SUMMARY BUSINESS PLAN 2015/16

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1 SUMMARY BUSINESS PLAN 2015/16 ANGLIAN COMMUNITY ENTERPRISE (ACE) COMMUNITY INTEREST COMPANY IMPROVING HEALTH AND WELL-BEING IMPROVING HEALTH AND WELL-BEING

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3 Contents Introduction and profile 4 ACE s services 6 Delivering quality of care 8 Social impact 9 Community and stakeholder involvement 10 Staff ownership and influence 11 Service delivery and development 11 Finance and performance 12 Commissioners and income 12 Improved efficiency and productivity 13 Business and financial risks 13 Governance and leadership 14 Governance framework 14 Key performance indicators 15 Current and future workforce profile 15 Organisational development 15 A N G L I A N C O M M U N I T Y E N T E R P R I S E ( A C E ) C O M M U N I T Y I N T E R E S T C O M P A N Y 3

4 Introduction ACE is a multi-award winning social enterprise providing a comprehensive range of community health and well-being services across Essex and increasingly in Suffolk. ACE has a history of safe, efficient service delivery. Each year we generate an income approaching 56 million. A Community Interest Company employing over 1,140 staff, ACE is limited by shares and employee owned. We maintain a NHS ethos and abide by the NHS Constitution. We continue to embed the National Nursing Strategy The 6C s of Care and Compassion Care, Compassion, Competence, Communication, Courage and Commitment across ACE. Achievements Over the past year, ACE has continued to develop as a social enterprise and a trusted provider of high quality health care services. Examples of some key successes are: An average of 99.03% compliance against target-based Key Performance Indicators; Maintenance of regulatory standards, e.g. Care Quality Commission Essential Standards of Quality and Safety (ESQS); registration as a Community Interest Company; Level 2 compliance in the national Information Governance Toolkit; The introduction of the Rapid Assessment Service (RAS), an innovative new model of health care designed to provide care closer to home and avoid unnecessary admissions to Colchester Hospital is going from strength to strength; Expansion of Services outside of North East Essex, for example the Weight Management Programme for Mid Essex; UK shortlisted finalist for Social Enterprise of the Year in the National Social Enterprise Awards ACE was the only spin-out organisation to be shortlisted and this has been acknowledged nationally as a tremendous achievement. Challenges 2015/16 continues to be a pivotal year for ACE, with the organisation s principal commissioner s procurement Care Closer to Home, having significant implications for ACE s future. We responded to this risk through the implementation of a structured programme of preparation to respond to these commissioning intentions. As a result in July 2015, ACE was awarded the seven year contract that will see patients having access to greater person-centred, co-ordinated care and support in the future. We hope you find this summary document both informative and easy to read. We would welcome any feedback via info@acecic.nhs.uk Lynne Woodcock Managing Director Richard Kearton Chairman S U M M A R Y B U S I N E S S P L A N / 1 6 4

5 Vision and missions To be the leader in the communities that we serve, providing innovation, quality, and value for money as we deliver healthcare services that are accessible to all The vision is achieved through the application of the complementary social and commercial missions which define ACE s key purpose. These are: Social mission To maximise our role as a service provider, employer, purchaser, community member, partner and investor to improve the health and well-being of the communities in which we work. Commercial mission To provide effective, profitable, value for money services which meet the needs of our customers and support organisational growth. and by our organisational values: Organisational values 1team Action-oriented Community-focused Excellence, in all we do Strategic Objectives ACE s vision, mission and values are delivered through 5 Strategic Objectives: Survive and thrive: Managing the business to ensure continual and on-going viability. With you, not to you: Delivering safe, high quality care. Keep lean, keep keen: One enterprise, one purpose, one voice: Continual development of efficient services that meet customer needs. Developing a culture of one team with a common purpose. Make and measure social impact: Making a social investment. 5 5

