Report to:
Board of Directors (Public)
Paper number: 3.1
Report for: Decision
Report type: Strategic/Governance
Date: 31 March 2016
Report author: Kevin Monteith, Trust Company Secretary
Report of: Wendy Wallace, Chief Executive
FoI status:
Report can be made public
Title: NHS Improvement One Year Operational Plan
Executive summary
The Trust is required to prepare and submit a one year operational plan to NHS Improvement by 11 April 2016 in line with their published planning guidance, which was published on 22 December 2015. The full suite of related documents can be accessed here.
The planning guidance requires:
1. A One Year Operational Plan – specific to C&I (focus of this paper).
2. A Five Year Sustainability and Transformation Plan (STP) to drive delivery of the Five Year Forward View based on a Strategic Planning Group footprint (North Central London - NCL). The responsibility for developing the NCL STP rests with the CCGs who need to work collaboratively with providers and stakeholders to agree the plan.
3.
Key issues for the Board to note:
1. The contextual background to the planning guidance with reference to delivering the ‘Forward View’.
2. The development of the plan has been overseen by the executive management team and reviewed by the Strategic Development Committee on 22 March.
3. The submission requirements for 2016 noting the full draft one year plan (narrative document and finance, activity and workforce data returns) by midday on 11 April 2016.
2
4. There is no prescribed format or template but an example structure and suggested length of approximately 25 pages is recommended in the guidance and the attached plan has been prepared in line with this.
5. The requirement to demonstrate linkage with the NCL Five Year STP.
6. NHS Improvement carried out a desk-based review of draft plans during February and March for which we had positive feedback. Final plans will be subject to a ‘high-level’ review during April and May.
Recommendation to the Board:
The Board of Directors is requested to:
APPROVE the Operational Plan for submission to NHS Improvement, subject to any final amendments (including final financial adjustments).
Trust strategic priorities supported by this paper
The focus of this paper relates to all of the Trust’s strategic priorities of Excellence, Innovation and Growth.
Risk implications
Contract negotiations and financial allocations may not be signed off in time.
Legal and compliance implications
Compliance with statutory requirements of the Health and Social Care Act 2012 and the Trust Constitution.
Finance implications
Planning assumptions need to be confirmed in relation to allocations for 2016/17.
Single equalities impact assessment
N/A
Requirement of external assessor/regulator
Compliance with NHS Improvement’s Code of Governance and issued planning guidance.
Final Draft Operational Plan Document for 2016-17
Camden & Islington NHS Foundation Trust
Page 2 of 27
Page 3 of 27
CONTENTS
Page
STRATEGIC CONTEXT
Introduction
Local health and social care environment
Mental health strategic context
North Central London sustainability and transformation plan
4
5
5
6
QUALITY PRIORITIES
Trust approach to quality
Key quality priorities
Care Quality Commission
8
8
11
OPERATIONAL REQUIREMENTS AND CAPACITY
Current and forward planning activity assumptions
Integrated Practice Unit activity assumptions
12
13
WORKFORCE
Approach to workforce planning
key performance indicators
Workforce priorities
Organisational development
Workforce development
14
14
15
16
16
INFORMATION & COMMUNICATIONS
TECHNOLOGY (ICT) AND DIGITAL DEVELOPMENT
Scope of the ICT and digital strategy 18
ESTATES STRATEGY AND CAPITAL PROGRAMME
Scope of the Estates Strategy
Capital Programme
19
19
FINANCIAL PLAN
Key planning assumptions for 2016/17
Overview of the Trust’s CIP Plans for 2016/17
Planned balance sheet for 2016/17
21
22
23
MEMBERSHIP
Growing a sizable and representative membership
Developing and active and engaged membership
Elections
Governor training and development
24
24
24
25
Page 4 of 27
STRATEGIC CONTEXT
Introduction
In April 2015, Camden and Islington NHS Foundation Trust (C&I) submitted an annual plan
that reflected objectives set out in the Trust five year strategic plan (June 2014). These
documents set out C&I’s overarching strategies for resilience and sustainability, which the
Board of Directors has kept under review throughout the year through the Strategic
Development Committee, a standing committee of the Board. This one year operational
plan recommits the Board to these strategies, which remain in line with the underpinning
planning assumptions. The Trust continues to work closely with commissioners on planning
assumptions and service development plans, including the emerging North Central London
(NCL) Sustainability and Transformation Plan (STP).
The Trust’s high level corporate objectives have been refreshed by the board in February
2016 and are designed to keep the Board and organisation focused on the continued
provision of high quality and safe care, innovative and integrated care solutions, and
organisational resilience. The Board of Directors will continue to pursue its strategic
objectives of Excellence, Innovation and Growth and will continue to focus on activities which
support the development of the STP to ensure the long term sustainability and development
of mental health services in North Central London.
Table 1: C&I’s 5 high level corporate objectives
C&I High Level Corporate Objectives
1. We will prioritise safe, high quality, compassionate care for service users, and promote
equality and diversity through a workforce with the right skills, values and behaviours.
2. We will make measurable progress towards implementing our new clinical strategy,
improve the integration of physical and mental health services and progress the rollout
digital healthcare.
3. We will achieve our income target and deliver an agreed surplus as part of our long term
financial plan and ensure that our plans are underpinned by affordable and sustainable
service delivery and investment.
4. We will develop the trust’s estate in order to deliver our clinical strategy in safe, fit for
purpose environments.
5. We will work in partnership with commissioners and providers in North Central London to
develop and implement new care models to meet the mental health needs of local people,
in line with commissioning priorities and resources.
Local health and social care environment
C&I is situated in a complex health economy in north central London. There are three acute
care providers within Camden and Islington, including two large teaching hospitals and three
mental health Trusts serving five boroughs. The community services are a patchwork of four
Page 5 of 27
providers across the five boroughs, with two of these providers mainly based in North West
London. The five CCG’s have begun work that aims to achieve clinical and financial
sustainability – the financial challenge for the sector as a whole is in the region of £1.2 billion
over the next five years.
