Our Operational Plan 2019/20 - Mersey Care NHS Foundation ... · be delivering fully integrated...

Our Operational Plan 2019/20

Item F1a - REVISED APPENDIX 1 of Operational Plan 2019/20

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Contents

1. Summary

2. Our five year strategy 2.1 An overview of our long term strategy 2.2 How this operational plan delivers our long term strategy 2.3 Our commissioning landscape and wider system working

3. Our services: Strive for Perfect Care 3.1 Our current position 3.2 Improving quality: Perfect Care 3.3 Improving quality (STEEP): Continuous improvement 3.4 Population health 3.5 Integration

4. Our people: Become the employer of choice in our sector 4.1 Becoming an employer of choice in our sector 4.2 Just and Learning Culture 4.3 Working side by side with service users and carers

5. Our resources: Develop a solid financial, estate and digital platform for future integration 5.1 Maintaining financial balance 5.2 Improving our estate 5.3 Invest in digital technology

6. Our future: Work with and learn from others to have greater impact 6.1 Developing Provider Alliances 6.2 Research and development 6.3 Commercialising our knowledge assets

7. Monitoring and measuring delivery of this plan 7.1 What this plan means for our divisions 7.2 Executive Performance Review

8. Financial impact of this plan 8.1 Resourcing our strategic priorities

9. Risks to delivery of this plan

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Mersey Care’s vision is to provide Perfect Care that enables people with physical health and mental health conditions, learning disabilities and addictions to live longer, healthier lives.

2019 is the first year of a new five year strategy. We will continue our focus on Perfect Care, improving quality and safely reducing cost. But we also need to change our focus for the future. We need to develop more preventatitve and integrated services for children, young people and adults that enable them to to take a more active role in their own health and we must think differently about our workforce models and realise the potential benefits of digital technology.

Our long term strategy is to develop new clinical models to prevent crisis in community settings, enable people to take more control of their own health and integrate services. These exciting new service models, developed using co-production with service users and carers, along with the continued development of a Just and Learning Culture and a focus on quality and inclusion, will make us the employer of choice in our sector.

Delivering our strategy will enable Mersey Care to remain in financial balance, through service redesign that develops more preventative and integrated services, but also through focusing on our main financial risks of medical recruitment, corporate services and community services. We will also invest in improving our digital and physical estate so that Mersey Care has a solid platform to enable our new service models for the future.

Mersey Care cannot rise to the quality, workforce and financial challenges we face by working on our own. The development of partnerships with other providers at neighbourhood, place and Cheshire and Merseyside levels is essential to the future sustainability of our services.

We will measure delivery of this strategy and plan ensuring quality improvements in our current service portfolio but also in our key workforce, estate and financial indicators. We will also measure delivery of this strategy by using key measures of integration including patient experience, effectiveness of team working, hospital readmissions and delayed transfers of care.

1OPERATIONAL PLAN: SUMMARY


Programmes

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Programmes

Initiatives

Initiatives

Measures

Measures

• Centre for Perfect Care• Community services

improvement plan• Patient safety

programme• Provider Alliances.

• Corporate services review

• Long term financial model

• Global Digital Exemplar

• Strategic estates programme.

• Perfect Care areas• Equality and inclusion action

plan• Small team review• Therapies review• Trust wide quality and safety

framework• Crisis Resolution Home

Treatment (CRHT) implementation

• Integrated Community Reablement and Assessment Service (ICRAS) rollout North Mersey

• Integrated Care Team implementation

• Integrate divisions• Primary care mental health

model• Introduce integration for

frailty/ dementia• Introduce integration for

complex lives/families• Introduce integration for

children

• Focus on three main financial risks – corporate services, medical staffing and community services

• Corporate transformation programme

• Core technology infrastructure upgrades

• Electronic personal health records

• Share2Care clinical platform• Plan for Liverpool 2 and

specialist learning disability low secure unit

• Future plan for Whalley and Maghull sites

• Improve community estate in partnership

• Open Hartley Hospital (Autumn 2019) and Rowan View (Autumn 2020).

• Progress on top three financial risks• Achieve financial control total• Cost Improvement Plan (CIP)delivery• Digital maturity and capability• Increase in category B estate• Increase in single sex, single room

accommodation.

• CQC good across all services• Incidents resulting in harm• Ligature incidents• Progress towards CRHT fidelity• Length of stay and delayed transfers of care

in mental health• Hospital readmissions• Improved patient satisfaction with

involvement in care planning• End of life care access/response times• People dying in place of

choice• Therapies

waiting times


Oversight by Perform

ance, Investm

ent and

Finance C

om

mittee

Oversight by Q

uality Assuran

ce Co

mm

ittee

Programmes

Programmes

Initiatives

Initiatives

Measures

Measures

• Provider Alliances• PROSPECT secure new

care model• R&D strategy• Commercial and

business development team

• Centre for Perfect Care (research).

• Equality and inclusion• Just and Learning

Culture• Organisational

effectiveness and learning

• Leadership development

• Life Rooms.

• Mobilise Provider Alliances in Liverpool and Sefton

• PROSPECT partnership go live

• Consolidate prison health progress

• Review and relaunch research and development strategy

• Increase commercial income from our knowledge.

• Equality and inclusion action plan

• Support health and wellbeing, reducing sickness absence

• Improve basic workforce systems

• Just and Learning Culture priorities

• Culture of care barometer implementation

• Develop Life Rooms model• New side by side active

participation process• Always events and passports

for carers.

• Effective integrated team working• Delayed discharges• Hospital readmissions• Length of stay in secure care• Commercial income.

• Patient and staff experience for those with protected characteristics

• Staff sickness• Time to recruit• Agency use• Culture of care• Triangle of Care• Patient experience• CQC well-led organisation.


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2.1 An overview of our long term strategy

Mersey Care’s strategy for Perfect Care was developed in 2012 and since then the Trust has changed considerably, not least acquiring specialist learning disability services in 2016 and then becoming a provider of community physical health care in 2017. In light of these changes, and the uncertainties in the environment in which we operate, we have reviewed Mersey Care’s five year strategy, identifying key trends that will impact us about how we will need to change in response to these future trends and bridge the gap between where we are today and achieving future success.

We face a range of challenges and uncertainties in the next five years (2019-24) which will require fundamental redesign of our organisation and the way in which we operate. Doing more ‘business as usual’ faster and more efficiently is not going to be a sufficient response to these challenges.

The key long term challenges and solutions for the next five years are summarised in figure 1.

Key future themesFrom these challenges and opportunities, we have identified a number of key themes which will direct our strategic approach over the next five years.

Continuous improvement in our clinical and operational platform – Mersey Care has been striving for Perfect Care in our services for several years. Our staff are passionate about delivering the best possible services for the people we serve, but achieving this in our current and future environment is not going to be easy. Even in a tough financial environment in which demand for our services is often greater than the service capacity that is available, we believe that our staff can always find new opportunities to improve our services and save money at the same time. Over the next five years we will continue to setting our own stretching goals for improvements in care rather than aiming to meet minimum standards, and we will increasingly get the basics of care right every time. We will accelerate the learning cycle, so that we are testing out improvements, learning from our mistakes and applying successful improvements and innovation faster. Over the next five years we will aim for an ‘Outstanding’ CQC rating, and we will seek out partnerships with other Trusts so that we can share our knowledge but also learn from others.

2OUR FIVE YEAR STRATEGY


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Prevention and population health focus - We must take action with partners to break the cycle of acute care dependency, which leaves less focus and resources available for preventative services. To do this, we will need to understand the specific needs of the local population, the impact of wider determinants and to explore gaps in care and unwarranted variation. In five years time, through the use of data, we will predict and prevent the increasing acuity of people’s needs; identifying those people most at risk from deteriorating health wellbeing and targeting earlier interventions and proactive care. Mersey Care will also enhance its preventative interventions alongside its core treatment services through our Life Rooms and through working in partnership with the voluntary sector and general practice.

Integration of physical and mental health, taking into consideration the social context, is going to be important in meeting future demand – There is a quality and cost improvement opportunity if we coordinate services to meet people’s needs. For example, there are over 7,000 patients currently accessing both mental health and physical

health services from Mersey Care and there appears to be little planned coordination of these interventions between our mental and physical health services. To meet growing demand for services and meet people’s needs holistically, we will integrate physical and mental health services. In five years time, we will be delivering fully integrated care at neighbourhood level. For example, care will be integrated for people with complex lives which draws together mental and physical health care, social care and the third sector to improve outcomes.

Effective community services will be vital if we are to break the current cycle of acute dependency – Community services play an invaluable, but often overlooked, role in people’s lives. We need a more ambitious and proactive approach to community services because they are important to people’s long term health needs more effectively and to support people’s long term physical and mental health more holistically. To make our community services more effective, we will standardise care pathways, ensuing consistent, high quality care, make best use of digital technology to improve productivity

Figure 1: Long term challenges and solutions


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and integrate physical and mental health services. In five years time, our community services will be paperlight and our staff will be expert in using digital technology, including patient held records and shared clinical information systems, to delivery proactive integrated care which limits the use of acute services.

Becoming an employer of choice in our sector – We must work to develop a high performing, happy workforce, getting the basics right for our staff and continuing to work towards a Just and Learning Culture. Whilst this will support our aim to become an employer of choice, we will need to work flexibly with other trusts to overcome workforce challenges across bigger footprints. In five years time, we will have mitigated our main workforce risks and secured sustainable recruitment and retention within our workforce. We will have equipped our staff with the knowledge and skills to work in new roles in neighbourhood integrated care; in particular skills to make full use of the digital tools which support integrated care.

