operational plan document for 2014-16 surrey and borders

Monitor AP Operating Plan 14/15 Monitor Submission 3rdApril14

Operational Plan Document for 2014-16

Surrey and Borders Partnership NHS Foundation Trust


1.1 Operational Plan for y/e 31 March 2015 and 2016

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

The attached Operational Plan is intended to reflect the Trust’s business plan over the next two years. Information included herein should accurately reflect the strategic and

operational plans agreed by the Trust Board. In signing below, the Trust is confirming that: The Operational Plan is an accurate reflection of the current shared vision of the Trust Board

having had regard to the views of the Council of Governors and is underpinned by the strategic plan;

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

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

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

Approved on behalf of the Board of Directors by:

Name

(Chair)

Richard Greenhalgh

Signature

Name Julie Gaze / Clive Field

Job Title Assistant Chief Executive / Director of Finance

e-mail address [email protected] / [email protected]

Tel. no. for contact 01372 216292

Date 3rd April 2014

mailto:[email protected]

mailto:[email protected]



Name

(Chief Executive)

Fiona Edwards

Signature


Name

(Finance Director)

Clive Field

Signature

1 Monitor AP Operating Plan 14/15 Monitor Submission 3rdApril14

Our Annual Forward Plan 2014/15 – 2015/16 – Operating Plan

Executive Summary

1.0 Introduction We are entering our 7th year as a NHS Foundation Trust. Our two-year Operational Annual Plan charts

the next steps for implementing our Strategic Direction revised in 2012/13. We are currently the major

provider of secondary mental health, drug and alcohol and learning disabilities services to the populations

of Surrey and North East Hampshire. We know we do our best for people when we work in partnership

with them as individuals and our colleagues working in other NHS providers, Local Authorities, the

voluntary and independent sector.

2.0 Our Strategic Context and Direction

Our core purpose for the next 9 years of our 10 year strategy is:

To work with people and lead communities in improving their mental and physical health and

well-being for a better life; through delivering excellent and responsive prevention, diagnosis,

early intervention, treatment and care

The ultimate benefit we aim to deliver is to improve the health and well-being of people who use our

services – to help them achieve a better life. Our approach is to develop a plan for each person using our

services that connects mind and body, family & friends, community and the environment.

Our services will offer:

Earlier intervention and prevention and health promotion

Mind and body approach

Targeted expertise

Training and equipping others

Consultancy and advice, as well as, treatment

Ready access to experts when needed

We will serve: People are looking increasingly for different models of care which fit better with the way they want to live

their lives e.g. technology assisted, more control, more choice. We believe our expertise could be of

benefit to a wide range of people who currently cannot have access to it. We want to expand our reach to

include more people who could benefit from them locally, nationally and internationally.


3.0 Our Quality Plan Our values compass describes what people told us they want from us and how we want people to

experience us.

We define a quality health and well being service as being composed of the following distinct elements –

experience, effectiveness and outcomes, safety and value for money for the taxpayer.

Our key quality priorities for the next three years are to:

Experience – be the best for the experiences for people who use our services, their carers and

families and staff

Effectiveness – be recognised by commissioners and individuals as outstanding in the

effectiveness of our services and the outcomes they help people achieve

Safety – provide the safest care, treatment and support for people

Value for money – offer good value for money for the taxpayer

We have a clear focus on improving our performance across four themes in our response to Francis and

CQC inspections to our services and feedback through patient surveys. These are

respect - this includes how we work within and design some of our environments

care and welfare - particularly how we involve people in their care planning and demonstrate this

the safety and suitability of our premises – how we maintain them every day, as well as

continually invest in them in the longer term

staffing - making sure we have the right staff, equipped with the right skills, available every day


4.0 Our Clinical Strategy and Enabling Strategies

Our strategy drives our Service Plans. By the end of 2015/16 we will have achieved the following priorities

to underpin each of these:

Clinical Strategy – investment in the development of our prevention and early intervention, diagnostic

and therapeutic services delivered in the community, supporting more people in out of hospital settings

with a continued decrease in our use of inpatient hospital services

Customer Quality - The improvement in the quality (safety, effectiveness, experience and value for

money) we offer to people with a particular emphasis on responding quickly to people’s feedback on how

we are doing and putting things right when they fall short of the standards we expect

Workforce – continuing to enhance our culture, leadership, membership and equality, ensuring the

consistent availability of excellent staff, developing the flexibility we can offer staff, recruiting and

developing good staff and planning our workforce and their support to meet the needs for the future.

Information and Communications Technology – transforming our services and the way we contribute

our expertise to people’s recovery and the wider system through innovation and enhancing our technical

capability to support the frontline

Property – investing to ensure all our environments are therapeutic and well maintained and disposing of

facilities that do not work well for people to reduce our overall footprint and make sure they provide

environments we would be happy for our families and friends to be treated within

5.0 Our Service Plans

Over the next two years we will be taking forward the following priority plans:-

Our construction of the new 24/7 Assessment and Treatment Acute mental health facility at

Farnham Road Hospital to ensure we can offer facilities we would wish for our families and friends,

whilst improving associated acute care pathways

Development of our community hubs to provide local integrated community services aligned with

Boroughs that provide equitable access

Further expansion of our Neurodevelopmental disorders services and post diagnostic support

services including our holistic Autistic Spectrum Disorders assessment service, adult ADHD

diagnostic service and our Foetal Alcohol Syndrome service

Completion of our new Children’s and Young People’s Service model implementation

Development of our vision for Older People’s mental health services and subsequent

implementation of the new service model

Development of our vision for Working Age Adult mental health services and subsequent

implementation of this new service model


Further development of new opportunities where we have expertise e.g. drug and alcohol and IAPT

(Improving Access to Psychological Therapies) services and developing our offering overseas

Implementation of our enabling strategies – workforce, Information Management and Technology

(IM&T), and property

6.0 Our Financial Plans

Our financial focus is on long term financial sustainability rather than simply the delivery of short term

targets. Over the next two years we are aiming to achieve the following key financial targets:

Continuity of Services rating of 4

a planned surplus of £0.8m in 2014/15 and £1.6m in 2015/16 to create the headroom for

transformational change and enable investment in the delivery of our objectives

to achieve this we are required to deliver a cost improvement programme totalling £10.9m on

recurrent basis and a growth plan of £20.5m over the next 2 years and absorb cost inflation above the

funded rate

and a capital investment of £43.1m to improve our facilities and invest in the technology which helps

our staff do their jobs well

7.0 Risks to Delivery

The Board will monitor carefully our activities and ensure the following risks are mitigated to successfully

deliver our Plans.

Failure to manage our finances effectively in the economic climate and failure to deliver increases in

productivity and efficiency

Failure to grow our market share and diversify our services to respond to market changes

Failure to achieve our focus on quality and safety

Failure to engage and manage our staff effectively

Failure to work in partnership with health and social care partners, including commissioners, to

integrate to make the best use of collective resources available to us

Failure to improve our reputation


Our Operating Plan 2014/15 – 2015/16

1.0 Introduction

We are entering our 7th year as a NHS Foundation Trust. Our Strategy (refreshed 2012) sets our direction

for the next 9 years, in the context of the new health and social care environment, the current and future

need demands upon our services from changes to our populations and wider national expectations of the

public sector.

Our two-year Operating Plan charts the next steps for implementing our Strategy. It has been developed

with our Governors through two joint workshops with the Board.

2.0 Strategic Context

2.1 Our current position

We are currently the major provider of secondary mental health, drug and alcohol and learning disabilities

services to the populations of Surrey and North East Hampshire. We also provide some services to the

surrounding counties and London Boroughs on our borders, and in-reach and liaison services into local

prisons and acute hospitals.

What is most important to us is people; our staff,

the people we serve - people who use services,

families and communities. We find our strength in

doing all things in partnership with others and

what we do well is promotion and prevention,

early detection and intervention, consultancy,

diagnosis and treatment. We are increasingly

shifting to focus on prevention, diagnosis and

early intervention.


