Staffordshire and Stoke on Trent
Partnership NHS Trust
Operational Plan 2016 - 17
Contents
Introducing Staffordshire and Stoke on Trent Partnership NHS Trust ........................ 3
The vision of the health and care system ................................................................... 4
Strategic direction of Staffordshire and Stoke on Trent Partnership NHS Trust ......... 5
The MCP model of care .......................................................................................... 5
Key priorities for the Partnership Trust 2016/17 ......................................................... 5
Strategic commissioning intentions......................................................................... 5
Multi-specialist Community Provider (MCP) development ...................................... 6
Home care services ................................................................................................ 6
Social care contract ................................................................................................ 6
Changes in management of community hospital beds ........................................... 7
Children’s services.................................................................................................. 7
Information Technology (IT) .................................................................................... 7
Delivering cost improvements ................................................................................. 7
Tendering for contracts ........................................................................................... 8
We put quality first ...................................................................................................... 9
Approach to quality planning .................................................................................. 9
Quality improvement priorities 2016/17 ................................................................ 10
Priority 1: Safe – Reduce avoidable harm ............................................................ 10
Our aim: Improve our safety culture and workforce, eliminating avoidable
harm of all types ................................................................................................. 10
Priority 2: Caring – Improve Service User Satisfaction ......................................... 10
Our aim: Sustain and maintain our overall service user experience ............. 11
Priority 3: Effective – improve our outcomes ........................................................ 11
Our aim: Improve the outcomes and personalisation of our services........... 12
Mortality ................................................................................................................ 12
Care Quality Commission (CQC) inspections ....................................................... 13
We focus on people.................................................................................................. 14
Recruitment and retention .................................................................................... 14
Skill mixing and different models of delivery ......................................................... 14
We take responsibility .............................................................................................. 16
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Introducing Staffordshire and Stoke on Trent Partnership NHS
Trust
The Partnership Trust is one of the UK’s largest integrated community health and
adult social care providers. Established in September 2011, the Trust successfully
integrated with Staffordshire County Council’s Adult Social Care on 1 April 2012. We
employ over 6,000 staff and have an annual turnover of over £370million.
The Partnership Trust is located within the geographical boundaries of Staffordshire
County Council and Stoke-on-Trent City Council, with sexual health services in
Leicester, Leicestershire & Rutland and infection control services in East Cheshire.
We serve a diverse population of over 1million people.
Our vision is to deliver personalised care of the highest quality, with the best
outcomes for users and carers, empowering them to remain independent.
This vision is underpinned by three values.
We put quality first
We deliver quality and do the very best we can
We focus on people
We treat people as individuals and take time to respect and understand their point of view
We take responsibility
We take personal ownership of things and see them through. We focus on finding solutions
We have five strategic goals.
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We will provide high quality and safe services which provide an excellent
experience and best possible outcomes
We will work with users and carers to deliver integrated services, simply and
effectively
Our organisation will develop and deliver sustainable, innovative services that
support independence
Our workforce will be empowered and supported to deliver care in a way that
is consistent with our values
We will make excellent use of our resources and improve levels of efficiency
across our services.
More information about the Partnership Trust can be found on our website:
www.staffordshireandstokeontrent.nhs.uk
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The vision of the health and care system
The Staffordshire and Stoke on Trent health and care system has embarked on an
ambitious transformation programme ‘Together We’re Better’.
The vision of ‘Together We’re Better’ is that Staffordshire and Stoke on Trent will be
vibrant, healthy and caring places where people will be as independent as possible
and able to live happy and healthy lives, getting high quality health and care support
when required.
How we will deliver the vision is represented in the following diagram.
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Strategic direction of Staffordshire and Stoke on Trent Partnership
NHS Trust
The NHS Five Year Forward View, published in October 2014, set out five new
models of care. 50 sites (called vanguards) are testing these across the country.
In Staffordshire and Stoke on Trent, we are following the developments of the
vanguards that are testing the multi-specialist community provider (MCP) model.
The aim of this model is to provide enhanced community care for the populations we
serve.