Use of digital technologies is going to be essential to meeting demand, addressing our workforce challenges and to making services affordable – In the short term, we must make the most of opportunities to improve productivity within

our services through mobile working and tele-health services and to improve patient care through the integrated patient held record and shared clinical records. In five years time, digital advances, such as virtual reality and wearable devices will have started to reduce the volume of physical premises that are required and by complementing skilled, experienced staff will help to mitigate some of the workforce challenges facing us. In five years time, Mersey Care services will be offered routinely through digital channels, so that people do not have to wait so long to receive treatment and do not always have to see a clinician in person to get the support they need.

Working with other providers is going to be essential to our long term strategy –Public services face significant challenges to continuously improve care within a constrained finances, whilst facing increasingly acute and complex demand. Collaboration between organisations will be vital way for public services to support each other and to raise standards in such an environment, and will also reflect the fact that people’s care needs are becoming more complex. For Mersey Care over the next five years, this means that we will increasingly operate as a platform of integrated care across the health economies that we operate in, and we will develop formal alliances and contracts to reflect this


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integration over time. Rather than providing services through separate organisational units that concentrate on narrow sets of interventions, we believe that in the next five years outcomes can be maximised through systems that are accountable for the end-to-end patient journey.

2.2 How this operational plan delivers our long term strategy

2019/20 is year one of our new five year strategy.This year, we will continue to improve quality and cost in our services, and from this strong platform, develop more preventative, integrated community-based services. Within this plan we describe how we will do this through a focus on continuous quality improvement and Perfect Care within our services. Initiatives to improve quality and safety include implementing our community services action plan, implementing a new crisis resolution and home treatment service, improving access to therapies, reviewing our specialist small teams and implementing team and ward accreditation as part of our Trust quality and safety framework. We will make progress in integration of community services through our work to implement integrated care teams at neighbourhood level and through redesign of the care we provide for people with frailty/ dementia and for people and families with complex needs.

We will make progress towards becoming an employer of choice by supporting staff health and wellbeing, reducing sickness absence, delivering our equality and diversity action plan and further development of a Just and Learning Culture. Recognising that service users are experts by experience, we will embed a new side by side active participation process and focus on supporting family carers. We will also seek to expand the reach of the Life Rooms.

Our strategy for guaranteeing the longer term financial sustainability of our services is to develop a more preventative (and thus cost-effective) clinical model and focus on our three key financial risks – medical recruitment, community services and corporate services. In the year ahead, we will transform our corporate services to enable us to deliver our strategy now and in the future and achieve significant cost efficiencies. Strategic investment is also important to the financial sustainability of our services, and we plan to invest in estate and digital infrastructure so that we have a solid platform for improvement and integration in the future. Specifically, our initiatives include a programme of

core technology infrastructure upgrades along with digital support to integrated service through patient held records and the Share2Care clinical record sharing platform. We will review our community estate with partners to make this fit to support integrated care and continue our Rowan View (medium secure unit) and Hartley Hospital developments. We will continue planning for new developments, subject to capital funding, and develop future plans for the Whalley and Maghull sites.

Our long term strategy also reflects the need for Mersey Care to work as part of a wider system at neighbourhood, place and system levels because the challenges we face require a collaborative effort to overcome them. In the year ahead, we will develop our system collaboration through Provider Alliances in Liverpool and Sefton, and our PROSPECT low and medium secure partnership. We will increase our research and development capability in support of our strategic direction and commercialise our knowledge capital to invest back into our services.

Mersey Care’s key long-term challenges and solutions are set out in the table overleaf, alongside the initiatives set out in this plan to address those challenges and the associated resourcing/ investment.


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Lon

g term challen

ges

Lon

g term so

lution

sO

ur op

erational p

lan respo

nse in 2019/20 - our

initiativesFinan

cial Imp

act

Realignment of existing resource

New resources subject to contact settlement

Maintained investment

Business case required

Cost efficiency savings

Planned investment

Income generation

Dem

and for services is increasing putting pressure on the current m

odels of service

Develop preventative, com

munity based services

that reflects co-m

orbidity and biopsychosocial solutions

Integrated Care Team

implem

entation at 30,000 to 50,000 population level

Develop Life Room

s model

Implem

ent new prim

ary care mental health m

odel

Side by side active participation process

Alw

ays events and passports for carers

There is unwanted variation in clinical quality in our

servicesSupport continuous im

provement in our clinical and

operational platform

CQ

C ‘G

ood’ in all areas

Trust wide sm

all team review

Trust wide therapies review

Trust wide team

accreditation

Crisis resolution and hom

e treatment team

implem

entation

ICR

AS rollout N

orth Mersey

Perfect Care areas

Consolidate prison health progress

Services are fragmented, causing quality issues and

waste

Integrate physical and mental health interventions.

Collaborate w

ith system partners to im

prove the w

hole care pathway

Integrate clinical divisions

Introduce integration for people/families w

ith complex lives

Introduce integration for frailty/dementia

Introduce integration for children

Significant shortages of clinical staff and NH

S Trusts are com

peting for a limited pool of people

Become an em

ployer of choice and work w

ith other Trusts to reduce com

petition. Transform corporate

services.

Support staff health and wellbeing, reduce sickness absence

Equality and inclusion action plan

Improve basic w

orkforce systems

Just and Learning Culture priorities

Implem

ent culture of care barometer

The resources available to the NH

S are not sufficient to support transform

ation

Save money through a preventative clinical

model: use of digital technology, focus on three

main financial risks

Transformation of corporate services

Sustainable medical staffing m

odel

Improve com

munity estate in partnership

Open H

artley Hospital (2019) and Row

an View

(2020)

Future plans for Whalley and M

aghull sites

Core technology infrastructure upgrades

Personal health records

Share2Care clinical platform

Com

mercialise know

ledge

Review and relaunch R&

D strategy

The challenges the Trust faces require partnership w

ith other providersEstablish alliances to encourage collaboration in our core geographies and sectors

Mobilise Provider A

lliances in Liverpool and Sefton

PROSPEC

T new care m

odel


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2.3 Our commissioning landscape and wider system working

Mersey Care is commissioned to provide services by Clinical Commissioning Groups responsible for Liverpool, Sefton, Knowsley, the wider North West and also by NHS England. We work as part of the Cheshire and Merseyside Health and Care Partnership in relation to region wide opportunities for joint working, for example where there are opportunities to develop or improve services across larger footprints.

In mental health services, local commissioners have indicated that they wish to prioritise the delivery of access standards within services and also the development of crisis care and primary care mental health liaison services across North Mersey. CCGs are committed to meeting the Mental Health Investment Standard, but point out that Mersey Care is not the only provider of mental health services to their populations.

We will seek to work with commissioners to develop an open and transparent view of the funding flows to support the Mental Health Investment Standard, with the aim of ensuring that funding is invested into core services to enable delivery of the five year Forward View Mental Health standards. Commissioners have indicated that their performance priorities in the year ahead are:• Falls • Communication• Psychotherapy • Crisis care • Core 24 mental health liaison • Dementia - care navigators• Physical health • Follow up of service users on CPA• Eating disorder treatment within 18 weeks• Learning disabilities

In community physical health services, commissioners have recognised activity growth within services and wish to standardise services across North Mersey in line with the recommendations from a series of service reviews. They also wish to see services increasingly aligned to neighbourhoods of 30,000 to 50,000 people, where appropriate.

NHS England commissions specialist mental health and learning disability services from Mersey Care. In 2019/20, its priorities are high quality specialised mental health services that are integrated with local health systems and are delivered as close to home as possible, driving further reductions in inappropriate out-of-area placements.

In addition, NHS England will continue with its commissioning intention to reduce the number of people with learning disability and autism who are treated in inpatient settings and supporting local health systems to manage the learning disability and autism care of their whole population.

In the year ahead, Mersey Care will continue to work with the Cheshire and Merseyside Health and Care Partnership (STP – Sustainability and Transformation Programme) to deliver system-wide efficiencies. In particular, we are a partner within their mental health programme, leading the secure workstream with delivery of the PROSPECT new care model for secure services.

Cheshire and Merseyside Health and Care Partnership mental health ‘at-scale’ priorities for the year ahead are planned to be crisis care, personality disorder and the new care model programmes for secure care and specialist child and adolescent mental health.


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3. OUR SERVICES: Strive for Perfect Care

3.1 Our current position

Feedback from patients and their carers Whilst the Trust receives positive feedback via the national patient surveys, we have identified through our engagement with patients, carers and through complaints analysis, that there is room for improvement, particularly in relation to communication and joined up care which meets the psychological, the social and the physical needs of patients.

We will test carer passports across the Trust to improve the experience of carers and test ‘always events’ for carers within Specialist Learning Disability services to consistently improve carer experience. We will also pilot a new ‘side by side’ process for active participation (co-production) when considering service improvements and redesign in 2019/20.

In the year ahead, we will prioritise the development of integrated physical and mental health care through the development of integrated care teams at neighbourhood level. This will improve the care coordination of people with complex needs, helping them to feel more informed about their care plan and improving communication with them.

Evidence tells us that in general terms, the more positive the experiences of staff within an NHS Trust, the better the outcomes and patient satisfaction. We will work with our staff by prioritising actions within our People Plan to ensure they feel valued and supported, along with further developments in embedding a Just and Learning Culture. Through our equality and inclusion action plan, we will focus on improving access, experience and outcomes within our services for those who share protected characteristics.

Care Quality Commission Mersey Care has an overall ‘Good’ rating from the CQC. We are currently waiting for the results of an inspection which took place in November and December 2018.

3.1. Current position

OUR SERVICES: Strive for Perfect Care 3


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3.2 Improving quality: Perfect Care

Our quality improvement strategy is simple: to deliver Perfect Care as defined by our service users and staff.

