FINAL Business Plan 2016/17 Approved 31 st March 2016
Table of contents Material changes between the Draft and Final Plan... 1 Introduction... 2 Statement of Intent Regarding our Future... 3 Approach to Activity Planning... 4 Approach to Quality Planning... 5 Approach to Quality Improvement... 7 Data for Quality... 8 Supporting our Staff... 9 Seven Day Services... 11 Quality Impact Assessment Process... 11 Approach to Workforce Planning... 12 Approach to Financial Planning... 13 Financial Forecasts and modelling... 13 Key Assumptions... 15 Strategic Developments... 15 Non Contract Income... 15 Financial Risks... 16 Efficiency Savings for 2016/17... 16 Capital planning... 17 Link to the Emerging Sustainability and Transformation Plan (STP)... 18 Membership and Elections... 19 Priorities for 2016-17... 20 Key risks to the delivery of our plan... 21
Material changes between the Draft and Final Plan In moving from the draft plan to final plan the following areas have been added in more detail. Further development and refinement of our efficiency plans and downside mitigations to our overall financial plan. Further identification and development of service transformation plans aligned to the emerging outcomes from the system programmes in place. Further refinement of specific service plans across the Trust within the overall plan. Finalisation of performance delivery plans for NHS mandate/constitutional standards. Finalisation of contract negotiations with commissioners. Finalisation of our capital investment priorities in line with the above. Outcome of Board s consideration of organisational position within the local health sector operating environment 1
Introduction This plan has been prepared in line with NHSI requirements and has been considered by the Board of Directors and approved. The plan has key areas of emphasis as follows; Continuation of the Trust s successful approach to establish a culture better able to support continuous service improvement and quality. A stretching financial plan to meet the control total set out by NHSI. Areas of stretch to meet key constitutional standards from current performance levels in some RTT specialties and new MH standards backed up with plans to achieve this. Dependency on significant partnership working with commissioner, local authorities and other NHS providers in Cumbria to transform services (Success Regime, Better Care Together Vanguard, Cumbria Mental Health Strategy, and Cumbria Children s Improvement Plan). A clear forward organisational ambition within the context of our wider health and care system. In preparing our plan we have taken forward negotiations with commissioners to; Acknowledge the dependency our plan has on the need for whole system transformation. Appropriately apportion risk between with commissioner and provider within the contract. Secure funding in line with national planning assumptions for our services. Secure ongoing funding for the delivery of key developments aligned with our plan. We have exchanged Heads of Terms for our contract settlement for 16/17 reflecting these issues. Explicitly, in our financial plans we have identified opportunities for internally generated efficiency of 2% and a reliance on system enabled efficiencies of at least 1.4% in addition to this. We have programmes in place to deliver the 2% efficiency in full during the year, however our ability to reach our control total is dependent upon whole system enablement and we are working hard to secure this in our contracts and in the Success Regime, Better Care Together Vanguard and Cumbria Mental Health Strategy. We have prepared contingency plans to mitigate this risk. 2
Statement of Intent Regarding our Future CPFT has created a compelling organisational vision and strategy that has driven engagement, improvement and cultural change over the last few years. Strong partnership working within the wider health and care system is a key plank of this strategy in order to transform services across care settings. Our collective effort with partners has resulted in the development of shared programmes of change in the Better Care Together Vanguard in the south; Success Regime in the north, east and west; and county-wide partnership strategies for Mental Health and Learning Disabilities, and Children and families. However, increasingly, there are mixed messages about what these programmes of change mean for our staff, for our services and for the long term future of our organisation. Therefore, the Board has developed a short statement setting out our organisational perspective and ambition within the wider system. This is intended to inform the development of shared vision and strategy in our system work; and serve as a base for refining our You and the Big Picture narrative internally, in order to provide greater clarity to our staff and stakeholders about our future. 3