Camden and Islington Clinical Commissioning Groups (CCGs) remain in financial balance but
they are very clear about the challenges ahead. The CCG’s in boroughs to the north of the
Trust have been in significant financial difficulty, the analysis has shown they spend
significantly more than comparator boroughs on acute care, with poor primary care and in
two of the boroughs low spend on mental health. Both Camden and Islington Local
Authorities, with whom the Trust is closely connected, are facing further budget reductions in
16/17. Camden, for example, is projecting a £70m budget gap by 2017/18 and there are
reductions of up to 20% in mental health expenditure, although the impact of this may be
mitigated to some extent by the creation of a Mental Health prevention fund. In Islington,
the intention is to protect direct mental health services expenditure. However, the wider
budget reductions affect general services and also housing support services, and these are
likely to have important consequences to C&I’s acute and community care pathways.
The Camden and Islington health economies are well integrated between mental health
services and social care and between community services and social care; however, there
remain many gaps in pathways of care in the health system. The local system, like all the
NHS, is facing increasing quality and governance challenges, with reduced tolerance of
quality failures, increased inspection and workforce challenges.
Mental health strategic context
Over the past few years there has been significant focus on mental health services and policy
based on achievement of ‘Parity of Esteem’, which is probably better expressed as equality
for mental health. Over the past year, Crisis Concordat actions have been delivered including
some expansion of home treatment team staffing to meet demand, and the development of
a 24 hour crisis helpline. Local services perform well against the standards expected; the key
strategic issue for the Trust is capacity rather than services available.
The Trust is also preparing for the introduction of the new access targets in mental health.
These are currently being achieved, and the Trust is fully engaged with preparatory work at
the London level.
C&I welcomes the increased emphasis both nationally and locally on turning the ‘parity of
esteem’ into a commissioning and contracting reality, and we look forward to working with
our local commissioners in this and subsequent years to deliver the fundamental expansion
and reorientation of mental health service delivery set out in current national policy. This
shift in policy, the new CQC inspection regime and increasing demand will make mental
health services more transparent, and will also increase pressure to deliver improved
performance in a much wider range of areas.
Page 6 of 27
Sustainability and Transformation Plan
The Trust is fully engaged in work within the North Central London sector to develop a North
Central London Sustainability and Transformation Plan (STP). Part of this work is a specific
mental health workstream, led by Camden CCG.
Acknowledging that there are significant mental health needs in the five boroughs of North
Central London, and that Camden, Islington and Haringey all have higher than average
prevalence of mental health problems, the work on the STP for mental health sets out the
following shared ambitions:
Table 2: North Central London Sustainability and Transformation – shared ambitions
North Central London Sustainability and Transformation – Shared Ambitions
1. To transform the nature, value and outcomes of local services close to home, through
building partnerships that deliver around the needs of individuals and communities.
2. Work with individuals and communities to support good mental health resilience.
3. Build high quality specialist services for those with complex and intensive needs, that are as
close to home as possible, and allow connection to local community services.
4. Develop alternative responses for service users with Mental Health needs who do not
respond, or prefer not to engage with current commissioned services.
5. Develop systems of early interventions which ensure people with Mental Health crises
receive a prompt and appropriate response.
6. Breakdown barriers between mental health physical health in a way which delivers better
outcomes for patients and better value to the system.
7. Workforce training to better equip health and social care workers to support patients with
Mental Health needs.
The Trust is part of the workstreams developing this approach, and has developed a revised
Clinical Strategy for Camden and Islington. This sets out the Trust’s aims to promote
recovery, resilience and independence, based around a service model that delivers services in
practice-based services and specialist care pathways. There are ten overarching themes and
principles on which this clinical model is based:
We will co-produce with our service users and carers their treatment and support
We will work in a recovery-orientated way;
We will offer evidence-based interventions;
We will choose outcomes that measure things that matter to service users and carers
and use these to shape our services;
Page 7 of 27
We will integrate with other services so that service users have their mental, physical
and social needs met in a coherent way;
We will prevent mental illness deteriorating or relapsing in all our service users and
we will contribute to initiatives that prevent mental health problems in children and
young people;
We will equip all our clinical staff to address drug and alcohol problems;
We will improve access to our services for everyone, regardless of gender, race,
ethnicity, disability, sexual orientation and other protected characteristics;
We will choose a quality improvement methodology and implement it; and
We will grow our already strong interest in research.
To deliver a service that is able to achieve this, we have agreed that we will:
Develop practice-based teams: that work locally with GPs and other services in
primary care, such as the IAPT services. They will offer rapid assessments near to
where people live by senior clinicians who can make decisions about treatment,
access services in the community or, if needed, refer to the specialist care pathways.
They will link people into the local community resources and services. They will be
better placed to see people who won’t engage with secondary care mental health
services. They will support GPs in managing people with chronic mental illness who
are stable. Along with acute services, these will be the entry point into specialist care
pathways. To date, these services have, on average, worked with 63% of all service
users without use of specialist care pathways.
Continue to develop our specialist care pathways: that deliver treatment and
support to people with similar needs due to mental illness. The focus of these
services will be to help people achieve their recovery goals and link into their local
social networks and community resources. Access to these pathways is based on risk,
intensity and the need for specialist treatment.
Improve the physical health of the population with psychosis through the
creation of an Integrated Practice Unit: for which the Trust has recently been
awarded lead provider status – using a set of co-produced experience and clinical
outcomes that aim to incentivize the delivery of services that deliver effective
outcomes and that, over time, reduce the mortality gap for people with psychosis.
This approach is at the core of our work as part of the STP, and closely mirrors the approach
of the other main provider in North Central London – Barnet, Enfield and Haringey Mental
Health Trust. Furthermore, we have begun the process of exploring areas where joint
working at scale may help to address the challenge of transformation; such as rehabilitation
pathway; opportunities in perinatal care; the scope for transformation of continuing care
pathways; and the potential for estates changes to underpin the delivery of significant
transformation – not least given the potential represented by the St Pancras and St Anne’s
hospital site development plans.