2.2. Strategic Context - External impacts

Our Strategy review took into account the following external factors which we anticipate will impact on the

need and demand for our services and how we need to operate to achieve our potential for the people

and communities we serve over the next 10 years:

External

Impact

Priority Actions Outcome

Increased

Competition

Economic

climate for

public

services

Changing

Health and

Social Care

system

Growing

population

needs and

demands

Increased

expectation

s and

potential for

eHealth

Clear

specifications

• Clear costing of services to support business development and sustainability; and internal cost improvement / efficiency and reinvestment decision-making.

• Clear service specifications and descriptions to support understanding of what we are confident we can provide safely; supported by costing and pricing model for sustainable and competitive services

Clear focus on

quality

experience

• Dedicated focus on improving experience • Enhancement of our quality culture to ensure lessons learned from

Saville, Francis and Winterbourne View • NHS Providers Licence requirements • Clear literature which describes our services, what to expect and the

benefits of using our services for people • Expansion of complementary e-Health approaches

Capital

development –

management

and alternative

funding sources

• Continued prioritisation of the capital investment plan to ensure compliance and quality and key service developments.

• Identification of alternative sources of funds to support development and investment in quality infrastructure including technology

Partnerships and

Public Service

Transformation

• Strong and creative relationships maintained with partners across system including ongoing development programme for our Governors; to harness their skills, interest and passion in our work for the benefit of the communities we serve.

• Active participation in local Public Health and Well Being strategies and boards.

• Development of partnership arrangements, both formal and informal, to provide joined up care pathways which benefit people, their families, carers and communities and support implementation of our clinical strategy

• Development of effective partnerships, both formal and informal, to support innovation and research and development

• Better Care Fund and Public Service Transformation

Business

opportunities

focus and

practice

• Active use of outcomes measures and reporting to demonstrate benefits of our services for people who use them and those who buy them on their behalf

• Development of commercial focus and practice • Diversification of our sources of income singly and in partnership with

others • Clinical Strategy connected with Better Care Fund and health and

social care delivery


We know the socio-economic forecast for publically funded services is reducing. Currently these sources

account for c75% of our total income. To thrive we need to diversify our income base – locally, nationally

and internationally i.e. non-NHS from local authorities and voluntary sector buyers and private payers.

We want to also offer new responses to the growing public health challenges if we are to realise our

ambitions as a public benefit organisation.

The amount of taxpayers’ money available to fund public services, including the National Health Service

(NHS), is reducing in real terms. We know we need to deliver more service with less resource. We can

do this by working differently and partnering with others whose expertise complements ours. We need to

provide services which help prevent people becoming ill to make the best use of the resources available to

us all.

In order to sustain our level of income we must find other people who want to buy services from us to

substitute the income we will lose from our traditional NHS commissioners.

2.3 Our core purpose

Our core purpose is:

To work with people and lead communities in improving their mental and physical health and

well-being for a better life; through delivering excellent and responsive prevention, diagnosis,

early intervention, treatment and care

The services we provide help people to develop, maintain, sustain and recover independence and better

lives by helping them to achieve better health and well-being. Our approach is focused on managing

factors which build resilience and support health and well-being as well as identifying and managing

factors which cause disease.

What we offer

We aim to achieve for people one plan of care and support through our partnership working with others.

Everything we do aims to keep people connected, so they can live better lives.


Our services will offer:

Earlier intervention and prevention and health promotion

Mind and body approach

Targeted expertise

Training and equipping others

Consultancy and advice, as well as, treatment

Ready access to experts when needed

We will serve:

People are looking increasingly for different models of care which fit better with the way they want to live

their lives e.g. technology assisted, more control, more choice. We believe our expertise could be of

benefit to a wide range of people who currently cannot have access to it. We want to expand our reach to

include more people who could benefit from them locally, nationally and internationally.

Over the next 5 – 10 years we aim to provide services locally, nationally and internationally to:

People

Families

Communities

Partner organisations in the public, private and voluntary sector, contributing our expertise in care

pathways where they take a lead

Commissioning organisations in the public, private and voluntary sector e.g. health and social care

commissioners (NHS England, Clinical Commissioning Groups, County Council social services),

education (including individual schools), charities, private medical insurers

Industry and businesses

3.0 The Short Term Challenge 3.1 Our Current Position

Over the last 12 months we have developed constructive working relationships with our two lead Clinical

Commissioning Groups (CCGs) who lead on behalf of the six Hampshire and Surrey CCGs which

continue to commission the majority of our NHS services - North East Hampshire and Farnham CCG and

Guildford and Waverley CCG (Children’s services); and with our Local Area Team (NHS England)

regarding specialist services.


We have also further cemented our relationships with Surrey County Council, as a partner in our

integrated services and their Public Services Transformation, and with Hampshire County Council through

a Section 75 agreement.

We have a strong track record since our establishment in 2005 of delivering service change which

achieves cost improvement programmes together with improved quality as a single organisation e.g.

rationalisation of our inpatient facilities; and in partnership with others e.g. Social Care Change

programme to achieve more independent lives for people with learning disabilities, and system leadership

of the dementia care pathway, enhancement of liaison with acute and primary care colleagues and out of

hospital care e.g. virtual wards for older people, and education e.g. Targeting Mental Health in Schools.

And redesigning our core services to move to earlier intervention e.g. Our Early Intervention in Psychosis

service has an average duration of untreated psychosis level of 19 days versus a national average of 30 –

40 days.

In 2013/14, we were particularly successful in growing our system-wide influence and services through

partnerships, notably:

expanding our system-wide role through involvement in Surrey County Council Public Services

Transformation

our continued work through acute system Transformation Boards and further development of our

acute hospital liaison services with Surrey Trusts particularly on winter pressures

signing our Section 75 agreement with Hampshire County Council

developing further our innovation, research and development foundation with the formation of a

Clinical Academic Collaboration with the University of Surrey

our partnerships with voluntary and independent sector partners – e.g. The Priory, Cranstoun,

Barnado’s

the expansion of our work with Surrey Police and the wider criminal justice system

Our challenge in the coming two years will be to work with Commissioners and other partners in the local

health and social care economy to achieve parity of esteem for mental health services. This will be

challenging as the parity described within Closing the Gap is not being complemented by the investment

which supported these initiatives within general care e.g. access targets.

3.2 Local Health Economy Short Term Challenges

The Commissioning Intentions of our local Mental Health and Learning Disabilities Commissioning

Collaborative published for 2014/15 presents us with a significant challenge. These set out the following

system-wide collaborative priorities:


Promotion and Prevention: Aim: Improve health and reduce health inequalities for people with

MH or LD

Early Diagnosis and Intervention: Aim: To prevent unscheduled admissions and secondary care

appointments and to promote independence. Improve the diagnosis, treatment and care of people

with common mental health problems and dementia and the co-morbidity of MH & LTC.

Improve Quality and Efficiency: Aim: Improve service user experience, improve care pathways

and their integration and deliver care closer to home. To increase efficiency and innovative

approaches to integration and partnership working across health, social care and the voluntary

sector to improve patient care.

Social and Individual: Aim: Address the social determinants and consequences of mental health.

Within this context our challenge in the short term is to achieve parity of esteem for our services with the

rest of the system, within which two CCGs are financially challenged, and within the limitations of a

continuing block contract arrangement.

