Strategic Plan Document for 2013-14
5 Boroughs Partnership NHS Foundation Trust
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Strategic Plan for y/e 31 March 2014 (and 2015, 2016)
This document completed by (and Monitor queries to be directed to):
Name
Dean Marsh
Job Title
Director of Finance and IT
e-mail address
[email protected]
Tel. no. for contact
01925 664 003
Date
31st May 2013
The attached Strategic Plan is intended to reflect the Trust’s business plan over the next three
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 Strategic Plan is an accurate reflection of the current shared vision and strategy of the Trust
Board having had regard to the views of the Council of Governors;
 The Strategic 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 Strategic 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;
 All plans discussed and any numbers quoted in the Strategic Plan directly relate to the Trust’s
financial template submission.
Approved on behalf of the Board of Directors by:
Name
(Chair)
Signature
Approved on behalf of the Board of Directors by:
Name
(Chief Executive)
Signature
Approved on behalf of the Board of Directors by:
Name
(Finance Director)
Signature
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A. Strategic Context and Direction:
The primary strategic ambition of the Trust Board is to enhance the end to end care pathway for
people with Mental Health and Learning Disability problems within the 5 Boroughs geographical
footprint; this includes providing broader community services ‘on patch’ either through direct provision,
partnering arrangements or alignment of services.
The strategic aim of the organisation over the next 3 years and therefore the primary focus of the
Board would be to
-
improve the quality of the services we provide
-
enhance the experience of our services for those people who use them
-
look towards improving access to and quality of our services along the pathways of care that we
deliver.
The Trust has also recognised the significant role it can play in improving the overall health and
wellbeing of the population that we serve.
This strategic ambition is underpinned by a sound financial strategy which is intended to generate
sufficient surpluses to maintain a Financial Risk Rating of at least 3 under the existing Monitor risk
assessment regime and a 4 under the proposed risk assessment framework. The strategy will also
generate sufficient cash to support the Trust’s 5-year strategic capital programme which is centred on
enhancing and improving the safety and quality of the environment for patients and staff
The Strategic ambition is also underpinned by a significant process of redesign across our key
services, aimed at the development of the most appropriate, effective and efficient pathways of care
for our service users, enhancing their experience of our services and improving access to the services
which we provide.
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B. Approach taken to quality:
The Trust’s Quality Strategy will be finalised by the end of June 2013, providing a structured
framework within which we can deliver high quality, safe and effective standards of care and can
demonstrate that we have improved the quality and safety of each of our services. The Trust’s
strategic aim is to demonstrate continuous improvement in quality and safety through the engagement
of clinical staff and by listening to feedback from our service users, their families and carers.
The Trust has an agreed definition of quality which has been created and approved by members of the
Trust Board, our clinical leaders, senior managers and our Council Members.
“The users of our services are the first priority in everything we do ensuring that they receive effective
care from caring compassionate and committed people, working within a common culture and
protected from avoidable harm”.
The Trust has two sub-committees of the Board, a Quality Committee and an Audit Committee. The
committees are responsible, on behalf of the Board, for ensuring there are good governance systems
and high levels of quality in place across the organisation, and for providing assurance to the Trust
Board.
The Trust produces an annual Quality Report/Account which provides an overview of; our continued
commitment to quality and highlights progress on our achievement of quality priorities and measures
in the reporting year and identifies the agreed quality priorities for the coming year which are all
agreed with our partner organisations, and Council of Members.
The Trust continues to undertake a programme of internal quality visits across all of our services. The
visits are led by the Nursing and Quality Team in partnership with operational colleagues, with a focus
on identifying good practice and high levels of quality and compliance with Care Quality Commission
standards, but also to identify areas in need of improvement.
In 2013/14 the Nursing and Quality Directorate will continue to work in partnership and engage with
operational colleagues to ensure high quality governance at all levels of the organisation in order to
ensure high quality services and to provide assurance to the Trust Board and partner organisations.
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C. Clinical Strategy:
The organisation is a specialist Mental Health Trust providing community and inpatient services to the
people of the Boroughs of Warrington, Wigan, Halton, Knowsley and St Helens alongside generic
community services in Knowsley, the Trust has a turnover of approximately £150m a year (covering a
population of 9,000). 5 Boroughs is the primary public sector provider of mental health services on this
footprint, alongside GPs, providing primary care support to patients and a number of independent
sector providers.
Where independent sector provision exists it is primarily in the areas of substance misuse, continuing
care for mental health and eating disorders. These are not services provided by the Trust as part of its
standard ‘offer’ across all 5 Boroughs and as such the Trust does not face significant competition for
its services from the independent sector. The primary source of competition lies around low secure
provision, but with The Trust being part of an existing framework agreement with specialist
commissioners, the risk of losing business is seen as low.