More broadly, the Trust continues to work with partners in Islington and Haringey specifically
(building on previous vanguard application work) to develop integrated working within
Page 8 of 27
North Central London, and is part of specific project streams led by Islington Council on the
better use of estates across the North Central London geography.
QUALITY PRIORITIES
Trust approach to Quality
C&I’s Clinical Strategy outlines our
ambition and vision for transforming our
services with a strong focus on quality
underpinning the principles set out in the
strategy. As well as setting out the strategic
direction over the next 5 years, we will also
focus on the immediate local quality issues and the following section of this plan outlines
these in further detail.
Risk Management
The Trust has an established process for managing risk, and detecting and responding to
quality concerns. Each Division has a risk register that is monitored regularly to ensure that
any risks that cannot be managed within the Division are escalated to the corporate risk
register. The risk management strategy is reviewed annually, with the Audit and Risk
committee having oversight of this process. Quality within clinical areas is monitored via the
service quality assurance reviews which consist of site visits, document review and staff
interviews. External stakeholders are invited to take part in the service quality assurance
reviews and help provide additional independent scrutiny in this process. Service
improvement plans are put in place to address any areas identified in these reviews.
Approach to Quality Impact Assessment
The importance of assessing the quality impact of any transformation initiatives and cost
improvement programmes is well understood within the organisation and the Trust has with
commissioners, an agreed process for assessing the impact of CIP programmes with an
agreed template that provides assurance on a number of key considerations for
commissioners.
A refreshed summary of C&I’s key quality goals
C&I’s quality priorities reflect our commitment to developing and maintaining a culture of
continuous quality improvement, and to providing care that is safe, effective and accessible.
The quality priorities reflect the Trust’s strategic aims of excellence, innovation and growth,
reflect our Trust values and are closely linked with the NHS outcomes frameworks. The
quality priorities presented here are developed with input from our stakeholders, including
staff, commissioners, service users and the Care Quality Commission (CQC).
They reflect themes from the CQC comprehensive inspection in 2014, from our robust
internal quality assurance framework, from work developing outcomes based services in
North Central London and from the Commissioning for Quality and Innovation (CQUIN)
targets agreed in collaboration with our commissioners. The quality priorities reflect areas
that will make a meaningful difference to service users and carers, and that will improve
safety, clinical effectiveness and patient experience.
Page 9 of 27
A summary of our key priorities which are linked to the quality domains of safety,
effectiveness and experience are provided below:
Table 3: Patient safety quality priorities
Clinical/Quality priorities Key actions required Key milestones
2016-2017
Patient Safety Establish a mortality and
morbidity review process
(Local priority – ‘Stolen Years’
Keogh Recommendation)
Nominate a Trust Lead for Mortality
Establish M&M meeting within each
division (sub- specialty)
Establish Trust Mortality Review Group
which will be a sub –committee to the
Board
Quarterly mortality report to
Board and /Quality Committee
Benchmarking data against other
Trusts
Completion of thematic review of
unexpected deaths
Mortality data to be included on
divisional dashboards (link to IPU
outcome data on mortality)
Ensure lessons are learned from
serious incidents
(CQC Action Plan)
Continued delivery of Learning the Lessons
workshops after serious incidents
Implementation of the serious incident
review group to ensure senior leadership in
sharing lessons and in developing
meaningful recommendations and action
plans
Implement a quarterly quality half day to
provide a learning exchange environment
for teams
ToR for serious incident review
group revised
Quality Half days established
To promote safe and therapeutic
ward environments by preventing
violence, reducing restraints and
supporting staff and patients
following assault incidents
(Local Priority – Staff and patient
wellbeing)
Training staff in preventing and managing
violence
Staff and service users working together to
formulate strong relapse signatures which
support identification of deterioration in
service user mental state, and enable early
intervention to prevent escalation to
violence
Promoting safe restraint practices when
violent incidents occur
Implementing reflective practice on all
acute wards
Monthly reflective practice
established on each acute ward
Template for relapse signatures
agreed
Equip staff, through raising
awareness and appropriate
training, to identify, prevent and
reduce domestic violence and
abuse
The Trust will work with other agencies to
prevent and reduce domestic violence and
abuse.
Staff will be trained to follow best practice
guidance when disclosures of domestic
Results from quarterly audits, and
necessary action plans developed
and implemented throughout the
year to ensure best practice
guidance is adhered to
Page 10 of 27
Clinical/Quality priorities Key actions required Key milestones
2016-2017
(NICE Guidance and Local CQUIN) abuse are made.
Adopt clear protocols and methods of
information sharing between agencies
Offer specific training to health and social
care staff on how to respond to domestic
violence
Strengthening of safeguarding processes
Table 4: Clinical effectiveness quality priorities
Clinical/Quality priorities Key actions required Key milestones
2016-2017
Clinical Effectiveness Compliance to 18 weeks referral
to treatment targets
(National Guidance)
Achievement of new IAPT and EIS access
and treatment targets
Delivery of crisis concordat standards
50% of people experiencing first
episode of psychosis treated with
a NICE approved care package
95% of people referred to IAPT
receiving treatment within 18
weeks
Finalise and implement evidence
based outcomes for the
Integrated Practice Unit for
Psychosis
(Local priority)
Outcomes defined and agreed with
commissioners
Reporting framework for the
agreed outcomes confirmed and
ability to report on at least 5
selected outcomes by Q2
Stopping smoking & substance
misuse
(CQUIN)
To increase the smoking cessation offer, as
evidenced by:
- Number of successful quit
attempts
- Number of nicotine replacement
therapy inpatient prescriptions
Number of service users with substance
misuse assessments and management plan
Development and implementation
of Integrated Practice Unit for
psychosis during 2016/17.
Consolidation of smoking
cessation programme within
inpatient services.
