NSFT Strategy 2016to21 screenres

OurStrategy
2016 to 2021
The changing
Introduction
health system
This document describes Norfolk and Suffolk NHS Foundation Trust’s
five year strategy. It incorporates input gathered from engagement
events with staff, service users, carers, stakeholders, commissioners and
regulators throughout 2015.
All NHS organisations work within a larger health community;
this is the group of acute hospitals, primary care services, GPs,
social care and commissioners who work as a system to deliver
health and social care to their local populations.
We are clear that we need to deliver quality driven mental health services; embedded through an
organisational culture of continuous improvement and co-production. This must be underpinned by
an engaged workforce, financial sustainability and our shared values: positively, respectfully, together.
To realise this, our strategy has three core goals:
ike the wider health and social care
community, our Trust faces long-term
challenges, often outside of our control.
Demand for our services continues to increase,
whilst our funding declines. While we must
control our own costs, we recognise that ‘parity
of esteem’ is yet to be reflected in parity of
resources. Our Board will continue to campaign
to improve this position.
1. Improving quality and achieving financial sustainability
2. Working as One Trust
3. Focussing on prevention, early intervention and promoting Recovery.
These support our mission to be a champion for positive mental health, by providing safe, effective,
trusted services together with our partners.
This document explains how and what we will be doing over the next five years to achieve this
clear ambition.
L
Though our strategy is driven by quality rather
than finance, we are currently running at a
financial deficit. We spend more on delivering
services than we receive from commissioners;
this is unsustainable and services must be
delivered within our means.
Nationally, the NHS is responding to the Five
Year Forward View, the NHS blueprint for the
future. This acknowledges that to meet the
challenges around demand, efficiency and
funding we must operate differently as
organisations; working collaboratively and
openly within the wider health community.
National guidance requires local health
community leaders to work together to create
five-year Sustainability and Transformation
Plans (STPs) to achieve this.
In support of the Five Year Forward View an
independent mental health taskforce was
commissioned to report specifically on the
transformation needed in mental health
services. It acknowledges that the NHS often
treats minds and bodies separately and that
mental health services have been underfunded
for decades. It makes recommendations for
the NHS to achieve the ambition of ‘parity of
esteem’ between mental and physical health,
including prevention, early intervention,
access to crisis care and better integration of
mental and physical health care with particular
emphasis on tackling inequalities. It also indicates
additional funding in the years to come.
Gary PageMichael Scott
ChairChief Executive
NSFT Trust Strategy 2016-2021
3
...so that
“parity of
esteem” for
mental health
is achieved and people’s
needs are recognised and addressed as a whole...
The Five Year Forward View also describes
options for future care models. Our preferred
model for the local health system is as a
Multispeciality Community Provider (MCP).
In this model, mental health, community
and social care services would wrap around
GP practices, breaking down the boundaries
between providers and transforming the
way people receive care in their communities
and reducing hospital admissions.
We will explore the opportunities for
creating MCPs with our wider health
community as we collectively develop our
local Sustainability and Transformation Plans.
This locality based integration would place
mental health at the centre of local care,
giving better access to physical healthcare
for our service users and to mental health
care for the wider population.
Within our wider health system our Clinical
Commissioning Groups (CCGs) and Local
Authorities are working to develop Integrated
Care Organisations, which bring services
from different organisations together around
patients and their carers to reduce the need for
hospital admissions. In addition, Norfolk and
Suffolk County Councils have expressed interest
in taking devolved responsibility from central
government which, if successful, could have
implications for the health budgets for Norfolk
and / or Suffolk.
Our Trust will play a central part in this
transformation of health and social care in
Norfolk and Suffolk. Pursuing the integration
of mental and physical health services will help
enable ‘parity of esteem’ for mental health;
ensuring people’s needs are recognised and
addressed as a whole, and making ‘no health
without mental health’ a reality.
Local demand
for services
Over recent years we have seen a sustained increase in demand for our
services across all age groups throughout Norfolk and Suffolk. Over the
next ten years Norfolk and Suffolk will have fewer people under 45 and
more people over 60 than the national average.
T
he two counties already have amongst
the highest proportions of people aged
over 75 in the UK and this is set to
continue and increase over the lifetime of this
strategy. This will mean greater demand for later
life services and increased co-morbidity with
long-term physical health conditions.
We are now planning services to meet this
demand; however, for our Trust and the NHS
as a whole to remain sustainable we must
focus on keeping people mentally and
physically well at a much earlier age.
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NSFT Trust Strategy 2016-2021
5
2
Our strategy for
local mental health services
Our over-arching vision is to work together for better mental health.
We are putting Recovery at the heart of what we do and, for us,
Recovery means people living the best life they can, with or without a
mental health condition.
Listening to our staff, service users, carers and stakeholders, we know we need to be clear about
our strategy to achieve this, which we will do through delivering our three core strategic goals. The
following explains what they mean for our Trust.