Approach to Activity Planning The Trust s services are provided from 4 operational care groups. Each of the services is specified in a block contract. The basis of the block contract has been an annual roll over of activity adjusted for changes (service reductions/increases) as agreed in contract negotiations. Baseline activity information has been jointly drafted with commissioners as a basis for contract negotiations. Specific areas of service change remain to be specified with activity levels for some inpatient and outpatient areas (neurology and community paediatrics) where RTT and DTOC service performance are also key issues for the Trust. The Trust has successfully secured agreements to recovery trajectories for key constitutional standards with commissioners as part of the contracting process. Following agreement of contracts we expect to meet activity levels in our contract albeit there are major dependencies on workforce supply and the effectiveness of improved rostering that the Trust is implementing. Specific areas of activity that are subject to detailed capacity and demand management are; Neurology Community Paediatrics Restorative Dentistry IAPT Paediatric Audiology These plans are dynamic and are reviewed monthly within the Trust s Quality Governance arrangements. The Trust has attended the NHS Improvement demand/capacity training and is utilising recommended tools/methods to address the issues we face. We have agreed with our commissioners recovery trajectories for the areas of performance risk for 16/17 and have plans in place to meet these trajectories accordingly. These plans are monitored throughout the year including through a monthly Board of Directors committee. The plans include limited use of the independent sector. 4
Approach to Quality Planning The Trust s vision and strategy is underpinned by 4 clear objectives; QUALITY (Q) Consistently delivering the highest possible quality of service we can achieve. PEOPLE (P) Realising the full potential of everyone we work with and the talent of all our staff. SERVICES (S) Transforming our services to improve them for the people we serve. EFFICIENCY (E) Being relentlessly efficient and effective to ensure we are financially sustainable. To ensure we achieve these strategic objectives the Trust has established a framework of key outcomes and a business planning process that defines and cascades our plans to all parts of the organisation. This planning process includes the annual appraisal process and we therefore embed everyone s role into achieving the overall strategic plan. The 20 outcome areas we focus on are given in the diagram below; Our strategy for quality improvement, Together for Quality 2014-17, sets out our quality priorities which are connected to the needs of the population and the 5 quality outcomes in the above scorecard. The Trust participates in the annual publication of avoidable deaths per trust in line with national requirements. In November 2015 the CQC carried out a comprehensive inspection of the services provided by CPFT, involving 85 inspectors carrying out a total of 61 planned inspections. 5
We welcome the CQC s inspection as a tool for continuous improvement. The Trust was assessed on the following five areas overall, which were each given a separate rating: 1. Are services safe? Requires Improvement 2. Are services effective? Requires Improvement 3. Are services caring? Good 4. Are services responsive? Requires Improvement 5. Are services well-led? Requires Improvement In total, 14 separate reports have been published which also rate services on these five areas. The 13 service areas were given the following overall ratings: Community services Community inpatient services End of life care Childrens and young people s universal services Learning disabilities inpatient services Learning disabilities community services Adult inpatient mental health services Older adult inpatient mental health services Adult Community Mental Health and Recovery Teams Older adult Community Mental Health and Recovery Teams Crisis Resolution and Home Treatment Team Mental Health Rehabilitation Child and Adolescent Mental Health Services Good Requires Improvement Requires Improvement Inadequate Inadequate Good Requires Improvement Requires Improvement Good Good Good Good Requires Improvement In taking forward improvements following the inspection the Trust has prepared an improvement plan which will be discussed with CQC, commissioners and partners at a quality summit in April 2016 in line with usual protocols following a comprehensive inspection. Following a significant refresh of the Trust s strategy the Trust has been implementing its quality improvement plans and broader strategic objectives for the past 18 months and as such has met the requirements of Monitor s enforcement undertakings applied in late 2013. In December 2015, Monitor lifted our Enforcement Undertakings following the outcome of an external review by Deloitte s of our quality governance arrangements against the Well Led Framework. There are no outstanding actions associated with the enforcement undertakings. The Trust is continuing to improve its arrangements and has recently agreed a Governance, Assurance and Accountability Framework to continue this process. The Trust s planning cycle enables a full and broad process of strategic assessment, review and planning to take place linked to all levels of the organisation and our external stakeholders. The process is set out in the diagram below; 6