Understanding outcomes of the
specialist care pathway
(Local priority)
Identify the specialist care pathways
Review the outcomes for each pathway
Evaluate outcomes and adapt pathways as
necessary
Evaluation of specialist pathways
outcomes reported to board in Q2
Increase staff knowledge and
understanding of Mental Capacity
Act to enable practical application
(CQC Action Plan)
Delivery of training to ensure that staff
have appropriate knowledge and skills in
MHA and MCA
Implement quarterly MHA Law application
workshops to enable staff to develop their
knowledge through case study and
scenario discussion
Quarterly MH Law application
workshops established.
Page 11 of 27
Table 5: Patient experience quality priorities
Clinical/Quality priorities Key actions required Key milestones
2016-2017
Patient Experience Involving service users and carers
in the implementation of the
clinical strategy
(Local Priority)
Launch of Patient Experience Strategy
Consult with service users and carers on
how they wish to be involved
Confirmation of method of service
user and carer engagement
following consultation period
Medication
(CQUIN)
To assess, monitor and improve
information and engagement with service
users over medication.
Auditing records for evidence of
information given for new prescriptions
about: purpose, dose, route, any special
instructions, side effects, monitoring and to
develop action plans to ensure positive
performance.
Development and implementation
of Integrated Practice Unit for
psychosis during 2016/17.
Ward transfers
(CQC Action Plan)
To continue to embed and develop ward
transfer protocols to ensure effective
handovers and to ensure ward transfers are
for clinical purposes.
The Quality Committee, through the
Quality Review Group, will monitor the
implementation of the action plan to
deliver the improvements and the on-
going review of bed pressures and bed
availability.
May 2016 – CQC report following
inspection in February 2016
Re-opening of acute ward at
Highgate Mental Health Centre,
following period of decanting for
ligature works.
Care Quality Commission
The Trust was inspected by the Care Quality Commission in February 2016. It is expected that
the result of the February inspection will be known in the first quarter of the 2016/17
financial year, and the Trust will work to address any identified issues in a robust manner.
Page 12 of 27
OPERATIONAL REQUIREMENTS AND CAPACITY
The Trust’s service profile is made up of 274 inpatient beds, of which 166 are acute inpatient
beds. This includes 24 crisis beds and 12 male psychiatric intensive care unit beds (PICU). We
continue to outsource female PICU beds to the private sector.
Our 2 year operational plan submitted in April 2014 provided a detailed analysis of the
drivers and assumptions informing the Trust’s activity planning, including 2015/16. This
analysis was set out against the Trust’s divisional services and related care clusters. These
estimates have now been revised based on more complete cluster data and in line with
guidance for Year of Care tariffs for 2016/17.
Current and forward planning activity assumptions
Based on our on-going analysis and performance data, C&I’s best estimate of activity for
2016/17 is provided below set against the related super clusters and care clusters and out of
scope services.
Table 6: Activity planning assumptions
Service
Category Services
Activity
Information
Care
Clusters
2015/16
Outturn
2016/17
Activity Comments
Assessments Assessment
Assessment
Clusters 11,088 11,282
Non
Psychotic
Mild/Moderate/Severe Episodes/ YoC 1 – 4 1,329 1,351
Very Severe and
Complex Episodes/ YoC 5 - 8 1,781 1,812
Psychosis
First Episode* Episodes/ YoC 10 427 435
Ongoing or recurrent Episodes/ YoC 11 – 13 2,534 2,579
Psychotic crisis Episodes/ YoC 14 – 15 1,009 1,027
Very severe
engagement Episodes/ YoC 16 – 17 439 446
Organic Cognitive impairment Episodes/ YoC 18 - 21 2,769 2,819
Out of Scope
Overseas Visitors in
Cluster 14/15 Episodes/ YoC 14 – 15 19 19
IAPT Contacts N/A 48,317 48,749
Based on 15%
prevalence at
4.8 contacts
per episode
SMS Episode starts N/A 2,052 2,474
Based on
tendered
activity levels
for 2016/17
Perinatal Contacts TBC TBC
Sexual problems Contacts TBC TBC
Page 13 of 27
In order to deliver this capacity, we are assuming that our current capacity will remain in
place across both community and inpatient services, with some increased capacity to deliver
a range of 7 day a week services, particularly in areas such as Home Treatment Teams, where
additional national funding has been announced. This includes re-opening one inpatient
acute ward that has closed (and temporarily replaced with 16 acute beds at East London NHS
Foundation Trust) whilst refurbishment has taken place. We also assume that we will
continue to roll out Primary Care Mental Health services in both Islington and Camden,
subject to the outcome of contract negotiations. To date, these services have diverted an
average of 66% of referrals from primary care, whilst providing an effective and popular
service for both service users and primary care practitioners. The impact of these teams
therefore forms an important element of our clinical strategy and our contribution to the
STP.
Within our activity plan, we are also assuming that we will reach agreement with Camden
and Islington commissioners in relation to the Integrated Practice Unit for psychosis. This
aims to bring together all elements of the mental health care, and physical health care
relating to long term conditions for those people in Camden and Islington who have a
psychosis. Based on a five year contract term, the aim is to work to co-produced clinical and
service user experience outcomes, with increased income stability, in return for greater levels
of payment for outcome. The activity we expect to be covered by the Integrated Practice
Unit arrangements is as follows:
Table 7: Integrated Practice Unit activity assumptions
Services Activity
Information
Care
Clusters
2015/16
Outturn
2016/17
Activity
First episode in psychosis Episodes/ YoC 10 387 394
Ongoing recurrent psychosis (low symptoms) Episodes/ YoC 11 956 973
Ongoing or recurrent psychosis (high disability)
Episodes/ YoC 12 811 825
Ongoing or recurrent psychosis (high symptom
and disability) Episodes/ YoC 13 539 548
Psychotic crisis Episodes/ YoC 14 701 713
Severe psychotic depression Episodes/ YoC 15 206 209
Dual diagnosis (substance abuse and mental
illness) Episodes/ YoC 16 154 157
Psychosis and affective disorder difficult to
engage Episodes/ YoC 17 240 244
Page 14 of 27
WORKFORCE
Approach to Workforce Planning
Our workforce plan is owned and informed locally and gives clear indications of current and
future workforce requirements to ensure continuous high quality delivery of care. In
formulating the workforce plans, C&I has fully considered our clinical strategy, professional
strategies and our modelling of future local populations and how this translates into the
skills, competencies and knowledge that we will require of our future workforce. Divisional
services, the nursing directorate, human resources and finance work together, reviewing
factors such as CIP plans, new business and any organisational development and workforce
issues each Division, the Trust and the NHS as a whole may be facing over the life span of
the plan. This also takes in to account the supply of qualified staff and HENCEL
commissioning intentions. The workforce plan is approved in detail by the Trust Workforce
Committee and progress against the plan will be monitored by the Resources Sub-
Committee of the Board.