The MCP model of care
To enable new ways of delivering care, the Partnership Trust will work with GP
federations, voluntary and community sector networks, local councils and other NHS
organisations to enable a shift of care out of hospitals and into the community.
The model of care will be developed to:
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work across organisational boundaries
deliver integrated health and social care to its service users
ensure that each individual receives the care they need where and when they
need it
maximise the independence of the population.
Key priorities for the Partnership Trust 2016/17
Strategic commissioning intentions
The Partnership Trust receives its funding by holding contracts with commissioners.
Commissioners can be from Clinical Commissioning Groups, local authorities, other
NHS organisations and the independent sector.
Each commissioner sets out its commissioning intentions for the next financial year.
In line with the strategic commissioning intentions for 2016/17, the Partnership Trust
will work closely with commissioners to identify the true costs of services. Our focus
will be on delivering a sustainable health system that is able to deliver better
outcomes at lower cost.
We will also work closely with commissioners on:
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Developing new and sustainable ways of delivering community care
Revising the specifications that describe how our services will improve the
health and independence of the people in our care (for 2017/18)
Ensuring our plans to improve quality and reduce cost match
Transforming services for those with long term conditions; improving quality,
better co-ordination of care and efficiency
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Strengthening approaches to identifying those people who would benefit from
our services and supporting them to co-ordinate all the services they are
receiving
Helping people to manage their conditions better
Making better use of technology
Building alliances with other organisations that provide health and care;
focusing on out of hospital care co-ordination and delivery.
Multi-specialist Community Provider (MCP) development
A key priority for the Partnership Trust is the roll-out of the model of care delivered
by the Multi-specialist Community Provider.
In North Staffordshire and Stoke on Trent it is intended that this will be complete by
the middle of 2017, based on the adoption of two additional populations every four
months. Two pilot sites will continue to evolve their new model.
South Staffordshire commissioners have taken a different approach. They have
confirmed that service developments should deliver improvements to quality,
innovation, productivity and prevention. They view this development work as a
vehicle to enable a broader multi-specialist organisational form in the future.
Home care services
There is more demand for domiciliary care than capacity available. This means that
our Living Independently Staffordshire services take on people requiring care at
home. This prevents them from doing the work that they are commissioned to do;
providing re-ablement. Re-ablement is the term used to describe care provided to
people living in their own homes that supports someone to maximise or regain their
independence following a period of illness or hospital admission. Re-ablement
supports people to be discharged from hospital earlier than would be the case
without the service. Staff working in this area have more training than those working
in domiciliary care, and so are paid more.
Ensuring there is more domiciliary care available will mean that more re-ablement
can be offered. Re-ablement significantly increases the number of hospital beds
available and reduces the length of time people stay in hospital because it supports
earlier discharge from hospital.
The Partnership Trust is developing an integrated re-design and workforce plan
(2016/17) which offers re-ablement earlier to patients with long-term conditions as
part of our multi-specialist community provider model. The proposal would comprise
a home care service that supports people with long-term conditions and provides
specialist district nursing support.
Social care contract
In 2015, a review of the Partnership Trust’s contract with Staffordshire County
Council was undertaken. The review recognised the progress that had been made in
the first two quarters of the year and also recognised that, the full year anticipated
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savings to which both parties aspired will not be achieved in 2015/16. The review
predicts continued growth in demand for adult social care which makes the
achievement of the savings required in 2016/17 unachievable without significant
changes to the current partnership agreement.
Further work is being done to identify savings and negotiations continue on the value
of the contract for 2017/18 and beyond.
Changes in management of community hospital beds
In conjunction with University Hospitals of North Midlands NHS Trust (UHNM), the
Partnership Trust is looking to change how its community hospital beds are used;
moving more towards providing care for people who are not well enough to stay at
home but don’t need to go to a bigger hospital.
Community hospitals are currently used to support discharge from the bigger
hospitals. It is the intention to move to a situation where more patients will be sent
directly home from the bigger hospitals, with support.
Significant cultural change will be needed for the whole system; not to see beds as
the first package of care and on developing assessment for home care rather than
bed-based care.