3.3 Our Contribution to the LHE Short Term Challenges

We are looking to build further on our successes and partnerships to play our part in delivering the health

and social care system-wide priorities to tackle these short term challenges which may be summarised as:

reducing avoidable hospital admission and facilitating earlier discharge – particularly for the

physically frail elderly and those with dementia, and the acute care pathway for people with mental

ill health to reduce inappropriate A & E attendance for mental health crises

earlier intervention and diagnosis – shifting the focus of our expertise to contribute to earlier

interventions and promotion and prevention of ill-health e.g. for children and families (early years

and schools), and diagnosis e.g. dementia, neurodevelopmental disorders (ADHD, autistic

spectrum, FASD) - to help increase the length of time people can live well and independently

before needing services

delegated commissioning (non-prescribed services) – continuation of delegated responsibility

to lead the commissioning of non-prescribed specialist mental health services to ensure people are

supported in the least restrictive environment as close to home as possible

Better Care Fund integrated system-wide solutions – contributing our expertise and already

formally integrated approaches with social care, voluntary and wider public services e.g. police, as

a platform for new partnerships and pathways to tackle other system priorities e.g. alcohol related

admissions, pain management and other long term conditions such as cancer care

These are reflected in the service plans we have prioritised over the next two years.


4.0 Our Quality Plan Our values compass describes what people told us they want from us and how we want people to

experience us. It is designed to help us to maintain a course that keeps us accountable to our members

and communities, and to the task of improving our services and people’s experience of them.

Our values, which emphasise our passion for people and their equality and human rights, remain core to

safeguarding our practice and guiding our endeavours.

4.1 Our Quality Strategy

Our Quality strategy promotes the underpinning behaviour change needed to actualise the organisational

culture to deliver our strategic ambitions. A culture within which our staff are ambitious for others and

themselves, which puts safety and effectiveness first and allows people who use our services to lead

rather than follow their care and support. It is focused on the continuous and systematic improvement of

services through attention to support and guide staff members to ensure that they are able to provide the

best possible service to vulnerable people. We know that improved quality demands rigorous scrutiny, the

commitment and focus of all our staff, from Board to ward, and sustained energy for continuous

improvement.

We are dedicated to treating people well and making sure we are open and honest when things do not go

as well as we would like. We try to make sure we take the time to gain a clear understanding of where we

are not yet living up to the standards we want and why; so that we can develop targeted programmes and

invest the time and hard work to see sustainable improvement.

We use many different approaches to ensure continued improvement in the quality of what we do. They

include:


Our walkarounds by members of our Board and Governors to our services, ensuring each one is

visited to provide opportunities for staff, people who use our services and carers to tell us how

things are from their perspective

Our expansion of our Your Views Matter (People Experience) Trackers providing people who use

services and carers with an opportunity to feedback to us about their experiences

Our enhancement of our in-house assessment tool, the Periodic Service Review, year on year to

increase the standards we expect from all our clinical and corporate teams

Learning from incidents

Our Deep Dive processes – led by our quality directorate into each service area and on a targeted

basis involving Governors to look more closely at particular areas or points of concern

Our bi-monthly newsletter “Synergy” sharing innovation and service improvement programme

information

Our integrated experience report “EXPERT” which collates and triangulates feedback and

qualitative data regarding the experience of people who use our services and carers

Our developing safe staffing monitoring and available staffing programme

Our Board monitors quality, risk and safety through a variety of mechanisms which include quality,

risk and safety reports, High Level Risk Register and Assurance Framework, Key Performance

Indicator dashboard and national surveys

In January 2014 we launched a new initiative with staff to help them to focus on the right thing every time

every day building on our learning from our CQC inspections and response to Francis, Berwick and Keogh

– the What’s Your Word? competition engaged staff who voted chose CARE – Communicate, Aspire,

Respond, Engage. CARE is being rolled out as a core part of our Quality Plan in 2014/15.

4.2 Our Quality Priorities and milestones

We define a quality health and well being service as being composed of the following distinct elements –

experience, effectiveness andoutcomes, and safety; to which, as a public benefit organisation, we add

value for money for the taxpayer.

4.2.1 Our Governance rating

We have maintained a GREEN governance rating throughout 2013/14.

4.2.2 CQC Inspections and improvements

Many of our services underwent CQC inspections as part of their routine unnounced inspection regime.

The twenty four inspections undertaken recommended a number of Minor – Moderate actions for

improvement but did not identify any Major impact concerns. CQC will be revisiting each service after

their initial inspection to ensure our action plans to remedy the areas identified are progressing on time


and have succesfully improved services. We have also been advised that we will be inspected in the next

wave of CQC’s new regime in June 2014.

4.2.3 Response to Francis, Berwick and Keogh

We have a clear focus on improving our performance across four themes in our response to Francis and

CQC inspections to our services and feedback through patient surveys. These are

respect - this includes how we work within and design some of our environments

care and welfare - particularly how we involve people in their care planning and demonstrate this

the safety and suitability of our premises – how we maintain them every day, as well as

continually invest in them in the longer term

staffing - making sure we have the right staff, equipped with the right skills, available every day

4.2.4 Our Clincial Quality Priorities

Our priorities for the next three years have been developed to take into account the above. They have

been discussed and agreed by our Board and Governors and form the basis of our Key Performance

Indicator (KPI) dashboard which is used to monitor our progress and delivery against these throughout the

year.

Clinical Quality Priorities Targets / Measures for 2014/2015

Experience

To be the best for the experiences for people who use our services, their carers and families and staff Benchmarked by: a) Achieving top quartile scores in the national community survey in relation to “overall, how would you rate the care you

2014/15: To increase the percentage of people, reported through Your Views Matter, who would recommend our services to friends and family members (from baseline of 68% (based on responses between Sept 13- Jan 14))

2015/16: To increase the percentage of people, reported through Your Views Matter, who would recommend our services to friends and family members (from 2014/15 results)

2014/15: To increase from the baseline of 41% of carers (based on responses between Sept 13- Jan 14) the percentage offered a carers assessment

2015/16: To increase from the percentage of carers (from 2014/15 results) the percentage offered a carers assessment


have received from the NHS mental health services in the last 12 months” by 2016 b) Achieving top quartile scores in the national staff survey to recommended the Trust as a place to work and a service for friends and family by 2016

2014/15 Improve our performance within the national staff survey with particular focus on the percentage of staff that would recommend us as a service to friends or family who need care, and as a place to work, and sustain a return rate in the top 3 nationally of mental health & learning disability trusts

2015/16 Improve our performance within the national staff survey with particular focus on the percentage of staff that would recommend us as a service to friends or family who need care, and as a place to work, and sustain a return rate in the top 3 nationally of mental health & learning disability trusts

Effectiveness / Outcomes For people to have outstanding care plans that they were both involved in writing and that they have a recognised and accessible copy. Benchmarked by: a) Achieving top quartile scores in the national community survey in relation to “have you been given a written or printed copy of your care plan” by 2017 b) Achieving an increase in

the number of community

contacts from 2013/14

activity baseline

2014/15 To attain 85% scored in ‘your views matters’ question – “Do you think your views were taken into account when deciding what was in your care plan?”

2015/16 To attain 85% scored in ‘your views matters’ question – “Do you think your views were taken into account when deciding what was in your care plan?”

2014/15: 90% of people who use our services will have a person centred care plan (excludes assessment and advisory services)

2015/16 : 90% of people who use our services will have a person centred care plan (excludes assessment and advisory services)

2014/15: 90% of people who use services and have a CPA have a health check and health action plan 2015/16: 90% of people who use services have a health check and health action plan

2014/15 Each division has a targeted plan to improve access to services for people who are currently significantly under-represented and implement at least two further project’s within each division

2015/16 Each division has a targeted plan to improve access to services for people who are currently significantly under-represented and implement at least two further project’s within each division

Safety

To provide the safest care, treatment and support for people

2014/15 Achieve compliance of 95% of all staff being up to date with their statutory training and at least 80% of all staff being compliant with their mandatory training

2015/16 Sustain compliance of 95% of all staff being up to date with their statutory training and at least 90% of all staff being compliant with their mandatory training

2014/15 Reduce the rate of patient safety incidents and percentage resulting in severe harm or death from the number in 2011/12 of which 5% resulted in severe harm or death.

2015/16: Reduce the rate of patient safety incidents and percentage resulting in severe harm or death from the number in 2011/12 of which 5% resulted in severe harm or death.