The introduction of Any Qualified Provider in 2012/13 has not yet had an impact on the provision of
community services in Knowsley or the Trust’s mental health provision. This may change over time if
‘Any Qualified Provider’ is extended beyond its current scope, but the Trust has not yet seen any
attempts locally to extend this.
The individual clinical strategies for each of our business streams (described as service lines by
Monitor for the purpose of this annual plan) are set out below
The overall clinical strategy for the organisation however can be summarised as:
-
Redesign community services
Make the inpatient infrastructure more efficient and effective
Integrate services along pathways of care where appropriate
Improve access to services (e.g. create single points of access)
Redesign of clinical roles across the Trust
Service Line Management Strategy
Adult Mental Health services
The Adult’s clinical strategy involves;
-
Realising the benefits of the newly redesigned community pathway and the future demand for
inpatient provision,
-
Bringing about greater integration of inpatient and home treatment teams,
-
Rolling out a new approach to inpatient care delivery entitled Recovery Focused Pathway to the
remainder of our inpatient units,
-
Revisiting our PICU strategy,
-
Developing Psychiatric Liaison services across our foot-print,
-
Consolidating our Primary Care Services to ensure effective and efficient provision.
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Child and Adolescent Mental Health Services
Children’s’ services have continued to review their strategic direction and are currently implementing
phase 2 of the 2011 programme. This includes
-
the CAMHS IAPT bid (3 proposals with partners in each locality) which is a service transformation
project embedded within current practice,
Single Point of Access plan to structure a new service from existing resources to provide timely
and equitable access to CAMHS, as well as a reconfiguration of services to maximise resources,
capacity and clinical delivery.
All plans have evolved through continued dialogue with stakeholders and with keen reference to
national drivers.
Community Health Services (in Knowsley) (CHS)
The strategic intent for the CHS business stream is to provide a range of interventions and treatment
by staff to the populations served across the business stream. This includes (Knowsley, St Helens and
Halton, Wirral and 5BP) :
-
To develop a healthier Knowsley with easy, seamless and timely access to local, quality and
evidenced based services; offering personalised flexible care to meet individual needs in a
professional manner with the best use of resources.
The CHS aims to develop capacity to offer equity of access to adults, children and families with a
range of lifestyle and clinical issues including those with mental health issues and learning disabilities,
urgent and emergency care, planned care that covers a vast array of services some of which are
delivered in people’s homes, community services and the local hospitals.
Forensic services
The Forensic clinical strategy:
-
-
-
Continue with Male service (Marlowe 15 beds). This has a clear ‘offender’ model,
Continue with female service (Chesterton) reducing to 15 beds and move towards a more offender
based model,
Review use of LD provision (Auden), though this is commissioned currently, it may be salient to
move into other areas of secure care, given competition and that currently referrals over last 18
months have been relatively static. This could open the way for possible expansion into the
‘personality disorder’ market, especially as the business stream is cognisant of female placements
in the private sector (OATS),
Rethink about the value of the step down facility, given probable commissioning intent. Could this
be used as a ‘step up facility’ i.e. community provision failing for a service user, and instead of
reintroduction to inpatient provision, a transfer to a ‘step up facility’,
Cement and enhance criminal justice provision e.g. build upon prison work currently to enhance
reputation beyond the Trust footprint.
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Later Life and Memory Services
Later Life and Memory Services have identified their clinical strategy which involves the development
and delivery of a new, evidence-based model of care, which will provide service users with timely
assessment leading to early diagnosis to support consistent and effective care. In order to achieve
this number of objectives have been identified:
-
The development of modern and evidence-based clinical pathways of care,
-
The effective deployment of technology to enhance the quality and effectiveness of care,
-
Ensuring that our systems and processes deliver agile and efficient working,
-
Establishing our workforce as highly skilled, efficient and motivated to deliver the clinical care in
the most efficient and effective way,
-
Developing our estate to provide an excellent therapeutic environment for evidence based care,
-
Establishing robust and effective working relationships with our stakeholders in order to ensure
seamless and coordinated approaches to the care of our service users.
Learning Disabilities
-
To provide an array of clinical pathways for learning disability and improve patient experience,
To remodel in–patient facilities given current occupancy and commissioner intent,
Develop responsiveness to assessment/diagnosis for ASD.