Children’s services
The Partnership Trust continues to work closely with partner organisations to
improve children’s services. Considerable work has been undertaken on developing
the way children move through services.
Significant cross-learning has been undertaken between children and adult services.
The next 12 months will see further development of links to social care and
education to embed change. Analysis will also be conducted into the viability of an
MCP model of care that provides care and support to all ages.
Information Technology (IT)
The Partnership Trust is using information technology to improve the way it manages
its business, including the care and support it provides.
The Partnership Trust participates in a local economy health care record programme
that supports the provision of joined up care and the reduction of Accident &
Emergency attendees.
Delivering cost improvements
The Partnership Trust continues to operate within a series of health economies with
considerable pressures. Significant work is being done to ensure a sustainable
financial position is achieved.
The Trust has a Quality Impact Assessment (QIA) panel which meets monthly to
review proposals to reduce costs and assess their impact on patient safety, clinical
outcomes and patient experience.
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The panel is chaired by the Medical Director with the Director of Nursing and Quality
as part of the membership along with further clinical representation from professional
leads (nursing, social care, allied healthcare professionals).
Tendering for contracts
During 2015/16 The Partnership Trust won a total of six tenders, four of which were
existing business. The Trust has retained existing business for the North
Staffordshire and Stoke Integrated Sexual Health Service. This includes an
expansion of services of psychosexual and young people’s support services to cover
North Staffordshire. New business has been won in Leicester where we already
deliver services and we have recently won a new service in Cheshire East.
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We put quality first
Approach to quality planning
Our Quality Framework 2013-2018, agreed during 2012/13, is our overall quality
strategy. The Quality Framework aim is that all service users receive the highest
quality of care, by ensuring that front line teams are empowered by the organisation
to provide this. The Framework contains six quality goals.
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Goal 1 Empowering our front line teams to deliver quality
Goal 2 Providing quality services in a joined up way
Goal 3 Providing the highest quality services that are viewed as excellent
Goal 4 Providing effective services with good outcomes for our service users
Goal 5 Providing services that meet essential quality standards
Goal 6 Ensuring service users help us to deliver quality.
The Quality Framework is supported by three key strategies that detail the policies,
systems and processes that we will use to achieve our six quality goals.
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Safety Strategy
Effectiveness Strategy
Experience Strategy
The three strategies have been revised for 2016/17 and aligned with the Trust’s
Quality Improvement Priorities. Implementation of the Quality Framework, and its
supporting strategies, is monitored by the Trust’s Quality Governance Committee.
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Quality improvement priorities 2016/17
The following three priorities are proposed for 2016/17.
Priority 1: Safe – Reduce avoidable harm
Our aim: Improve our safety culture and workforce, eliminating avoidable harm
of all types
Measures for 2016/17
Number of avoidable and
attributable grade 3 and 4
pressure ulcers developed in
our care
Number of serious incident
falls reported whilst in our
care
Why this is important 2016/17 target
Links to
Reduction, in line with our Related to NHS
We want to half
aim to half avoidable harm outcomes framework
avoidable harm by
by 2018
2018
domain 5
Zero grade 3 and 4 avoidable Safety Strategy
and attributable pressure
Related to our Sign up to
ulcers developed in our care safety pledge
in community hospitals
NHS mandate
Minimum 10% reduction in
the incidence of avoidable
and attributable community
grade 3 and 4 pressure ulcers
developed in our care (i.e. a
tolerance of 21 cases
maximum in community
services)*
*Tolerance targets will be
subject to rebasing due to the
changing nature and profile of
our services
Reduce serious incident falls Related to NHS
in all our care settings, by a outcomes framework
minimum of 10% for 2016/17 domain 5
(with a tolerance of 11 cases Safety Strategy
maximum in our community Related to our Sign up to
hospitals and bed-based
safety pledge
rehabilitation services)
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Total number of adverse
incidents reported (all
incidents)
(Aligned to indicator 5.6 in the
2015/16 NHS mandate)
Safety is everyone’s
job; staff on the
lookout to improve
safety will see and
report more incidents
and “near misses”.