Approach to Quality Improvement In line with our overarching strategy and the 4 strategic objectives above the Trust has established a core set of values to shape the culture of continuous service improvement within the organisation. These are set out below; The Director of Quality & Nursing has Board-level accountability for quality governance and for delivery of our quality priorities, which for 2016/17 remain as:- learning lessons, patient, service user, carer and staff experience and engagement avoidance of harm During 2015/16 the Trust established a Governance, Assurance and Accountability Framework (GAAF). The GAAF demonstrates how the Trust s quality systems and organisational learning is overseen and supported by an effective committee 7
structure. The framework also links to Monitor s Well-led framework for Governance and the well led domain of the Care Quality Commission (CQC) comprehensive inspection framework. A Quality and Safety Directorate is in place ensuring expertise on key areas such as safeguarding, patient experience, legal processes, clinical governance and risk management is deployed throughout the organisation s 4 care groups and support services. In addition during 2015/16 the Trust has built capacity and capability in quality improvement through the development of a workforce and OD function and creation of a service improvement team. We are a founder partner of the Cumbria Learning and Improvement Collaborative (CLIC) to deliver training on implementing the Cumbria Production System for quality improvement to staff across the Trust (over 200 to date). This set of improvement tools is largely based on proven lean methodologies. The same improvement methodologies are also adopted by partners across the health and social care system and this is a key enabler for system wide collaboration and integration. Data for Quality During 2015/16 we rolled out quality and safety dashboards to clinical services. Quality and safety dashboards contain real-time performance information and are therefore an enabler in the management and mitigation of risks to quality, safety and efficiencies. Dashboards are readily accessible to clinical and operational leads and enable triangulation of quality, workforce and financial performance indicators at Board, Service and team level. We will continue to refine and develop the use of dashboards during 2016/17. The Board of Directors receives integrated reports, based upon triangulated performance information, at each meeting. These are used to inform Board-level decisions on strategic matters. Clinical safety dashboards, which are populated with live data, are readily available to teams and services and enable timely planning and response to quality issues which may arise. The Board has identified that continued improvements to both reporting and data quality within the Trust are major enablers and priorities to underpin our overall quality improvement journey. To achieve these improvements the Trust is implementing electronic patient record (EPR) systems across all services with 3 of the 4 care groups now using these systems by 31 st March 2015. During 2016/17 we plan to roll out EPR to the Mental Health services and our implementation plans are fully reflected in our annual plan submission. Risks to the achievement of our strategic objectives are articulated in our Board Assurance Framework and monitored through our risk management processes. The Board of Directors has line of sight to the management of significant risks through our corporate governance and Board Assurance Framework processes. Our clinical governance arrangements and quality governance frameworks are structured to enable the effective identification, management, escalation and reporting of risks to quality. 8
The Trust has in place a structured approach to performance indicators to support quality improvement; These indicators are developed to support effective practice at the frontline (micro level) available to practitioners and we are building the meso and macro reporting throughout the organisation across our 4 strategic priority areas of QPSE; Quality, People, Services and Efficiency. This approach gives a balanced view and enables us to empower individuals in addition to have a whole organisational view. Our Governance, Accountability and Assurance Framework includes a detailed list of the indicators we utilise and these have all been agreed in our care group clinical governance forums during the year. Supporting our Staff Through our regular You and the Big Picture process for staff engagement we undertake values-based appraisals which promote our golden thread aligning individual objectives with organisational priorities so that everyone is clear about which team they belong to, what is expected of them, how they are doing, and how their work contributes to the overall aims of the Trust, as well as engaging with staff about their training, development and educational requirements. This then feeds into our systematic learning needs analysis process, now into its second year, which culminates in care group and support service plans, ensuring prioritised and targeted allocation of training and development funding. Our appraisal window is during April to July in order to embed our business plan priorities into team and individual work plans at an early stage in the year. 9