Clinical workforce strategy
The clinical workforce strategy involves:
-
-
Revisiting our workforce plans and projections to identify opportunities to develop new roles and
skills within our workforce that will enhance the delivery of our clinical pathway and quality of
services including extending our use of Assistant Practitioners and considering opportunities to
maximise opportunities such as the use of non-medical Approved Clinicians (in 2012 the first nonmedical clinician was approved in the North West and this person came from our Trust),
Maximising opportunities to embrace technology to support our workforce and increase clinical
time and thus deliver more efficient services,
Utilising continuous service improvement processes, including the productive series approach, to
achieve efficient and effective patient and community teams,
The Trust is involved in an AQuA project to fully implement shared decision making to enhance
service user participation in CAMHS clinical delivery.
Increase utilisation of activity workers/life skills/educational posts.
The Trust's clinical services are composed of those that map onto individual boroughs (Adult, LLAMs,
CAMHS, LD and CHS) and those which service a wider footprint (Forensic). Each of these services is
delivered on an economically viable scale. Other than the potential impact of AQP, there are no known
planned commissioning intention changes which would threaten this over a 3 year period.
Consultant staffing is consistent with the principles set out in the Royal College of Psychiatrists' report
of 2012, "Safe patients and high quality services; a guide to job descriptions and job plans for
consultant psychiatrists." The Trust continues to gain approval from the RCPsych when designing and
recruiting to consultant posts. The Trust currently has no consultant vacancies. A small number of
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posts are currently occupied by good quality fixed term consultant appointments whilst we maintain
flexibility in numbers over the next year. Consultant rotas are fully staffed. The Trust continues to train
junior doctors from the Northwest and the Mersey Deanery. Each six monthly rotation typically carries
unfilled posts from a total of 54 potential posts. The Trust has an active approach to recruitment of
fixed term junior doctors in order to maintain the service provision element which junior doctors
contribute."
D. Productivity & Efficiency:
Thematically the five main areas within the Trust’s Cost Improvement Programme (CIP) are consistent
with the Trust’s clinical strategies. This is not surprising since the Cost Improvement Programme is
driven by the Trust’s clinical strategies rather than the other way round. Thematically the Trusts ‘top 5’
CIPs are:
i)
ii)
iii)
iv)
v)
Inpatient efficiencies
Community services efficiencies
Estates re-organisation
More efficient support services
Other operational efficiencies
This means that the Trust will continue to drive improvements and efficiencies along its pathways of
care and within its community services to provide support closer to home. This will take pressure off
inpatient services and allow for the Trust’s inpatient infrastructure to be re-aligned to support the new
models of care and support a more efficient model of delivering inpatient services. Greater integration
of services along pathways and across community services, allied with more effective support and
infrastructure will provide the opportunity to provide services in a more cost efficient way.
CIP Governance
A number of years ago, accountability for CIP delivery was transferred from the Director of Finance to
the Chief Operating Officer within the organisation. The shift in accountability was to ensure that CIPs
were operationally led and were borne out of the output of the service strategies from each Business
Stream. The Director of Finance, as the person responsible for the financial stewardship of the
organisation, is still heavily involved in the process. The Chief Operating Officer has delegated project
management responsibility for the delivery of CIPs to one of the Operational Assistant Directors, to
maintain the operational focus of the project.
CIP delivery is monitored and reported on a monthly basis, as part of the Trust’s performance regime,
within each Business Stream and at the Trust Performance meeting and the Trust Board. Within this
regime any issues with regard to delivery are raised and the appropriate management action is taken
to either bring the original scheme back on track or identify mitigating schemes as a replacement.
There is also a CIP group which meets monthly. The attendees are the Assistant Directors within the
Trust who are the project leads for the individual schemes. The purpose of the group is to look at the
delivery to date of in year CIPs and to highlight where there will be risks of none or partial delivery of
schemes and to agree mitigating schemes. The group also manages the identification of CIPs, the
production of the project plans and monitoring of key milestones for future CIP schemes.
The Trust has a strong history of delivering against its CIP targets, as can be seen in Table 1. This has
been as a result of having effective processes, reporting arrangements, and management in place.
Ensuring CIPs have been borne out of service strategies and that clinicians are supportive of the
proposed changes has also been key to the Trust’s success. As a consequence of this the Trust is
confident this level of performance can be maintained.
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Table 1 – CIP performance 2009/10 to 2012/13
Target
Actual
Variance
£000
£000
£000
2012/13
5,947
6,326
379
2011/12 (inc KIPS)
7,445
7,443
-2
2010/11 (inc KIPS)
5,688
6,230
542
2009/10
3,516
3,477
-39
Year
CIP profile
The Trust has identified 9 thematic schemes that reduce revenue expenditure and 3 revenue
generation schemes which are summarised in Table 2.