6 ACE s services Year on year, we make improvements in services and work closely with local communities and partners to bring about the most effective outcomes, enhance quality of care and improve the health and well-being of the local population. A summary of the services that ACE provides is shown in the table below. For further information on all these services, please visit the ACE website at Children s Services Paediatric Rehabilitation (Occupational Therapy and Physiotherapy) Paediatric Speech & Language Therapy Specialist Health Visitor and Specialist Continence Nurse Children s Community Services (Health Visiting and School Nursing) Looked After Children Learning Disabilities Occupational Therapy Speech and Language Therapy Physiotherapy Football for Life Dietetics Sexual Health Primary Care Dental Services Health and Well-being Stop Smoking Service Sexual Health Tier 2 Weight Management Health Trainers NHS Health Checks GP Care Advisers End of Life End of Life Care Team A N G L I A N C O M M U N I T Y E N T E R P R I S E ( A C E ) C O M M U N I T Y I N T E R E S T C O M P A N Y 6 6

7 ACE s services Rehabilitation Occupational Therapy Physiotherapy Podiatry Tier 2 Musculoskeletal Intermediate Care Falls Prevention Speech and Language Therapy (Adult) Early Supported Discharge Service for Stroke Clinical Assessment Service Care Closer to Home Community Matrons Community Nursing 2 Community Hospitals Rapid Assessment Service (RAS) Minor Injuries Unit Lymphoedema Service Long Term Conditions Cardiac Rehab Chronic Obstructive Pulmonary Disorder (COPD) Heart Failure Home Oxygen Assessment and Support Service Pulmonary Rehabilitation Tissue Viability Urology and Continence Services Alternative Provider Medical Services (APMS) 4 GP Practices Other Services Primary Care Support England Safeguarding Children and Adults Infection Prevention and Control Community Dental Service S U M M A R Y B U S I N E S S P L A N /

8 Delivering quality care ACE is proud of the high quality services that it provides. We have robust quality assurance and governance systems that ensure: ACE staff at all levels are engaged in the quality and assurance agenda; Evidence of compliance with registration and legislative standards and requirements; Outcomes and effectiveness of service delivery is monitored; Service user opinion and feedback is collected, analysed and lessons learnt on their experience of services and care provided; Assurance for commissioners, the public and all stakeholders that resources are well deployed; Assurance for service users and carers that safety is not put at unnecessary risk and that safety incidents are reviewed and lessons learnt result in practice development and service improvement; and The right structures and effective reporting with appropriate controls and risk management at all levels. Each year we produce an annual Quality Account, giving us the opportunity to look back and reflect on the quality of our services during the previous year and set out priorities for quality improvements. It is written and provided to the populations we serve and is influenced by the outcomes of patient experience surveys, discussions with staff, and a review of the many indicators of quality we measure as a matter of routine. The Quality Account can found on the ACE website S U M M A R Y B U S I N E S S P L A N /

9 Social impact The guiding principle for ACE is our Social Mission. ACE s Social Impact Plan supports the achievement of the mission, with resources within it combining expertise, time and money. Decisions on the implementation of each element of the plan are agreed with the full input of ACE shareholders and stakeholders. 2014/15 has seen the continuing implementation of the plan, with achievements including: Element 1 - Investment Through the Social Impact Fund (SIF) ACE provides a percentage of any profit each year to Anglian Community Trust (ACT), to be used in line with the charity s objects: to promote and protect the social, mental and physical health, welfare and wellbeing of people in the communities in which ACE provides services. During 2014/15, ACT funded 129k to 38 projects/schemes. For 2015/16, we will develop a social return on investment mechanism. Element 2 - Corporate and Personal Volunteering In 2014/15, the Corporate and Personal Volunteering Strategy commenced implementation, with a directory of volunteering opportunities available which was jointly developed with ACE and the local Volunteer Centres. An example of corporate volunteering is three staff who took part in the Big Beach Clean Up with Marks & Spencer and the Marine Conservation Society. They spent a day, not only keeping the coastline clean and looking it s best, but to help preserve sea life at risk of ingesting plastic rubbish. For 2015/16, we will increase the number of staff shareholders who have undertaken corporate volunteering to 15. Element 3 - Career opportunities for both new entrants and those returning to employment ACE is working to support young people through apprenticeships and during 2014/5 has worked with Health Education East of England to develop a formal Apprenticeship Scheme and has recruited 5 apprentices. For 2015/16, we will support a further 10 (internal/external) apprenticeships. 9 9