This year we will remain focused on our long term quality improvement goals, building on our success to date in each area. Our Centre for Perfect Care will support the following key priorities in 2019/20:

Zero suicide • Zero inpatient suicides in 2019/20• Develop world leading practice guidance on reducing self harm in people with

personality disorders by October 2019.Reducing restraint • Full compliance with Reducing Restrictive Practice Guide by March 2020

• Reduce restraints in specialist learning disability services from 2018/19 baseline by 20% in 2019/20.

Physical health for mental health service users

• Identify innovation in the physical health offer to mental health service users by July 2019 with implementation proposals to follow.

Pressure ulcers • Zero deterioration of pressure ulcers within our care in 2019/20.

Just and Learning Culture

• Our priorities for 2019/20 can be found in the ‘our people’ part of this plan

Learning from deaths • Produce high impact plan to reduce mortality in our services, incorporating learning and best practice, by October 2019.

Enablers • Enable all divisions to improve their use of data for improvement, including use of statistical process control, by March 2020

• 100% increase in number of improvement projects across the Trust from 2018/19 baseline and development of quality improvement database by March 2020.

Figure 2: Our Perfect Care priorities for 2019/20


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3.3 Improving quality (STEEP): Continuous improvement

Having reviewed benchmarking and performance information and through engagement with our clinical divisions, we have identified quality improvement requirements aligned to the STEEP framework (safe, timely, effective, equitable and person-centred). Our clinical divisions will retain a focus on improvement in these areas through our Operational Management Boards and our Board of Directors will retain focus through our Quality Assurance Committee.

The headlines STEEP priorities for the year ahead are shown in the table below. Divisional summaries (see page 32 to 35) provide more detail.

We will work to achieve a Care Quality Commission rating of ‘Good’ across all community physical and mental health services and maintain ‘Good’ in other service areas.

Safe • Implementation of community services improvement plan and post-Kirkup quality and safety improvement plan

• Implement a standardised Trust Quality and Safety Framework, including dashboards and ward/ team accreditation by September 2019.

• Audit and monitoring of the deteriorating patient pathway (including NEWS2 and sepsis pathway)

• Focussed awareness-raising and increased reporting of safeguarding risks within community physical health division

• Address risks to children in care by fully implementing the Children in Care Quality Improvement Plan

• Roll out standardised falls assessment and management across older peoples services and other high risk areas

• Safety planning in secure mental health and prison services• Improved risk assessment processes and training for section 17 leave• Address high levels of ligature incidents in specialist learning disability services.

Timely • Reduction in waiting times for therapy services (including psychological therapies in the community) across the Trust, with a Trust-wide review of therapy services.

• Achievement of national mental health waiting times and performance targets• Reduced length of stay and delayed discharges in mental health services. • Implementation of Red2Green across all appropriate services.• Timeliness of access and assessment in end of life care services and work with

partners to increase the number of people able to die in their place of choice.

Effective • Single Integrated Community Reablement and Assessment Service (ICRAS) model across North Mersey

• Implement crisis resolution and home treatment service• Integration of our children’s services within neighbourhoods as part of integrated

care team development.• Build on progress in unplanned care, working with partners in urgent care treatment

centre developments.• Clearly articulate our prevention offer, working jointly with partners to deliver

preventative health services.• Trust wide accreditation for wards and teams.

Equitable • Improvement to patient experience for those with protected characteristics, including monitoring harm by protected characteristics.

• Fully implement equality analysis with quality impact assessment process for service change, transformation and Cost Improvement Plans (CIPs)

Person centred • Pilot carers passport across the Trust• Increased reporting of satisfaction with involvement in care planning• Implement framework to embed thematic learning from data and information on

the experience of people who use our services by December 2019


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3.4. Population health

The NHS is currently out of kilter with the needs of the population it serves, health needs data tells us that the people of Liverpool and Sefton are living with multiple enduring long term conditions but NHS services are commissioned to provide acute episodes of care to particular groups. Population health has been steadily deteriorating despite money spent on the NHS and this in turn is driving increased demand for services.

A focus on population health means aiming to improve the health of an entire population. It is about improving the physical and mental health outcomes and the wellbeing of children, young people and adults, whilst reducing health inequalities within and across a defined population. It includes action to reduce the occurrence of ill-health, including addressing the wider determinants of health, and requires working with communities and partner agencies.

Population health management improves population health by data-driven planning and delivery of care to

achieve maximum impact. It includes segmentation, stratification and impact modelling to identify local “at risk” groups and in turn, designing and targeting interventions to prevent ill health and to improve care and support for people with on-going health conditions, reducing unwarranted variation in outcomes.

Through this approach, we will better understand access, exprience and outcomes for people who share protected characteristics and take action to reduce inequalities, making every contact count across the breadth of Mersey Care services.

Population health management is a theme of our long term strategy, as through this approach we will be able to understand people’s needs more effectively, and understanding the population’s health needs will enable the NHS to develop services that predict, prevent and intervene more effectively. This is illustrated in figure 3.

Milestones for 2019/20• Develop shared approach to population health segmentation with local authorities and CCGs by April 2019• Confirm population segmentation categories, data flows and produce initial report of ‘raw data’ for

Liverpool and Sefton by April 2019• Construct segmentation tool by August 2019• Go live with activity data in September 2019 and costing data by March 2020.

Figure 3: Taking a population health approach to develop more preventative care


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3.5 Integration

The term ‘Integration’ means to address fragmentation in services, and enable better coordinated and more continuous care for people of all ages.

Mersey Care is focusing on integration in community physical and mental health services because patients receiving care in community settings often have multiple, complex health needs and depend on many health and social care services to meet these needs. Rather than continue to run separate mental health, social care or physical community services, Mersey Care will help local providers to operate within an all-age ‘One Team’ ethos for out of hospital care, uniting primary care, social care, community physical and mental health services and the voluntary sector.

The Liverpool and Sefton Provider Alliance plans set out how we will begin to use our collective resources to have greater impact by pulling in the same direction, working in similar ways and collaborating to provide more holistic support to people in our communities.

In practice, integration will mean that patients have to be assessed and referred between separate organisations less often because those organisations are working together to produce one care plan.

Patients will receive care that factors in their physical, mental health and social needs and their social needs will be met more effectively through non-medical services such as the Life Rooms, services provided by local voluntary organisations and Information and advice hubs/children’s centres.

People will be enabled to take more control of their own health through the development of a personal health record, and through psychological support that takes into consideration someone’s motivations and life circumstances. This is illustrated below in figure 4.

Our plans for integration will be supported by a social care strategic plan which we will develop this year in partnership with social workers and the local authority.

Figure 4: What integration will mean in practice

An integrated care team that understands that Mary has:• anxiety• loneliness• insecurity• confusion• dependency

Enablers:• Person Held Record• Telehealth• Proactive care plan

ROOMSLIFEThe

WALTON

Network of voluntary services

Information and advice hubs/

citizen’s centres

Community connections

Create a single care plan


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For Mersey Care in 2019-20, our integration initiatives focus on the integration of Mersey Care’s own mental health and physical health services. This integration will be carefully managed and phased slowly, in recognition of the scale of organisational change for our people and to acknowledge that previous Liverpool Community Health services require support to reduce variation in quality.

This balance of beginning to integrate Mersey Care’s mental health and physical health services, with the continued quality improvement support to physical community services is reflected in our milestones for the year.

Milestones for 2019/20• Through the Provider Alliances, implement

integrated care teams, including our children’s services, at 30,000 to 50,000 population across Liverpool and Sefton by October 2019.

• Implement new primary care mental health model, subject to commissioner investment

• Integrate Mersey Care clinical divisions – one division for secure and specialist LD services by December 2019, and one division for local mental health and community services by April 2020.

• Introduce integration in Mersey Care’s services for frailty/dementia

• Introduce integration in Mersey Care’s services for people/families with complex lives

• Introduce integration for children

Key measures• Effectiveness of team working using ITMA tool

(Integrated Team Monitoring and Assessment)• Patient experience and activation using validated

measurement framework• Hospital readmissions within 30 days of discharge• Delayed transfers of care.


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4.1 Becoming an employer of choice in our sector

Our People Plan 2018 to 2021 sets out our commitment to focussing on our people; those who deliver services and support our communities. We recognise that there has never been a more important time for Mersey Care to have a workforce that has the right values, skills, support and development to deliver Perfect Care. The vision for our People Plan is simple, “to create a compelling place to work where we attract, retain and develop the best people to deliver the best care and be the best they can be”.

The People Plan describes five strategic key priorities that are aligned to deliver the overall Trust aims, all of which we know to be fundamental to creating a high performing, happy workforce, and to the delivery of Perfect Care in accordance with our values and a Just and Learning Culture.

In our workforce planning, we have identified three trustwide workforce planning risks – nursing supply, medical supply and age profile (both the workforce coming up to retirement resulting in a loss of experience and experience levels of the remaining staff in post). We will prioritise actions in our People

Plan which help us to recruit, retain and develop the future workforce.

Milestones for 2019/20: • Continue to review workforce plans, alongside the

divisional transformation programmes, to ensure we continue to have actions in play to mitigate our workforce risks and to ensure that our workforce becomes more reflective of the communities we serve

• Support our workforce through complex organisational change, transition and integration

• Implement culture of care barometer across all clinical divisions to provide a regular temperature check of teams, and use data to identify required actions by September 2019

• Ensure leaders demonstrate Mersey Care values and behaviours and have the courage to challenge and address issues where colleagues are not acting in accordance with our values

• Implement the action plan resulting from the review of how people raise concerns across Mersey Care from May 2019

• Cleanse and review electronic staff records to ensure they reflect new structures and therefore record and report accurate data by March 2020

• Continue to review and streamline recruitment process and delivery of the Trust’s time to hire targets throughout the year.