Table 2 – Summary of CIP schemes
Scheme ( CIP & Revenue)
Type Risk Rating
Community Efficencies
Inpatient efficiencies
Medical efficiencies
Other Operational
Corporate support
Non pay efficencies
Drugs
Estates
Community Efficencies
Medical efficiencies
Other Operational
C
C
C
C
C
C
C
C
R
R
R
Total schemes
2013/14
£000
2014/15
£000
2015/16
£000
1,196
10
1,515
1,093
351
520
364
329
26
178
690
471
729
1,505
730
400
218
442
-
700
980
400
1,600
700
400
94
300
-
5,582
5,184
5,174
The forward looking CIP programme is set around a number of key themes, which form part of the
Trust’s service strategy. The first of these is the improvement in the efficiency of the way the
community teams’ work through increasing the number of daily contacts per WTE. The second is the
continuation of the redesign of clinical pathways to reduce the use of inpatient services. Linked to the
two previous themes is the more efficient utilisation of the Trust’s estate. In order to support the
redesign of clinical pathways, medical efficiencies and prescribing are also key themes.
The Trust has invested a lot of resources in support functions in order to ensure robust systems have
been put in place to support the clinical services as effectively as possible. As those services have
matured the Trust has embarked on a programme of making sure its support functions are efficient
while maintaining a high level of service. Continuation of the integration of the Community Health
Services in terms of operational and support services efficiencies is also a feature of the CIP.
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CIP enablers and Quality Impact of CIPs
All CIPs that are proposed are as a result of the output from each Business Stream’s service strategy,
which are formulated from consultation with a wide range of clinicians, such as the medical lead, nonmedical lead, and modern matrons. The CIP project lead through the CIP group manages the
forward looking process to ensure CIPs are in line with Trust’s strategy, have clinical support, and are
achievable, and will approve schemes to go forward for executive approval as part of the annual
planning process. The 3 year CIP plan, as part of the annual plan is ultimately approved by the Trust
Board before submission to Monitor.
At executive level, CIPs have to be signed off by the Nursing and Medical Directors as part of the
quality impact assessment. The Trust reports on risk and a range of quality indicators to the Trust
Board on a monthly basis, and, where necessary, management action is identified to address issues
raised.
The Trust has a variety of mechanisms to support change processes, such as an Organisational
Development Team as well as a Business Transformation Team. Where there is a need to support
change through additional staffing to manage the transition, or capital investment, this would be
indicated in the project plan, and would be built into the forward financial plans.
E.Financial & Investment Strategy
In 2012/13 the Trust has continued to demonstrate a strong financial performance. Over the past
three years the Trust has seen a steady growth in its underlying surplus while delivering on CIP
targets. Over this three year period the Trust has had healthy cash balances and maintained an
overall risk rating of 4.
Table 3 illustrates the historic performance of the Trust along with the three years included in the
plans.
Table 3 – historic and forward looking financial performance
2010/11 2011/12 2012/13
£’000
£’000
£’000
2013/14 2014/15 2015/16
£’000
£’000
£’000
Income
146,861 152,282 148,026
145,871 143,564 142,155
Expenditure
143,715 147,892 143,623
141,869 138,825 137,156
Underlying Surplus
3,146
CIP
Delivered/
Target
£6.2m
Risk Rating
4
4,390
4,403
4,002
4,739
4,999
£7.4m
£6.3m
£5.6m
£5.4m
£5.4m
4
4
4
4
4
The key financial risks to the organisation over the 3-year period are:





Delivery of Cost improvement programmes
Delivery of quality improvements to secure CQUIN income
Timely clustering and recording of patients under PbR to ensure all appropriate income is received
Loss of contribution from services if de-commissioned under Any Qualified Provider initiatives
Pressure on services from increased demand
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The delivery of the financial strategy and the planned surplus is dependent upon delivering the
required level of efficiencies in each of the years under consideration. These efficiencies will continue
to be delivered by implementing the Trust’s clinical redesign programmes in each of its key service
areas. There is a programme of business transformation on-going in the Trust with a clear
overarching governance and accountability framework which links directly to the Executive team and
Board.
The Trust has robust frameworks in place for monitoring the delivery of Cost Improvement
Programmes, delivery of clinical redesign programmes, delivery of CQUINs, implementation of PbR
and the impact of AQP. All of these frameworks are led and managed by Operational and Clinical
Senior Managers from within the Trust to ensure appropriate ownership and accountability is
maintained.
These risks also form part of the Trust’s Assurance Framework with the controls and independent
assurance around them reported directly to the Board on a regular basis.
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Appendix 1: Financial commentary (NOT FOR PUBLICATION)
The key assumptions in the Trust’s forward plan are as follows:
i)
ii)
iii)
iv)
v)
Current levels of contract income are broadly maintained
Minimal growth in income from new business
Minimal income generating CIPs
1.3% per annum tariff reduction
CQUIN income of 2.4% received
The Trust has signed off all of its contracts for 2013/14.Over 95% of the Trust’s planned income is
under contract and therefore secure.