The Trust budgeted FTE posts are detailed in the table below:
Table 8: Budgeted FTE posts
Staff Group Budgeted FTE posts (March 2016)
Professional Scientific and
Technical 246.57
Clinical Services 405.70
Administrative and Management 340.35
Allied Health Professionals 50.01
Estates and Ancillary 7.00
Medical 128.08
Nursing Registered 425.46
Local Aauthority 165.41
Other 8.27
Total 1776.85
The Trust currently has a vacancy factor of 10.6%, with the majority of the vacancy factor in
corporate services and the rehabilitation &r recovery division. Targeted recruitment
campaigns are underway in the R&R Division for hard to recruit to posts and a number of
corporate areas are being reconfigured, with plans to recruit to new posts or to delete posts.
Page 15 of 27
Key Performance Indicator projections for 2016/17 are as follows:
Turnover is reported month by month, cumulatively and is anticipated to be around 16%
annually. The same assumption is made for vacancy rates, factoring in our robust annual
recruitment plans and streamlined time to hire, preventing high levels of vacancies that are
unfilled for any length of time.
Workforce priorities for 2016/17
To successfully meet future challenges, our workforce will need to be flexible; they will need
to work across health and social care with independent or private sector providers, be
flexible in the provision of care at differing points of the patient pathway, provide care and
treatment for both physical and mental health care, support those with learning disability to
receive care and treatment in mainstream pathways, provide care in different locations
(including the home) and use new technological developments. The future workforce will
have the skills, values and behaviours required to provide co-productive and traditional
models of care. They will need to be adaptable, innovative and able to provide ‘whole
person’ care.
Some of the principles from the Lord Carter Review are being responded to in our approach
to reducing vacancy rates and thereby reducing our reliance on bank and agency staff and
associated costs. During 2016/17, the Trust will scope ways in which the recommendations
from the Carter Review can be fully adopted and embedded within the Trust to ensure
sustained improvement in workforce performance and effective utilisation of resources.
Page 16 of 27
The Clinical Strategy captured 10 overarching themes has areas to prioritise over the course
of the next five years. During 2016/17, the workforce priorities aligned to the Clinical
Strategy will include the following themes and programmes of work:
Development of capability to deliver changing models of care
Engage with staff as part of the overarching campaign on the Clinical Strategy about
new models of care delivery and the impact this will have on staff in terms of their
practice;
Co-ordinate arrangements for divisional wide skills mix reviews to identify skills gaps
In partnership with staff side, develop agreed processes for the implementation of
change programmes;
Explore options for increased flexibility through the use of new technology to facilitate
mobile working , leading to more effective use of the estate, and delivery of care in
primary care and nearer to patients homes;
Development of pathways for RGN’s as well as RMN’s aligned to new service models
which link mental to physical health;
Map out the core competencies and skill sets required of staff to work using the
principals of co-production and strengthen governance arrangements to support this
approach as a new way of working;
Ensure that the annual learning needs analysis for the trust is fully aligned to the new
Clinical Strategy and to the specific developments linked to the move into primary
care and the IPU – and that budget priorities and commissioning reflect those needs.
Embedding values and improving staff engagement
Co-develop with staff side a refreshed framework for partnership working within the
Trust;
Further develop the innovation greenhouse approach to facilitate opportunities to
engage with staff on issues that matter to them, including crafting suitable responses
to concerns expressed through the annual staff survey;
Implement a values based approach to recruitment;
Develop and implement a staff engagement strategy co-produced with staff side and
the workforce;
Plan and deliver the four medium to short term work streams identified in the OD
Strategy that were derived from staff discussion through innovation greenhousing
events.
Supporting staff to keep healthy, maximising health and well being
Successfully transition from the old to the new OH and EAP service provision.
Undertake an organisational health needs assessment to determine the specific
priorities for the Trust and develop a targeted action plan.
Roll out across the Trust the health and wellbeing toolkit developed by NHS
Employers.
Linked to health and mental wellbeing, ensure early diagnosis at work for staff and
facilitate fast track access to good quality psychological intervention and support
linked to causal factors.
Page 17 of 27
Identification of talent, building clinical leadership and enhancing opportunities for
staff development
Enhance the learning experience for staff through the use of e-learning, increased use
of evidence based teaching and simulation;
Further develop coaching and supervision skills to maximise the learning experience
for staff;
Develop a portfolio of learning activities based on a core set of management and
leadership competencies and behaviours for existing and aspiring managers/leaders;
Develop and roll out a physical health and psychological therapies training
programme;
Develop and roll out organisational wide training in recovery delivered by service
users and staff;
Support staff by delivering development interventions, including action learning sets
and toolkits to enhance learning as a way of building staff capability of working in a
way which promotes co-production;
Monitor the embedding and qualitative feedback on the new appraisal process;
Develop our support workforce through the implementation of the Advanced
Development Programme, vocational, and build robust plans to progress
development of our apprenticeship schemes;
Establish a transparent and fair system of talent management that engages the
workforce and interprets talent in the most appropriate way.