10 Element 4 Doing business with local firms so we maximise the sustainability of the local economy. In 2014/15, 25% of ACE s spend on services/products/supply in its supply chain was with local businesses. For 2015/16, we will increase the number of local businesses that ACE has in the supply chain. We continue to be a Cabinet Office Mutuals Pathfinder organisation and ACE s Managing Director, a Mutuals Ambassador. This has enabled us to support aspirant mutual organisations and promote social enterprise. Community and stakeholder involvement Engagement and involvement of the public and stakeholders is a key principle in the continued success of ACE and crucial for maintaining incorporation as a Community Interest Company. A coherent and prioritised action plan has been developed and implementation is taking place to ensure that ACE is maximising the opportunities for wider community involvement and influence over the next 5 years. The action plan is broken down into Information Exchange between ACE and its communities; Access and Engagement to enable the community to be substantively engaged with ACE; and Exercise of Power to enable the community to be part of service development and in the longer term, the governance of the organisation. If you would be interested to receive regular updates about what ACE is doing, with a view to becoming involved, please go to our website at to subscribe

11 Staff ownership and influence In accordance with ACE s Articles of Association, all permanent and fixed term contract members of staff are eligible to hold a 1 share in the organisation. This share has no financial benefit, with no dividends payable, but it does enable shareholders to have an influence on key organisational decisions. Approximately 50% of eligible staff are shareholders, with numbers continually increasing. ACE aspires to have 90% of eligible staff members as shareholders in the future, with an objective during 2015/16 of increasing the current percentage. Shareholders have the ability to influence the decision making of the organisation through the elected Staff Council, for example: Joint work between the Community Forum and Staff Council on consideration of applications for social impact funding. Consideration of re-appointment to second term of office for Non-Executive Directors. Service delivery and development ACE s services are provided across communities, health pathways and in partnership with many other local service providers with a principle of providing services as close to home as possible. Patients want to receive and we want to deliver, high quality and integrated services, where teams within a discrete locality really know and understand the local community they serve. Alongside this, the NHS continues to face challenging times, with demand for services increasing, whilst efficiency savings need to be realised. Commissioners and patients want to see innovative solutions to this challenge. Through service transformation, ACE has been responding to delivery of care closer to home, outside of traditional hospital settings and in local community settings or in the home over the last few years by extending the range of services offered, the places from which they are delivered and developing a community-based workforce ready to work in new and different ways. This model of service delivery aligns to the commissioning intentions for 2015/16 of the North East Essex Clinical Commissioning Group, NHS England and Essex County Council, together with key strategy documents such as North East Essex Clinical Commissioning Group s 5 Year Strategy; Essex joint Health and Well-being Strategy and NHS England s Everyone Counts: Planning for Patients 2014/ /19. As we develop services for the next 5 years, we are: Retaining focus on our key purpose of maintaining and improving the health and well-being of our population; Continuing to play our role in increasing the quality, capacity and productivity across the full healthcare system in North East Essex; Supporting people to help themselves and keep themselves well; Building on our community involvement to enable the community to be involved in service development and delivery

12 Finance and performance ACE has continued to thrive in 2014/15 and has had a successful year in both service and financial growth. Financial Year Surplus (Before Taxation) 1 January March ,111,103 1 April March ,171 1 April March ,463 ACE has an expectation of delivering a profit in 2015/16 and based on current projections, the detail of this is shown below: Financial Year 2015/16 Income Expenditure Profit Before Tax 57.1m 57.1m 0.1m Commissioners and income We are contracted to provide NHS services, the vast majority of which are free at the point of access. In 2014/15, ACE s services were commissioned by the following commissioners: North East Essex Clinical Commissioning Group majority of community health care services. West Essex Clinical and Mid Essex Commissioning Groups Learning Disabilities Services Essex County Council - Public Health Services and School Nursing. NHS England GP Practices Contract, Community Dental Contract, Health Visiting and School Nursing Immunisations. Public Health England Immunisations. S U M M A R Y B U S I N E S S P L A N /

