DCHS Operational Plan 2017/18 – 2018/19
1. Introduction & Strategic Approach
In November 2016, DCHS launched its new clinical strategy, which refreshes its established Integrated
Business Plan (IBP) and reflects its position as an established Foundation Trust. This strategy reflects the
significant strategic developments that have led to the formulation of the Derbyshire Sustainability and
Transformation plan (STP), our continued close and effective relationships with our commissioners, partners
and stakeholders; and with our staff and service users.
Our strategy is built upon the foundation of high quality clinical care, as reflected in our recent Care Quality
Commission (CQC) visit and the recognition of the outstanding level of caring delivered by our workforce.
This will help to guide us on our on-going journey; from
good to great and to maintain our category 1 status under
the new NHSI regime. This Operational Plan details our
approach to the delivery of the first 2 years of this strategy
and has been written in accordance with NHSI planning
guidance
Our clinical strategy follows the ‘Triple Aim’, developed by
the Institute for Health Improvement (IHI) which will ensure
that we work together, as an organisation and with our
partners in the Derbyshire Health and Care Community to
close the gaps and realise the Triple Aim vision of
‘simultaneously improving the health of the population,
enhancing the experience and outcomes of the patient, and
reducing the per capita cost of care for the benefit of
communities. To ensure that, our plan will deliver:



High quality services that our communities require now, defined around their needs and what is
important to them.
Improvements to the health of our population and the resilience of our communities for the future.
A sustainable health and care system where our resources are used efficiently and responsibly,
making the best use of the Derbyshire £
The financial climate within which the contract settlements, that underpin this plan, have been agreed has proved
to be extremely challenging and this is reflected in section 6.3. This requires the Trust to deliver a stretched
control total surplus of £5 million, and an efficiency programme of £9.8m (5.3%). This is well in excess of previous
performance, and brings additional risk to the delivery of the financial plan.
The delivery of our plan will
therefore
require
strong
leadership to ensure that we are
confident in our aspirations and
create coherence across the
organisation and wider system.
We will need to work effectively
with our partners in a shared
environment
to
co-create
solutions and manage out conflict
whilst leading with courage and
conviction.
As such we
understand the challenge ahead
is great; but if effectively delivered the opportunities to transform care for the people of Derbyshire will more than
justify the effort. To successfully address these challenges we will need to develop our leaders and our leadership
behaviours; building upon the DCHS Way and the organisational models that underpin this.
1
2. Strategic and Planning Context
The final version of the Derbyshire STP was submitted on the 21st October. The STP recognises the
financial Challenges across the Derbyshire Health and Care system and is based upon the 5 priorities of:
Place based
Care
Prevention and
Self
Management
Urgent Care
System
Efficiency
System
Management
This plan places significant emphasis on place based care and DCHS will work with its partners to develop
the necessary services based on the investment available, which is reflected in section 4.3 below. We
recognise that in delivering place based services our actions need to be universal, to address inequalities
and improve outcomes, and to be delivered at a scale and with an intensity that is proportionate to the level
of need.
2.1 Better Care Closer to Home
We know that people do better mentally and physically if they can be cared for close to home by health and
care staff based in the community. North Derbyshire and Hardwick Clinical Commissioning Groups launched
the ‘Better Joined-Up Care Closer to Home’ consultation at the end of June. The proposals represent a
collaborative approach to transforming care at a system level so that people can be supported in their own
homes and communities more effectively. DCHS will work with other healthcare providers such as General
Practice and Mental Health services to help implement the agreed outcomes. However no decisions about
the proposals will be made until after an independent analysis, led by East Anglia University, has been
concluded, and this plan reflects this position.
2.2 Closer working with Derbyshire HealthCare Foundation Trust
DCHS and the Derbyshire Healthcare Foundation Trust (DHcFT) have been looking at the opportunities for
closer working that would allow us to remove any organisational barriers to providing the very best clinical
care for the benefit of the citizens of Derbyshire. On 27th October 2016 the Boards approved the Strategic
Outline Case (SOC) that explored options for collaboration between the organisations in response to a
number of shared challenges outlined in the STP. The preferred option for both organisations has now been
identified, which is for the two Trusts to pursue a merger through acquisition, with DCHS being the acquiring
organisation. Work is now in hand to undertake a full business case to progress these proposals, with the
outline business case to be completed by April 2017.
2.3 Erewash Vanguard
DCHS continues to work with partners in Erewash to further develop the Vanguard Multispecialty Community
Provider (MCP) model. All partners have committed to an Alliance contract to deliver the best outcomes for
the people of Erewash and deliver care in a seamless way. The development of On-day services, for those
patients who require an urgent appointment or same day access, will be a key priority within the vanguard
and DCHS will continue to develop these throughout 2017 and 2018.
3. Improving the health of the population
3.1 Public Health Organisation
Prevention and Wellbeing are at the heart of the STP and DCHS is strongly committed to the delivery of a
public health approach throughout the organisation. We have the potential to impact positively on the health
and wellbeing of each person every time that we come into contact with them. If we do this well it will
positively improve the health of our population in the future. Because the most effective way to spend public
money is on preventing ill health or on identifying illness early, we want to ensure that all opportunities are
taken by adopting a systematic population-based approach to improving health which will include our work to
support the development of Wellness Hubs, within the context of the STP. This will be a new way of working
for many of us, through which we will pursue the objectives detailed in Table 1
2
Table 1
Public Health
Areas
Actions
Educate staff about maximising the use of finite commissioning resources and encourage conscious
decision making from the ground up for best use of resources.
Delivery of clinical and cost effective care by reviewing and applying evidence based pathways of care
and minimising variation in service delivery
Development of preventative approach to care, educating the wider workforce on what the wider
determinants of public health are, the impact these can have on population health, and how adopting
approaches such as Making Every Contact Count (MECC) across the organisation can improve
outcomes for patients.
Promote ‘brief intervention’ approaches ensuring staff are confident to take a holistic approach when
discussing with the patient their health needs
Support staff wellbeing based on the findings of the staff health needs assessment (January 2017)
Improving the vaccination and immunisation uptake rates
Refresh the Emergency Preparedness plan to reflect the potential merger with Derbyshire Healthcare
Foundation Trust.
Ensure future flu campaigns meet the needs of our increasingly agile workforce
Healthcare
public health
Improving the
wider
determinants
of health
Health
Improvement
Health
protection
3.2 Supporting Research, Innovation and Growth
The DCHS Research and Innovation Group will ensure that research expertise within the Trust is used to
support services to deliver improved outcomes for their patients and to develop research competencies in
front line services. We will develop strategic partnerships with research networks, universities and other
NHS providers to increase our research credibility and to ensure we are better positioned to undertake
research studies generated nationally by academic or commercial organisations and by our own staff. We
will engage our service users so that they can choose to be part of the development of the evidence base
and have access to the latest emerging treatment. Through these steps DCHS will contribute to the
development of clinically effective practice.
4. Improving the experience of care - Quality and Satisfaction
4.1 Approach to Quality Governance
4.1.1
Named Executive Lead
Executive leadership is provided by Carolyn White, Chief Nurse and Director of Quality, in partnership with
Rick Meredith, Medical Director
4.1.2
From Good to Great – Our approach to achieving our ambition.
As a trust we are committed to our journey from ‘good to great’ and it is with this in mind that we will be using
the output of our recent Care Quality Commission (CQC) inspection reported in August this year to identify
and plan actions that will build on our overall ‘Good’ rating. DCHS has developed a comprehensive quality
improvement and assurance framework over the last three years which has facilitated year on year
improvements in the quality of our services and the underpinning governance arrangements.
Quality improvement is central to all that we do, with our patients being at the centre of all of our decisions.
Through our Quality Always programme we have three components that we see as fundamental to
continuous improvement:



Clinical standards across 13 domains which teams self-assess themselves against and which are
peer reviewed on a regular basis, driving improvement towards overall accreditation as a Quality
Always Gold accredited team.
Clinical leadership is supported through a bespoke personalised development assessment centre to
equip our clinical leaders with the skills to transform and improve services
Clinical standards improvement is supported through the auspices of Safe Care Champions –
individuals who are selected and trained to ensure that best practice is consistently delivered.
3
Our quality plans have been developed to ensure we deliver high quality person centred care and that we
ensure that our staff are able to deliver services that meet the standards defined in the NHS Constitution and
the CQC. To help us on our journey we will work to ensure that our Quality Always programme assessments
are aligned to the expectations and standards of the CQC so that our ‘Gold’ accreditation corresponds to the
‘Outstanding’ measure.
4.1.3
Patient Safety
DCHS is actively engaged with the national ‘Sign Up To Safety’ Campaign. We remain committed to the
reduction of harm to patients through the continued delivery of high quality care and to ensure that 95% of
patients receive care with no avoidable harm. To deliver this we will continue to implement our targeted
reduction strategies such as those for pressure ulcers and the targeted interventions of our Safe Care
Champions. Where serious harm does occur we will ensure that the Duty of Candour is exercised and that
patients or their advocates are informed of any lessons learned. Our current patient safety objectives have
been developed internally through the priorities and performance objectives identified through our Quality
Service Committee.
4.1.4
Measures being used to demonstrate and evidence the impact of investment in quality
improvement
Our Quality Always programme is led by the Chief Nurse and overseen by a programme management
approach. Key performance indicators for the programme have been developed and are reviewed regularly.
In addition the programme is supported by our research team who are undertaking its formal evaluation and
the benefits this has realised.
In addition the trust has developed an interactive real time clinical dashboard for clinical managers to assess
and monitor their own performance and compare and contrast this with similar trust services.
4.2 Quality Improvement Plan
Table 2
Initiative
National clinical
audits
The 4 priority
standards for sevenday hospital services
Safe staffing
Improving the quality
of mortality review
and Serious Incident
Investigation and
subsequent learning
and action
Anti-microbial
resistance
Infection prevention
and control
Falls
Sepsis
Pressure ulcers
Quality Improvement Plans
The trust participates in those national audits relevant to our services which currently include:
sentinel stroke, national audit of diabetic foot care, national audit of dementia, learning
disability mortality and the review of Young People’s Mental Health study
DCHS is working with the wider health and social care community on STP plans to ensure
care is delivered as close to home as possible and is provided equitably over 7 days in
accordance with these standards
DCHS will be reviewing its safe staffing requirements in line with STP place based care
proposals going forwards
All unexpected deaths are peer reviewed and all serious incidents undergo root cause
analysis. We will be reviewing our processes for sharing learning going forward. Our End of
Life Strategy, to be launched early in 2017 details our robust audit and assurance process.
We will respond to the recommendations and actions as detailed in the CQC review into
Learning, Candour and Accountability (December 2016) to ensure we deliver good practice
across all areas.
All inpatient antimicrobial prescribing is audited and reported through our infection prevention
and control group. In the coming year we will be strengthening our systems for monitoring
prescribing in the wider community
DCHS has a strong track record for good infection prevention and control. We will continue to
monitor this through regular IPC audit
Our falls working group will continue to work towards reducing falls in hospital and in patients
own homes and have set clear objectives to achieve this
Sepsis education forms a key part of our staff training programme as part of our recognising
the deteriorating patient. This will continue to be delivered and its impact monitored
Pressure ulcers remain our single greatest challenge and DCHS have set an ambitious 20%
reduction target this year which will be achieved through greater focus on:
4
End of Life Care
Patient experience
National CQUINS
 Exploiting technological support solutions
 Improved clinical care through greater staff awareness and training
 Patient/carer engagement
Our end of life governance group reviews ensures robust audit of end of life care and we
continue to implement changes from the new Derbyshire end of Life Care pathway. We will
launch our new End of Life strategy in 2017 and work to implement this across the
organisation and in our work with our partners.
We will continue to engage with and learn from our patients and carers through our network
of patient engagement. As we work to deliver more services in and close to home we
recognise the importance of the development of social capital and person centred goals in
improving the experience of care and wellbeing and avoiding social isolation. Our
commitment to driving improvements is reflected in our complaints management process, by
improving the timeliness and quality of our responses and ensuring that we share and act on
our learning.
Through the implementation of our operational plan we will deliver our CQUIN targets across
the following key areas: Improving Staff Health and Wellbeing, Supporting proactive and safe
discharge, Preventing ill health by high risk behaviour e.g. in relation to alcohol and tobacco,
Improving assessment of wounds and Personalised care and support planning
The delivery and monitoring of the actions associated with the delivery of these will be
included through the on-going development and governance of our delivery plan (appendix 1)
The Trust’s measure of compliance against these standards will be monitored through the Quality Schedule
which will be reported to the Quality and Performance group of the STP
4.2.1
Quality Planning – creation, assessment, governance and monitoring
Schemes for service and cost improvements are developed at an operational level and assessed for
feasibility by the Executive led Plan Delivery Group. Each project plan includes a quality impact assessment
(QIA), equality impact assessment, risk assessment and financial profile. Schemes deemed viable by the
Plan Delivery Group are independently assessed for its potential impact on quality by a panel consisting of
the Chief Nurse, Medical Director and a Non-executive Director. The process is facilitated by the
Programme Management Office which also provides progress reports to the Plan Delivery Group and
Quality Business Committee of the Board. Our Governance process was developed using Birmingham
Children’s hospital framework illustrated as best practice in the NQB Quality Impact Assess provider Cost
Improvement plan Guidance 2013. It can be summarised as follows:
Initiate
Plan
•Feasibility agreed
•Benefits identified
Implement
•Delivery against key
milestones
•Management of risks
•Tracking of KPIs
•QIA signed off
•Project plan and
risk assessment
signed off
1
Review
2
•Benefits and
quality review at 6
months
•Confirmation of
plans for future
reviews
3
4
4.2.2 Triangulation of quality with workforce and finance
The Board receives an integrated performance dashboard on a monthly basis which includes staffing, quality
and financial metrics. In addition all clinical managers have access to a live interactive clinical dashboard
which details key performance indicators for quality and staffing
5
4.3 This section outlines the operational plans which are intended to ensure that our services remain sustainable whilst meeting the objectives laid out within the NHS
Mandate and the Planning “Must Dos”. These plans are aligned with those of our partners and will support the effective implementation of the business cases
within the STP and the effective transformation of care within Derbyshire, where resources allow. The themes reflected below will be supported by detailed
operational delivery plans and clear reporting mechanisms (see appendix one) to provide assurance to our Board and its sub committees that we maintain an
effective grip on delivery, timing and budget and that through this we will mitigate our Board Assurance Framework risks outlined in Appendix 2
Table 3
Ref
1
Service
Area
All
2
All