4OUR PEOPLE: Become of the employer of choice in our sector


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Our approach to staff sickness in the year ahead will include:• Targeted focus on well being to assess impact

from April 2019• Develop easy to read electronic booklet to

explain managing attendance policy for staff and managers by June 2019

• Review and redesign management development training sessions with HR and staff side by June 2019 and roll out from September 2019.

• Pilot HR/operational management coaching and support sessions within hot spot areas from June to September 2019

• Review available electronic solutions to support line managers in managing absence by June 2019.

• Review and report the timeliness of employee relations cases and embed any learning in line with our Just and Learning Culture approach (including a focus on those with protected characteristics) by end of June 2019.

Key measures:• Maintain staff sickness at 6.5% or below.• Ensure a maximum time to hire of 45 days• Achieve 95% core mandatory training compliance,

with 90% role specific training by March 2020.• Achieve clinical supervision levels of 90% by June

2019.• Achieve 95% PACE compliance within rolling 12

month period.• Maintain a vacancy rate at 11% or below for

qualified nurses (mental health and community)• Maintain a vacancy rate at 14% or below for

consultant doctors (mental health and community)

Our Equality and Inclusion Strategy sets out our equality objectives for 2019 to 2021, which are:• To improve year on year the reported employee

experience for protected groups• To embed high quality analysis through the use of

data into the design and delivery of our services including our decision making processes

• To reduce health inequalities for protected groups by improving access to all services

• To improve year on year the reported patient/service user experience for protected groups

Mersey Care is committed to taking equality, diversity, inclusion and human rights into account in everything we do, whether that’s through our aspiration to deliver Perfect Care for our patients and services users to employing a diverse workforce in a Just and Learning Culture.

Milestones for 2019/20: • Deliver our Equality and Inclusion Action Plan to

improve experience for staff and service users by March 2020.

• Maintain a continual focus on the recording of protected characteristics within our clinical services, with a particular focus on community division where there is a lower baseline position.

• Commission health needs analysis, reporting by October 2019, focussing on access, experience and outcomes for people who share protected characteristics within our services to allow the development of a focussed improvement plan

Key measures:• Improve equality, diversity and inclusion staff

experience to above average levels for 2019/20, as measured by the national staff survey.

• Improve the five workforce race equality scheme key questions, as measured by the national staff survey by March 2020.

• Achieve 95% recording of protected characteristics data of staff within our services. We will agree an improvement trajectory for community division by April 2019.


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4.2 Just and Learning Culture

Mersey Care is a national pioneer in developing a Just and Learning Culture in the NHS. In the two years since we began work on Just and Learning Culture, we have achieved significant impact for our staff with a 54% reduction in disciplinary investigations.

In the year ahead, we will consolidate our progress and ‘hard wire’ cultural change by embedding Just and Learning Culture within every day working practices. Our priorities in 2019/20 are set out below:

Milestones for 2019/20:• Developing and implementing a tool / framework

to support restorative conversations in practice. • Developing a tool/framework, aligned to our

organisational values, that fosters and supports civility in practice.

• Every team to have Just and Learning conversations, highlighting learning from routine with processes working well, alongside learning from processes when something doesn’t go to plan.

• Refreshing Datix (incident reporting) pro-formas, process, training offered and guidance on completion.

We will also focus within our Just and Learning Culture on the experience of black, asian and minority ethnic staff and of those who share protected characteristics.

4.3. Working side by side with service users and carers

Seeing things from our service users’ perspectives, and working side by side with them to design and improve services gives us powerful opportunities to continually improve experience and outcomes for the people we serve and to stop doing things which don’t add value.

Over recent years, the way in which Mersey Care engages and works with service users and carers has evolved from simply talking to people; to getting people more involved; to asking people to actively participate in our work. The acquisition of community health services, as well as the need for a Foundation Trust to engage more actively with a wider membership and the communities we serve, requires us to think differently about and strengthen our approach to engagement.

In 2019/20, Mersey Care will implement a new process for active participation (co-production) when


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considering service improvement and redesign. This approach was developed taking account of feedback from various service user and carer groups as well as the discussions with members of the Service User and Carer Assembly.

Life RoomsOur Life Rooms in Walton and Southport have had over 80,000 visits since their openings in May 2016 and 2017 respectively. Life Rooms at Hugh Baird College in Sefton opened in February 2019, with a focus on meeting the needs of young people. Currently over 60 GPs are referring to the Life Rooms and over 3,500 social prescriptions are managed.

In the year ahead, the Life Rooms will continue to be strengthened in order to provide support to people outside the traditional models of service delivery and enable people to take more control over their health and recovery. This will build upon the established Life Rooms pathways for patients discharged from community mental health team caseloads. In partnership with Liverpool and Sefton Provider Alliances, the Life Rooms will form part of a single ‘social prescribing’ pathway for Liverpool and Sefton which makes the most of the community and voluntary sector non medical support and services with neighbourhoods.

Milestones for 2019/20• Pilot a new side by side process for active

participation (co-production) when considering service improvement / redesign by March 2020

• Pilot service user and carer participation in our leadership programmes by March 2020

• Pilot ‘Always events’ for carers within Specialist Learning Disability services from June 2019, and review with a view to further roll out

• Pilot carer passports across the Trust from June 2019

• Pilot Life Rooms Ashworth by March 2020• Continued development our student mental health

offer• Contribute to the design and delivery of a social

innovation model for Liverpool and Sefton in support of integrated care teams throughout 2019/20.

Key measures:• 90% compliance with Triangle of Care in mental

health services. We will develop measures applicable for the breadth of our services in 2019/20.


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5.1. Maintaining financial balance

NHS Operational, Planning and Contracting Guidance published in January 2019, sets out how the five year funding settlement for the NHS announced in June 2018 will be implemented. This, amongst other national finance changes has resulted in a change in the Trust’s control total for 2019/20 of breakeven.Over recent years the Trust has acquired several organisations which has increased our turnover from £213m (April 2016) to £370m (April 2019). Over the same period the Trust’s surplus has reduced to £1.842m which reflects the additional level of investment across front line services.

In 2018/19 the Trust will achieve its financial control total. However, in achieving the financial position the Trust has experienced financial risks associated with:• Medical staffing cost pressures• Non achievement of corporate efficiency savings• Non delivery of savings anticipated from the

integration of physical and mental health.

In 2019/20 the Trust has a financial plan of breakeven which will attract a Provider Sustainability Fund allocation of £3.721m. This creates an overall use of resources risk rating of 2 which is expected to improve

to 1 by the end of the financial year as a result of the Trust achieving its agency spend target.

Additional investment identified as part of the NHS Long Term Plan recognises mental health and community services as areas of priority. As such, financial resources have been identified through the national NHS five year funding settlement to support the delivery of the service transformation. This will enable the achievement of mental health investment standard alongside support for current and future cost pressures associated with a growth in demand.

We have reviewed our cost improvement scheme in light of the changing demand and acuity facing our clinical services. We have also taken account of the recommendations of the Carter Review regarding corporate/back office functions.

As a result the efficiency savings planned for 2019/20 are set out in figure 5.

OUR RESOURCES: Develop a solid financial, estate and digital platform for future integration 5


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This translates into a cost improvement plan (CIP) of £10.041m. The Trust will deliver the service and workforce changes necessary to release this efficiency saving whilst maintaining a high quality and safe clinical services.

The financial plan recognises a number of risks which will need to be addressed in 2019/20. They are medical staffing cost pressures, corporate services transformation programme and mental health and community service integration savings.

We will take the following actions in order to management those risks effectively:

• Medical staffing – In the year ahead, we will improve medical recruitment and retention, reducing relliance on medical locums, and embed a Just and Learning Culture. We will develop new roles (physician associates) as part of a wider restructure of medical leadership roles and a new approach to job planning.

• Community services – Implementation of the community services improvement programme post-Kirkup will continue in the year ahead, taking account of the emerging findings from the post-acquisition review work. Our ability to deliver the required transformational change safely at the intended pace is challenged by the level of clinical and quality risk that transferred with the services. The introduction of additional funding has enabled the Trust to defer any efficiency requirements until the service has been stabilised.

• Corporate services – Effective corporate services are essential in supporting our clinical divisions to provide high quality care. In the year ahead, we will develop our corporate services so they consistently provide high quality customer service and enable us to deliver our strategy now and in the future. Following the acquisitions of Calderstones Partnership NHS Foundation Trust and Liverpool Community Health NHS

Trust, our corporate services have grown and in 2019/20 we will agree a new target operating model for high quality corporate services within Mersey Care by December 2019, which will also generate efficiencies and cost savings to support delivery of our cost improvement plans. The cost improvement plan for corporate services in 2019/20 is £6.501m. Some of these corporate savings will be delivered by the opportunities highlighted within the Carter recommendations. In addition, the trust has begun to implement more collaborative working across the local delivery system and wider health economy with regards to corporate functions.

Milestones for 2019/20:• Agree principles of corporate target operating

model and identify high level opportunities from stakeholder engagement by June 2019

• Develop target operating model by September 2019

• Commence implementation of target operating model, including consultation where required, by December 2019

• Target operating model implemented by April 2020

• Throughout this process, implementation of functional CIPs identified through diagnostic exercise.

Key measures• Deliver total Cost Improvement Plan (CIPs) of

£10.041, of which £6.501m relates to corporate services, in 2019/20.