Recruitment and retention of staff embodying our values and supporting the delivery
of quality safe care
Delivery of agreed annual workforce, recruitment and training plans , including
strategies to develop new roles and recruit hard to fill vacancies, including the
introduction of nursing associates and apprentices through skill mix reviews;
Development of a robust month-by-month recruitment plan with vacancy and
pipeline monitoring data being reported against the plan at Safer Staffing Group and
Workforce Committee. We will undertake urgent work to ensure access to and
reporting on all data for Local Authority staff on secondment to C&I;
Ensure that establishments are adequately resourced, skill mix reviews identify where
roles can be redesigned and vacancies are actively and quickly recruited to, with key
data reported at the Safer Staffing Group, in order to minimise reliance on bank and
agency staff;
Continue to invest in the rapid response teams to build an internal flexible resource
Implement rotation schemes to facilitate the development of experience in a range of
different care settings;
Development of links with local job centres, advertising in local press and attending
local and other careers fairs to promote the Trust as an employer of choice for local
people;
Implement a package of initiatives for newly appointed nurses to provide pastoral
support during the first 6 months of employment and pulse check new recruits to
track their on-going experience during the first 12 months of their employment;
Page 18 of 27
Use feedback from staff via the staff survey, exit questionnaires and targeted
engagement campaigns, plus benchmarking against appropriate organisations and
utilising relevant research to develop robust, evidence-based retention strategies;
Rolling out improvements in the health roster system and improving capability within
the Trust to realise the full benefits of the system – including the roll out of a mobile
system, providing live staffing data.
Promoting an inclusive environment that recognises difference and promotes equality.
The Equality Delivery System and Workforce Race Equality Scheme Action Plans are being
monitored on a quarterly basis via the Equality and Diversity Committee. Actions being
progressed from the plans and Workforce Strategy during 2016/17 include the following:
Equality and diversity principals and practice including unconscious bias, will be
included in leadership and management development programmes;
A census will be undertaken to refresh our workforce information on the protected
characteristics of our workforce;
Local action plans will be implemented in each Division to address areas which are
out of balance in terms of representation of the main characteristics across our
workforce;
Equality impact training will be prioritised and rolled out across the Trust;
Implementation of a BME network will be supported and we will explore with the
workforce how best to engage with other key staff groups Provide the opportunity
for staff to apply internally for management roles prior to being advertised externally
and we will actively work towards removing the barriers to progression of our BME
workforce through a range of proven HR practices in this area;
Undertake an assessment of BME staff learning needs in respect to progression
within the trust – and make provision of practical support in light of the feedback
received.
Organisational development
The Trust will be implementing the revised Organisational Development strategy, approved
by the Trust Board in January 2016. Our OD activity at this time is intrinsically linked with
ensuring the effective delivery of our new Clinical Strategy. Our work in this area includes
delivering on projects that seek to enhance communication across the trust and to insure the
organisation against silo working at a critical time when integration is central to our internal
practice and our engagement with the wider health and social care economy.
The Organisational Development model is firmly underpinned by the trust’s six Changing
Lives values and aims to support the further embedding of those values in the day to day
practice of the trust, from ward to Board and with each and every member of staff, so that
they inhabit everything that is done within the trust. Additionally, the strategy is built around
four key themes: Collaboration, Adaptability, Transparency and Environment.
Each theme has a set of activities designed to be implemented in 2016 and 2017. The themes
were identified as enablers to build an environment where staff are able to live and work by
Page 19 of 27
the trust values and by that deliver on the challenges of the Clinical Strategy and Strategic
Plan. To reinforce embedding of our Trust values, each theme also corresponds to at least
one specific trust value, as follows:
Collaboration – working as a team;
Adaptability - being professional;
Transparency- being respectful; and
Environment- being welcoming, kind and positive.
Page 20 of 27
INFORMATION AND COMMUNICATION TECHNOLOGY
(ICT) AND DIGITAL DEVELOPMENT
Over the last three years, we have made considerable investment in new ICT Infrastructures
that have facilitated significant change in working practices and culture throughout the Trust.
Service led demand for more flexible and agile working solutions has been driven by
previous investments in flexible mobile working solutions. In four years we have moved from
thirty-five (35) laptops to over six hundred plus (600+) laptops and tablets, the future is to
ensure that efficiency opportunities offered by the Trust’s new EPR are exploited to improve
clinical care.
Our procurement process towards ICT investment is to conduct assessments with our user
population in order that we can provide fit for purpose devices and systems, to enable more
agile working solutions. All mobile devices are encrypted and underpinned by fast, secure
remote access, allowing access to systems from anywhere within the UK. These investments
have allowed C&I to work beyond its traditional geographical boundaries and to take
advantage of working uninhibited by geographical location. The current ICT Strategy will
continue to support the Trust’s growth potential and support working in new locations and
service areas. We will be developing our new Digital ICT Strategy during 2016 to address the
NHS England Digital Maturity Assessment.
Scope of Strategy
The key priority of the current strategy is to continue to focus on building upon the previous
investments already made and ensuring the return on those investments are achieved. Some
of the key objectives in progress are:
Deployment of a replacement Electronic Patient Record (EPR). The Carenotes system
has been operational since September 2015, with mobile working currently being
piloted. Implementation issues continue to be resolved, with the aim to move to the
next stage of system development to create a more bespoke solution during the
2016/17 financial year.
Work with CCGs to implement effective clinical and patient portal arrangements that
support integrated working, and, not least, the implementation of the psychosis
Integrated Practice Unit.
The implementation of action plans relating to the Trust digital self-assessment.
Improved scope and analysis of data, reporting and dashboards;
Deployment of Wi-Fi across all Trust sites.