3
All



4
All

5
All

6
All

7
All


8
ICS &
PC
HW&I &
ICS
9
Service Development Priorities






10
ICS

Work to improve the efficiency and experience of the patient journey for both patients and referrers.
Engage our partners to ensure that we support the development of evidence based care pathways and to deliver proactive approaches to care
to improve the management of long term conditions e.g. diabetes, dysphagia and musculoskeletal and to monitor their efficacy.
Identify patients who are scheduled for outpatient or primary care follow-up and would benefit from personalised care and support
Continue to focus on the prevention agenda, maximising health gains and avoiding unnecessary health care costs.
Engage our patients to understand their needs and requirements and to increase their knowledge, skills and confidence to manage their
health and wellbeing.
Embed this approach within all services supported by additional/further training in MECC and the support of our Health Psychology service
Develop specific services to meet the needs of specific place population,
Respond to feedback from clients and service users when developing and improving our services, such as ensuring our services are available
at different times and days (including out of hours, evening sessions and some Saturday mornings) and are delivered in local community
venues with an emphasis on delivery in the most deprived areas
Develop our medicines management function to support the reduction in antibiotic consumption. We will continue to develop our non-medical
prescribing initiatives and develop robust and appropriate governance arrangements to support this.
Review the locations of clinical activity and services to ensure the maximised use of, and maximum value from, our estate and assets and to
facilitate effective integrated working with our voluntary sector and social care partners
Maximise the use of technology and equipment to ensure efficient co-ordination and provision of care and to improve the monitoring of
patients
Utilise telehealth opportunities to support proactive self-care at home and promote maintenance of independence in Place
Reduce unwarranted variation across clinical and corporate services to reduce duplication and inefficiency and embed a standardised
approach to the delivery of care that optimises clinical quality, efficiency and productivity.
To reduce the delayed transfers of care and meet our target of 3.5% by September 2017
Support the appropriate use of personal budgets and personal health budgets to support person centred care and engagement to deliver
individual packages of care in the most effective and efficient way.
Maximise the efficiency of General Practice and Integrated community teams to support proposed inpatient rationalisation and to work
collaboratively with other agencies in Place to provide quality person centred care
Develop consistent seven day services, where appropriate and in collaboration with partners. Particular areas of focus include: Community IV
service - development of step up service and reviewing the current level of provision (High Peak) , development of the discharge to assess
and manage service, access to same day GP appointments, the development of Personalised Care and Support Planning , delivery of the
DCHS End of Life and Frailty Strategies
Develop collaborative Comprehensive Geriatric Assessments that are shared across pathways, including the implementation of 'Trusted
STP
Objective
P, PC, Pr
Pr & P
P
SE
C&M & SE
Pr & SE
SE
Pr
P
P
6
11
ICS

12
ICS

13
ICS

14
ICS


15
PC

16
PC

17
PC

18
19
PC
HW&I


20
21
HW&I
HW&I



22
23
HW&I
HW&I


24
HW&I


Assessments' across agencies and Improve the outcomes for those living at home with frailty
Reduce the numbers of older people with dementia being admitted into an acute mental health bed for assessment/treatment by providing
this in an appropriate community setting via a specialist community multi-disciplinary team (Dementia Rapid Response Team - DRRT) and
through the early recognition and treatment of delirium
With partners in health, care and the voluntary sector develop Older People’s Mental Health services, as part of a community facing,
enhanced organic pathway to improve the experience and outcomes for people with dementia, and their carers.
Develop a Unified Community Learning Disability model to promote new approaches to care and support pathways; including the development
of more personalised, efficient and effective short break respite services.
Develop our staffing model to enhance our skill mix and expertise to support the future Place based community model
Develop our emergency and urgent care services to ensure patients are seen by the most appropriate person, at the right place at the right
time. We will work with our partners to maximise the use and effectiveness of our urgent care services including MIUs, Step Up facilities (AVS,
Falls, Care Home support & IV therapy)
Progress the review of the portfolio of services with partner providers to ensure that the community provision meets the health needs of the
population in a locally accessible and sustainable way
Continue to support and implement the recommendations from the commissioner led review of wheelchair services, to ensure high quality and
sustainable service provision, in the context of increasing complexity
Consolidation of our catering facilities through a more effective ‘hub and spoke’ model and to ensure that we provide a quality, nutritionally
balanced and freshly cooked menu for patients, visitors and staff; and respond to patient feedback.
Develop a county wide single point of access and local triage to enable easy access for all agencies
Improve health literacy and sexual health awareness of the target populations by offering and increasing the uptake of testing, by focusing on
increasing accessibility such as testing at home and developing walk-in services
Establish a wider range of self-management diabetes education programmes for people with Type 2 diabetes in partnership with our CCGs
Improve access initially by ensuring all practices are signed up to the Extended Hours Directed Enhanced Services and support the delivery of
the GP5YFV. Increase the use of online and telephone management and review the process for streaming patient demand.
Develop a shared infrastructure between our own practices, including reviewing our skill mix to develop new roles and using existing roles
innovatively to improve efficiency and quality for all patients
Influence the future development of the place based model of care to incorporate the children and young adult agenda
Respond to feedback from clients, in particular from children and young adults themselves on how we are able to ensure our services are
accessible, responsive, welcoming and inclusive to all.
Work with our schools to help children and young people to make healthy life choices and to develop their emotional resilience and wellbeing.
Work with our county and city commissioners to continue to promote and improve the health of the population, including the reduction of
childhood obesity and the continued improvement in breastfeeding sustainment rates
HS, MH &
P
Pr, HS, P
& MH
LD & SE
P & HS
P, PC &
HS
SC
Pr
P & LD
Pr
Pr & P
P & SE
C&M
C&M
C&M
Service Areas: ICS – Integrated Community Services, PC – Planned Care, HW&I – Heath, Wellbeing & Inclusion
STP Objectives: P – Place, Pr – Prevention & Self Management, UC – Urgent Care, SE – System Efficiency, SM – System Management, HS – Appropriate
& effective treatment at hospital sites, LD – Learning Disability, C&M – Children’s & Maternity, MH – Mental Health, PC - Planned Care, SC – Specialist
Community Service
7
5.4 Workforce
5.4.1 Workforce Strategy
DCHS recognises the significant risks surrounding future workforce requirements for the delivery of its
plans and in response to this we have worked with each Division, our staff forums and the Workforce
planning groups to refresh our Workforce strategy; ensuring this is aligned to the clinical and STP
strategies across Derbyshire.
We recognise the important contribution that the voluntary and community sector make in the delivery
of care and the promotion of social value. We will continue to work with our partners in these areas,
recognising their contribution to developing a sustainable workforce, developing services in
partnership with them and working to explore new opportunities for them to make a difference to the
wellbeing of our patients as we develop our volunteer strategy.
The implementation of this plan and the wider STP will require strong leadership to ensure that we are
confident in our aspirations; create coherence across the organisations and wider system; work
effectively with partners to co-create solutions and manage out conflict whilst leading with courage
and conviction. Leaders will need support and development to help them rise to this challenge and
this will need to be underpinned by effective communications and change management. To deliver
this effectively we will also need to ensure the appropriate change management capacity is available.
5.4.2 Workforce Planning
We have a cyclical, robust, internal workforce planning methodology which triangulates service,
finance and workforce requirements. We have shared this approach with our STP partners to promote
a system wide methodology and we have also led workforce modelling activity, using the Strategic
workforce and education planning (SWiPE) approach.
5.4.3 Workforce Efficiency
Historically we have a strong track record of reducing our use of agency and locum spend though we
continue to be set challenging targets. As such we are developing further innovative responses (see
6.5.1) and are engaged in regional work to address “under price cap” arrangements. We continually
review our actions with the Trust Board to seek every opportunity to address our position and we are
very active in the Derbyshire health economy in relation to increasing the responsiveness, and
efficiency of the combined Derbyshire workforce, for example:




Chairing the Derbyshire Strategic Workforce Implementation Group
Director lead on the workforce “Back office” efficiency schemes
Active member of the Local Workforce Advisory Board, and Chair of Implementation Group
Hosting initiatives such as the regional Return to Practice post and encouraging its expansion
beyond Nursing to Allied Health Professionals.
We generally source all of our workforce from our host community so to date have not entered into
any overseas recruitment.
5.5.4 Workforce Transformation & New Models
Within the context of the financially constrained climate we recognise that there will be no workforce
growth in 17/18 and potential workforce rationalisation in relation to back office efficiencies and
decommissioning of service by the CCGs. Recruitment to our clinical workforce will however continue
to ensure we fill our vacancies as they arise. Beyond this our workforce plans recognise the STP
focus on Place and will support delivery of the emerging care models, where, we will help to create
integrated and co-located teams working more efficiently to deliver care across Derbyshire. The new
care models described within the STP will require:
8






New ways of working, such as in the integrated teams which we are already developing with
our partners.
New roles, such as the approach we have developed in relation to Advanced Clinical
Practitioners and our work with care providers to increase applicants into this sector.
Review of our learning and development offer to ensure that this is specific to existing and
developing roles, underpinned by a more robust approach to training needs analysis.
Increased support to our staff to enable them to work more flexibly and across different
settings
Improving our understanding about current workforce risks and challenges.
Supporting and learning from our partners and developing shared flexible workforce solutions.
DCHS will continue to offer clinical and non-clinical placements to promote future workforce supply,
and we will maximise our offer in areas where we have a workforce challenge, such as Allied Health
professionals and the registered Nursing workforce. We will also develop our approach to
apprenticeships to ensure that from April we are able to deliver those requirements. In response to
the changing arrangements for bursaries we have put in place schemes to both fast track existing
staff to undertake registration as well as opportunities for staff to learn whilst they are also earning
through Open University courses. Through our leadership within the STP and work with the Local
Workforce Action Board (LWAB) we will align our workforce strategy with the needs of the local health
and care system.
5.5.5 Workforce Governance
To ensure the robust governance of our workforce plans we have strengthened our internal approach
to the review of emerging operational needs, the on-going position in relation to workforce supply and
our agency workforce requirements. This in turn strengthens the assurance we are able to give to the
Trust Board, through the Quality People Committee, regarding the delivery of our workforce plans.
5.6 Equality, Diversity & Inclusion
DCHS is currently reviewing the Equality, Diversity and Inclusion Strategy; this will reflect a longer
term strategic approach to support service transformation and to manage its impact on our
communities. Key actions identified to ensure the delivery of the strategy and to support our journey
from good to great are detailed here:
Table 4
Equality Objective
Consider the impact of what we do (or are
planning to do) on all sections of the
community / protected characteristics
Increase and improve DCHS’ awareness and
understanding of equality, diversity, inclusion
and Human Rights issues – improve
organisational culture
Better understand, and more effectively
meet, the needs of all our service users /
patients
Better understand the profile and
experiences of our employees and achieve a
diverse workforce
Action
 Increase the completion rate of Equality Impact
Assessments (EIA’s) to:
− 50% of all key decisions by end March 2017,
− 100% of all key decisions by March 2018
 Establish an ‘Equalities Allies’ programme by end March
2017
 Have 100 ‘Equalities Allies’ in place by end March 2018



Progress the equalities agenda within DCHS


Move from 50% of services on TPP completing the Diversity
Monitoring Questionnaire to:
− 75% by end March 2017
− 100% by end March 2018
Produce and publish the 2016 Annual Workforce Profile
Report and Analysis by 31 Jan 2017 and the 2017 report 31
Jan 2018
Undertake analysis by Protected Characteristic of the 2016
staff survey by end March 2017 and 2017 staff survey by
end of March 2018
Consolidate the ‘Achieving’ level of the Equality Delivery
System 2 (EDS2) by end March 2017
Achieve the ‘Excellent’ level by end March 2018
9
6. Reducing the per capita cost of healthcare
6.1.1
Approach to Activity Planning
DCHS recognise the importance for the Trust to have realistic activity plans which align with
commissioners plans delivered through robust demand and capacity modelling. This is essential to
ensure there is sound financial and workforce planning, and that there is sufficient capacity to meet
demand and ensure achievement of operational standards including A&E waits and Referral to
Treatment (RTT).
A coordinated two step approach to activity planning has been taken:

Baseline activity plans have been based on agreed 2016/17 forecast out-turn. Within DCHS
specific service leads have informed these baseline plans, where 2016/17 month 1 to 5 actual
activity has been taken, and then forecast forward based on agreed historic activity profiles and
then adjusted for full year impact of any service developments and any factors which have had a
non-recurrent impact. These baseline plans have then been shared with commissioners and
compared to their plans to identify and understand any significant variances, to then allow us to
agree a common baseline.