Cost efficiency savings required*

2019/20 (£m)

Local division (carried forward from 2017/18)

0.940

Corporate division 6.501Community services 2.600Total 10.041

Figure 5: Cost efficiency savings required


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Capital developments 2019/20 *subject to business case approval 2019/20 (£m)Medium secure unit (Rowan View) 27.9Low secure unit* 1.5Southport Redevelopment (Hartley Hospital) 5.4Community Hub Investment* 1.0Global Digital Exemplar 1.9Secure ward refurbishments 4.2Liverpool Inpatient Facility (Liverpool 2) – Scoping /Enabling* 1.0Step Down Unit* 2.0Training Facility* 1.0High Secure HDU Redevelopment* 0.5 Saturn House* 0.5Total 46.9

Figure 6: Our estates framework 2019 to 2024

Figure 7: Capital developments 2019/20

5.2. Improving our estate

Our vision is for our buildings to not only meet 21st century standards but to reshape services themselves, allowing us to deliver integrated care which is more preventative and less crisis-focussed, whilst delivering clinical excellence in our services. Specifically, in developing our estate, we will ensure that the right environment is provided to deliver integrated care for neighbourhoods of 30,000 to 50,000 people and stratify our beds according to acuity of need. Our estates framework (2019 to 2024) is summarised below in figure 6:

Since 2012 we have invested £97m in our estate to provide high quality care. This includes the opening of Clock View, the Sid Watkins Brain Injury Unit, the Hope Centre (addictions), investment in community mental health bases, high secure ward refurbishments and a brand new pharmacy.

We are also investing a further £72m in building a new 123 bed medium secure unit (Rowan View) and a 40 bed inpatient facility in Southport (Hartley Hospital).

The Trust plans to invest £46.9m in its estate in 2019/20.

In addition to these investments set out in figure 7, we are also planning a new inpatient facility in Liverpool, a new low secure unit for people with learning disabilities and a new high dependency unit in high secure. These projects are subject to capital funding being available.

It is important that the we continue to deliver a surplus and manage our resources effectively, as this allows us to continually invest in improving our estate.


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Our estates developments will be tested against a number of key principles, which reflect our service transformation and quality improvement priorities: • Our buildings will support the Trust’s ambition

to deliver Perfect Care (safe, timely, effective, equitable, patient centred)

• Our buildings will reflect the clinical and emotional needs of service users

• Our buildings will provide an environment in which colleagues want to work

• Our buildings will support agreed partnership pathways across the health economy and wider community.

Milestones for 2019/20:• System wide review of community estate in

partnership with other organisations within each ‘Place’ (for example, Liverpool and Sefton) to enable integrated care.

• Identification of pilot neighbourhoods for shared estate by May 2019 and mobilisation thereafter.

• Continued development of Southport’s Hartley Hospital – due to open from Autumn 2019

• Continued development of Rowan View Medium Secure Unit – due to open Autumn 2020

• Continued planning for Liverpool 2 and Learning Disabilities Low Secure Unit

• Planning and business case for high secure high dependency improvement works

• Forward plan for future use of Whalley and Maghull sites

• Work with Cheshire and Merseyside Health and Care Partnership (STP) to enable consolidation of estate across Cheshire and Merseyside and ensure that Mersey Care developments are reflected in their capital planning.

Key measuresOver the five years of our strategic estates plan (2019 to 2024), we will see:• 5% savings on estates running costs• Reduction from 8% (2018/19 baseline) unoccupied

floor space to 2.5%• Increase from 59% (2018/19 baseline) of facilities

in acceptable condition/satisfactory performance to 100%

• Increase from 42% (2018/19 baseline) of estates in category B condition or above to 100%.


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5.3. Invest in digital technology

Digital technology will transform the way we deliver person-centred, productive, and integrated care. Digital tools and systems have already changed how we operate, but we know there is so much more that technology can do to help us work effectively, safely, and efficiently. We also know that digitisation is as much about people as it is about technology.

Digital solutions must be designed around insight, co-production and digital skills development with our workforce and with our service users.

Our vision is to transform the digital experience for our workforce and the populations we serve so that technology is both the visible alternative to traditional ways of working and the invisible enabler, working effectively in the foreground and background supporting what we do.

Figure 8 shows the way in which digital technology can support us to meet growing demand for services and our workforce and financial challenges.

Figure 8: Using technology as a solution to our long term challenges

Picture here


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In 2019/20 we will invest strategic capital to strengthen our digital foundations.

Our aspiration to fundamentally redefine the way services use digital technology will only be realised if we have a strong, dependable and cyber secure infrastructure. The following themes are therefore key in a rolling programme of infrastructure and core technology upgrades:

• The right tools for the job – End user device rolling replacement programme, including upgrading all of the PC/Laptop estate to Windows 10 by January 2020.

• Wi-Fi – Upgrading the Wi-Fi infrastructure to improve connectivity by July 2019.

• Agile working – Roll out Express Access as part of the rolling replacement programme; and Skype for business by May 2019.

• Servers and data centres – Upgrading and consolidating servers for improved performance and efficiency, including Windows Server 2016 updates by January 2020.

We’ll also continue building on our plans as a Global Digital Exemplar by embedding digital tools in services and innovating to develop digital solutions that help align the right resources to the right people and enable the right care.

Digital technology is a critical enabler of our plans to provide proactive integrated care at neighbourhood level. As such we launched a personal health record system in December 2018 and are working with other providers in Cheshire and Merseyside to share clinical records to improve continuity of care by having access to discharge letters; clinical correspondence; pathology and labs; and GP records. Mersey Care will share care plans; crisis plans and discharge letters with other providers.

By rolling out paperlight solutions, we will allow our clinicians working in the community to capture data at the point of care and have access to key information from anywhere at any time.

Milestones for 2019/20• Mobilise personal health record pilot sites at

neighbourhood level with three community integration teams testing the functionality of: shared care plans, crisis plans and appointments from the RiO and EMIS Community Systems; goal setting; trackers for mood, sleep and activity; and diary in April 2019.

• Launch phase two of personal health record pilot sites with at least 5 integration teams to include: link to social prescribing platform; messaging; social care data; and patient surveys and questionnaires from September 2019.

• Join the regional clinical record sharing platform Share2Care in August 2019.

• Link the Personal Health Record to the Share2Care platform to give service users and patients access to parts of their clinical records from all providers across Cheshire and Merseyside region by March 2020.

• Modernise patient administration system in Community Equipment Store (go live March 2019), Child Health Information Service (digital enhancements throughout 2019/20) and Sexual Health (go live March 2020).

• We aim for all adult community services to have completed paperlight by March 2020

• Work with our digital system provider Informatics Merseyside to gain security assurance accreditations for the systems they provide by March 2020.

Key measures:• An increase from current levels to a minimum

of 70% digital maturity, with 85% maturity achieved in relation to clinical records, by 2020/21. We aim to achieve 90% digital maturity by 2024/25.


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6.1. Developing Provider Alliances

Mersey Care must work with other organisations if we are to deliver our aspiration for continuous improvement, reflecting population health and integration set out in this operational plan. Mersey Care is leading the development of place-based care in Liverpool and Sefton, and the development of a more effective secure services pathway with providers across Cheshire and Merseyside.

Place-based provider alliancesWe have established Provider Alliances in both Liverpool and Sefton which bring together health, social care, third sector and housing providers to use our collective resources to deliver new, integrated models of care designed to improve the health and wellbeing of our communities. We will work together to reduce fragmentation of care for people with complex comorbidities, ensuring the person is at the centre of our decision making. Our new community based services will focus on prevention and proactive care, thereby reducing demand on crisis and urgent care, and promoting choice and independence. This new model of care is focussed on delivering highly effective integrated care teams for populations of 30,000 to 50,000.

In the future, we expect that the Provider Alliances will have a greater influence over tactical commissioning

decisions with the role of CCGs being one of a strategic commissioner, setting the outcomes for its populations. As a result, in 2019/20, we will establish formalised programme management arrangements for the Provider Alliances under the leadership of Mersey Care.

In the year ahead, the Provider Alliances will deliberately move away from multitude of condition specific projects/schemes driven by a single condition policy or targets and identify high impact collective action for population by segmentation and identifying needs, service utilisation and alternative for particular cohorts/segments of the population. Together, we will also work to deliver the children’s transformation plan for Liverpool.

The Provider Alliances will build new operating system (people, processes and technology) for integrated care, specifically:• Integrated care teams based on neighbourhoods

for 30,000 to 50,000 population• Social prescribing to support integrated care teams

at 30,000 to 50,000• Outpatient services and alternatives• Digital technology to support integrated care

teams and outpatient review• Urgent care review

OUR FUTURE: Work with and learn from others to have greater impact 6


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The operating system will be tested for two population segments in 2019 - frailty/dementia, and complex needs. Achieving measurable change for these cohorts will be high impact for the health system and will generate ‘headroom’ for further change in the system over the longer term.

For Mersey Care, this will mean more integrated working for Mersey Care’s community physical and mental health, learning disability and addiction services. Staff in our local and community divisions will be expected to work increasingly on a neighbourhood basis and as part of an all-age ‘one team’ ethos for that neighbourhood. This will mean closer working with colleagues from social care, housing, the voluntary sector and other agencies working in that neighbourhood.

We are conscious of the need to ensure that the pace of integration of existing Mersey Care services is carefully managed and does not distract colleagues from delivering other aspects of our operational plan. To this end, we will carefully plan the phases of integration with operational colleagues.

Milestones for 2019-20 • Establish integrated care teams in each of the 16

neighbourhoods across Liverpool and Sefton by October 2019.

Key measures:• Effectiveness of team working using ITMA tool

(Integrated Team Monitoring and Assessment)• Patient experience and activation using validated

measurement framework• Hospital readmissions within 30 days of discharge• Delayed transfers of care.

PROSPECT new care model in secure servicesMersey Care will also continue to develop provider alliances for our secure mental health services.