1
Improving quality and achieving financial sustainability
This means we will:
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Deliver trusted, effective, quality-driven services
Support and empower our staff to be the best they can in delivering services which are trusted and valued by local people
Involve service users and carers in development and decisions about the care and support they can access
Staff services safely to make sure we have time
to care
Ensure accountability and responsibility sits at the right level, so business and clinical decisions are made quickly and effectively
Become financially sustainable; delivering
services within our means
To achieve this we will:
• Embed a continuous quality improvement culture
• Lobby for appropriate funding for mental health services
• Embed our service user and carer involvement strategy
• Develop our leadership and management capability
• Employ and retain a skilled and responsive workforce
• Implement our cost improvement programmes and effectively manage our budgets
• Only deliver services where we are
appropriately funded to do so
Working as One Trust
This means we will:
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3
Work together as one organisation, for
better, sustainable mental health services, realising the benefits of our merger
Embed our values and behaviours across
all our services, and measure ourselves
against them
Give clear accountability and responsibility
to our staff throughout the organisation via our operating model
Play a central role in the system-wide
response to local health and social care challenges, increasing our collaborative working with other agencies
To achieve this we will:
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Implement Trust-wide clinical models wherever
it is possible, that are needs-led and flexed to local commissioning arrangements
Reflect our values and behaviours in
everything we do
Share performance information with our staff and hold people to account for delivery
Work together, sharing best practice and learning across the organisation, and with the wider health community
Develop strategic partnerships, where
appropriate, to deliver effective and sustainable services within our county boundaries and beyond
Focusing on prevention, early intervention
and promoting Recovery
This means we will:
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Increase our focus on primary care and prevention, whilst providing good quality in patient care for those who need it
Continue to positively promote Implementing Recovery through Organisational Change (ImROC) principles
Reflect local needs and deliver improved outcomes for our population
Seek integration, across Norfolk and Suffolk, with primary care, local authorities and other providers
To achieve this we will:
• Develop evidence-based clinical strategies for each service; co-produced with service users,
carers and commissioners, which improve outcomes
• Balance NICE and other national guidance with local commissioning priorities and funding
• Adopt Lean-based processes to underpin the delivery of needs-led pathways, and identify and address clinical improvement opportunities
• Maximise face-to-face clinical time, supported by more efficient ways of working and technology
• Centralise services where it is not possible to deliver them safely and sustainably at a local level
• Work with other agencies to keep people well
and to support Recovery
NSFT Trust Strategy 2016-2021
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...person-centred,
co-ordinated care...
One
Clinical Strategy
We are engaging our clinicians, service users, partners and commissioners
in developing a Trust-wide clinical strategy of core pathways and
packages of care which incorporate best practice and guidance.
Pathways will reflect what is needed and valued by our service users,
in order to achieve more consistent outcomes, increased choice and
improved patient experience regardless of location.
T
hrough this we will continue our
commitment to Implementing Recovery
through Organisational Change (ImROC).
This focuses on helping people who use our
services find ways to lead meaningful lives, with
or without ongoing symptoms of their condition;
where more people receive care which is,
This means:
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Service users will be seen in a timely manner by the person with the right skills first time. They will be listened to and their needs understood from the beginning of their care. There will be fewer repeated assessments. Care plans will be developed with service users and their carers to meet their needs in a co-ordinated manner
The core pathways will be sufficiently flexible to accommodate the local needs and requirements of each CCG and their population. For example, a CCG with a largely rural population and a higher proportion of older people may have different requirements to a more as far as possible, ‘self-directed’ and reflects
their own preferred goals and outcomes.
We will work in partnership with carers,
adopting Triangle of Care principles across
the Trust; valuing and supporting them so
that service users receive the best possible care.
•
•
•
urban CCG. The standard pathways may
require locally agreed enhancements
to reflect this
Local delivery will evolve over the lifetime of this strategy, reflecting the local
response to the Five Year Forward View, increased integration between providers
and new delivery models
The importance of meeting service users’ physical health needs and accessibility for people with learning disabilities will be reflected in all pathways
Quality will be more easily maintained and monitored, with clarity for staff and more efficient use of resources
In developing this model we will work with
the wider health and social care system to
integrate mental health care into their
services to meet people’s health needs in a
person-centred, co-ordinated way, reducing
duplication and improving people’s
experience and outcomes.
To deliver quality services we require the
right level of funding and resources. Where
evidence shows an investment in enhanced
pathways creates greater savings elsewhere
in the local health and social care system,
agreement on appropriate funding will be
sought from commissioners.