13 Improved efficiency and productivity The need to deliver services more efficiently and the on-going drive for productivity continues within both the NHS and Local Authority Commissioning sectors. The NHS target is to deliver 4% in year, although the CCG has a more ambitious target to achieve and this may further impact on ACE. Business and financial risks ACE s Board Assurance Framework (BAF) provides the organisation with a comprehensive method of recording and managing its principle strategic risks against strategic objectives. The critical strategic risk for ACE in 2015/16 is the loss of current or future business due to the impact of commissioning intentions and the expiry of some current contracts. 2014/15 continued to be a pivotal year for ACE, with the commencement of the organisation s principal commissioner s procurement Care Closer to Home, along with its re-design of Urgent Care and End of Life Care. These intentions had substantial implications on ACE s future, with a potential significant loss of income and risk to the viability of the organisation, if the contract was not awarded to ACE. ACE responded to this critical business risk through the implementation of a structured programme of preparation to respond to these commissioning intentions. As at result in July 2015, ACE was awarded England s largest current healthcare Care Closer to Home contract a seven year contract that will see patients having access to greater person-centred, co-ordinated care and support in the future. Governance and leadership ACE s governance arrangements aim to provide an effective overall framework which support ACE s commercial and social missions. Staff and stakeholder involvement in the governance of ACE is an important aspect for both the development of the organisation and to remain as a Community Interest Company. In the same way as a private limited company, ACE is controlled by the appointed Board Members and its shareholders. However, in addition, the Directors and Shareholders are responsible for ensuring that the company is run in such a way that it will continue to satisfy the Community Interest Test. Accountability for the success of ACE rests with the Board, however every member of staff also has a responsibility to own the actions and achievements of the organisation which will require cultural change. ACE s Articles of Association can be found on the ACE website at

14 Governance framework The ACE Board comprises four Non-Executive Directors (including the Non-Executive Chair) and four Executive Directors who have a wide range of skills and backgrounds. They are: Richard Kearton, Chair (Non-Executive) Lynne Woodcock, Managing Director David Harrison, Non-Executive Director Lawrie Payne, Non-Executive Director Anne Thain, Non-Executive Director Nicola Carmichael, Director of Operations Sharon Charlton, Director of Resources Jayne Hiley, Director of Clinical and Corporate Governance Further information about the Board, including each member s biography can be found on the ACE Website at S U M M A R Y B U S I N E S S P L A N /

15 Key performance indicators Key performance indicators have been identified to provide information and analysis and support decision making, monitoring and the development of key people related themes for the organisation. These are used to benchmark change and drive improvement within the organisation and also enable benchmarking with external organisations using recommended best practice indicators. The KPIs will change over time to ensure they are relevant for the organisation s needs. Analysing the indicators enables ACE to plan targeted actions or to drive or support change programmes. KPIs are reviewed at local management, Director and Board level. Current and future workforce profile The organisation currently operates with a workforce of 1140 staff (917 WTE), with the largest workforce areas being nursing and allied health professionals. Due to the need to drive efficiencies and contribute to the local economy s quality, innovation, productivity and prevention programme (QIPP), we recognise that the workforce will change over the coming years. In order to reduce the likelihood of redundancies we have maintained flexibility by holding vacancies, where possible, using temporary staff to fill some vacancies and have reviewed our age and length of service profiles. Therefore, we know we can redeploy staff and manage our resources effectively over forthcoming years. Organisational development ACE s Workforce and Organisational Development Strategy, continued to be implemented in 2014/15. Incorporating organisational development, it includes areas such as leadership and succession planning; performance management and appraisal and the rationalisation of mandatory training. ACE is continuing to work with the staff side on flexibility of the workforce. Multi-skilling is at the heart of the current discussions and by creating an interest in this and opportunities to join job swap banks etc, we intend to support and encourage movement around the organisation which will become accepted when flexibility due to service change etc takes place in the future

16 Anglian Community Enterprise (ACE) Community Interest Company The Crescent, Colchester Business Park, Colchester, Essex, CO4 9YQ 16

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