Our PROSPECT partnership was established to manage the local low and medium secure bed base in an efficient and consistent way, and that any changes to practice and provision are subject to the PROSPECT 4D test, and therefore must impact in one of the following ways; minimise delay, reduce duplication, avoid drift, prevent disempowerment.

Single point of referralTrusted assessment

Appropriate level of securityCare bundles

Bed stratificationEstimated discharge dates

Clinical oversight groupMulti service planning

Transition planningHousing

Community forensic services

Duplication

DelayDisempowerment

Drift

Figure 9: PROSPECT 4D test: Our new care model


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Milestones for 2019/20:• ‘Go live’ as a New Care Model site, following sign-

off of a full business case by July 2019.• Ongoing implementation of a new clinical

model of care which has been developed by the PROSPECT Clinical Network, specifically a single point of assessment and clinical oversight group.

• Bidding for national money to develop enhanced community forensic services to deliver a much more robust community offer and pathway by May 2019.

• Continuing to work with local commissioning colleagues to design and deliver a housing and community support for people discharged from a forensic pathway.

Key measures• Reduce average length of stay for service users

within the PROSPECT low and medium secure services by 5% once the single point of assessment and clinical oversight group are fully implemented.

6.2 Research and development

While there is good knowledge about causes and treatment of mental disorders there are still many gaps which need further understanding and research if we are to improve outcomes. Mersey Care’s aim is to increase research into mental health conditions across the life span, support treatment discovery in biological, psychological social and digital sciences and bring these benefits to help mental and physical health services to provide better health outcomes. As our services grow and there is greater integration with physical health and focus on population health we will work with other stakeholders and partners to support, develop and conduct research in these disciplines too.

Milestones for 2019/20:• Increase our capability in conducting and delivering

research by developing a programme of training and support to increase the number of clinicians involved in active research as Chief Investigators and Principle investigators and continue to achieve

our targets for National Institute for Health Research (NIHR) adopted studies.

• Form a strategic alliance with Liverpool Health Partners to influence collective effort towards mental health research in the city of Liverpool. Through this collaboration and with Clinical Trials Units in acute provider Trusts, we will seek to conduct our first commercial clinical trial.

• Support ongoing digital research (Swim app, AVERT – artificial intelligence applications) to completion and scope further research in evolving technologies.

• Continue to support internally generated research towards Perfect Care priorities of suicide prevention, reducing restraint, improving physical health and Just and Learning Culture.

• Work with academic partners to apply for external research grants.

Key measures:• Five additional Chief Investigators and Principle

Investigators in place by March 2020.• Achievement of our external research grant target

of one external grant in 2019/20.

6.3 Commercialising our knowledge assets

The overarching aim of Mersey Care’s commercial strategy is to deliver a financial return which contributes to the Trust’s efficiencies and additional income targets, helping to reinvest back into the Trust, safeguarding and developing the front line services that the we provide.

Mersey Care possesses a unique combination of clinical expertise and academic expertise, in a broad range of specialist areas. Our improvement and innovation cycle has the potential to generate more value to be reinvested back into the NHS, through developing consultancy to other organisations and through developing services and products that are valuable to the wider health system (for example, the Zero Suicide Alliance).


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Milestones for 2019/20• Finalise Commercial Opportunity Assessment Tool

kit by April 2020• Create a process and develop expertise for the

management, protection, development and commercialisation of our intellectual property (IP) assets, which runs alongside our innovation process by October 2019

• Develop a ‘commercial and innovation’ process for internal and external opportunities, and be able to manage these through a process including Commercial Assessment, intellectual property and trademarking process, marketing and management and support and development of a commercial pipeline by October 2020

• Develop a governance and quality assurance process to identify our assets, develop our assets and then commercialise our products. The majority of our products will be developed from a research and evidence base (Centre for Perfect Care) through our innovation process.

• Progress areas identified as truly distinctive and market leading in recent commercialisation review from April 2019.

Key measures:• Successful progress of three commercial

opportunities by October 2019 and six by March 2020

Strategicinnovation

Prototype Incubate

Tomorrow’sbusiness

AdaptExistinginnovations

Accelerate

Figure 10: Commercialising our knowledge capital to reinvest back into the NHS

New ventures and innovation


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7.1 What this plan means for our divisions

We have worked with each of our divisions in the production of this plan and in the following pages we set out their specific areas of focus in supporting the delivery if this operation al plan in 2019/20.

7.2 Executive Performance Review

Delivery against both our strategic aims and operational plan priorities will be reported via the Executive Performance Report, which will be updated to reflect the structure and priorities set out in our plans along with the measures and targets set for 2019/20.

Quarterly performance reviews with each division, established in 2018/19, will continue, identifying areas of under performance and agreeing performance improvement plans where required. This will ensure regular oversight of delivery of our operational plan in 2019/20.

We will also undertake quarterly performance reviews with our corporate strategic programmes, to ensure delivery by corporate services of our strategy and plan, continually prioritising our resources in year.

MONITORING AND MEASURING DELIVERY OF THIS PLAN 7


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re H

DU

red

evel

opm

ent

prog

ram

me

• O

pen

Row

an v

iew

med

ium

sec

ure

unit

in A

utum

n 20

20.

• Sp

ecia

list

LD lo

w s

ecur

e un

it pr

ogra

mm

e (s

ubje

ct t

o fu

ndin

g)•

Cor

e te

chno

logy

upg

rade

pro

gram

me.

Ou

r Fu

ture

• G

o liv

e as

a n

ew c

are

mod

el f

or s

ecur

e se

rvic

es (P

ROSP

ECT)

fro

m

June

201

9.•

Impl

emen

t ne

w c

linic

al m

odel

of

care

dev

elop

ed b

y PR

OSP

ECT

clin

ical

net

wor

k, s

peci

fical

ly s

ingl

e po

int

of a

cces

s an

d cl

inic

al

over

sigh

t gr

oup

• Bi

d fo

r na

tiona

l mon

ies

to e

nhan

ce c

omm

unity

for

ensi

c se

rvic

es.

We

will

mea

sure

ou

r d

eliv

ery

of

ou

r d

ivis

ion

al p

rio

riti

es w

ith

in t

he

op

erat

ion

al p

lan

usi

ng

th

ese

key

ind

icat

ors

:•

Mai

ntai

n an

d im

prov

e ex

istin

g C

QC

goo

d ra

tings

• Re

duce

d le

ngth

of

stay

in s

egre

gatio

n•

Redu

ced

use

of fl

oor

rest

rain

t (s

upin

e) in

Spe

cial

ist

LD•

Incr

ease

d ta

ke u

p of

mod

erat

e ex

erci

se•

Redu

ced

leve

ls o

f ha

rm•

Redu

ced

leng

th o

f st

ay a

nd d

elay

ed d

isch

arge

s•

Patie

nt e

xper

ienc

e of

tho

se w

ith p

rote

cted

cha

ract

eris

tics

• St

aff

sick

ness

leve

ls•

Equa

lity,

div

ersi

ty a

nd in

clus

ion

staf

f ex

perie

nce.

Wh

at t

his

op

erat

ion

al p

lan

mea

ns

for

us

in 2

019/

20 –

Se

cure

an

d S

pec

ialis

t Le

arn

ing

Dis

abili

ty D

ivis

ion

s

Ou

r Pe

op

le•

Inte

grat

e se

cure

and

spe

cial

ist

lear

ning

dis

abili

ty d

ivis

ions

by

Dec

embe

r 20

19•

Impl

emen

t cu

lture

of

care

bar

omet

er•

Team

acc

redi

tatio

n pr

ogra

mm

e•

Impl

emen

t di

visi

onal

Jus

t an

d Le

arni

ng C

ultu

re a

ctio

n pl

an•

Use

new

sid

e by

sid

e pr

oces

s fo

r ac

tive

part

icip

atio

n in

ser

vice

im

prov

emen

t/ r

edes

ign

by M

arch

202

0•

Pilo

t Li

fe R

oom

s A

shw

orth

fro

m M

arch

202

0.


Ou

r Se

rvic

esLo

ng

ter

m q

ual

ity

imp

rove

men

t -

Perf

ect

Car

e ar

eas:

Zero

su

icid

e:•

Ensu

re c

ompl

ianc

e w

ith le

vel 1

sui

cide

tra

inin

g.

Red

uci

ng

res

trai

nt

• A

cces

s to

de-

esca

latio

n/ b

reak

away

tra

inin

g fo

r pr

iorit

ised

sta

ff b

y M

arch

202

0.

Phys

ical

hea

lth

• Sh

are

lear

ning

fro

m W

ard

35 r

egar

ding

fal

ls a

sses

smen

t an

d m

anag

emen

t ac

ross

clin

ical

div

isio

ns.

Pres

sure

ulc

ers

• Ze

ro d

eter

iora

tion

of p

ress

ure

ulce

rs w

ithin

our

car

e.•

Del

iver

pro

gram

me

of t

arge

ted

trai

ning

to

men

tal h

ealth

sta

ff o

n pr

essu

re u

lcer

s/ s

kin

care

by

Mar

ch

2020

.

Lear

nin

g f

rom

dea

ths

• Im

plem

ent

actio

n pl

an p

rodu

ced

follo

win

g re

view

of

harm

in L

iver

pool

Com

mun

ity

Hea

lth s

ervi

ces.

Co

nti

nu

ou

s q

ual

ity

imp

rove

men

t –

STEE

P:

Safe

: •

Focu

ssed

aw

aren

ess-

rais

ing

and

incr

ease

d re

port

ing

of s

afeg

uard

ing

risks

.•

Impl

emen

t th

e C

hild

ren

in C

are

Qua

lity

Impr

ovem

ent

Plan

.•

Full

impl

emen

tatio

n of

pos

t-K

irkup

qua

lity

and

safe

ty im

prov

emen

t pl

an.