Our ambition is to increase
NHS outcomes
the number of incidents
framework 5.6
reported by 10%, for all
Safety Strategy
reporting services compared
to those reported by the same
services in 2015/16*
*Measures and tolerances
Services that report
will be rebased due to the
more “near misses”
have a better safety change in our profile of
services
culture
Percentage of reported
If a team has an
Reduction in the proportion of NHS outcomes
serious incidents
increasing proportion serious incidents from all
framework 5.6
applicable to the Trust
of serious incidents
reported incidents
Safety Strategy
(Aligned to indicator 5.6 in the there may be a safety
2015/16 NHS mandate)
issue.
Services that report
more incidents, with a
low proportion of
serious incidents, have
a better safety culture
Safe staffing dashboard
Our staffing escalation Baseline to be developed
Safety Strategy
(Community Nursing and
policy traffic light
hospitals):
system includes the
Number of RED flag safe
requirement to
staffing occurrences
escalate and report
instigated via safe staffing RED staffing levels
dashboards
Priority 2: Caring – Improve Service User Satisfaction
Our aim: Sustain and maintain our overall service user experience
Measures for 2016/17
Friends and Family Test
Why this is important
The Friends and Family
Test has been in use
across many parts of the
NHS since October
2013. It is now in use in
almost all NHS services.
Feedback gathered can
be used to stimulate
improvement in our
services.
2017/17 target
More than 90% would
recommend our services to
their friends and family if they
needed similar treatment and
less than 5% would not
recommend us.
Links to
Indicator 4c (Friends
and Family Test)
from the 2017/17
NHS outcomes
framework
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Measures for 2016/17
Feedback from service
users and carers on the
quality of care that they
have received from our
services
Why this is important
In 2014/15 we consulted
with our service users
and carers; this was a
core theme from their
feedback
2017/17 target
At least 90% of our service
users and carers are
extremely satisfied with the
quality of our services
Links to
Related to Domain 4
(Ensuring that
people have a
positive experience
of care) of the
2015/16 NHS
outcomes framework
Priority 3: Effective – improve our outcomes
Our aim: Improve the outcomes and personalisation of our services
Measures for 2016/17
Number of teams
utilising outcome
measures
Why this is important
Target
Links to
Focussing on outcomes
Key services collect and
Quality Framework
reflects a whole-systems analyse outcome data, and
goal: Effective
approach to health and
have plans for improving the Outcomes and
social care.
outcomes of their service.
Effectiveness
Strategy 7.9
Care plan audits:
The ADASS national
Target: continued trajectory Related to Adult
proportion of people
survey highlighted good
increase to 75%
Social Care
offered a copy of their
practice around copying
Outcomes
care plan or equivalent
care plans to service
The baseline audit results:
Framework domain 3
care plan information
users, compared with our 2014/15 - 55%
2014/15 baseline audit
2015/16 - 63%
Feedback from service
In 2014/15 we consulted 90% of our service users
NHS Standard
users and carers that
with our service users
and carers agree that they
Contract section 12
they feel involved in
and carers; this was a
feel involved in decisions
2015-2016.
decisions regarding
core theme from their
regarding their individualised
their individualised
feedback.
plans of care.
Related to Domain 4
plans of care.
of the 2015/16 NHS
outcomes framework
Compliance with
Ensuring that our service Newly published NICE
Effectiveness
relevant NICE guidance
provision is in line with
guidance is reviewed for
Strategy
best practice guidance
relevance and compliance
NICE policy
offers assurance that
assessed within set
care is safe and effective. timeframes
Mortality – all
Monitoring and
Mortality review to be
Effectiveness
unexpected deaths
investigating unexpected completed for all
Strategy
reviewed by the
deaths occurring within
unexpected deaths within
NICE policy
mortality review group
our services enables
the care of trust services.
identifying any risks and lessons to be learned and
learning
applied moving forwards
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Mortality
The Partnership Trust has a Mortality Review Group (MRG), which aims to support
the continuous quality improvement through the promotion of ongoing quality
assurance programmes in relation to mortality.