The Trust has assumed a reduction of 1.3% each year on tariff in line with Monitor and DoH guidance
as detailed in Table 4. This still enables the Trust to grow its underlying surplus each year (based on
the delivery of CIPs)
Table 4 - Income tariff assumptions:
Weighted
inflation
2013/14
Weighted
inflation
2014/15
Weighted
inflation
2015/16
Cost Pressures
2.70%
2.70%
2.70%
Cost Improvements
-4.00%
-4.00%
-4.00%
Net tariff reduction
-1.30%
-1.30%
-1.30%
The Trust’s plans reflect notification of the cessation of the Community Diabetic Team and Substance
Misuse Team within Community Health Services which occurred during 2012/13. This has been
factored into the Trust’s income in 2013/14 and 2014/15, reducing by £671k and £138k respectively
within the plan. This represents less than 1% of block contract income.
During 2012/13 Commissioners introduced AQP for elements of the Community Health Services
Podiatry and Musculoskeletal services. The Trust has taken a prudent approach and assumed the
same level of income will be maintained under AQP.
The Trust has a reference cost position of 95 which demonstrates a cost effective provider of service.
Any move to a national tariff for mental health under PbR would be of benefit to the Trust’s income
position; however the Trust has taken a prudent approach and not been included it in the plans.
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Table 5 – Income Performance 2012/13
Category
12/13
£000's
143,697
12/13 Plan £000's
Block Contract
139,088
Other clinical revenue
from
mandatory 1,888
services
Total Clinical Income 140,976
Actual
Variance £'000s
4,609
2,246
358
145,943
4,967
Other income
6,960
6,783
- 77
Total Revenue
147,935
152,726
4,791
In 2012/13 the Trust’s actual income was some £4.8m more than planned, as can be seen in Table 5.
The block contract income variance was £4.6m, the largest variance was due to the Trust receiving
additional non recurrent income £1.9m for initiatives across mental health services such as A&E
liaison, Care Home Liaison, skin camouflage, £0.4m re shared care, non-recurrent transitional monies
£0.4m and achievement of CQUINs above plan of £0.4m. Within Community Health Services in order
to deal with pressures over the winter period the Trust also received £0.4m of non-recurrent funding.
The Trust is planning a growth in the underlying surplus for 2014/15 and 2015/16 as illustrated in the
table below. In 2013/14 the Trust is implementing a new clinical information system, and therefore has
built in £800k of implementation costs in 2013/14. Table 6 summarises the overall I and E position for
the Trust for the 3-year period of the plan.
Table 6 – I and E plan 2013/14 to 2015/16
2013/14 2014/15 2015/16
£’000
£’000
£’000
Income - NHS
144,221 142,032 140,623
Income - Non NHS
1,650
Expenditure
Underlying
Surplus
141,869 138,825 137,156
4,002
1,532
4,739
1,532
4,999
Demographics
The Trust plans to deliver services to the registered population for which we are contracted. In terms
of Mental Health and Learning Disabilities services the registered population of Wigan, Knowsley,
Halton, St Helens and Warrington is in the region of 938,000. The Trust also continues to provide
community services to the population of Knowsley, which is circa 150,000. The activity assumptions
made and agreed with commissioners include local weightings for deprivation for each of the above
local authority boroughs as outlined in the 2001 census.
Each year as part of the contractual renewal process, activity assumptions and targets are reviewed.
There have been no fundamental changes made to the activity assumptions for this planning period.
Market Share
The Trusts market share for Mental Health and Learning Disability services is not planned to change
fundamentally over this three year period. However, as the Trust is now contracted in Merseyside
under Any Qualified Provider (AQP) for both podiatry and musculoskeletal services, we are exploring
opportunities to expand our services to a wider geographical area thus increasing the market share
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across these services. This has not been reflected in activity plans as our current plans represent our
contractual commitments and as AQP is non-contracted there are no baseline activity plans.
Demand Management
There are currently no formal demand management protocols in place across the contracts within the
Trust; however this may change as a result of the implementation of Payment by Results (PbR) for
Mental Health services, as the timescales for PbR have now changed the Trust and our
commissioners are not, as yet, looking to implement demand management.
All activity targets have been worked through with clinical and commissioner colleagues and reflect
the planned service redesign as outlined within the operational strategic plans.
Workforce
Over the next year the Trust does not envisages a significant change in its total headcount numbers, but
recognises that, as a direct result of service change and in order to take full account of the
recommendations from the Francis Report, additional skills will be required. This is documented at
Business Stream level via Workforce Resourcing & Development Plans.