• Im

plem

ent

stan

dard

ised

saf

ety

hudd

les

from

Apr

il 20

19, a

udite

d qu

arte

rly

Tim

ely

• Re

duce

wai

ting

times

for

the

rapi

es s

ervi

ces

alig

ned

to T

rust

-wid

e re

view

of

ther

apie

s.•

Impl

emen

t Re

d2G

reen

acr

oss

ever

y ap

plic

able

com

mun

ity s

ervi

ce b

y O

ctob

er 2

019.

• 10

0% C

HC

ass

essm

ents

with

in 2

8 da

ys o

f id

entifi

catio

n by

Mar

ch 2

020.

Effe

ctiv

e•

Dev

elop

and

impl

emen

t ac

cess

and

ass

essm

ent

targ

ets

for

end

of li

fe c

are

by

Sept

embe

r 20

19.

• W

ithin

spe

cial

ist

serv

ices

, max

imis

e pr

even

tion

offe

r in

201

9/20

.•

Sing

le p

oint

of

cont

act

for

dist

rict

nurs

ing

and

com

mun

ity m

atro

ns b

y Se

ptem

ber

2019

.•

Revi

ew o

f sm

all t

eam

s w

ithin

com

mun

ity s

ervi

ces

by J

uly

2019

.

Equ

itab

le:

• Fu

ll pr

otec

ted

char

acte

ristic

s re

cord

ed a

cros

s al

l ser

vice

s an

d re

view

ed a

long

side

har

m d

ata.

• Re

view

ref

erra

l doc

umen

tatio

n to

ens

ure

early

iden

tifica

tion

of le

arni

ng d

isab

ility

by

Mar

ch 2

020.

Pers

on

-cen

tred

• C

arer

s as

sess

men

t ro

utin

ely

offe

red

by D

ecem

ber

2019

• Im

plem

ent

patie

nt in

form

atio

n le

aflet

s at

poi

nt o

f tr

ansi

tion

by S

epte

mbe

r 20

19

Ou

r Pe

op

le•

Inte

grat

e lo

cal a

nd c

omm

unity

div

isio

ns b

y A

pril

2020

.•

Mob

ilise

inte

grat

ed c

are

team

s, in

clud

ing

Chi

ldre

n’s

serv

ices

, acr

oss

all 1

6 ne

ighb

ourh

oods

by

Oct

ober

201

9.•

Org

anis

atio

nal c

hang

e w

ith s

ervi

ce li

ne d

eliv

ery

alig

ned

to

neig

hbou

rhoo

d de

liver

y by

May

201

9.•

Impl

emen

t cu

ltur e

of

care

bar

omet

er•

T eam

acc

redi

tatio

n pr

ogra

mm

e em

bedd

ed b

y O

ctob

er 2

019.

• Im

plem

ent

divi

sion

al J

ust

and

Lear

ning

Cul

ture

act

ion

plan

• En

hanc

ed p

sych

olog

ical

sta

f f s

uppo

rt o

ffer

for

com

mun

ity s

taff

by

June

201

9, o

pera

tiona

l acr

oss

all s

ervi

ces

by M

arch

202

0.•

Use

new

sid

e by

sid

e pr

oces

s fo

r ac

tive

part

icip

atio

n in

ser

vice

im

prov

emen

t/ r

edes

ign

by M

arch

202

0.•

Embe

d cl

inic

al c

ompe

tenc

ies

in O

LM a

nd r

epor

ting

by S

epte

mbe

r 20

19

Ou

r R

eso

urc

es•

Revi

ew o

ur c

omm

unity

est

ate

in p

artn

ersh

ip w

ith o

ther

or

gani

satio

ns•

Iden

tifica

tion

of p

ilot

neig

hbou

rhoo

ds f

or s

hare

d es

tate

by

May

20

19.

• C

ore

tech

nolo

gy u

pgra

de p

rogr

amm

e•

Pape

rlite

acr

oss

all a

dult

com

mun

ity s

ervi

ces

by M

arch

202

0.•

Mob

ilise

use

of

Shar

e2C

are

clin

ical

rec

ords

pla

tfor

m f

rom

Aug

ust

2019

.•

Mod

erni

se p

atie

nt a

dmin

istr

atio

n sy

stem

s in

CES

, CH

IS a

nd s

exua

l he

alth

.

Ou

r Fu

ture

• D

eliv

er in

tegr

ated

car

e as

par

t of

Pro

vide

r A

llian

ce p

riorit

ies

in

Live

rpoo

l and

Sef

ton,

wor

king

with

Prim

ary

Car

e N

etw

orks

.

We

will

mea

sure

ou

r d

eliv

ery

of

ou

r d

ivis

ion

al p

rio

riti

es w

ith

in t

he

op

erat

ion

al p

lan

usi

ng

th

ese

key

ind

icat

ors

:•

CQ

C g

ood

acro

ss a

ll se

rvic

es•

End

of li

fe a

cces

s an

d re

spon

se t

imes

• W

aitin

g tim

es f

or t

hera

pies

• U

rgen

t ca

re r

espo

nsiv

enes

s•

Patie

nt s

atis

fact

ion

and

goal

att

ainm

ent

(inte

grat

ion

scor

ecar

d)•

Redu

ced

leve

ls o

f ha

rm•

Patie

nt e

xper

ienc

e of

tho

se w

ith p

rote

cted

cha

ract

eris

tics

• St

aff

sick

ness

leve

ls•

Equa

lity ,

div

ersi

ty a

nd in

clus

ion

staf

f ex

perie

nce

Wh

at t

his

op

erat

ion

al p

lan

mea

ns

for

us

in 2

019/

20 –

C

om

mu

nit

y D

ivis

ion


Ou

r Se

rvic

esLo

ng

ter

m q

ual

ity

imp

rove

men

t -

Perf

ect

Car

e ar

eas:

Zero

su

icid

e:•

Sing

le r

isk

man

agem

ent

fram

ewor

k th

at in

corp

orat

es s

afet

y pl

anni

ng, r

isk

asse

ssm

ent

and

form

ulat

ion

deve

lope

d an

d ro

lled

out

to 1

00%

pat

ient

s by

Mar

ch 2

020

• D

ecis

ion-

supp

ort

fram

ewor

k

Red

uci

ng

res

trai

nt

• A

gree

(by

Oct

ober

201

9) a

nd im

plem

ent

an a

cuity

mea

sure

acr

oss

all w

ards

by

Mar

ch 2

020.

• Im

plem

ent

the

appr

opria

te c

ore

redu

cing

res

tric

tive

prac

tice

inte

rven

tions

in a

ll w

ards

by

Apr

il 20

20.

Phys

ical

hea

lth

• C

ontin

ue t

o im

prov

e ph

ysic

al h

ealth

scr

eeni

ng p

erfo

rman

ce a

cros

s th

e di

visi

on w

ith a

foc

us o

n co

mm

unity

ser

vice

s.

Pres

sure

ulc

ers

• Re

ceiv

e pr

ogra

mm

e of

in-r

each

and

tra

inin

g fr

om c

omm

unity

phy

sica

l hea

lth

serv

ices

, prio

ritis

ing

com

plex

car

e w

ards

Lear

nin

g f

rom

dea

ths

• U

nder

take

tw

o th

emat

ic r

evie

ws

base

d on

mor

talit

y da

te b

y M

arch

202

0.•

Ensu

r e o

utco

mes

fro

m a

ll re

view

s ar

e di

scus

sed

mon

thly

in g

over

nanc

e m

eetin

gs.

Co

nti

nu

ou

s q

ual

ity

imp

rove

men

t –

STEE

P:

Safe

: •

Impr

ove

risk

asse

ssm

ent

proc

ess

for

leav

e (c

oron

ers

lett

er d

ate)

with

le

ave

plan

s in

pla

ce f

or a

ll se

rvic

e us

ers

by A

pril

2019

.•

Stan

dard

ised

ele

ctro

nic

solu

tion

obse

rvat

ions

and

ass

essm

ents

, ena

bled

by

digi

tal b

oard

by

Mar

ch 2

020.

Tim

ely

• Im

plem

ent

actio

n pl

an t

o r e

duce

wai

ting

times

for

psy

chol

ogic

al t

hera

pies

, w

ith t

raje

ctor

ies

set

by A

pril

2019

.•

Impl

emen

t Re

d2G

reen

in e

very

inpa

tient

war

ds b

y O

ctob

er 2

019.

• D

eliv

er n

atio

nal I

APT

rec

over

y an

d w

aitin

g tim

es t

arge

ts, s

ubje

ct t

o co

mm

issi

oner

fu

ndin

g.

Effe

ctiv

e•

Impl

emen

t C

risis

Res

olut

ion

and

Hom

e Tr

eatm

ent

(CRH

T) w

ith f

ull r

ecru

itmen

t in

pla

ce b

y M

ay 2

019.

• Im

plem

ent

unit

co-o

rdin

ator

res

ourc

e ac

ross

inpa

tient

ser

vice

s by

Apr

il 20

19.

Equ

itab

le:

Embe

d pr

otec

ted

char

acte

ristic

s in

all

gove

rnan

ce m

onito

ring

from

Apr

il 20

19.

Pers

on

-cen

tred

• Re

view

and

ado

pt s

ecur

e se

rvic

e ca

rer

invo

lvem

ent

tool

kit

with

div

isio

nal a

ctio

n pl

an b

y Ju

ne 2

019.