The Trust has actively taken forward plans to support staff, for example implementing Great Care Great Teams, the Trust s adaption of the workforce and team engagement toolkit developed by Wrightington, Wigan and Leigh NHS Foundation Trust. This and other initiatives are reflected in the most recent national staff survey outcomes; Summary of Your Organisation 2015 staff survey scores: The Trust scores very well in this section with encouraging improvements since 2014 and many scores in the top 20% for the sector. There have been significant improvements in the "Friends and Family Test" questions since last year. 59% of staff would recommend the Trust as a place to work (up from 49% last year); and 70% would be happy with the standard of care for a friend / relative (up from 61% last year). These scores are both well above average. 79% of staff say that they are enthusiastic about their job (an improvement on 72% last year and now in the top 20% for the sector). Overall staff survey results compared to other local organisations; Headline Data from the 2015 NHS Staff Survey Q21 Care of patients/service users is my a Q21 My organisation acts on concerns raised by b Q21 I would recommend my organisation as a c Q21 d Score CPFT UHMB NCUH CCCG Distance from Average Distance from Average Distance from Average Comparator Average Score (+above -below) Comparator Average Score (+above -below) Comparator Average Score (+above -below) Distance from Average (+above -below) Comparator Average organisation's top priority - % 75 +2 73 74-1 75 65-10 75 58-25 83 patients/service users 75 0 75 71-2 73 54-19 73 57-25 82 place to work - % 59 +2 57 62 1 61 43-18 61 25-51 76 If a friend or relative needed treatment, I would be happy with the standard of care provided by this organisation - % 70 +3 67 64-6 70 52-18 70 18-47 65 KF1 Staff recommendation of the organisation as a place to work or receive treatment - Score on OIS E a 0 to 5 scale 3.78 +0.07 3.71 3.72-0.04 3.76 3.36-0.4 3.76 3.08-0.87 3.95 Overall Indicator of Staff Engagement - Score on a 0 to 5 scale 3.87 +0.06 3.81 3.78-0.01 3.79 3.6-0.19 3.79 3.48-0.49 3.97 10
Seven Day Services The Trust provides services that are a mixture of elective and non-elective care. Non elective care is provided through primary care assessment and minor injuries units which are 24/7. General community nursing provide services 24/7. Community Mental health crisis services are also 24/7. Inpatient services in both mental health and general community services are 24/7 although admissions to general community services during weekends are limited by availability of key medical skills in some remote locations. CAMHS out of hours services (including weekends) are not commissioned or adequately provided for in Cumbria and this remains a key priority for the Trust and commissioners to address in future. Most other services provided by the Trust are elective and as such are largely offered across the county in convenient locations during weekday working hours. We recognise the ambition set out in in the NHS Forward View to expand the range of seven-day services and deliver better integrated services to enhance the patient offer and will use our strategic partnerships to develop a safe, affordable and riskbased approach to the expansion of seven day services across Cumbria. This will form part of the Sustainability and Transformation Plans (STP) for Cumbria. Quality Impact Assessment Process The Trust has an agreed Quality Impact Assessment process which is overseen by our Medical Director and supervised by a sub-committee of the Board. The process is clinically-led, managed through our established governance framework, and through the Board s Quality & Safety Committee, provides the Board of Directors line of sight to the impacts of cost improvement programmes and major change schemes. To deliver our efficiency programme we have in place a formal efficiency programme board that is CEO chaired and has medical and nursing directors as core members alongside all other executive team members and care group representatives. Our approach includes in-year monitoring and reporting of actual quality impacts. We will continue to follow this process for our 2016/17 efficiency programme and for any major change schemes that form part of the STP. Our QIA process is set out below: 11