2014/15 Demonstrate an increased willingness by staff to report experiences of discriminatory abuse with a 20% increase from 2013/14 in the number of incidents reported by staff citing discrimination.

2015/16 To reduce the number of incidents of discriminatory abuse experienced by staff in the workplace.


4.3 Enabling Strategies

To underpin our organisational change programmes and deliver on our quality improvement programme,

the following key projects are being progressed as part of the implementation of our enabling strategies:

4.3.1 Workforce

Our Workforce Strategy is focused on delivering our aim, to engage our staff, promote their health and

well-being and harness their passion for providing excellent care and treatment. Well trained and

equipped they can support the development of our organisation and our services. It is shaped by the

following key themes:

Our staff will need to transition their skills from the secondary care into community and

individual/personalised care markets; and from our current emphasis on treatment models to deliver

earlier interventions, diagnosis and advice and consultancy support to people and the wider system.

Through effective succession planning and professional development coupled with the use of modern

technology, we will ensure our staff transition with us so that we have a motivated workforce able to

deliver the highest possible levels of care.

Our clinical strategy will require a new range of skills and technical competencies within our workforce and

new diagnostic capability leading to the consideration of new roles. Our partnership modes of delivery will

mean less health care support staff directly employed by us. Overall this will lead to a reshaping of the

workforce with newer and less expensive employees allowing for a decrease of 242.9 wte over next two

years across our current portfolio.

This will impact differentially on our different staff groups as we try to ensure we have the optimal skill mix

within our largely multi-disciplinary teams to offer quality services (safe, effective (good outcomes),

experience and value for money) for people.

Key Themes

Improve staff experience

More community less secondary

More partnership working

Early intervention

More family designed services

Consultants and experts within a care pathway

Less site based more remote working

More personalised care less group provision

New markets include private and international opportunities


The following programmes are being taken forward to support this change:

Culture, Leadership, Membership and equality – including our Changing Future programme, our

Leadership Faculty work including talent and succession planning and staff survey action plans

Flexible contracts – within national frameworks

Workforce Planning – using our Leadership Definition work, our learning and development

programmes to support care pathway skills development e.g. early intervention and detection

Recruitment – focusing on recruiting to our vacancies, planning for our potentially high retirement

levels, reducing temporary workforce and our assessment centre for selection

4.3.2 Property Strategy

This is focused on improving our built environments, improving their efficiency and safety and developing

alternatives to property ownership for providing services to people in locations they would find welcoming

and provide environments we would be happy for our families and friends to be treated within.

4.3.3 Information and Communications Technology Strategy

This is focused on maximising the benefits of our investment in systems to date, transforming staff skills

and use of technology to work and deliver services differently and more efficiently e.g. mobile and remote

working, and developing our digital vision for services.

4.3.4 Innovation for Business Development

Focusing on Research and Development – developing our infrastructure for inspiring and acting on our

staff’s ideas and initiative and; Business Development and new ventures – providing dedicated focus to

improving our business insight in support of our clinical strategy ambitions.

4.4 Membership Development

Our membership numbers reduced during 2013/14 following a thorough data cleansing exercise. We are,

however, planning to increase the public and people who use our services constituency to a total of 7000

members over the next two – five years. This will be achieved by a variety of membership promotions

targeting under-represented communities amongst our membership including young people, black and

minority ethnic group and people who use our services. We are anticipating a small increase in our staff

constituency this year following the commissioning of new services.


5.0 Operational Requirements and Capacity for 2014/15 – 2015/16

5.1 Our Service Plans

Over the next two years our Plans will reflect an investment in developing our services to focus more on

prevention, promotion, diagnosis and earlier intervention alongside our existing portfolio of treatment

services for people and on developing more our expert consultancy, advice and promotion to the wider

health and well-being community. Our headline plans over the next two years in each of our service

Divisions and our enabling support teams are set out below:

24/7 Assessment and Treatment Acute mental health hospital modernisation programme -

Completion of our new hospital facility at Farnham Road Hospital and Review of our Acute Care Pathway

Local integrated community services aligned with Boroughs that provide equitable access -

Development of our community hubs – in North East Hampshire, Guildford, Chertsey/Woking and Redhill,

supported by further roll out of mobile working

Development of Neurodevelopmental disorders services and post diagnostic support - Further

expansion of our Neurodevelopmental disorder diagnostic and assessment services including Autistic

Spectrum Disorders, an adult ADHD diagnostic service and our Foetal Alcohol Syndrome service

Completion of our Children’s and Young People’s Service model Implementation – including

Expansion of our Targeting Mental Health in Schools programme, implementing the decision of the joint

strategic review; and retender of CAMHs

Development and implementation of a new Older People’s mental health service model

Development and implementation of our Working Age Adults mental health service model

Development of new opportunities where we have expertise – including our drug and alcohol and

IAPT (Improving Access to Psychological Therapies services, and developing our offering overseas and

new e-Health solutions

5.2 Productivity, Efficiency and Cost Improvement Programmes (CIPs)

To deliver the required level of improved productivity and efficiency within our services we will continue to

build on our track record of successfully delivering cost improvement, both transformational and

incremental efficiency driven schemes. Our operational plans are underpinned by the following key

elements:

Transformational service redesign to ensure that the best outcomes are being delivered in the

most effective and efficient manner

Continued roll out of our centralised Community Hubs for all services to reduce our building costs

and to improve service efficiency through the greater co-location of local teams


Increasing use of information technology e.g. increased mobile working and new e-health

solutions to facilitate the delivery of services in the most convenient, flexible and efficient manner

and so to improve the customer-experience and the efficiency of services

Continued asset and estate rationalisation and a thorough review of all Hard and Soft Facilities

Management

Improved workforce efficiency through review of all terms and conditions, including the

establishment of a ‘wholly owned subsidiary’ to facilitate the introduction of new remuneration and

reward structures

The generation of additional income through the development and marketing of new services and

the response to specific tenders especially in partnership with other organisations

Many of our programmes to deliver our CIPs are the continuation and realisation of initiatives which

commenced last year as part of our three-year Annual Plan.

6.0 Our Financial Plan

Our financial focus must be on long term financial sustainability rather than simply the delivery of short

term targets, giving the key priorities as:

Generating sufficient I&E and cash surpluses to:-

o support on-going operations

o to fund known capital investment requirements and to provide future funds for the purchase of

new assets, the investment in new business opportunities or the re-fresh of existing assets

Ensuring sufficient resources are generated and held to maintain liquidity requirements in addition to

providing investment in assets over 10 years

Delivering a long-term Continuity of Services risk rating of 4 to demonstrate to key stakeholders,

future commissioners and regulatory authorities that we are financially robust and can provide

sufficient investment to deliver the required quality of care for future years.

The key priorities shaping our Financial Plan are:-

The maintenance of existing business and income

The delivery of:

o A gross £40m income growth target over the five years of the Plan, with £20.5m targeted in the

first two years.

o The delivery of a reduced surplus in 2014/15 (i.e. £800k surplus generated) to allow clinical

services the time to properly plan and implement the transformational service changes required

to deliver savings of nearly £26 million in 5 years


o the required recurrent Cost Improvements Programmes (CIPs) in Operational and Corporate

services to ensure medium to long-term transformation of services and the delivery of year on

year productivity improvements

The redevelopment of Farnham Road Hospital site within the costs identified within the Full Business

Case

The management of our capital plan prioritise essential expenditure over developmental prioritiesand

deliver our disposals programme

The management of risks to the financial plan through downside planning and mitigations

The implementation of a commercial model to ensure all services remain financially sustainable while

contributing to our strategic objectives

The key assumptions underpinning our Plan are:

A nationally required 4% annual efficiency target for all providers of NHS services

The funding of inflationary cost increases in line with the PbR tariff adjustments, including a national

1% pay award for all staff

These plans do not include any additional QIPP schemes requested by local commissioners; these will

be subject to negotiation and the agreement of specific plans to be delivered in partnership with

primary care and other local providers including acute hospitals.