Table 7 – Workforce Numbers
Staff Group
Medical
Nurses and
contract)
Midwives
(inc
bank,
agency,
Sci Tech & Therapeutic
Healthcare assistants
Other clinical staff (inc agency and contract)
Admin & Clerical
Other non-clinical staff (inc agency and contract)
Total
2013/14
2014/15
2015/16
136.70
122.70
113.20
991.20
937.30
882.10
602.30
584.40
576.10
540.00
526.10
521.2
9.30
9.30
9.30
652.3
628.30
615.60
257.90
251.40
248.20
3,189.70
3059.50
2,965.70
The workforce strategy that underpins these numbers and the Trust’s clinical strategy will mean staff
becoming skilled in new areas and providing new ways of working, which rely much less on particular
professions and more on the most suitable person to deliver the outcomes we are trying to achieve for our
service users.
With the redesign of services taking place and the expected changes in skill mix of teams the Trust will
ensure it makes the most of the opportunity to create new roles so as to ensure they are able to meet the
changing demands of its service users. The Trust will work closely with the North West Workforce
Modernisation Hub Team to ensure we make the most of the opportunity to develop more Assistant and
Advanced Practitioners in the workforce. The Trust has been the host organisation for the Northwest
Workforce Modernisation Hub since July 2011 and this has allowed the Trust to more effectively explore
the benefits of new ways of working.
The Trust will continue to ensure that on a yearly basis, the full benefits of Assistant and Advanced
Practitioners are explored, and appropriate bids are made to secure these positions within the Trust, via
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the Health Education Northwest application process. There is a risk to the Trust that new services/ways of
working cannot be developed if the skills required to deliver these services do not exist within the
workforce.
The Trust will achieve its targeted workforce reductions in two ways. Firstly the Trust has recently
undertaken a MARS process which has identified 63 roles that will no longer be required in the workforce
for future years. Secondly, the vast majority of the workforce reductions will be achieved by natural
wastage in order to mitigate against any redundancies as part of the plans over the coming three years.
There are currently 174 staff within the Trust who are currently aged 60 or over and planning for these
staff who will be potentially retiring will be vital. The change in the way services are being developed within
the Trust, specifically the reduction of inpatient services, will impact greatly on staff. How these staff are
redeployed and developed will be key to the success of any service redesigns.
The HR department will ensure they effectively utilise all workforce data available to them to produce
effective and useful workforce information to the business streams. They will oversee all HR implications
of any workforce changes and ensure that all flexibilities afforded by Agenda for Change are explored and
maximised. In order to facilitate the changes to the workforce and to support future workforce plans,
Business Streams and Directorates will be provided with learning and organisational development
support. This will entail tailored and targeted learning and development training programmes to ensure
individuals and teams have the right knowledge and skills to deliver the highest standards of care,
managers and teams will be supported with appropriate team development sessions and leadership
development to ensure high levels of leadership and team effectiveness. There will be potential resource
issues within operational teams as on the job development such as shadowing takes place. More formal
training and development will present potential capacity issues for the Learning and Development Team,
for all in-house training. Any training and development required outside of 5BP will see potential financial
resources, to pay for staff to attend courses.
The Trust is also looking to develop a comprehensive Career Framework for its support workers using a
competency based approach. The work will form part of the Trust’s high level workforce strategic objective
during 13/14.
Technological developments will also see key changes for our workforce in the coming years,. In 2013/14
the Trust will be implementing e-Rostering which will fundamentally change the way our workforce are
utilised to ensure that consistent and efficient care can be provided to our service users across all
services. It will also improve fairness of working patterns and play a role in ensuring staff morale is kept
high and sickness absence kept to a minimum.
The Trust will also be implementing a new Clinical Information System called RIO which will provide more
efficient platform for all clinicians within the Trust to work with.
Though these two major IT developments will provide their own learning and development needs, as well
as changes in team culture, the benefits they will bring to staff will help to ensure they are being given the
best opportunity to full develop their skills and provide front line care.
The Trust Board will receive assurance of workforce issues via the monitoring of the strategic objective
related specifically to Business Stream workforce plans, and workforce risks identified via the Assurance
Framework. This monitoring will be undertaken by the Trusts Operational Management Board and
Leadership Forum
15
Capital Expenditure
The Trust’s Estate Strategy is focused on supporting operational and clinical service plans to deliver a
high quality, safe and efficient physical environment which, in turn, promotes effective and high quality
healthcare for our service users. Due consideration is given to sustainable development and other
environmental initiatives for all our building and infrastructure schemes. The Trust’s capital
programme is also designed to promote agile and other innovative ways of working to deliver further
efficiencies whilst also enhancing the effectiveness of our services.