Approach to Workforce Planning The Trust has in place a People and OD strategic plan that covers the breadth of issues that are relevant to our workforce. During 2015/16 the Trust appointed a Workforce Futures Manager in order to build skills and capabilities around workforce planning. Through this appointment, the Trust is now leading work to roll out the population centric six-step workforce planning methodology recommended by Health Education North West. Our clinical leaders are working with the Workforce Futures Manager on implementing the population centric workforce planning model within our Care Groups. We are also exploring and working together with our partners on implementing workforce planning tools and initiatives system-wide. The Trust is integrating the WRaPT workforce planning tool adopted at system level by the Success Regime and Better Care Together Vanguard. This tool supports our approach to workforce utilisation through analysing our attributable workforce at pathway and service level, and modelling skills and role requirements in line with service changes. Our operational plan for 2016/17 has been developed having due regard to workforce capacity to meet expected activity levels, delivery of our clinical strategies and quality priorities, and also the impacts of plan objectives on our financial position. We actively work with local universities and education providers on supporting existing staff and new students to access healthcare qualifications as a means of developing and building the resource pool for the Cumbria health economy. We are also working with local schools on Dream Placements. Key areas of workforce supply are risks to the Trust including medical staff in psychiatry, neurology and community paediatrics, and nursing staff in both mental health and general nursing. The Trust is currently utilising temporary staffing solutions (agency and locums) to mitigate these risks as much as possible. Residual 12
risk remains and the Trust has acted to restrict service availability in order to ensure safe services are offered in line with national requirements. Strategic workforce planning is intrinsic to our integrated business planning processes for future years. The development of a fully integrated business planning cycle is a priority for 2016/17 that includes more defined and developed workforce planning. In order to make best use of our current workforce and to reduce the cost of temporary staff we are taking forward a number of initiatives including; Introduction of e-rostering Expansion of the local nurse bank Adoption of the agency price caps and frameworks Targeted recruitment initiatives We have commenced improvements in rostering practice with the introduction of improved rostering policies and procedures in 2015/16 as a pre-cursor to introducing e-rostering during 2016/17. We are engaged with our system partners on the identification and development of transformational schemes, which may have workforce impacts. These schemes are currently under development and will be commented upon further as part of the Sustainability and Transformational Plan (STP). Approach to Financial Planning Financial Forecasts and modelling During 2015/16 Monitor undertook a detailed review of the Trust s plan submission as the Trust was planning an internally financed deficit for the year of circa 10m. The outcome of this process was that Monitor largely confirmed the Trust s assessment of its financial standing, but identified with the Trust opportunities to deliver a stretch target outturn for the 15/16 year of 7.4m. Based on M11 outturn and detailed forecasting, the forecast I&E outturn for 2015/16 is a deficit of 7.4m in line with the stretch target. This reflects an underlying deficit of 10m, partly offset by non-recurrent savings and delayed timing in strategic developments. The forecast closing cash balance for March 2016 is 9.2m which is in line with the original plan for 15/16, as the Trust offset the impact of delays to planned land disposals with an in-year decision to delay planned capital expenditure and other strategic developments, alongside non-operating expenditure underspends. The plan for 2016/17 is for an improvement in the I&E position to a deficit of 5.6m in line with the control total set out by NHSI. This reflects inflationary pressures, particularly pay and pensions, and the full year impact of strategic developments, but also contract income inflation assumptions based on national guidance, income from the Sustainability and Transformation Fund of 0.9m in line with the amount available via NHSI), and ambitious efficiency saving targets of over 3%. Due to the continuing (though reduced) deficit and the Trust s minimal capital expenditure plan, the cash balance is forecast to reduce to 6.9m by March 2017. On this basis the 13