The MRG will co-ordinate a review framework across the Partnership Trust and will
monitor and review the systems in place for promoting and supporting programmes
of work, ensuring that learning is embedded within clinical and nursing practice. It will
ensure that the Trust’s Quality Governance Committee is kept fully informed of all
significant clinical risks, and any associated developments or issues.
The MRG will oversee the Partnership Trust’s participation in the annual publication
of avoidable mortality.
Care Quality Commission (CQC) inspections
The Care Quality Commission (CQC) inspected the Partnership Trust in November
2015.
The CQC provided their initial feedback in writing on 13th November. On 15
December 2015, the Care Quality Commission issued a warning notice under
Section 29A of the Health and Social Care Act 2008.
The Trust has developed a comprehensive quality improvement plan identifying the
key improvement actions associated with all of the feedback.
The Trust responded with the actions that it had taken with respect to the areas
identified within the warning notice on the 30 December and again on the 26
February.
The feedback from the Care Quality Commission has influenced our quality
improvement priorities for 2016/17, notably to continue our focus on safe staffing as
part of our safety priority.
Three reports have so far been issued, two services were rated as Good (Living
Independently Staffordshire Moorlands and Living Independently Staffordshire
Lichfield & Tamworth) and one as Requires Improvement (Brighton House).
On 29 March, the CQC issued drafts of seven further inspection reports, which we
expect to be published in May 2016.
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We focus on people
The Partnership Trust ensures staffing levels are safe by using a mixture of
professional judgment; ensuring staff have the appropriate competency to perform
a task and analysis of demand for the services.
Regular workforce planning training sessions and workforce drop-in clinics are held
to develop a culture within the organisation where all managers are aware of a
standardised method to workforce plan, have an understanding of workforce
planning (both in terms of the methodology and responsibility) and its importance to
service delivery. Workforce planning masterclasses are held for the Trust
Leadership Programme to convey the importance of workforce planning at the
strategic level also.
Recruitment and retention
The Partnership Trust has recently undertaken an end to end review of our
recruitment process which identified a number of improvements. Considerable
changes have been implemented.
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Identifying new ways to attract high quality candidates via use of social media,
open days, articles in professional journals etc.
 Time to recruit – we have piloted “one stop” shop recruitment days –
interviews, occupational health and ID checks all completed on one day.
 Candidate experience – actively seeking feedback from candidates in order to
improve the experience and help with retention.
 Extending the temporary staffing bureau to provide an alternative to using
agency staff
 The Recruitment and Retention policy has been refreshed to ensure that more
innovative ways to attract, empower and sustain our workforce are
implemented; a fundamental element of the Trust’s Workforce Strategy.
We will continue to develop our “1 Vision” events which are led by the Chief
Executive and directors. They offer an opportunity for staff to meet directors face-toface and raise any concerns or issues they may have. It is also used as an
opportunity to share good practice amongst teams.
Skill mixing and different models of delivery
In 2014, the Trust developed a programme to identify tasks that could be safely
delegated to non-registered staff such as phlebotomists, health care support workers
and assistant practitioners.
A review of the amount of administration done by registered nurses was also
undertaken and as a consequence tasks were identified which could be delegated to
clerical workers.
The combination of these two processes identified time that could be released for
registered nurses to concentrate on the more complex cases.
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Over the last 12 months the Trust has recruited to these support posts and teams
are now starting to see the benefit of the skill mix.
Due to the national shortage of nurses and other professions the Trust is actively
considering different models of delivery for some of its other services i.e. use of
assistant practitioners.
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We take responsibility
Whilst the strategic objective remains to return the Trust to financial balance, this is
going to be extremely challenging in 2016/17. For the financial year 2016/17, we are
assuming a deficit of £6.2m at the end of the year. To achieve this would require a
£12m cost reduction over one year.
A challenge of this magnitude in this timeframe will need strong leadership and tough
decisions to be made.
Whilst the strategic objective remains resolutely to return the Trust to financial
balance, it will be necessary for the Trust Board to further reflect on these key
challenges, and the sustainability of achieving a stepped improvement of this size in
2016/17 whilst also rising to the challenge of maintaining or improving performance.
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