This means:
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•
Where we are providing a clinical service which has not been commissioned,
this will not continue unless
appropriately funded
Where pathways cannot be developed that
are safe and effective within the allocated budget, despite every effort, we will seek appropriate funding from commissioners or agree alternative interventions. In the event
that this is not achievable, we will reserve the
right to give notice on this element of our
contract, rather than deliver them at the cost
of other services or put our service users or
staff at risk
•
•
The clinical strategy will make best use
of the available resources, requiring
changes to practice to increase service
user contact time for clinical staff. This
will be supported by better use of
technology and greater integration with
the wider health system
The long-term use of temporary staff is neither financially sustainable nor conducive to team working and
continuity of care. Where it has
proven impossible to recruit to
vacancies for an extended period, safe alternative means of delivery will be identified, tested and implemented
This work will be led by senior clinicians and operational managers working collaboratively with service
users, carers and commissioners and be delivered and embedded over the lifetime of this strategy.
NSFT Trust Strategy 2016-2021
9
Workforce and Organisational
Development Strategy:
Putting People First
We have a workforce that has been commended for the care of
our service users. We value and are proud of the commitment and
contribution of every member of staff and want our staff to be
equally proud to work for our Trust.
We want staff to feel fulfilled, treated fairly
and valued in their roles, recognised for the
important contribution they make every day
and engaged in positively shaping the services
they provide and the culture of the environment
they work in.
Our model shown below illustrates organisational
development through our workforce and forms
the basis of our Workforce and Organisational
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The focus of how we achieve this is based
on developing a more engaged, skilled, and
responsive workforce, operating within a
supporting infrastructure of effective systems
and processes. Therefore, the three core
domains of the Workforce and Organisational
Development Strategy are:
• An engaged workforce
• A skilled workforce
• A responsive workforce
The pillars represent the enabling strategies
underpinning delivery. The model also highlights
the fundamental importance of developing a
culture of equality, diversity and inclusion,
which wraps around all three domains.
Development Strategy 2016 – 2021: Putting
People First. It reflects the strong evidence
base linking excellent workforce capability with
excellent organisational capability and higher
levels of staff experience with higher levels of
patient experience. We believe that if we can
develop our staff to be the best they can be
within a supportive but accountable leadership
culture, wider organisational improvements
will follow.
This will positively impact on the culture of the
organisation and improve its effectiveness and
quality by:
Trust objectives being cascaded
from the Board down into the
individual objectives of every
employee in a timely way
Developing an ethos of learning
from challenges and mistakes;
creating new solutions and
sharing knowledge
Minimising bureaucracy and
maximising attention on what
adds value
Using systems and data to drive
quality and efficiency improvements
Using data to measure impact
Supporting the development of a
culture that is supportive, cohesive
and positive where every employee
lives and operates by our values
Honest and timely communications
Whilst recognising the existing and emerging
challenges we face, through delivery of our
Workforce and Organisational Development
Strategy we will create a sustainable and
thriving organisation with an excellent
reputation for high quality patient care;
delivered by a proud workforce, who
positively shape our services and culture.
• Embedding the operating model
with clarity on leadership roles
and responsibilities
• Developing a culture that necessitates
the taking of responsibility with clear consequences for non-delivery
Organisational Capability
Our values and behaviours:
Patient Experience
Equality, Diversity and Inclusion
Positively... Respectfully... Together...
Equality, Diversity and Inclusion
Staff Experience
Our values were created by 1,300 staff
members, service users and carers, and
reflect what we believe makes the most
positive difference to the care we offer
Volunteer Workforce
Electronic Staff Record
Temporary Staffing
E-Rostering
Organisational and Role Design
Responsive
workforce
New Roles and Career Pathways
Talent and Succession Planning
Education, Training and Development
Recruitment, Reward and Retention
Staff Recognition
Staff Wellbeing
Vision, Values and Behaviours
Leadership and Management
...supporting
our staff to
be the best
they can
be…
Workforce Planning
Skilled
workforce
Engaged
workforce
Our values mean we will all:
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Involve people
Support people to set and achieve goals
Be professional
Recognise people
Keep people updated
Value everyone
Have two-way conversations
Step into others’ shoes
and the way we work. They underpin our
strategic planning, all we do and how we
behave within the Trust and with our
service users, carers and stakeholders.
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Speak up
Take time to care
Be proactive
Share knowledge and learning
Take pride
Be effective
Take responsibility
Workforce Capability
NSFT Trust Strategy 2016-2021
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How we will
deliver this locally
Our operating model provides a framework
for the management, governance and delivery
of all our services.
Involving service users and carers
In October 2015 we launched our service user and carer strategy
‘Improving Services Together’.
Modern
Matron
Lead
Clinician
Co-produced with service users and carers, it
brings together six commitments designed to
ensure people can positively engage with the
Trust and have a say in the way services are
developed. Its aim is to ensure the same
6 6
For clinical services this is delivered through a locality
manager, modern matron and lead clinician(s) working
as a team to manage services locally.