trust has provisionally notified NHSI that it is unlikely to require access to financing (distress funding etc.) during 2016/17, subject to delivery of the financial plan and the risks set out below. In preparing the plan a detailed analysis of current position, pressures and trends has been undertaken across all areas of expenditure in the Trust. The draft plan has been reviewed by the Board through its Finance, Investment and Performance Committee in January 2016 and similarly by both forums in March 2016. The summary plan is as follows. million 2015/16 2016/17 PLAN FORECAST Income & expenditure Income 170.9 174.4 Pay costs 132.7 135.1 Non pay costs 40.1 37.4 EBITDA (1.9) 1.9 Depreciation, dividend & interest 5.4 6.8 Restructuring costs 0.1 0.7 Net surplus/(deficit) (7.4) (5.6) Capital expenditure 4.3 4.9 Closing cash balance 9.2 6.9 Financial Sustainability Risk Rating 2 2 The key movements in I&E position between 2015/16 and 2016/17 are: million million Forecast (deficit) 2015/16 (7.4) Non recurrent items 2015/16 0.5 Pay inflation & pension costs (4.2) Income inflation 1.8 Improved CQUIN performance 0.5 Sustainability & Transformation Fund 0.9 Recruitment to vacancies (0.8) Total (3.4) Less agency staff replaced 2.6 Strategic developments full year effect (3.4) Staff recruitment (1.4) Data centre managed service (0.6) Capital charges (1.4) Efficiency programme 5.8 Other 0.7 Planned (deficit) 2016/17 (5.6) 14
Key Assumptions The Trust has made the following key assumptions in line with national guidance and information. 3.4% increase in pay costs due to pay awards, NI and Pension changes. 1.1% increase in block income based on national net tariff uplift guidance. 3.4% efficiency delivered via; 2.0% efficiency in line with national efficiency requirements 1.4% efficiency delivered through agreed measures enabled by the Success Regime and Better Care Together Vanguards. Strategic Developments There are no major strategic developments assumed within our plan. Two internal developments are included in line with previous plans; IM&T Strategy Continuous Improvement and Service Transformation Capacity The Trust s IM&T strategy implementation includes the roll out of EPR during 2016/17 in Children s and Mental Health Services and renewal of the IT infrastructure. Capital investment in renewed infrastructure has taken place utilising funding from the national technology funds and so the Trust is aiming to complete the major elements of the IM&T strategy during the year. Implementation costs and capital charges are included in our plan. Recognising the ongoing requirement to both improve service quality and transform services to be more sustainable the Trust has invested in capacity for continuous service improvement (see above sections) and transformational change. The transformational change plans are key elements of the Trust s efficiency programme and are intended to be delivered in alignment with the Success Regime and Better Care Together Vanguard enabling processes. Non Contract Income CQUIN income plans for 15/16 are for 90% achievement and the Trust does have some risks to achieving this. However, in line with improved management and accountability arrangements that have been implemented performance is expected to improve for 2016/17 and so 90% achievement is included in our plan. 15/16 achievement is expected to be approximately 83%. The planned 5.6m deficit is in line with the Trust s control total as proposed by NHSI, and we are working to ensure compliance with the other conditions relating to the Sustainability and Transformation Fund (STF). We have therefore included in the plan the Trust s 0.9m allocation from the general STF. No assumptions have been made at this stage concerning any targeted STF income and the Trust is expecting to have access to this in due course when guidance is issued. 15
Financial Risks This plan represents a significant improvement in the current underlying financial position and will be challenging to achieve in the current financial climate. The key risks are: Ability to achieve the necessary level of efficiency savings (both internally generated and those enabled by Success Regime and Better Care Together Vanguard). Contract income settlements that are agreed at Head of Terms level require final sign off. Achievement of CQUIN income. Unplanned costs, including the cost of key specialist staff if workforce plans are unsuccessful in supplying substantive staff. Impact of system wide programmes (Better Care Together in South Cumbria and the North Cumbria Success Regime). Timing of capital expenditure and ability to limit capex to the modest control totals in our plan. Ability to meet the conditions for the general element of the STF and availability of the targeted element thereof. Ongoing budgetary control and containment of costs despite workforce supply risks (see above sections). Further sensitivity analysis of these risks to the Trust s plan will be undertaken so that both base-case and downside scenarios with mitigations are included in the final plan submission. The Trust is working to move away from National Programme for IT (NPfIT) products as it implements electronic