Growth has then been applied to these baselines. Growth takes into account demographic and
activity growth based on a consistent national methodology. This has been applied to Outpatients
(First and Follow-up), Non-Electives, Electives (Inpatients and Day Cases) and A&E attendances.
The table below details the high level 17/18 cost and volume activity plans
Table 5
2017/18 Activity
Plan
National Tariff
Local Cost and
Volume
Total
Service
Accident and Emergency
Diagnostic Treatment Centre
Diagnostic Imaging
Community Podiatry
Physiotherapy
Podiatric Surgery
Pulmonary Rehab
Speech and Language Therapy
Vasectomy
Activity
67,208
47,575
3,625
153,449
125,999
15,790
703
21,598
391
436,339
For the block contract services, growth has been applied at 2.4%. This will be applied
disproportionately across service lines to ensure that service risks and pressures are addressed. To
fund this growth, commissioners will apply an equivalent QIPP target. They have agreed to inform of
service lines they wish to divest in by the end of January 2017.Integrated community services activity
historically hasn’t been as accurate and as well understood compared to other services. This is linked
to the use of block contracts and the gradual roll-out of TPP system one electronic patient information
system, which commissioners now recognise and understand. Further joint detailed work with
commissioners is being undertaken to agree accurate baselines for each locality, taking into account
any issues with historic data and changes to information systems. This will prepare both
commissioners and the Trust to prepare for the development of PLACEs across the county and to
plan and monitor the impact of investments and disinvestments on activity.
To develop appropriate capacity across winter and to ensure system resilience DCHS will ensure that
corporate clinical staff are able to directly support clinical services. DCHS will build on the agreement
and investment it has secured via the A&E Delivery Board and System Chiefs Group to increase
resources to respond to whole system pressures. This includes the provision of discharge planning
and support services along with additional winter beds, a roster of corporate clinical staff who can
support direct clinical service provision at times of high demand.
10
6.1.2
Achievement of Key Milestones
DCHS have historically performed strongly against operational standards linked to A&E and RTT.
Commissioners and DCHS are committed to ensuring achievement of these operational standards
continues. Indicative activity plans and block contracts are currently being worked through and agreed
to ensure this is achievable. This includes consideration of current performance and capacity, impact
of demographic growth using the national Indicative Hospital Activity Model (IHAM), and impact of
transformational service changes. The impact of these activity plans will then be reflected in
operational delivery plans, taking into account workforce impact and session planning.
6.1.3
Financial Planning
The financial context within which the Trust operates continues to be challenging. Although the
Derbyshire system is broadly planning to achieve its control total in 2016/17, this will be delivered
through significant non-recurrent measures. Therefore the contracting discussions for 2017/18 and
2018/19 have been difficult with affordability of contracts becoming a key issue for commissioners.
With affordability a key issue for the Derbyshire system, the level of financial risk taken by each
organisation within their plan has grown. For DCHS, we will be required to deliver efficiencies of 4% to
achieve our stretch control total, and a further 1.3% to achieve commissioner QIPP. These levels of
efficiency are much greater than the Trust has previously achieved. Therefore the key financial
challenge in 2017/18 will be delivery of the efficiency plan.
Moving forward, the Sustainability Transformation Plans will be the vehicle through which integrated
service and financial plans of commissioners and providers will be delivered. The Trust will continue
to fully participate in the development of the Derbyshire STP.
The Trust has demonstrated its financial resilience during these testing times through continuing to
achieve its financial plans and targets. For 2017/18 and 2018/19, all providers have been issued with
surplus control totals. The Trust has been issued with a control total of £4.923 million surplus in
2017/18 and £5.113m in 2018/19. For those providers which deliver their 2016/17 control total and
accept the 2017/18 control total and associated conditions, NHS Improvement have provided
flexibility for providers to set their own control total for 2018/19 within a set framework. For the Trust,
as we are in surplus (before STF funding) in 2017/18, we are required to maintain a surplus at the
same level as 2017/18 in 2018/19. The Trust is therefore planning for a surplus of £4.923m, and full
receipt of STF funding in 2018/19.
Against this context, the Trust has developed a realistic two year financial plan which will deliver an
EBITDA margin of £11.4m (6.01%) in 2017/18 and a surplus of £4.923m or 2.58% of turnover. In
2018/19 EBITDA margin is planned at £11.4m (6.02%) and a surplus of £4.923m or 2.58%
The plan is dependent on the successful delivery of an efficiency programme of £9.783m in 2017/18
and £3.8m in 2018/19.
6.1.4
Financial Forecasts and Modelling
The initial plan as presented is based on a number of key planning assumptions:- The national efficiency requirement has been confirmed at 2.0% for 2017/18 and 2018/19.
National costs pressures are assumed at 2.1% in each year which when offset against the 2%
efficiency, results in a tariff uplift on 0.1%.
- The clinical income assumptions underpinning the plan are aligned to the contract values
agreed with Commissioners for 2017/18
- Revenue surplus of £4.923m in both years.
- Capital Investment Plans of £5.0m each year which is in excess of the forecast depreciation
levels of £4.0m by £1.0m, the funding gap being met from internally generated resources.
11
Table 6 (income and expenditure) details the high level income and expenditure position planned for
in 2017-18 and 2018-19. The surplus levels represent 2.58% of forecast turnover.
Table 7 (balance sheet projections) details the current balance sheet projections. The initial cash-flow
forecast shows that the Trust is planning to increase its cash reserves held from £14.3m at the end of
2016-17 to £22.3m at the end of 2018-19.
The cash-flows associated with the capital programme as currently modelled are in excess of the
Trust’s forecast depreciation levels by £1.0m which will be met from internally generated resources.
The most significant schemes include the re-development of the Walton site, the new build on the
Heanor site and the on-going investment into the Trust’s IM&T infrastructure. The Trust is currently
actively marketing the surplus land on the Walton site. There is a clause within the original transfer
document from the Department of Health to the Trust that states that the DH will claw back 50% of
any profit on sale. It is anticipated that the likely sale proceeds will be approximately £2.44m which
would represent a profit on sale of £1.0m and 50% of this or £0.5m would be returned to the DH.