To support these developments, the Trust is assuming a capital programme for ICT of £1.5M
for 2016/17
Page 21 of 27
ESTATES STRATEGY AND CAPITAL PROGRAMME C&I has a property portfolio of just over 57,000 square metres, located across 33 sites in
Camden & Islington. Space occupied by the Trust is approximately 45,000 sqm, after
deduction of accommodation occupied by a small number of NHS organisations and other
tenants. The Trust’s property portfolio is predominantly freehold, representing 50% of the
sites and 80% of the accommodation. St Pancras Hospital (SPH, transferred from the
dissolved Camden Primary Care Trust from 1st April 2013) represents 43% of the Trust’s
entire portfolio. The next largest building is Highgate Mental Health Centre, which at 10,996
sqm, represents 18%. By comparison, all other 31 sites within the Community are relatively
small.
Scope of Estates Strategy
Long Term Objectives 2016-21
To commence the redevelopment of St Pancras Hospital as the centre piece of the
Trust’s operations and service provision. This represents a fundamental once in a
corporate lifetime opportunity for the Trust to best achieve its strategic objectives;
Continued consolidation of the Community Estate in order to provide local services
more efficiently from a smaller number of more efficient buildings; and
To align estates requirements to the Trust’s recently updated Clinical Strategy.
Short Term Objectives 2016-17
In respect of the redevelopment of St Pancras, the Trust Board has agreed a strategic
outline case (SOC). This was completed in early 2016 and the Trust will prepare an
outline business case by the end of 2016. This will look at the two favoured options of
total vacation of the SPH site and partial vacation of the SPH site. It has agreed to
develop a plan for the total estate of the Trust in light of these two options, and that
a range of measures will be tested to ensure that the proposed development choice
is affordable for commissioners. C&I will also work in a structured way with any public
bodies who may have an interest in the site. Private sector partnerships and strategic
estates partnerships will also be evaluated.
The Trust is maximising its use of accommodation at SPH until there is clarity over
timescales for the site’s redevelopment. The current assumption is that
redevelopment will still not commence for 4-5 years. This enables short term
maximisation of an existing asset and avoids further space acquisition or supports
vacation of other accommodation. The site is now effectively full.
Reduction of Community estate through vacation of leased properties where
possible.
Disposal of surplus freeholds. Two in particular are likely to be confirmed. Tottenham
Mews which has been vacant for some time and Hanley Road1 which is
significantly underutilised and poorly located for Trust services.
1 Not included in the 2016/17 financial plan due to uncertainty regarding the timescale.
Page 22 of 27
Capital Programme
The Trust Estates capital programme for 2016-17 is £3.2m. Approximately £1.25m of this
relates to continuing services infrastructure works required at St Pancras required to ensure
appropriate resilience and statutory compliance pending redevelopment of the site.
Approximately £600k is allocated to compliance and backlog maintenance issues at HMHC
and a similar amount is allocated for the acquisition of Blenheim Court in Islington for
SAMH’s services displaced from Hill House and new Primary Care facilities. The remaining
capital is spread across a number of environmental and backlog projects throughout the
Estate. The Trust’s approach is to employ capital investment in such a way as to directly
support and enhance service delivery, efficiency and the patient environment. The strategic
direction is to continue to focus on reducing the estate footprint through consolidation and
improved space utilisation. A focus on ICT mobile working is regarded as a key facilitator in
space reduction.
Table 10: Trust capital expenditure projects for 2016/17
Capital Expenditure Projects £000
Estates 2016/17
Trustwide (274)
St Pancras Hospital (512)
St Pancras Hospital Electrical Infrastructure (750)
Highgate Mental Health Centre (597)
Community (342)
Blenheim Court – new premises (600)
Environment Group (125)
Sub-Total Estates (3,200)
ICT
Hardware and Software Project (450)
Data Centre Project (700)
Data Infrastructure Project (250)
ICT relocations Project (100)
Sub-Total ICT (1,500)
Total Capital Programme (4,700)
Page 23 of 27
FINANCIAL PLAN
2015/16 Performance
The Trust is likely to achieve a continuity of service risk rating of 3 for 2015/16, with key
financial planning assumptions for 2016/17 as set out below:
Key Planning Assumptions for 2016/17
The Trust is planning to deliver a surplus of income over expenditure of £0.9M for 2016/17.
We expect this position to deliver a planned financial sustainability risk rating score of 3,
however we note that the position is consistent with a score of 4, with the overall score being
reduced by the Variance from Plan metric being capped at a lower level due to 2015/16
performance.
Table 11: The Trust’s planned I&E performance for 2016/17:
Income & Expenditure
15/16 4cast 16/17 Plan
£k £k
Income
135,542 132,223
Expenditure
-126,487 -122,579
EBITDA
9,055 9,644
PDC
-4,218 -4,650
Depreciation
-4,501 -4,258
Interest
164 164
Normalised Surplus
500 900
-1,100 0
-600 900
EBITDA Margin
6.7% 7.3%
Normalised Surplus Margin
0.4% 0.7%
The Trust is planning for an income reduction over the whole year due to changes in
Substance Misuse income as a result of re-tendering activity in 2015/16, a reduction in
Estates & Facilities recharges (offset by a reduction in the provision of services) and a
reduction in deferred income that was carried forward into 2015/16.
The general financial assumptions being made by the Trust for its 2016/17 financial plan are:
Page 24 of 27
Tariff will be funded by CCGs in line with national guidance, meaning inflation will be
funded at 3.1%, with the national cost improvement programme at 2%, giving a net
1.1% uplift;
The re-opening of one acute ward at Highgate Mental Health Centre which will
address a current non-recurrent cost pressure on external bed usage;
That c£48M of costs will be covered by the arrangement for the psychosis Integrated
Practice Unit;
That Parity of Esteem is delivered via the full application of CCG uplifts (2.17% for
Islington and 1.1% for Camden) to mental health funding (via either CIP reductions or
growth funding);
That there is a risk of income loss associated with payment for outcome;
A 2.6% CIP Target (assuming a £900k surplus), will be required. This equates to
£2,310k CIP, increased to 4.5% to include £1,000k headroom and £3,310k overall
programme;
That the Trust will be compliant with all relevant NHSI financial and cost
improvement requirements, including those on staffing and procurement
arrangements;
That additional funding relating to the Prime Ministers’ fund for Mental Health is
allocated within the plan in line with announcements as they are made.
