIP. Service Standardisation has been taken on further through Locality Service Forums covering Acute service, Older People, CAMHS, Recovery and Primary Care

Locality/Services to further refine the areas for service redesign and identify timetable for programme and associated supporting resource, to include links with the development of service standardisation plans in conjunction with SLR (ongoing). Additional project management support to be identified for more significant schemes. Trust to review pay protection policy with a view to reducing protected period from 5 years. Trust to review terms and conditions of staff on agenda for change. Work underway to agree the Dementia Strategy with PCTS and other partners for implementation over the coming years, including QIPP initiatives and funding, cost improvement and redesigned pathways of care.


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Measures2010/112011/122012/13

A high profile clinical case damaging the reputation of the Trust

Governance. Implementation of service standardisation (SLR Programme Board). Action Plan to the Service Governance Sub Committee and the Trust Board for subsequent implementation.Implementation of risk management training for all clinical staff (mandatory) (Head of HR). Development of a Trust policy and procedures about the transfer of service users from Forensic to Community teams. Training to be developed on the clinical management of this patient pathway and undertaken by clinicians as appropriate.

Prework undertaken prior to the imminent publication of an enquiry (June 2010). Implementation of training August 2010. Development of Trust policy August 2010. Ongoing review of the outcomes and monitoring of policy and procedures.

Risk to clinical services due to Treasury funds reduction through efficiency and/or reduced financial allocations to PCTs

Financial Strong link with CIP risk above. Many of the actions and mitigations are similar. The Trust has agreed funding with PCTs for 2010/11 that includes additional funding for activity and cost pressures over and above the 0% inflation uplift. Financial plans include a significant margin for reduction in financial performance before a level 3 risk rating would come under threat.

Similar action plan to that for CIP risk above. The Trust will discuss worsening funding positions with PCTs and other partners to identify solutions that are best for the system as a whole. This would involve further analysis of potential QIPP schemes.

Risk of losing existing contracts for mandatory & non mandatory services or failure to win new

Financial. This may have a potentially adverse impact on the Trust Vision to expand its market

Develop further relationship building with key commissioners (ongoing)

Use Locality Boards to work with PBC groups - Prepare to bid for services being


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Measures2010/112011/122012/13

contracts share as well as impacting on the delivery of existing services.

- Failed tenders evaluated - Head of Marketing undertook some analysis to identify those services at greatest risk / impact and this has been e-mailed round - Reserve monies identified and available for tendering support - Pre-drafted sections of information about each service for inclusion in future tenders as appropriate (ongoing) - PBC Groups engaged in contractual process - Bid Team in place - New guidance to PCT's on community service future models- Unsuccessful in bids for Prison Healthcare & Eating Disorder services

tendered (IAPT) within timescales set - Bid for new services currently out with Trust services (GY & W) - Consideration of other potential opportunities for business expansion Trust is developing its partnership arrangements with private and voluntary sector organisations with a view to bidding for services on a different basis in the future.


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Template 9: Regulatory (cont.)


Measures2010/112011/122012/13

Potential adverse impact of the introduction of Payment by Results for Mental Health on competitive position

Strategic as regards Trust's ability to expand its service provision. Financial

Trust-wide SLR Programme Board in place overseeing development of SLR/SLM and PbR. Version 2 of ABACUS (costing and SLR/SLM system) launched 31 Jul 09 Phase 2 of ABACUS rolled out to Lead Clinicians (Oct 09). 2008/2009 reference costs confirmed at 98 Programme of clinical and managerial engagement is in full progress. Locality/Service HoNOS PbR being monitored via Abacus Agreed a joint project board with NHS Norfolk to take forward implementation of PbR. This will include the shadowing of a tariff in 2010/11 on a small number of services.

Education and development session with EOT as regards how Ref Costs are identified and costed. Detailed timetable being developed for Trust readiness for Apr 11 start HoNOS PbR targets to be set. Finance Department restructure to ensure that SLR becomes part of everyday management accounting service.


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Financial Summary

£m 2009-10 2010-11 2011-12 2012-13

Actuals Plan Plan Plan

Revenue (Total)

131.1 134.4 133.5 133.7 Employee Expenses

(96.0) (100.7) (98.8) (98.3)

Drugs

(2.6) (2.6) (2.6) (2.6) PFI operating expenses

0.0 0.0 0.0 0.0

Other costs

(23.2) (22.7) (23.1) (23.3) EBITDA

9.2 8.4 9.1 9.5

Depreciation and amortisation

(3.8) (4.1) (4.7) (4.9) Net interest

(0.0) (0.0) (0.1) (0.1)

Other

(4.2) (2.7) (2.7) (3.0)

Net Surplus / (Deficit)

1.1 1.6 1.6 1.5

EBITDA % Income % 7.0% 6.3% 6.8% 7.1% CIP % of costs %

4.6% 4.4% 3.7%

Net Surplus / (Deficit)

1.1 1.6 1.6 1.5

Change in working capital

0.1 (1.8) 0.5 0.3 Non cash I&E items

8.0 6.8 7.5 8.0

Cashflow from operations

9.3 6.6 9.6 9.8 Cashflow from investing activities

(4.1) (6.6) (13.0) (4.4)

Cashflow before financing

5.2 0.0 (3.5) 5.5 Cashflow from financing activities

(2.9) (0.5) (0.3) (3.6)

Net increase/(decrease) in cash

2.3 (0.5) (3.7) 1.9

Cash at period end 19.3 18.8 15.0 16.9

Cash and Cash equivalents at PE 19.3 18.8 15.0 16.9

Norfolk and Waveney Mental Health NHS … plan 10...Norfolk and Waveney Mental Health NHS Foundation...

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Transcript of Norfolk and Waveney Mental Health NHS … plan 10...Norfolk and Waveney Mental Health NHS Foundation...