Therefore the Trust would receive a cash receipt of £1.9m. This has not been modelled into the
Trust’s cash-flow forecasts based upon recent guidance received by NHS Improvement.
Table 6
Table 7
Income and Expenditure - December Submission
Balance Sheet - December Submission
Forecast
2016-17
£m's
Plan
2017-18
£m's
Plan
2018-19
£m's
Forecast
Plan
2016-17 2017-18
£m's
£m's
Plan
2018-19
£m's
Non Current Assets
86.6
87.5
88.5
Current Assets
20.9
25.0
28.7
-10.7
-10.7
-10.8
Net Current Assets / Liabilities
10.2
14.3
17.9
Provisions - Non Current
-0.1
-0.1
-0.1
0.0
0.0
0.0
96.7
101.7
106.3
Clinical Income
Other Income
183.0
10.9
180.4
9.8
180.6
9.8
Total Turnover
193.9
190.2
190.4
Operating Expenses
-183.2
-178.8
-179.1
EBITDA
EBITDA - %
10.7
5.51%
11.4
5.99%
11.3
5.93%
Depreciation
Interest Income
-4.0
0.1
-4.1
-0.1
-4.0
0.1
Represented By:-
PDC Dividend Payable
-2.4
-2.5
-2.5
Public Divided Capital
Retained Earnings
Revaluation Reserve
0.2
74.2
22.3
0.2
79.1
22.3
0.2
83.8
22.3
4.4
2.26%
4.9
2.58%
4.9
2.58%
Total Assets Employed
96.7
101.7
106.3
Surplus / ( Deficit) In Year
Surplus / ( Deficit) In Year - %
Current Liabilities
Deferred Income - Non Current
Total Assets Employed
NHS Improvement has introduced a new Single Oversight Framework for both NHS Trusts and NHS
Foundation Trusts which replaces Monitor’s Risk Assessment
Our forecast Use of Resources
metric under the new Single
Oversight Framework is a 1
(lowest risk). (table 8). It is
important to understand the level
of financial headroom available
within the plan as presented
here. In order to reduce the
rating to a 2 there would need to
be a reduction in margin of
£3.1m. A further reduction of
£0.8m would reduce the overall
rating to a 3.
Table 8
Single Oversight Framework - December
Submission
Metric
Weight
Forecast 2016-17
Score
Rating
Plan 2017-18
Score
Rating
Plan 2018-19
Score
Rating
Capital Service Capacity ( x times )
20.00%
4.58
1.0
4.60
1.0
4.60
1.0
Liquidity ( Days)
20.00%
20.4
1.0
28.9
1.0
36.9
1.0
I&E Margin (%)
20.00%
2.35%
1.0
2.59%
1.0
2.59%
1.0
Distance from plan (%)
20.00%
0.00%
1.0
0.00%
1.0
0.00%
1.0
Agency Expenditure (%)
20.00%
2.70%
2.0
0.00
1.0
0.00
1.0
Overall Rating
1.0
1.0
The plan as presented here represents the Trust’s base case and most realistic assessment of likely
financial position over the next two financial years. However, in addition to the above, there are a
number of key risks inherent in the Trust’s planning assumptions and therefore it is important to
understand the impact that these risks could have on the Trust’s financial projections and overall
financial rating.
12
The key sensitivities / risks that have been considered are detailed below and the table provides an
analysis of the impact each of these would have on the base plan presented here. The individual
Table 9
sensitivities identified whilst
eroding the Trust’s margin
2017/18
2018/19
and cash position are not
Sensitivity - Combined
Surplus
Cash
Surplus
Cash
Rating
£000's
£000's
£000's
£000's
2017/18 2018/19
sufficient in isolation to have
an impact of the Trust’s
Trust Base Case Plan
4,923
18,318
4,923
22,241
1
1
overall Financial Rating of a
Combined
-2,448
-2,448
-3,248
-5,696
1. In the situation where all of
the risks identified materialise
Revised Position
2,954
16,329
1,362
18,707
1
2
this combined scenario would
be sufficient to reduce the
Trust’s rating to a 2 in 2018/19. Clearly this would be the position before the implementation of the
Trust’s mitigation plan. This is shown in the table 9
Table 10
6.2 Efficiency Savings for 2017/18 to 2018/19
Table 10 shows the level of efficiencies that the Trust will be required
to deliver over the two year planning period. This is a combination of
the national efficiency target for all providers of 2% plus unfunded
cost pressures and the additional transformational efficiencies
identified by commissioners. At the time of submission, there
remains £1m of the Trust’s internal efficiency programme which is
unidentified. The Trust will work over the final quarter of the current
year to identify further schemes to close the current gap in the
programme. The Commissioner QIPP is also currently unidentified. A
deadline of the end of January 2017 has been set to agree the
schemes which will deliver this additional efficiency. As a result the
level of efficiencies to be delivered in 2017/18 is significantly greater
than previous years which brings additional risk to the plan.
2017-18
%
Pay & Prices
Tariff Inflation
2018-19
%
2.1%
0.1%
2.1%
0.1%
-2.0%
-2.0%
Techncial Efficiency - £000's
7,238
Techncial Efficiency - % 3.95%
3,800
2.08%
National Efficiency
CCG QIPP
CCG QIPP
2,545
1.37%
Total Efficiency
Total Efficiency
9,783
5.32%
3,800
2.08%
6.3 Capital Planning
Capital Investment Plan
The plan assumes capital investment of £5m pa. The major areas planned for investment are the
redevelopment of the Walton and Heanor sites, continued investment in the Trust’s IM&T
infrastructure and routine backlog maintenance. This level of investment is in excess of the forecast
annual depreciation of £4.0m The Trust is not seeking external financing and therefore the balance
will be funded from internal cash resources. The Trust is anticipating a capital receipt during 2017/18
in relation to the sale of surplus land on the Walton site which will assist in maintaining a good level of
liquidity.
6.4 Estates Management
Within Derbyshire estates costs are projected to increase by £25m over the course of the next 5
years. We recognise the inefficiencies in our current estate and have, with our partners, identified a
range of opportunities that will be key to delivering our service developments and aspirations as well
as delivering improvements in efficiency and utilisation. The outcome of the public Better Care Closer
to Home consultation will have a major impact on how our services are delivered in the future, and as
such determine the capital/estates priorities and work schedule for the coming years. In addition we
will work to deliver the ‘One Public Estate’ initiative to maximise the utilisation of NHS and Public
sector buildings and estates and to facilitate integrated and collaborative working, such as the
development of an integrated hub in Buxton. The table 11 captures the STP estates priorities for
DCHS
13
Table 11
Transactional Schemes
Revaluation of estate – awaiting outcome
Maximise utilisation of LIFT buildings (St
Oswalds)
Rent reductions (NHSPS – Babington)
Transformational Schemes
Better Care Closer to Home Consultation outcome actions
Site utilisation and accommodation
– London Road Community Hospital, Belper,
Heanor, Walton & Wheatbridge
Closer working with DHcFT
6.5 System Efficiency
The Trust will be working with Lord Carter, NHS Improvement and other providers to develop the
efficiency workstream for community and mental health trust providers in 2017/18. We are already
well advanced on this work and we are progressing in the following areas:
6.5.1
Agency Rules
DCHS has been identified by the Lord Carter case study as a best practice example for temporary
staffing solutions. We have undertaken further work to reduce our Agency spend whilst continuing to
make patient safety our absolute priority. This includes:









6.5.2
Successfully recruiting additional team members to our Responsive Workforce team.
Identifying additional actions to increase the bank fill rate; including enhanced rates and
opportunities to implement a weekly payroll
Recruiting additional posts to our bank, especially in workforce groups where we have known
challenge, such as around Allied Health Professional recruitment
Large-scale recruitment campaign which aims to not only fill current clinical vacancies but
also anticipates where we might need extra staff or where vacancies might arise.
Where ‘hard to fill’ areas have been identified we will explore targeted recruitment incentives
to secure a permanent workforce more easily.
Introducing a central daily ‘staffing monitoring’ service within People & Organisational
Effectiveness, to find solutions to gaps and is reducing shifts sent to bank/agency.
Scrutinising agency spend line by line to remove any unnecessary expenditure, only
permitting use in Clinical services to ensure that patient safety is not compromised
Engaging with our existing Advanced Nurse Practioner workforce to see who is prepared to
work extra hours within our GP practices and also liaising with a framework agency to support
ANP work to reduce GP locum spend.
Implementation of an additional senior clinical on-call rota to ensure that clinical judgments
relating to staffing can be swiftly made to prevent the need for agency cover
Back Office
DCHS is working collaboratively with its STP partners to identify system wide efficiencies such as
those that have been identified in relation to utilities, food and waste management costs. We are also
working closely with colleagues at DHcFT and have identified significant efficiencies in relation to
closer working across IM&T, People & Organisational Effectiveness, Estates, Facilities Management
and Procurement. Project management support will be provided to enable the implementation of
these initiatives.
6.5.3 Procurement
The Trust has developed its procurement strategy which applies to all its procurement activity and
which commits it to take action on all areas of non-pay expenditure by applying good practice in
selection, purchasing, prices, stockholding and usage to achieve value for money and appropriate
quality.
14
In line with the Carter Report, we have developed a Procurement Transformation Plan. This sets out
the key changes and actions required to improve our performance against the key Carter metrics. In
addition, the procurement department are working with clinical services to support the delivery of non
pay efficiencies, as well as working with partner organisations to drive further savings through
collaborative procurement.
6.5.4
Reducing unwarranted variation
As part of our approach to delivering the Carter principles DCHS is committed to reducing
unwarranted variation and improving efficiency across all services. Work on our business intelligence
system continues to support these developments. We will continually review the quality, effectiveness
and productivity of our community therapy, nursing and specialist service provision across the city and
county. By following this approach we will reduce duplication and inefficiency, embed a standardised
approach to the delivery of care to ensure that will optimise clinical quality, efficiency and productivity
and ensure that we deliver appropriate and measurable outcomes.
6.5.5
Commercial Developments
We continue to monitor commercial development opportunities in line with our commercial
development strategy and work closely with our public health commissioner in relation to the delivery
of these contracts. This will require us to evaluate the future tender arrangements for our public health
contracts and work to further align all these contracts with the key priorities within the STP. We have
revised our Business Development Framework and adopted a benefits realisation approach to all
commercial investments which is monitored through the Quality Business Committee
6.5.6 Informatics and Technological Transformation
We will continue to exploit both our existing and new technologies to provide increasingly high quality
and efficient care and support our clinicians to exploit that technology to its fullest extent to deliver
better quality outcomes to the people of Derbyshire. DCHS is a key member of the Derbyshire
Information Delivery Board (DIDB) which has agreed a Derbyshire Local Delivery Roadmap. This sets
out our IM&T objectives, which are shown in Appendix 3, in relation to the STP priority areas.
6.5.7
Business Continuity
The Trust has in place a Major Incident & Business Continuity Plan and maintains and develops
business continuity arrangements in line with national guidance and BS25999. In 2014-15, following a
peer review from the lead CCG, the Trust received 'full assurance' against the wider Emergency
Preparedness, Resilience and Response (EPRR) work programme.
7. Governance and Assurance
7.1 Governor Elections, Training and Development
9 new Public and 5 new Staff Governors commenced their tenure with DCHS on 1 November 2016.
Governor training, development and activities to facilitate future engagement and recruitment will
include:
 Election “drop in” sessions at locations and DCHS services across the county
 An induction programme for new Governors
 Articles in members’ newspaper and staff magazine; press releases: social media messages;
internet and intranet web content; emails to members; posters; electoral agent electronic
election platform; video interviews with Governors
 Provision of a “buddy” to ensure the successful integration to the Council
 Continued support to Governor groups covering Strategy, Quality, Governance and
Engagement
 Strategic development workshops and membership engagement activity
 Visits to sites and services including the national Governor conference
15