Current action plans and on-going discussions will ensure that the costs of Delegated Commissioning

will be covered by a sustainable financial framework agreed with local commissioners

6.1 Income and Expenditure

FOT

13/14 14/15 15/16 16/17 17/18 18/19

£'000 £'000 £'000 £'000 £'000 £'000

Income (150,153) (152,141) (160,581) (164,677) (169,088) (173,474)

Pay 108,894 110,483 116,279 119,969 123,186 126,787

Non Pay & Contingency 32,762 33,588 34,910 35,088 36,279 37,322

EBITDA (8,497) (8,071) (9,391) (9,620) (9,623) (9,364)

Capital Charges 6,860 7,231 7,751 7,980 7,983 7,724

Other Financing Costs 37 40 40 40 40 40

(Surplus) / Deficit before

Exceptional Items(1,600) (800) (1,600) (1,600) (1,600) (1,600)

Profit on Disposal (4,130) 0 0 0 0 0

Impairment 1,035 600 5,000 4,379 0 0

(Surplus) / Deficit after

Exceptional Items(4,695) (200) 3,400 2,779 (1,600) (1,600)

ProjectedIncome & Expenditure

(including Specialist

Services Commissioning)


Key aspects of this high-level projection are

2014/15

o An Income loss of £4.3m in line with commissioning intentions offset by new income growth

of £9.3m

o An adjustment to the planned surplus to reduce the in-year CIP target by £0.8m to allow

time for the required service transformation and redesign projects to be properly planned

and implemented

2015/16

o An increased Income growth target of £11.3m; services must seek to develop new services

which can be pro-actively marketed to commissioners as well as responding to tenders

o An increased CIP target of £0.8m to ensure a Continuity of Service Risk Rating of 4

6.2 Income Growth

We are targeting a gross £40m increase in income over the next five years through:-

Working in partnership with private and third-sector providers to develop innovative, best value

solutions in response to specific tenders issued by NHS Commissioners

Development of new services to deliver higher value for commissioners

The table below summarises the new Income plans over the next two years, indicating the contribution

that is being targeted.

Income Contribution 14/15 15/16 16/17 17/18 18/19 Total

£'000 £'000 £'000 £'000 £'000 £ ‘000

Income Growth (9,250) (11,250) (6,500) (6,500) (6,500) (40,000

)

Cost of New Business 8,325 10,125 5,850 5,850 5,850 36,000

Net Contribution (925) (1,125) (650) (650) (650) (4,000)

Known Income Loss 4,295 460 0 0 0 4,755

Expenditure reduction (2,811) (324) 0 0 0 (3,135)

Net Income Loss 1,484 136 0 0 0 1,620

Net Contribution Loss / (Gain) 559 (989) (650) (650) (650) (2,380)


6.3 Cost Improvement Plans

The table below summarises the scale of Cost Improvement Plans over the next five years.

CIP Target 14/15 15/16 16/17 17/18 18/19 Total

£'000 £'000 £'000 £'000 £'000 £ ‘000

In Year CIP Target

4,318 3,988 3,528 3,371 2,953 18,158

Other Cost Pressures 2,112 512 4,291 456 456 7,827

Total CIP Target 6,430 4,500 7,819 3,827 3,409 25,985

The CIP targets reflect the Surplus reduction which shifts £0.8m from 2014/15 to 2015/16,

effectively smoothing the impact upon Operational Divisions. However, CIPs in 2014/15 should still

be planned to meet the higher target, taking into account the time required to implement significant

service redesign.

The CIP target in 2014/5 includes an investment for safe staffing currently estimated at £1.2m.

Our work continues to further analyse the requirement and refine the assessment of additional

funding needed taking into account planned service redesign, existing CIPs, and temporary

staffing spend. This may reduce the level of further investment required.

In addition, Trust Wide theme targets have been set to ensure delivery of the total CIP and financial

surplus. These are summarised in the table below. Schemes to deliver these targets will require significant

transformational change,

Trust Wide Theme

(Transformational) CIPs

2014/15

£’000

2015/16

£’000

Total

£’000

Community Hubs 0 415 415

Workforce 500 750 1,250

Mobile Working 0 150 150

Service Redesign 1,200 1,500 2,700

Total 1,700 2,815 4,515

Within this framework, individual Directorates and Divisions have developed individual schemes,

ensuring that clinicians have been closely involved as members of the multi-disciplinary directorate

team. Cost Improvement Programmes requiring significant change are subject to engagement and

consultation (as necessary) with those directly affected including people who use services, carers and


staff, and their representatives; or business case processes. They are also supported by Equality

Analysis. Each of these significant consultation and business cases is signed off by individually by the

Executive Board before they proceed.

We use a Programme Office Approach template to support our development of CIP projects and to

monitor their delivery. The planning and phasing of overall Financial Plan is reviewed and delivery is

monitored by the Director of Finance and reported through to the Executive and Trust Boards.

6.4 Capital Plan

£m

2013/14

FOT

2014/15

Plan

2015/16

Plan

Development 7.2 27.0 8.5

Maintenance 4.5 5.5 5.2

Other 0.3 0.4 0.1

Disposals 15.6 12.5 5.8

Our capital plan over the next two years invests in the following key priorities:-

The completion of our new build Oakwood (Grandview) for people with learning disabilities

The completion of our redevelopment of our hospital services at Farnham Road Hospital and

associated acute care pathway

The completion of an improved facility for our Windmill service

Creation of our community hubs – developing a centralised and combined community service provision

in each borough and support for mobile working

Further Investment in IT – the development of an infrastructure to support mobile working and

telehealth as well as the replacement of the Trust’s Patient Information System

Continued investment in maintaining the quality of our environments and updating our ICT

infrastructure and equipment


6.5 Continuity of Services Risk Rating

Our projected Continuity of Services Risk Rating (CoS), for each year of the financial plan is shown below

2013/14 2014/15 2015/16

FOT Plan Plan

Capital Service Cover (times)

x2.86 x2.45 x2.62

Liquidity (days)

65.7

24.7

17.5

Capital Service Rating

4

3

4

Liquidity Rating

4

4

4

Continuity of Services Risk Rating(CoSRR)

4

4

4

Cash balance for liquidity £25.8m £9.9m £7.4m

The capital spend on Farnham road impacts in 2014/15, decreasing our cash balance and reducing the

capital Service Cover Rating to a 3. However our overall CoS Risk Rating remains at a 4.

7.0 Risks to Delivery Failure to manage our finances effectively in the economic climate and failure to deliver increases

in productivity and efficiency

Failure to deliver Financial Plan to secure a sustainable financial position

Failure to grow our market share and diversify our services to respond to market changes

Failure to develop new markets for existing and new products

Failure to develop realistic costing and pricing model for our services to support business

development and ensure the competitiveness of our services in specific market sectors

Failure to develop effective partnership arrangements to support new business opportunities

Failure to develop a Wholly Owned Subsidiary to support new business opportunities and support

competitiveness of our offering


Failure to achieve our focus on quality and safety

Failure to achieve and evidence ongoing compliance with Registration and Licence requirements

Failure to measure and report on the quality outcomes and benefits of our services and interventions

Failure to focus on quality during scale of change

Failure to focus on experience improvements

Failure to improve our data quality

Failure to engage and manage our staff effectively

Failure to secure continued improvement in staff management and experience

Failure to develop a technology enabled organisational culture and skilled workforce

Failure to work in partnership with health and social care partners, including commissioners, to

integrate to make the best use of collective resources available to us

Failure to develop services which meet the needs of our different purchasers and make best use of

resources

Failure to improve our reputation

Failure to build confidence in our capability as an organisation, the services we offer and benefits

people achieve from using our services

Failure to engage our communities and harness their energies to help achieve our overall purpose