Ou

r Pe

op

le•

Inte

grat

e lo

cal a

nd c

omm

unity

div

isio

ns b

y A

pril

2020

.•

Impl

emen

t cu

ltur e

of

care

bar

omet

er•

T eam

acc

redi

tatio

n pr

ogra

mm

e•

Impl

emen

t di

visi

onal

Jus

t an

d Le

arni

ng C

ultu

re a

ctio

n pl

an•

Use

new

sid

e by

sid

e pr

oces

s fo

r ac

tive

part

icip

atio

n in

ser

vice

im

prov

emen

t/ r

edes

ign

by M

arch

202

0.

Ou

r R

eso

urc

es•

Revi

ew o

ur c

omm

unity

est

ate

in p

artn

ersh

ip w

ith o

ther

or

gani

satio

ns•

Ope

n H

artle

y H

ospi

tal i

n A

utum

n 20

19.

• C

ontin

ued

plan

ning

for

Liv

erpo

ol 2

inpa

tient

uni

t.•

Cor

e te

chno

logy

upg

rade

pro

gram

me

• M

obili

se u

se o

f Sh

are2

Car

e cl

inic

al r

ecor

ds p

latf

orm

fro

m A

ugus

t 20

19.

Ou

r Fu

ture

• D

evel

op p

rimar

y ca

re m

enta

l hea

lth r

ole

to s

uppo

rt in

tegr

ated

car

e at

nei

ghbo

urho

od le

vel,

subj

ect

to c

omm

issi

oner

fun

ding

.•

Lead

Per

sona

lity

Dis

orde

r re

desi

gn a

s pa

rt o

f C

hesh

ire a

nd

Mer

seys

ide

Hea

lth a

nd C

are

Part

ners

hip

prio

ritie

s.

We

will

mea

sure

ou

r d

eliv

ery

of

ou

r d

ivis

ion

al p

rio

riti

es w

ith

in t

he

op

erat

ion

al p

lan

usi

ng

th

ese

key

ind

icat

ors

:•

CQ

C g

ood

acro

ss a

ll se

rvic

es•

Redu

ced

leng

th o

f st

ay a

nd d

elay

ed d

isch

arge

s•

Impr

oved

pat

ient

sat

isfa

ctio

n w

ith in

volv

emen

t in

car

e pl

anni

ng•

Wai

ting

times

for

psy

chol

ogic

al t

hera

pies

• Pr

ogre

ss t

owar

ds C

RHT

fidel

ity m

odel

• Re

duce

d le

vels

of

harm

• Pa

tient

exp

erie

nce

of t

hose

with

pr o

tect

ed c

hara

cter

istic

s•

Staf

f si

ckne

ss le

vels

• Eq

ualit

y, d

iver

sity

and

incl

usio

n st

aff

expe

rienc

e.

Wh

at t

his

op

erat

ion

al p

lan

mea

ns

for

us

in 2

019/

20 –

Loca

l Div

isio

nItem F1a - REVISED APPENDIX 1 of Operational Plan 2019/20

Ou

r Se

rvic

esC

orp

ora

te s

ervi

ces

will

co

nti

nu

e to

su

pp

ort

ou

r cl

inic

al

div

isio

ns

to p

rovi

de

con

sist

ent,

hig

h q

ual

ity

care

.

Co

rpo

rate

div

isio

n w

ill s

up

po

rt t

he

del

iver

y o

f o

ur

lon

g

term

qu

alit

y im

pro

vem

ent

Perf

ect

Car

e ar

eas

as w

ell a

s o

ur

con

tin

uo

us

qu

alit

y im

pro

vem

ent

(STE

EP)

pri

ori

ties

in

2019

/20

thro

ug

h k

ey p

rog

ram

mes

, in

clu

din

g:

• C

entr

e fo

r Pe

rfec

t C

are

• C

omm

unity

ser

vice

s im

prov

emen

t pl

an•

Patie

nt s

afet

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37

FINANCIAL IMPACT OF THIS PLAN8

8.1 Resourcing our strategic priorities

Delivering our strategy will enable Mersey Care to remain in financial balance, through service redesign that develops more preventative and integrated services, but also through focusing on our main financial risks of medical recruitment, corporate services and community services.

The initiatives that we will pursue in 2019/20 are accounted for within our financial planning for the year ahead. In the main, these initiatives will be resourced through maintained investment, realignment of existing resource and new commissioner resources, subject to contract settlement, as summarised below:

Realignment of existing resource

New resources subject to contract settlement

Maintained investment

Business case required

Planned investment

• Integrated care team implementation

• Side by side active participation process

• Always events for carers• Trust wide therapies

review• ICRAS North Mersey• Integrate clinical

divisions• Introduce integration

for frailty/ dementia, complex lives and children

• Improve community estate in partnership

• Future plans for Whalley and Maghull sites

• Mobilise provider alliances

• Implement new primary care mental health model

• Crisis resolution and home treatment implementation

• PROSPECT new care model

• Perfect Care areas• Consolidate prison

progress• Reduce sickness

absence• Equality and

inclusion• Just and Learning

Culture priorities• Open Hartley

Hospital and Rowan View

• Review and relaunch R&D strategy

• Quality and safety framework

• Develop Life Rooms model

• Core technology upgrade

• Personal health records

• Share2Care clinical record sharing


38

Productivity gainA number of our initiatives in 2019/20 will support greater productivity, helping us to maintain financial balance, whilst improving quality with our services. Examples include introducing integration with our services for people with frailty/dementia, where we have identified duplication with our services, reviewing therapies provision across the trust in order to standardise services and improve access. Implementing core technology upgrades, including paperlight, will allow our staff to make better use of their time for face to face care.

Furthermore, we know that integrated, proactive care can bring benefits for the wider system by reducing reliance on hospital care. Evidence from the Kings Fund suggests that those who receive proactive care have a 20% less chance of admission to hospital in the subsequent 12 months.

Cost savingsIn 2019/20, we have identified a £6.501m cost improvement plan (CIP) for our corporate services. Following recent acquisitions, our corporate services have grown. By pursuing opportunities for internal efficiency and greater collaborative working across with wider system partners, we will develop and agree a new target operating model for high quality corporate services by September 2019. This will support our clinical divisions to delivery high quality care and enable us to deliver our strategy now and in the future.

Implementation of the community services improvement programme post-Kirkup will continue in the year ahead, taking account of the emerging findings from the post acquisition review work. Our ability to deliver the required transformational change safely at the intended pace is challenged by the level of clinical and quality risk that transferred with the services.

Through improvements to medical recruitment and retention and embedding our Just and Learning Culture, we will reduce our reliance on costly medical locums in 2019/20. This will accompany the development of new roles as part of a wider restructure of medical leadership and a new approach to job planning within Mersey Care.

Value generationIn the year ahead, we will generate income and value to be reinvested back into our services through commercialising our knowledge assets and progressing our research and development activities with a focus on improving health outcomes.


39

79RISKS TO DELIVERYOF THIS PLAN

Risk area (and related BAF risks where relevant)

Risk/impact to plan How the operational plan addresses the risk

Maintaining quality and safety whilst delivering organisational change and efficiency

SRR 2018/19 – 04; 11; 02

If cost reduction becomes a stronger driver than quality, then the quality of our services may be adversely impacted, resulting in quality of care not meeting required standards.

Continuous improvement in STEEP priorities (page 14)Community services improvement plan (page 34) and divisional plans (page 33)Perfect Care priorities (page 13)Regular board monitoring and measurement of delivery of this plan (page 32)Corporate services transformation (page 23)

Delivering the required savings

SRR 2018/19 – 01

If the required savings are not delivered, then we may not achieve best value from our financial resources, resulting in failure to meet financial duties.

Strong management of the CIP delivery programme and focus on top three financial risks (page 23)Monitoring of savings delivery through the PIFC.Long term financial planning.

Our people

SRR 2018/19 – 061305LOC. 140

Without appropriate staffing, and leadership skills to lead change, quality of care may not meet required and our clinical transformation and integration plans will not be realised.

People plan (page 18)Workforce modelling and actions to support recruitment and retention, including ‘growing our own’, succession planning, leadership development (page 18) Development of Just and Learning Culture (page 20)Programme of staff engagement.


40

Risk area (and related BAF risks where relevant)

Risk/impact to plan How the operational plan addresses the risk

Availability of capital

SRR 2018/19 – 03SPLD CM 04

If national restrictions on capital prevent the planned investment, then quality of care will be affected.If capital resources are not made available for NHS England to replace the Specialist LD low secure unit, staff uncertainty will grow and may impact on the ability to maintain safe services.

Estates strategic framework (page 24)Prioritise and sequence capital investment (page 24)Seek alternative funding sources.Relationship with Cheshire and Merseyside Health and Care Partnership (STP) planning and prioritisation (page 25)Plan for Whalley site and learning disability (LD) low secure unit (page 25)

Managing demand for our services

If demand for our services increases above the level for which we are funded, then both delivery of our services and our financial resources may be impaired, resulting in adverse impacts upon quality of care and financial performance.

Adopt neighbourhood level preventative, integrated approach to care to manage demand. (page 28)Manage demand more effectively in partnership with primary care (page 28)Standardise pathways of careInnovate to meet needs at earliest stage in their condition/pathway (page 7)Seek opportunities through provision of physical community services to support self care (page 28)

System leadership If we do not develop our senior leaders to work in partnership across the health and care system, there is a risk to ongoing sustainability in North Mersey/ Cheshire and Merseyside.

Adopt system leadership role in Sefton and Liverpool through Provider Alliances. (page 28)PROSPECT new secure care model leadership across Cheshire and Merseyside (page 29)Explore other opportunities for greater impact through partnerships (page 28)


Contact detailsContact us at the following address:Mersey Care NHS Foundation TrustV7 Building, Kings Business Park, Merseyside, L34 1PJ

@Mersey_Care

MerseyCareNHSFoundationTrust

MerseyCareNHSFT


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