Governor involvement with community groups such as Patient Participation Groups
Partnership working through joint meetings with Governors and Directors from key
organisations across the system, including Derbyshire Healthcare Foundation Trust
As we work closer with our colleagues in Derbyshire Healthcare NHSFT, we will work to explore the
actions required to develop a Council of Governors following the anticipated merger by acquisition.
7.2 Membership Strategy
As part of the review of the Trust’s Strategy members were consulted directly to obtain their views on
the priorities for the Trust and to understand what could be improved upon. As a result of this we will
continue to develop our membership strategy by:






Developing a member survey asking their opinions on activities and engagement for the
coming year.
The Trusts Communication and Engagement Team supporting the Patient Experience Team
(PET) to engage members in defined protected characteristics projects
Providing a varied programme of quality visits (PLACE) and educational training sessions for
our members on popular health-related topics (such as Heartstart)
Regularly contacting members about health events in their area
Strengthening links with a wide range of community and voluntary groups to build a diverse
membership
Reviewing members’ engagement in the public session of the Trust Board, supporting the
Trust Secretary and Chair to maximise engagement and transparent operation of the Board.
To engage with the wider public we will:


Actively promote the Board meeting to members and public; including the open question and
answer session that precedes the Board
Actively promote the Governor elections as and when they arise – through press releases,
promotional materials, social media communications and our website. We will additionally
actively recruit new members and promote the benefits of trust membership during this time.
7.3 Governance of the Plan
7.3.1 Risks to plan delivery
Our plans over the next 2 years are both transformational and challenging so we recognise that there
are significant risks associated with their delivery. In 2016 we reviewed our BAF risks to ensure these
appropriately reflect the challenges we face. Appendix 2 details how the actions contained within the
operational plan, along with the objective and priorities of our Derbyshire STP, come together to
mitigate these BAF risks and to provide assurance on the continued delivery of the Trusts strategic
objectives and therefore the overarching vision and values of the Trust.
The challenging financial context means that the effective governance of the delivery of the plan is
extremely important and therefore the plan has been structured to reflect the way this will be
implemented through the Board’s Quality Service, People and Business committees taking account
the key aims of service sustainability, viability, public accountability and transparency.
The monitoring plan, shown in appendix 1, details arrangements for ensuring delivery and ensures
that our actions are aligned to our strategic objectives and address any associated BAF risks.
Whilst this plan sets out the DCHS operational priorities within the context of the STP it is significantly
reliant on the plans of our partners and their commitment to an integrated delivery and risk sharing
approach. We will therefore continue to work hard to support system delivery and work closely with
16
our partners to achieve our joint aims whilst promoting the continued provision of our own high quality
care delivered by our own high quality workforce.
17
Appendix 1 – Draft Monitoring Plan
Objective
Action
Strategic
Objective
Specific
actions
should be
included
Division or
Corporate
Area
Responsible
Lead
The
accountable
person(s) for
delivery of
the action
and
addressing
any adverse
performance
STP Objective
CQUIN
Carter Metric
KPI/Measure
Milestones
What we expect to
achieve following
completion of the
action eg the
achievement of a
specific target,
standard or outcome
which should be
measurable
Dates when the
actions should
be progressed
and completed
Reporting
Structure/
Overseeing
Committee
Will the delivery
of the action be
formally
monitored by a
sub-committee
or Q Committee?
If not - report to
PDG
Frequency
of Reporting
Status
RAG rating either as at
present or as
forecast for
year
end/achievem
ent of
milestones
18
Appendix 2 – Board Assurance Framework Risks (2016/17 – as at 30th November 2016)
BAF
Risk Description
Reference
Quality Service
1.1
There is a risk to management capacity and overall service continuity from the process of bidding for and acquiring new
services and/or the requirement to retender for existing services
1.2
There is a risk to comprehensive patient information due to discontinuity between systems employed
1.3
There is a risk to the provision of safe, effective elective care due to lack of
consistent clinical leadership and expertise
1.4
There is a risk that DCHS does not provide patient centred care due to a lack of engagement and involvement of service
users and stakeholders
1.5
There is a risk that our Clinical Governance initiatives do not deliver the outcomes necessary to support our Strategy
for high quality care
1.6
There is a risk to the provision of safe, effective care due to a lack of consistent employment of the trust’s quality
improvement and assurance framework
1.7
There is a risk to the provision of effective care due to a failure to learn and share lessons and implement change
resulting from audit and feedback
There is an overarching risk to patient quality and safety during periods of major system change and employment of new
governance systems and processes related to PLACE based care.
1.8
Quality People
2.1
There is a risk of our staff not being able to provide high quality care due to national and local workforce supply shortages
and the challenges of developing the workforce to have the appropriate skills and competencies to provide the future
model of care resulting in poor patient outcomes
2.2
There is a risk to patients, service-users and employees due to staff performance and behaviours not being monitored
and improved resulting in an adverse impact on the provision of high quality care and organisational reputation
2.3
There is a risk that the Trust fails to develop a proactive Health and Safety culture across the organisation, resulting in the
trust not achieving zero harm to staff, visitors, contractors and members of the public
2.4
There is a risk to organisational performance due to the high volume of organisational and health system change, which is
likely to continue to be a feature of our health economy for several years
2.5
There is a risk to service users, staff and DCHS’ reputation due to staff not adhering to the principles of an equal, diverse
and inclusive culture, resulting in discriminatory and non-inclusive behaviours, non-compliance with Equality Act and
potential legal costs
17/18 – 18/19 Operational Plan
Action Reference
Section 6.6.6 (Commercial
Developments)
6, 9, 10, 11, 12, 18
15, Section 5.4 (Workforce)
1, 2, 3, 5, 6, 8, 9, 10, 11, 12, 13,
14, 15, 17, 18, 19, 20, 22, 23, 24
1, 4, 15 Section 7 (Governance
of the Plan)
Section 4.2 (Quality Plans),
Section 7.4 (Governance of the
plan)
Section 4.2 (Quality Plans)
3, 6, 9, 13, 14, 22, Section 4.1.3
(Safety),
Section 4.2 (Quality Plans),
Section 5.4 (Workforce)
2, 4, 5, 6, 7, 9, 10, 11, 12, 13, 14,
20, 21, Section 5.4 (Workforce)
Section 5.4 (Workforce)
Section 4.1.3 (Safety)
Section 4.2 (Quality Plans)
Section 5.4 (Workforce), Section
6 (Reducing the per capita cost of
healthcare)
2, 3, 5, 8, 9, 10, 11, 12, 13, 15,
16, 17, 18, 19, 22
19
2.6
There is a risk to the personal engagement, morale, and health and wellbeing of our staff due to the uncertain operating
environment DCHS is working in
Section 1 (Introduction and
Strategic Approach), Section 3.1
(Public Health Organisation),
Section 4.2 (Quality Improvement
Plan), Section 7.2 (Membership
Strategy)
Quality Business
3.1
There is a risk to the organisation achieving strategic objectives due to inconsistent implementation / organisational
support of the Sustainability and Transformation Plan resulting in poor outcomes for patients and poor use of resources
3.2
There is a risk to the organisation of delivering public health contracts due to local authority price cuts resulting in poor
outcomes for patients and poor use of resources
3.3
There is a risk to future sustainability due to change in national policy for out of hospital care and commissioner priorities
1, 2, 5, 6, 7, 9, 10, 11, 12, 14, 15,
16, 18, 21, 22, 23,
15, 22, 24, Section 6.6.6
(Commercial Developments)
1, 2, 3, 8, 9, 15, 16, 20, 21, 24
3.4
There is a risk to the effective and efficient provision of DCHS services due to the impact of funding cuts within Local
Authorities resulting in greater activity being directed towards health services and flow of patients being disrupted
3, 7, 9, 19, 22, 24
3.5
There is a risk to the organisation due to capital controls leading to poor estate impacting upon patient care resulting in
poor outcomes
3, 5, 7, 15, Section 6.4 (Estate
Management)
3.6
There is a risk to the organisation regarding the efficient use of resources constrained by Health Economy Plans
3.7
There is a risk to the financial stability of the organisation of not meeting future Sustainable Quality Improvement
Programme over the next two years (2016/17 and 2017/18)
2, 3, 5, 7, 8, 9, 11, 13, 14, 15, 16,
19, 20, 21, 23, 24, Section 6
(Reducing the per capita cost of
healthcare)
1, 5, 6, 9, 11, 12, 13, 14, 15, 17,
Section 6.2 (Efficiency Savings)
3.8
There is a risk to the organisation that activity levels will exceed contractual activity and capacity plans, resulting in
financial risk and / or increased waiting times
1, 6, 7, 9, 14, 15, 16, 19, 21, 24,
Section 6.1.1 (Activity Planning)
3.9
There is a risk to the organisation due to non-delivery of elements of the IM&T strategy, resulting in financial risk benefits
not being realised and impact on patient care
6, Section 6.5.6 (Informatics &
Technological Transformation)
3.10
There is a risk to the organisation due to lack of comprehensive financial data quality systems resulting in poor decisions
that could affect outcomes and financial loss
3.11
There is a risk to the Trust’s resilience, due to an emergency or severe disruption, resulting in an impact on patient care,
inability to meet targets, loss of revenue
There is a risk to the organisation, due to failure to align and influence stakeholders resulting in poor relationships that
6, 7, 9, 24
Section 6 (Reducing the per
capita cost of healthcare)
1, 5, 9, 11, 14, 15, 21, Section
6.5.7 (Business Continuity)
1, 3, 5, 9, 10, 11, 12, 14, 15, 16,
3.12
20
impact on patient care
Quality Governance
4.1
There is a risk to the organisation due to not having strong corporate governance systems in place resulting in Trust vision
not being delivered
4.2
There is a risk to the organisation due to not meeting regulatory, contractual or legal obligations resulting in sanctions
4.3
There is a risk to the organisation due to not having strong risk management controls in place resulting in failure to put
effective mitigation plans in place promptly
4.4
4.5
There is a risk to the organisation due to not having strong risk management controls in place resulting in failure to put
effective mitigation plans in place promptly
There is a risk to the organisation due to lack of comprehensive data quality systems resulting in poor decisions that could
affect outcomes and financial loss
18, 19, 21, 23, 24
Section 7.4 (Governance of the
plan)
11, 12, 13, 15, 16
Section 7.4 (Governance of the
plan)
Appendix 1
7, 11, 12, 15, Section 7.4
(Governance of the plan)
6, Section 6.5.6 (Informatics &
Technological Transformation)
21
Appendix 3 Derbyshire Local Delivery Roadmap
22