Appendices: commercial or other confidential matters - NOT FOR PUBLICATION

A1 Our Cost Improvement Programmes 2014/15 – 2015/16

Ref Scheme Scheme description

including how

scheme will reduce

costs

Under-pinning IT /

information or

management

systems

Total

savings

£m

Phasing over two-

year period

(£k)

Has the

scheme been

subject to a

quality impact

assessment

(Y/N)

Who is

responsible for

signing off on

the quality

impact

assessment

Key

measure of

quality for

plan

Scheme Lead

Year 1 Year 2

1 Divisional

Schemes

Review of all

Divisional &

Corporate operational

services

All existing

systems

10.93 6,430

4,500

Y Executive

Board

Divisional &

Corporate Directors

2 Asset

Rationalisation

The continued

rationalisation of our

Estate will lead to

reduced capital

charges etc enabled

by IT

Mobile working 0.15 150 Y Executive

Board

Improveme

nt in ERIC

returns

Reduction

in sq m

footprint

Director of Strategic

and International

Development

3 Service

Redesign

Review of bandings

and roles on staff

turnover etc.

changes to the way

service is delivered to

reduce costs

All existing

systems

2.7 1,200 1,500 Y Executive

Board

Staff

turnover /

Skill mix

Divisional Directors


4 Community

Hubs

Development of

service hubs reducing

overall footprint and

increasing efficiency

through co-location

Mobile working 0.42 415 Y Executive

Board

Director of Strategic

and International

Development

5 Workforce

Improved workforce

efficiency through

review of terms and

conditions and

establishment of

wholly owned

subsidiary

ESR

Wholly owned

subsidiary

Changing Futures

1.25 500 750 Y Executive

Board

Director Of Human

Resource & Director

of Innovations &

Development

Totals 15.45m 8,130k 7,315k


A2 Our Business Development Plan 2014/15 – 2015/16

Ref Scheme Scheme description Total

growth

£m

Over 2 years

Phasing over two-year

period

(£m)

Scheme Lead

Yr. 1 Yr. 2

1 Core service – organic Liaison

Neurodevelopmental

TaMHS

0.75m 0.40m 0.35m Director of Business Development

2 Core service – bids Drug and alcohol

IAPT

Domiciliary care

Supported living

Custody and courts / Prison Mental Health

12.6m 5.8m 6.8m Divisional Directors / Business Development

3 Partnership Bids Education, Criminal Justice, Private and Voluntary

providers

Major Service Bids (ie Bedfordshire)

Advice & Consultancy

5.25m 2.2m 3.05m Divisional Directors / Business Development

4 Business Development New development

Low secure (The Priory)

Private healthcare

International

E- Health Products

The Meadows

1.90m 0.85m 1.05m Director of Business Development

Totals 20.50m 9.25m 11.25m


A3 Downside and Upside

A3.1 Downside

In downside scenarios, the following adverse variances from the basecase have been included:-

o non-delivery of the targeted cost reductions

o non achievement of growth targets

o increase in Commissioner expectations i.e. QUIPP, efficiency

Potential downside scenarios have been developed to test our base-case assumptions to ensure our

sustainability over the next two years. The downside risks included in our Plan submission are;

Should these risks materialise and remain unmitigated, then the Trust would have a CoSRR of a 3 in

14/15 and a 4 in 15/16. The £5.82m financial risk assumed in 14/15 represents 3.8% of income or the

equivalent of 90% of the CIP not achieved in the year. It is considered unlikely that this scenario would

arise.

A3.2 Upside

In our upside scenarios the following beneficial variances from the base-case have been included:-

o accelerated delivery of our targeted Trust wide schemes, including service redesign

o An improved bid success rate will contribute a net £10k for every additional £100k of

income.

14/15 15/16

£m £m

Block Contract income -QIPP reduction -1.20 0.00

-0.50 -0.60

Delegated Commissioning Overspend -1.90 0.00

30% of CIP not achieved -2.22 -1.36

Total Risk -5.82 -1.96

50% of Revenue Generation Margin not

achieved

Downside Sensitivity


A4 Contracts

A4.1 Contract Status

We receive the majority of our income for our clinical services via block contracts from both NHS and

Social Care Commissioners. While these contracts are not driven by levels of activity, we are required to

provide detailed activity reports to all commissioners showing performance against key indicators. Within

the terms of the NHS Standard Contract, we can be subject to financial penalties wherever agreed KPIs

are not met. Within the agreed NHS Contracts, CQUIN schemes representing additional payments

totalling 2.5% are also being negotiated.

Contract values for 2014/15 have been agreed with local commissioners with the exception of the

following specific issues:

Surrey CCG’s Commissioning Collaborative - have requested financial reductions in addition to the

agreed 4% tariff efficiencies offset by uplift for inflation (excluding the 0.3% CNST and 0.3% tariff

uplift). They have also requested an additional 2% QIPP which we have disputed; discussions are

focussing on how the Trust can work with local CCGs to provide cash releasing savings from across

their commissioning portfolio.

Delegated commissioning - discussions are on-going with the Co-ordinating Commissioner regarding

a sustainable funding agreement to support our continued delegated commissioning role.

In addition the following services are subject to particular discussion within our negotiations regarding

commissioning intentions in 2014/15:

o CAMHS re-tendering

o Assertive Outreach Team

o The Willows


A5 Our Service Plans

Over the next five years our Plans will reflect an investment in developing our services to focus more on prevention, promotion, diagnosis and earlier

intervention alongside our existing portfolio of treatment services for people and on developing more our expert consultancy, advice and promotion to the

wider health and well-being community. Our key strategic priorities which must be achieved over the next two years to underpin delivery of our strategy are

summarised in Section 5.1 of the public Operational Plan. The milestones for strategic development which must be delivered over the next two-five years of

the Plan are described below:-

Strategic

development

Contribution to

Strategic Plan

Financial

Impact

(income/

costs)

Actions/

Milestones

Regulatory

Requirements

and risks

Resources Measures of progress

24/7 Assessment

and Treatment

Acute mental

health hospital

modernisation

programme

Customer quality – experience and value for money

Clinical strategy -reduced reliance on beds

Property

£28.5m

capital

investme

nt

Build / re-furbish

hospital provision

Rationalise from six

sites to three or less

sites

Review high quality

acute care pathway –

within hospital and

community services

across all Divisions

Low capital

receipts from

disposals;

relocation of

other services to

optimise land

sale receipts;

decant options;

commissioner

future plans;

escalating costs

of build

Workforce

redesign to

deliver

flexible and

capable

workforce

across the

mental health

care

pathways

2014/15 – Continue build

Acute Care Pathway model developed and

confirmed

Review of plans for NW and East Surrey and

development / approval of options

2015/16 – Complete and commission new

service

Acute care pathway (non- inpatient)

implemented to support

Implementation of plans for NW and East

Surrey

Disposal Ridgewood Centre

2016/17-2018/19

Completion of plans for NW and East and

Mid Surrey


Local integrated

community

services aligned

with Boroughs

that provide

equitable access

Clinical strategy – telehealth, mind and body

Customer quality – experience, outcomes and value for money

Property

ICT

£3.7m

investme

nt in

communi

ty hubs

Development of

community hubs and

telehealth

Integration of Older

persons community

services

Further expand young

people’s services /

early intervention

Insufficient

capital to deliver

investment

Commissioning

support required

to deliver

change to CRS

Workforce

development

to make shift

to mobile

working

Identification

of suitable

community

hubs for co-

location

2014/15

Community hubs implemented – Woking;

Spelthorne/ Redhill Phase 1

Established care pathways aligned with

Farnham Road Hospital

2015/16

Completed community hub – Camberley;

Epsom; Runnymede

2016/17

Completed community hub - Redhill Phase 2;