Table 12: An overview of the Trust’s CIP plans for 2016/17:
CIP
£k Pay
Non-pay
15/16 headroom b/f 1,000 750 250 Staffing efficiencies in service areas 260 250 10 SAMH Home Treatment* 250 0 250 IPU savings 100 100 0 Estates savings (incl 15/16 efficiencies relating to FM provider, energy
pricing and estate rationalisation)** 350
50 300 Corporate teams rationalisation 350 310 40 Capital Charge savings on disposals 30
30
Other misc schemes 337 250 87
2,677 1,710 967
*The Home Treatment CIP has delivered £510k prior to 16/17
** Ongoing E&F CIP workstreans have previously delivered £212k prior to 16/17
Upsides to the plan include any contribution generated to the Trust’s surplus by the
provision of extra activity and new services, but currently the Trust is not planning on any
income generating CIPs in its’ 2016/17 financial plan.
Page 25 of 27
The capital plan is limited to £3.2m for Estates schemes and £1.5m for IT and equipment
schemes for 16/17 in order to manage capital charges and liquidity after several years of
capex being greater than depreciation. In addition, the Trust plans to progress 2 potential
property disposals in 2016. The first, the disposal of Tottenham Mews is more advanced, and
is currently the only disposal included in the financial model.
The Trust currently maintains a balance sheet with good levels of liquidity, and intends to
maintain this liquidity throughout the coming financial year. The following table shows the
Trust’s planned balance sheet for 2016/17:
Table 13: Planned balance sheet for 2016/17:
Balance Sheet
31.3.16 4cast 31.3.17 Plan
£k £k
PPE
131,626 129,911
Current Assets
12,000 12,000
Cash
41,000 42,085
Current Liabilities
-22,491 -20,982
Non current Liabilities
-39 -18
162,096 162,996
PDC Reserve
60,348 60,348
Reval Reserve
59,621 59,621
I&E Reserve
42,127 43,027
162,096 162,996
Memorandum Items
14/15 4cast 15/16 Plan
£k £k
CIP requirement
5,000 2,677
CIP headroom
1,000 1,000
CIP programme
6,000 3,677
CIP programme %age turnover
4.4% 2.8%
Capex
9,521 4,700
Page 26 of 27
MEMBERSHIP
The Trust continues to make good progress against the four objectives set out in its
membership strategy:
Growing a sizable and representative membership;
Developing an active and engaged membership;
Enhancing governance; and
Learning and improving.
A high level summary of the Trust’s accomplishments over 2015/16 is set out below,
alongside details of key areas which will be the focus of further development over 2016/17.
Growing a sizable and representative membership:
Public members: In 2015/16, the Trust exceeded its growth target of 3% within its
public constituency, taking the total number of public members to 4300. The public
membership remains broadly representative of C&I’s local communities and the
Trust’s aim in 2016/17 will be to achieve a marginal increase the number of members
coming from ‘Asian or Asian British’ and ‘Black or Black British’ backgrounds.
Service user members: Despite a targeted campaign being carried out in year,
growth within C&I’s service user constituency was less successful - 7% growth against
a target of 15% - and the number of service user members remains relatively low
(around 800). One reason for this is that many service users continue to choose to
join the public rather than the service user constituency. As such, a key area of focus
in 2016/17 will be to strengthen the Trust’s messaging around the unique benefits of
joining the service user constituency.
Staff members: To date, no staff have chosen to opt out of the Trust’s membership.
Developing an active and engaged membership
2015/16 saw a marked increase in the number of engagement opportunities held by the
Trust, as well as in member turnout at events. The Trust ran regular expert talks, a community
open day, a ‘become a governor’ event, and an Annual Members Meeting. C&I also held two
events to seek members’ input on our new Clinical Strategy. A key aim in 2016/17 will be to
establish membership subgroups to enable regular targeted communication with members
interested in informing and shaping delivery of the strategy.
Enhancing governance
Council of Governor Elections: 2015/16 saw the introduction of online voting and
an election microsite to improve accessibility and ease of voting, provide richer
information to voters, and to begin the move towards more cost-effective and
environmentally friendly elections. The Trust was successful in attracting a healthy
number of candidates (at least 2 candidates for every contested seat), however voter
turnout was less successful. The Trust will be using the findings from a voter profiling
study (which analyses demographics of non-voters to help identify any patterns) and
Page 27 of 27
the Trust’s annual member survey to help improve performance in this area in
2016/17.
Governor Training and Development: C&I continue to invest in the training and
development of its Governors. In addition to running an in-house induction
programme, C&I sponsors and actively encourages its Governors to attend the full
range of GovernWell training programmes offered through NHS Improvement. C&I
has also recently developed a partnership with UCLH to commission joint bespoke
GovernWell training modules (e.g. on Accountability and Representing / Engaging
with Members). The Trust will continue to identify new opportunities for training and
development into 2016/17.
Accountability: The Trust has continued its efforts to facilitate engagement between
Governors and members (as well as between Governors and NEDs). Governors are
encouraged to attend membership events to interact with their constituents and they
report back on their activities and achievements through a ‘Governor Annual Report’.
Members are invited to provide feedback on the degree to which they view
Governors as representing the interests of the membership and the wider public
through an Annual Members’ Survey.
Learning and improving
The Trust has worked hard to ensure that mechanisms for learning and improving are in
place so that we can continue to improve our membership offering. Our newly introduced
‘Annual Members’ survey is a good example of this in that it asks for members to provide
honest feedback on all areas of membership. The learning from this survey, which is currently
being analysed, will be used to benchmark membership performance and to highlight
further areas for development over 2016/17.
Top Related