Our model has six objectives:
1. Simplify and standardise structures
2. Specify responsibilities so lines of accountability are easily visible
3. Align governance and support structures to provide effective support to front
line services
4. Strengthen how Trust objectives are cascaded to align everyone’s efforts
5. Strengthen how issues are escalated for additional support or intervention
6. Support devolved / earned autonomy by providing a risk-responsive assurance system that encourages innovation and safeguards against quality failure
Locality
Manager
standards of excellence are in place across all
services and localities. We will embed these
commitments over the lifetime of the strategy
through our annual operational plans and
individual objectives.
The six commitments are:
The lead clinician sets the clinical direction with
the modern matron monitoring and promoting
practice standards; led by the locality manager
who ensures resources are available and wellmanaged. Whilst these three roles have distinct
responsibilities they work together to ensure
the delivery of strategy, quality care, staff
engagement, financial balance, stakeholder
management and contract requirements. They
are supported by corporate team members,
including HR business partners, management
accountants, and the governance team.
Our specialist and corporate services are also
managed, governed and delivered using these
six operating model objectives.
1. Service users and carers will be able to
have their say in Trust business
2. There will be opportunities for service
users and carers to use their skills and experiences to improve services
3. We are changing the way we provide our services in line with our commitment
to organisational change
4. We will strengthen links and create partnerships with other agencies and service user and carer-led organisations
5. We will reach out to diverse and other under-represented groups
6. Service users and carers will ‘judge’ whether this strategy is being delivered
NSFT Trust Strategy 2016-2021
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How our strategy fits together
What this
means to me
Transforming care
through technology
We know that through technology we can
improve service delivery, increase face to face
contacts and better support our service users
and their carers. Our technology strategy will
be developed in partnership with our service
users, carers and clinicians and as part of the
digital road maps all NHS providers
are developing.
Trust operational plan
Initiatives include:
How and
what we will
do to deliver
our strategy
• Using Skype so we can talk to each other and our service users (where appropriate) across counties, saving travelling time
• Sending service users and GPs instant and up-to-date electronic communication on progress and decisions, keeping people involved and informed about their care and progress to support safety and quality
• Ensuring our single electronic patient record fully supports clinical decisions and care, keeping everyone involved in a service users care informed
• Safely sharing information with other health providers, so we support people, whenever they need it and wherever they are, through having the right information
Our over-arching
plan and goals to
achieve our mission
As part of this our focus remains on reducing
the number of costly and / or unsuitable sites
and developing health campuses; where
possible, in partnership with other agencies.
We will also play a key role with other health
and public sector groups on the sharing of
accommodation and working towards
“one public estate”.
Five-year Trust strategy
1. Improving quality and achieving financial sustainability
2. Working as One Trust
How we all act with
each other, our service
users and carers
© April 2016. NSFT. Leaflet code: 16/015. Review date: April 2021. GFX: 4125
As part of our commitment to the national Sign
up to Safety campaign, a fundamental principle
for all our estate is to provide an environment
that reduces the risk of harm.
Supporting strategies
Clinical, workforce and organisational development,
service user and carers, technology, estates
Reviewed
every
3-5 years
Consolidating our estates
Effective estates management plays an important role
in providing quality care and our estates strategy will be
developed and delivered alongside our clinical strategy.
Reviewed
yearly
Locality and service plans
How we
all deliver
this locally
Our aim is to give staff the skills and tools
to work smarter and spend more time delivering care.
Our focus is to provide a robust, responsive
infrastructure and support service to all our
staff through effective technology solutions
which support clinical care.
My objectives
Our future – why
we come to work
Our purpose – what
we want to achieve
for everyone
3. Focusing on prevention, early intervention and
promoting Recovery
Our values and behaviours
Positively, respectfully, together
Revisited
every
6-10 years
Our vision
Working together for better mental health
Our mission
To be a champion for positive mental health,
by providing safe, effective, trusted services
together with our partners
Doesn’t
change
NSFT Trust Strategy 2016-2021
15
Patient Advice and
Liaison Service (PALS)
NSFT PALS provides
confidential advice,
information and support,
helping you to answer any
questions you have about
our services or about any
health matters.
Trust
Headquarters:
Hellesdon Hospital
Drayton High Road
Norwich
NR6 5BE
If you would like this leaflet
in large print, audio, Braille,
alternative format or a
different language, please contact PALS
and we will do our best to help.
Email: PALS@nsft.nhs.uk
or call PALS Freephone 0800 279 7257
01603 421421
nsft.nhs.uk
@NSFTtweets
NSFTrust
Norfolk and Suffolk NHS Foundation Trust values and
celebrates the diversity of all the communities we serve.
We are fully committed to ensuring that all people
have equality of opportunity to access our service,
irrespective of their age, gender, ethnicity, race,
disability, religion or belief, sexual orientation, marital
or civil partnership or social and economic status.