Mole Valley; Elmbridge

Development of

Neurodevelopme

ntal disorders

services and post

diagnostic

support

Clinical strategy – consultancy, diagnosis

Customer quality – experience, outcomes and value for money

£0.45m

growth

Build on current FASD

service

Build on complex

needs expertise

Develop consultancy

model to wider system

Increased

regulation

arising from

Winterborne

View – supports

repatriation and

enhanced

community

based services

CQC

registration

requirements to

be met

Workforce

development

to make shift

to new

service

models

Identification

of suitable

community

hubs for co-

location

2014/15

Enhanced care pathway for people with

Autistic Spectrum disorders

Implementation of

Working Age

Clinical strategy – mind and

Develop and

implement new care

pathways

Changes to

commissioning

Workforce

development

to make shift

2014/15

Development of and consultation on redesign


Adult Mental

health vision

body, early intervention, diagnosis, consultancy

Customer quality

ICT

Property

workforce

Build upon liaison and

out of hospital care

models with primary

and community

providers, including

voluntary sector

Competition

Commissioner

support

Underpinning

workforce

change and

engagement

Strong

collaborative

partnerships

to deliver

model of care

vision

Consolidate PICU beds for Mid and East

Surrey

2015/16

Implementation of new model and pathways

Implementation of

Children’s and

Young People’s

Service model

Clinical strategy – mind and body, early intervention, diagnosis, consultancy

Customer quality

ICT

workforce

Implement new model

Expand Early

Intervention

Expand on connection

with schools

Build on primary care

for early years,

particularly for families

and children with

complex needs

Changes to

commissioning

Competition

Commissioner

support

Underpinning

workforce

change and

engagement

Workforce

development

to make shift

2014/15

Implement service model – Phase 2

Expand TaMHS

CAMHS tender

2016/17-2018/19

CYPS intensive eating disorder day service

Implementation of

Older People’s

mental health

vision

Clinical strategy – diagnosis, mind and body, consultancy

Customer quality

ICT

Develop and

implement new care

pathways

Build upon liaison and

out of hospital care

models with primary

and community

providers, including

Changes to

commissioning

Competition

Commissioner

support

Workforce

development

to make shift

Strong

collaborative

partnerships

to deliver

2014/15 and 2015/16

Development and Implementation of older

people’s mental health services remodelling

Expansion of dementia products

2016/17-2018/19 tbc


Property

workforce

voluntary sector Underpinning

workforce

change and

engagement

model of care

Development of

new business


Customer quality

ICT

Workforce

Expansion of services

focused on early

intervention /

diagnosis and

promotion

Competition

Market not as

developed as

strategy

Investment in

doing new

things

Increased

agility to

response to

opportunities

and invest in

collaborative

partnerships

2014/15

Expansion of IAPT services through tenders

Expansion of drug and alcohol services

(tenders)

Development of on-line therapy

Repatriation of care pathways to local

services from specialist and out of area

placements e.g. low secure provision learning

disabilities (beds in partnership)

Development of international business

Courts and custody expansion

Partnership development – The Priory

Wholly Owned Subsidiary - implemented

2015/16

Development of international business

Community detox programme

Expansion Windmill residential detox

International medical training

Extended Health Psychology

Recovery college

App development


2016/17-2018/19

Parkinson’s and Lewy body dementia

services

Enabling strategy

implementation


Customer quality

ICT

Property

Implementation of

core enabling

strategies to underpin

Strategy delivery

2014/15

RIO post 2015 procurement

PLICs implementation

Costing and pricing implementation

Workforce transformation – T & Cs;

alignment with clinical model

Quality programme – Real Time experience

Leadership and culture programmes – What’s

your word?; SABP way; Level 3 leaders focus

2015/16

RIO post 2015 implementation

Workforce transformation – alignment with

clinical model

Quality programme

Leadership and culture programmes

2016/17-2018/19

Workforce transformation – alignment with

clinical model

Quality programme

Leadership and culture programmes


A6 Risks to Delivery Category of Risks Description of risk

(including timing)

Potential impact Mitigating actions / contingency

in place

Residual concerns How Trust Board will monitor

residual concerns

Failure to manage our

finances effectively in

the economic climate

and failure to deliver

increases in

productivity and

efficiency

Failure to deliver

Financial Plan to secure

a sustainable financial

position

CoS reduced to less

than 4

Clear plans to deliver

Clear monitoring through;-

Executive Board; - Strategic

Change Programme Board;

Executive Team

Negotiation of CQUIN

targets – system wide

risk

Specialist

Commissioning –

overspend within

retained budget

responsibilities

Financial reporting to the Board

-Director of Finance

CQUIN assumption 75% in

14/15 Assurance Framework /

Risk Register – Director of

Quality

Downside plan includes

mitigation through phasing of

24/7 programme – Director of

Strategic & International

Development

Monitoring of Service Plans

through Strategic Change

Programme Board – Divisional

Directors

Proactive management of care

pathways within retained budget.

Director of Finance / Medical

Director


Failure to grow our

market share and

diversify our services

to respond to market

changes

Failure to develop new

markets for existing and

new products

Missed opportunities

for new income

streams

- risk to sustainable

services and to

financial plan

achievement i.e. more

CIPs needed

-

Targeted investment in Business

Development and sales /

marketing (relationships)

operating.

Business Development

programme board governance

Head of Business Development /

Chief Executive

Due diligence of new business

opportunities

Director of Finance

Business Development

programme board reporting to

Board (growth)

Chief Executive

Failure to develop

realistic costing and

pricing model for our

services to support

business development and

ensure the

competitiveness of our

services in specific market

sectors

Lack of clear pricing

strategy leading to non-

competitiveness and

over/ under pricing

Investment in PLICs and

transition plan to PBR

Director of Finance

Activity recording, monitoring

and reporting in place to support

model

Product specification Medical

Director

Data Quality to

support use of PLICS

and move to PbR

Business Development reporting

to Board growth.

Chief Executive

Failure to develop

effective partnership

arrangements to support

new business

opportunities

Loss of IP and missed

opportunities to secure

new business & learn

from others’

complementary skills

Development of a range of

partnership arrangements (formal

and informal- to support our

strategy

Director of Finance / Chief

Executive / Medical Director


to Board growth.


Chief Executive

Failure to develop a

Wholly Owned

Subsidiary to support

new business

opportunities and

Loss of existing

business within highly

competitive social

care markets

Initial vehicle created by March

14

Head of Business Development

Targeted advice based on

learning from elsewhere on initial

Consultation required

with staff


to Board


Chief Executive


support

competitiveness of our

offering

service and staff transfer Staff consultation

Director of Quality (Nurse

Director)

Failure to achieve our

focus on quality and

safety

Failure to achieve and

evidence ongoing

compliance with

Registration and Licence

requirements

Deregistration of

services / loss of

licence – impact of

commissioner

penalties; ineligibility

for new business

opportunities e.g.

PQQs, AQP;

reputational damage

Continued rigorous assessment of

services to ensure early warnings

spotted and acted on

Director of Quality

Quality Risk and Safety reports

to Board. KPI dashboard, Deep

Dives, PSRs, Walkarounds now

including Governors, Risk

Register - Director of Quality

Failure to measure and

report on the quality

outcomes and benefits of

our services and

interventions

Commissioners

withdraw contracts /

do not aware new

contracts as value is

uncertain

Outcome reporting in place

CORC - Director of Quality

Service Line Reporting in place

(PLICS) – Director of Finance

Outcomes monitoring

(HONOS) not

successful – other

method being

introduced

Clinical Quality indicators

Director of Quality

Failure to focus on

quality during scale of

change

Increase in incidents

and / or serious

incidents and ensuing

reputational damage

Ward to Board reporting – KPIs,

Deep Dives, PSR, walkarounds,

risk register- Director of Quality

PMO approach to change –

Director of Strategic Change

Clear implementation plan and

hotspot monitoring in place to

support 24/7 programme – pays

attention to each phase – Director

of Mental Health

Low incident reporting

expressed by Staff

Survey responses

Staff survey action plan –

incident reporting culture

Quality risk and safety reporting

to Board – (ward to board)