patient records. A transition period is expected and the Trust has engaged fully in the planning for this. The Trust has applied for transition support for a small period beyond the lapse of the national contract in July 2016 the outcome of this is not yet quantified or included in the plan. Efficiency Savings for 2016/17 Our efficiency programme is managed by our Efficiency Programme Board (EPB). The EPB is chaired by the CEO with full membership from the Executive team. We have implemented recommendations from PWC in early 2015 to increase the programme management of our efficiency programme and are planning to further build on this approach in 2016/17. Internal efficiency schemes have been identified and have been quality impact assessed ready for implementation in 2016/17. To date 3.2m has been identified, with 2.6m of schemes in preparation. The proposals have been assigned a RAG rating to reflect the risk to deliverability, as follows.; STATUS million Green 1.8 Amber 1.0 Red 0.4 Total identified schemes 3.2 Schemes in preparation 2.6 Target 5.8 Note; 0.3m of the identified schemes are non-recurrent. 16
The schemes in preparation include system level service changes that have been discussed with our commissioners and are being included in our contract heads of terms for 16/17. In line with the Carter findings the Trust is looking to deliver efficiencies in workforce, estates and purchasing. Further work to examine opportunities for savings in medicines costs will also be explored. Cost containment Agency rules The Board of Directors has line of sight to safe staffing levels in our clinical areas through the monthly Hard Truth s reporting arrangements. Board-level reports on workforce matters also routinely include details bank and agency usage. These were introduced in 2015/16 as part of continual improvements in our quality governance around safer staffing through an increased use of bank staff rather than agency usage. Since the publication of the nursing agency rules, we have worked with our agency providers to develop an approach that is compliant with Monitor s requirements. All of our agency usage is now coordinated through a designated agency provider who are signed up to the national framework. Board-level reporting of our compliance with Nursing Agency Rules will be enhanced during 2016/17 through our contract management arrangements with the agency provider. The Trust is well within its cap of 3% for nursing agency and expects to comply with the national price caps wherever possible. A detailed implementation plan for this approach is currently in place and being delivered. Procurement A procurement steering group has been established and is planning a number of initiatives to reduce non-pay costs across the Trust. The Trust outsources its procurement function to Morecambe Bay University Hospitals Trust. Our procurement arrangements and procurement activities are being reviewed and monitored through the Procurement Group, which is led by the Associate Director of Corporate Governance. Opportunities to identify efficiencies and savings through procurement activities are actively sought and implemented, however more can be done in this area during 2016/17 to ensure we are achieving maximum efficiencies from procurement activities. Capital planning Our strategy to make better use of the NHS estate in Cumbria is under development and will be highly influenced by the two major transformation programmes in Cumbria; Better Care Together Vanguard and the Success Regime. We are engaged with partners in these transformation programmes. Further details around estates strategy will form part of the STP. 17
In 2016/17 we will continue to invest in activities to implement IMT strategy and 2.0m is allocated in our plan for this investment. 2.9m is in the plan for estates investment and equipment replacement, restricted to only the highest priority schemes in line with key clinical safety and quality priorities. This will result in modest investment in areas with significant backlog maintenance requirements. Underpinning our efficiency plans are moving from paper based records to electronic care records with this as an enabler to free up estate in the long term. The capital investment planned is entirely in line with these key aims. Link to the Emerging Sustainability and Transformation Plan (STP) The Trust expects to contribute to 2 STP s - North Cumbria and Lancashire/South Cumbria. The footprint for these STP s will require that the Trust s plans are split into two and this is a major difficultly for the Trust in terms of ensuring an overall representation of our place within the two STP footprints. Only very limited dialogue on this matter has taken place and further dialogue on this with NHSI will be useful prior to STP submission. Across the Trust there are major strategic service initiatives taking place; East/West/North Cumbria Success Regime Better Care Together Vanguard Cumbria Mental Health Strategy Cumbria Children s Improvement Plan The trust