The Trust pro-actively manages its property assets and since Foundation Trust status was achieved
in March 2010 this has included the sale of 4 freehold properties realising total receipts of £1.034m.
Currently three freehold properties are held for sale with the intention of adding a fourth property in
the first quarter of 2013/14. The disposal of these properties is expected to realise £2.260m.
Tenure is primarily a mixture of freehold and short term leasehold or licence, the latter to provide
flexibility of occupation.
The majority of the property portfolio falls within the ‘fully used’ category. The sale or surrender of
vacant properties has improved estate utilisation and procedures have been put in place to ensure
there is optimum utilisation of space with regular audits.
A condition survey was conducted in 2012 which used the same measurement of conditions as a
formal facet survey. This exercise identified that a high percentage of the estate remains in Condition
A or Condition B (‘as new’ or ‘sound, operationally safe and exhibits only minor deterioration’). The
Trust recognises that the quality of its accommodation needs to meet or exceed service user needs
and the challenges presented by a modern day mental health service. The original 5 year backlog
programme has been adjusted to include new schemes to produce a 13/14 plan totalling £0.9m with a
further £0.5m planned over the 2 year period 14/15 to 15/16. It is anticipated that there will only be
minimal backlog maintenance required on Community Health premises as these properties are
relatively new.
A high level standard of quality has been achieved. PEAT returns have now been replaced by Patient
Led Assessment of the Care Environment (PLACE). This is the main indicator for which results have
been consistently high, and there has also been consistent compliance with outcome 10 of CQC
standards.
The Trust recognises the need for its accommodation to meet the needs of services and reflect the
changes in delivery that this will require and has outlined a number of projects to complement service
transformation which will be in line with new care pathways. In this respect the Trust intends to spend
£0.5m in 13/14 and £14m in 15/16. Additionally, the Trust anticipates spending £8m in 13/14 and
£20m across 14/15 and 15/16 on accommodation and infrastructure improvements.
16
The timing of the delivery of these schemes is dependent on the timely production and approval of business cases. Further risk may result due to an
extended consultation process. The Trust is keen to exploit shared efficiencies between business streams and capital projects will reflect this.
The 13/14 capital programme will be financed entirely from internally generated funds. However, there will be a requirement to access external financing
to fund the Trust’s longer term programme in support of its transformational schemes.
Table 8- Capital Expenditure Programme 13/14, 14/15 and 15/16
Key Expenditure Priorities
Contribution to Operational Plans
Timeframe
13/14
A
Service Transformation (a)
The Trust recognises the need for its
accommodation to meet the needs of
service and reflect the changes in
delivery that this will require. These
schemes will provide an environment
which are in line with care pathways.
Service Transformation (b)
The Trust is undertaking a review of
its service model for the provision of
in-patient beds within the Adults and
LLAMS business streams. The estate
will reflect the needs of the service.
17
Key Actions & Delivery
Risks
14/15
15/16
£467k
Timely
production
and
approval of business cases.
Site C (LLAMS)
£3m
Site D (LLAMS)
£11m
See Assumptions
B
Accommodation
Improvements
C
Risk Management
and
Infrastructure These schemes reflect the need for
the Trust to ensure its accommodation
meets and exceeds service user
needs in terms of access and care
pathway. This category includes the
Leigh New Build project which will
provide an environment which better
supports privacy and dignity, safer
environment, increased utilisation of
space and an overall improvement in
the quality and efficiency of the
operational environment.
These works are being undertaken to
address identified and assessed risks
and create a safer environment for
service users and staff.
18
£7.765m
£700k
£18.5m
£1.093
Timely
production
and
approval of business cases.
Risk of delay due to
extended
consultation,
pushing activity and spend
into outer years. Interrelationship
between
different business streams,
the need to produce project
plans which complement
each other, and the need to
exploit shared efficiencies.
New risks being continually
identified
creating
new
schemes throughout the
year.
Key Expenditure Priorities
Contribution to Operational Plans
Timeframe
13/14
14/15
15/16
£295k
£220k
D
Backlog Maintenance
The Trust recognises that the quality
of its accommodation needs to meet
and exceed service user needs and
the challenges presented by a modern
day mental health service. This
element addresses deferred repairs
and maintenance of buildings.
£857k
E
Other
Fees to deliver schemes.
£250k
Total
£10.039m
19
Key Actions & Delivery Risks
The extent of backlog is adjusted
to fit with current plans for the
estate.
The amount of fees required is
dependent on the number of
schemes
being
undertaken.
Where
necessary
in
house
capacity has been added to by the
use
of
external
project
management and non-traditional
procurement methods.
£18.795m
£15.313m
Revenue Costs
The only changes to activity that we have assumed relate to CIP schemes, as we have not assumed
any income growth over the 3 years.