Director of Quality

Risk Register

Strategic Change programme

board reporting


Director of Strategic and

International Development

Failure to focus on

experience improvements

Damage to reputation

leading to loss of

business

Missed opportunities to

attract new customers

Real Time Experience priority in

Quality programme

Director of Quality

Staff survey action plan

Inpatient and Community Survey

– deep dive actions plans

Director of Quality

Indicators from

national survey in

lowest 20% nationally

- incident reporting

- feeling make a

difference

- medication

information

- care plans

- environment

-

Quality reporting to Board

Quality Committee assurance

processes

Audit programme

KPI – Real Time Experience

tracking

Deep Dive progress reporting

Director of Quality

CQC action plans

Director of Quality

Failure to improve our

data quality

Inability to accurately

monitor our

performance

Continued improvement

programme for data quality Data Quality

recommendations

implementation

Auditor s

recommendations

implementation

CIO reporting to Board

Director of Strategic &

International Development (CIO)


Failure to engage and

manage our staff

effectively

Failure to secure

continued improvement in

staff management and

experience

Difficulties in

recruitment and

retention of high

quality, capable and

motivated staff –

resulting in poor

experience/

outcomes/ safety for

people who use our

services

Mandatory training deliver;

Clinical community engagement

-Medical Director

Appraisal and supervision and

Workforce strategy

implementation -Director of

Quality

Staff KPIs

Director of Quality

Leadership Faculty programme

Assistant Chief Executive

Failure to develop a

technology enabled

organisational culture

and skilled workforce

Missed opportunities

for quality (outcomes,

safety and

experience)

improvement,

efficiency

improvement and

business

development.

Failure of our

community hubs

Development of generic

specification for community hubs

– developed with focus on

Innovation and building in use of

technology to transform service

Director of Strategy &

International Development

Failure to work in

partnership with

health and social care

partners, including

commissioners, to

integrate to make the

best use of collective

resources available to

us

Failure to develop

services which meet the

needs of our different

purchasers and make best

use of resources

Loss of services and

income – jeopardising

sustainability

Missed opportunities to

secure new business

and contribute to

system-wide

transformation –

resulting in continued

Clinical strategy implementation


Medical Director

Director of Innovation &

Therapies

Better Care Fund –

ring fence to protect

mental health services

from top slice not

respected locally

As above for business

development programme

(growth) reporting

Chief Executive

Negotiations with commissioners

to ensure mental health is

prioritised for BCF investment

but not top slice


pressure on core

services

Director of Finance

Failure to improve our

reputation

Failure to build

confidence in our

capability as an

organisation, the services

we offer and benefits

people achieve from using

our services

Loss of existing

services / income and

failure to secure new

business development

opportunities

Continued focus on increasing

positive media; our digital

communications; and targeted

info. For key opinion formers e.g.

GP clinician to clinician,

Connecting for a Better Life

programmes

Medical Director/ Assistant

Chief Executive/ Director of

Quality

Quality programme focus on

outcomes and experience

Director of Quality

Leadership Faculty work

programme


Increased recognition through

national awards


Experience monitoring and

reporting to Board

Marketing and communications

programme

Director of Quality

Financial, Leadership Faculty

and business development

reporting to the Board

Director of Finance / Chief

Executive

Failure to engage our

communities and harness

their energies to help

achieve our overall

purpose

No improvement in

stigma experienced by

people who use our

services

No improvement in the

mental health of the

Governor development

programme

Connecting for a better life

embedding

Increased membership

recruitment and community

engagement e.g. Time to talk,

Continued Governor

development to

develop collaborative

relationship with

Board – culture

change re: new duties

Health and Social

Joint Board and Council

workshops

Governor development

programme implementation

overseen by Council


communities we serve Time to Change

Changing Futures (staff)

Director of Quality

Care Act Development Committee

Board development programme

including Non-Executive

Director succession plan (end of

term of office)

New Council elections and

Governor induction


Increased membership and

membership activity

Director of Quality


A7 Workforce priorities

Our Workforce Strategy and plans over the next two years are summarised in Section 4.2.1 of the

Operating plan. It anticipates a shift in our skills mix and changes to the overall numbers in the next two

years. The table below lists our anticipated alterations to workforce establishments by professional

groups within our current portfolio. This detail has developed in line with our clinical strategy, our service

delivery plans and overall performance and financial frameworks. Within our planned service

reconfigurations there are no planned redundancies and any that emerge will be minimised through

redeployment and will occur only as a last resort.

Actual as at 31 March

2014

April 2015 April 2016

Clinical Staff

Consultants (not locums) 81.7 74.7 72.2

Locum Consultants 5.9 5.4 5.3

Consultants (Total) 87.7 80.1 77.5

Junior Medical – career grade 34.5 31.5 30.4

Junior Medical – trainee grade 27.2 24.8 24.0

Junior Medical – Other 0.37 0.3 0.3

Junior Medical (Total) 62.1 56.6 54.7

Registered Nurses – Acute, Elderly &

General

595.7 570.4 551.5

Registered Midwives 0 0.0 0.0

Registered Health Visitors 0 0.0 0.0

Other Nurses, Midwives 0 0.0 0.0

Nurses and Midwives (Total incl Bank) 595.7 570.4 551.5

Allied Health Professional 126.0 115.1 111.2

Other Scientific, Therapeutic and

Technical Staff

163.8 149.6 144.6

Health Care Scientists 0 0.0 0.0

Sci, Tech & Therapy (Total incl bank) 289.8 264.7 255.8

Nurses and Midwives – agency, contract

Sci, Tech & Ther – agency, contract

Healthcare assistants etc 498.0 454.7 439.7

Ambulance paramedics 0.0 0.0

Social care staff 0.0 0.0

Other clinical 222.7 203.3 196.6

1755.9 1629.9 1575.8

Non-clinical staff

Admin & Clerical 251.3 229.4 221.9

Executives and Managers 90.1 82.3 79.6

Chair & NEDs 7.0 6.4 6.2

Agency & Contract

Other non-clinical staff 188.4 172.0 166.4

536.8 490.1 474.1

Total 2292.72 2120.0 2049.9


To underpin our organisational change programmes and deliver on our quality improvement programme, the following key projects are being progressed:

Strategic

development

Contribution to Strategic Plan Resources Actions/ Milestones

Risks to delivery

Culture,

Membership

and equality

Developed sense of belonging to SABP

Mutually respectful relationships between staff and staff and staff and people who use our services

Less reported incidents of abuse of staff

Reported by staff as the best place to work

Recommended as a place to receive services to their friends and family

Flexible contractual terms

Equality and Diversity social marketing strategy and quality and service improvement programme

Changing futures

Connecting for a better life

Talent and succession planning

Staff survey action plan

National negotiations distract from local conversations

Workforce

planning

All clinical staff will be skilled in physical health care

RAID model implemented

Early detection and early intervention capability increased

Consolidation of administration and duty staff to reflect community hub development

24/7 workforce ready for specialist acute hospital programme

£ 60k Learning and development priorities

Leadership development

Busy operational roles prevent time release for reskilling / re-training staff for future roles New ways of working may take time to embed in teams

Recruitment

Strategy

Increased recruitment of staff in younger age groups

Good preceptorship programmes

Clinical leadership development centres to grow capability and expertise

Increase commissioned numbers of nurses and doctors in education - influence programme to provide skills needed for clinical strategy

Human

Resources and

marketing plans

Influence at LETB

Assessment centre

Care pathway skills development – acute care pathway, personality disorders, body and mind, early detection and intervention

Resource sufficient to maintain high quality programmes for development and assessment programmes reaching beyond senior leadership within the organisation

Labour shortages of mental health nurses and psychiatrists

Our Board monitors key workforce performance targets through the Key Performance Indicator dashboard which focus on the following key aspects of

ensuring a strong workforce; Sickness absence, Appraisal, Statutory and mandatory training, Vacancies. All significant service transformation projects

are subject to business case approval at the Executive Board and include consideration of the impact on staff.

operational plan document for 2014-16 surrey and borders

Documents