is active in each of these and is working to ensure our plans are fully aligned to the outputs of these processes. However the processes remain immature and have yet to demonstrate pace/momentum and so the Trust is expecting this to be more clearly achieved between this draft plan submission and finalisation of the STP in June. Significantly, the scale and nature of change required across both STP footprints is large and so major engagement/consultation with the public is being planned for within these processes. Commissioning intentions for both STP areas have not been developed and as such the Trust is not yet able, alongside other provider partners, to actively plan beyond the short term until these strategic processes become more mature and definitive. The Trust is fully engaged in the emerging STP process and aims to utilise this to set out a sustainable 5 year plan by 30 th June 2016. 18
Membership and Elections Our Governors Council elections are held annually in September. The next round of elections will be in September 2016. Governors hold a three-year term of office, which are staggered so that one third of the Council is due for election each year. Online voting was offered for Governors elections in 2015, the response rate to which (11%) was encouraging. We plan to develop this further in 2016 with the support of a Membership Database Service Provider. We have a very active Governors Council. In addition to meetings of the Council of Governors, governor development sessions are scheduled throughout the year to raise awareness of governance issues in order that they better able hold the Trust to account on behalf of their membership. In January 2016, the Governors Council agreed a training and development plan and self-assessment process to evaluate their effectiveness. We will support governors with that training programme during 2016/17. Two Members meetings were held in 2015, one of which was the Annual meeting where two hundred members of staff and public attended. Governors attend Members meetings and local groups to listen to their views and encourage the public and staff to understand the role of the governor. We encourage Governors to attend public meetings on the major transformational programmes (Success Regime and Better Care Together) in order that they can engage with the Trust in representing their membership s views on those programmes. Lead Governors from the Trust and University Hospitals Morecambe Bay Trust (UHMB) are also discussing joint development sessions for Governors from both Trusts to understand how they can work together in the future. The first joint session was held on 2 March 2016. The Governors Council approved our Membership Engagement Strategy in September 2015. Implementation of the strategy is being overseen by the Membership & Communications Committee who will provide regular updates to the Governors Council during 2016/17 on progress towards achievements of the strategy s targets. These include increasing representation of minority ethnic groups, younger members, and the proportion of male members. 19
Priorities for 2016-17 Our core Trust priorities for 2016/17 are aligned to our longer term service strategies and cost improvement plans, and have been developed with significant involvement from clinical leaders and wider leaders with the Trust. QIA process to support delivery of the plans will be undertaken as required. 20
Key risks to the delivery of our plan Risks to our strategic goals are monitored on a quarterly basis by the Board of Directors via the Board Assurance Framework. Risks to our strategic goals are set out below. The Board has identified the strategic risks which might impact on our business: Strategic risk descriptions A. Patients or service users do not receive high quality care because either safety, outcomes or experience are compromised B. Unable to realise the cultural change needed to improve the quality of care for all patients and service users C. High quality and sustainable care is compromised by inability to implement improvement strategies for hard and soft infrastructure (facilities, estate, applications, IT) D. Failure to effectively deliver improvement and transformation to our services E. Unable to use our partnerships to deliver sustainable Cumbria Health and Social care system F. Unable to deliver leadership, workforce capability and capacity improvements to deliver modernised and transformed services G. We don t use our differentiating strengths (USPs) to maximum advantage, nor to reach our full potential H. Inability to balance financial sustainability with maintaining high quality, safe services An assurance framework for each has been developed with 1 st, 2 nd and 3 rd lines of assurance identified and assessed. Board-level reports on the Board Assurance Framework include a summary of the assurance levels for each risk, together with an assessment of the proximity of each risk, as shown below, which was agreed by the Board of Directors in January 2016. 21
22