In terms of the inflationary impact of increments, this has been calculated to acknowledge the profile
of the workforce and that more staff are reaching the top of scale; £1,595k in 2013/14, £1,555k in
2014/15, and £1,521k in 2015/16. There is an assumption that the current pay award (1%) will
continue over the next 3 years with an impact of; £1,069k in 2013/14, £1,085k in 2014/15, and
£1,058k in 2015/16. In terms of non-pay the Trust anticipates 1% pressure in future years 2014/15
and 2015/16 excluding drugs where there is an assumption that inflation will be 5% per annum. The
Trust’s inflationary assumptions are summarised in Table 9.
Table 9 - Pay and non-pay inflationary assumptions, 2012/13 to 2015/16
Increment %
Increment (£'000s)
Pay %
Pay (£'000s)
Non Pay %
Non Pay (£'000s)
Drugs %
Drugs (£'000s)
2013/14
0.93%
1,084
0.93%
1,069
0.50%
99
5.00%
115
2014/15
1.08%
1,085
0.91%
1,068
1.0%
187
5.00%
94
2015/16
1.12%
1,128
0.91%
1,058
1.0%
176
5.00%
88
The Trust’s plans include non-recurrent expenditure relating to the implementation of the new clinical
information system at £800k in 2013/14, reducing to £199k in 2014/15 and £634k in 2015/16 relating
to transitional costs regarding service change.
20
Appendix 2: Cost Improvement Plans (CIPs) - Top 5 CIP Schemes (NOT FOR PUBLICATION)
Note: this schedule is to provide additional information regarding CIPs. Please refer to CIPs guidance on page 5.
Ref
Scheme
Scheme
description
including how
scheme will
reduce costs
Underpinning IT /
information
or
management
systems
Total
savings
£m
Phasing over three-year
period
WTE Reduction
(£000)
Yr. 1
Yr. 2
Yr. 3
Has the
scheme
been
subject to a
quality
impact
assessment
(Y/N)
1
Community
Efficiencies
£2.6m
£1196
£690
£700
14/15: 18.50
15/16: 18.80
2
Medical
Efficiencies
£1.1m
£10
£729
£400
14/15: 8.20
15/16: 6.20
3
Other
Operational
£4.6m
£1515
£1505
£1600
14/15: 27.10
15/16: 21.80
4
Corporate
Support
£2.5m
£1093
£730
£700
14/15: 10.10
15/16: 11.80
5
In patient
efficiencies
Adults and
LLAMs
£1.5m
£0
£471
£980
14/15: 15.80
15/16: 32.90
21
Who is
responsible
for signing
off on the
quality
impact
assessment
Key
measur
e of
quality
for plan
Scheme
Lead
Appendix 3: PFIs costs and utilisation (NOT FOR PUBLICATION)
Not applicable
Appendix 4: Use of external assurance (including internal audit) (NOT FOR PUBLICATION)
5 Boroughs Partnership NHS Foundation Trust is required to register with the CQC and its current
registration status is registered without conditions. The CQC has not taken enforcement action against 5
Boroughs Partnership NHS Foundation Trust during 2012-13.
During 2012/13 the Trust was inspected by the CQC as part of their scheduled annual visits. Three visits
took place; a review of Auden Unit in February 2013, part of the Trust’s Warrington Location, and visits to
Iris Ward and Taylor Ward in February and March 2013, part of our St Helens location. The outcome of
the inspections is that the Trust is meeting all the essential standards of quality and safety reviewed during
the inspections, maintaining the Trusts registration as ‘registered without conditions’.
Reports from all three inspections have been received by the Trust and have been published by CQC on
their website.
The Trust’s programme of internal quality visits assesses compliance with CQC standards.
The 2012/13 internal audit plan was designed to cover the Trust’s key risks and was derived taking into
account the output from a risk workshop attended by the Trusts leadership group. This plan was approved
by the Audit Committee, which monitored delivery of the plan throughout the year. A similar exercise has
been carried out for 2013/14 with the senior leaders in the organisation identifying the key risks for the
organisation looking forward, in order to support the creation of the Trust’s Assurance Framework and
internal audit plans moving forward.
During the year a number of reviews were undertaken, culminating in the Head of Internal Audit opinion
which provided substantial assurance that there is a sound system of internal control which is designed to
meet our objectives.
Appendix 5: Commercial or other confidential matters (NOT FOR PUBLICATION)
The Trust is submitting its annual plan template with 4 checks present on the check page relating to
the PPE reconciliation (check 15 asset movement check) due to the fact that the PPE has been
reduced in quarter 1 by £280k to reflect the plan to move 7&9 Wilson Patten Street to assets held for
sale.