PURPOSE OF REPORT: To provide an update on strategic planning, including an update on implementation of the Strategic Framework for 2014-15 and the proposed Trust 2-year plan, as is required by the Trust Development Authority. ALIGNMENT WITH STRATEGIC OBJECTIVE AND CONTEXT: The Strategic Framework includes all four strategic aims, and the underpinning strategic objectives. RECOMMENDATION(S):

a) That the Board notes progress made in the implementation of the Strategic Framework for 2014-15

b) That the Board approves the Trust 2-year Operational Plan.

SUMMARY OF KEY ISSUES: The Strategic Framework for 2014-15 was approved by the Board in January, so we are now beginning to implement the strategy. This paper provides an update on the things that we have done since January to implement the strategy, and as part of this process, Executive Director names are nominated to lead on strategic initiatives. The paper also sets out Board approval the Trust 2-year Operational Plan, which we are required to complete and sign-off by the end of March 2014. The Operational Plan has been developed through engagement with colleagues from the three divisions and is aligned with our Strategic Framework for 2014-15. It is fully compliant with the requirements set out in the Trust Development Authority planning guidance issued in December 2013. IMPACT ON ASSURANCE FRAMEWORK: The Strategic Framework and Performance Assurance Framework have been aligned. IMPLICATIONS: a) Values: The Strategic Framework is aligned with Trust values.

REPORT TO: Trust Board REPORT TITLE Strategic planning update DATE: 26th March REPORTING OFFICER: Louise Edwards CONTACT DETAILS: Tel: 0151 473 2767 Email:

Louise.Edwards3@merseycare.nhs.uk

b) Quality/ Clinical: The Strategic Framework sets clear priorities in relation to

quality.

c) Financial: The Strategic Framework has a number of objectives and programmes

that relate to improving the efficiency of our organisation and of the services we

provide.

d) Legal/compliance: The Strategic Framework complements and supports the

Trust’s ability to maintain statutory compliance.

e) Workforce: Becoming an employer of choice is a specific objective in the

Strategic Framework, and empowered employees is a cross-cutting theme through

the objectives in the Framework.

Strategic Planning Update

This paper provides an update on Strategic Framework implementation, and our two year plan 2014-16.

1) Update on Strategic Framework implementation

I. The Strategic Framework aims, objectives and strategic initiatives for 2014-15 were approved by the Trust Board in January. The summary of the Strategic Framework that was approved in January is shown below in our strategy ‘wheel’.

Since the January Board seven pieces of work have been initiated in order to begin implementation of our strategy:

i) Defining our Perfect Care Goals The Strategic Framework was approved in January 2014 with the commitment that we would further define how a ‘perfect care’ approach could work in Mersey Care. A working group of 25 clinicians from across the Trust services met on February 14th to discuss via a teleconference with Dr. Ed Coffey how Mersey Care might adopt a ‘perfect care’ approach to improving its services. As a result of this discussion, three themes have been proposed as initial areas of focus – reducing restraint in inpatient areas, improving the depression pathway, and improving the physical health of those in our care. As part of the new Centre for Perfect Care and Wellbeing (an update on which was presented to the January Board) a small core team is developing the processes and improvement methodology we will apply in these areas in order to achieve ‘breakthrough improvements. For depression, the Centre for Perfect Care and Wellbeing is organizing several roundtable events hosted by Mike Farrar whereby we will invite leading thinkers from the fields of mental health, quality improvement, innovation and business to develop innovative depression care and prevention in the future. We are also actively pursuing collaboration with South London and Maudsley NHS Foundation Trust, who have established their own Centre for Learning in mental health.

ii) Deciding lead responsibility for the strategic initiatives Using the systems and processes we established for implementing the Strategic Framework in 2013-14, we will be ascribing lead responsibility for every strategic initiative with an Executive Director, and this will then be cascaded down to their senior management teams in the local, secure and corporate divisions respectively. Executive Directors and their senior teams will be held to account for delivery of the strategic initiatives through the quarterly Strategic Operations Reviews. This year, plans for each initiative will be developed with support from the clinical and corporate divisions. We will be agreeing these plans in planning days on March 31st and April 1st.

The proposed lead responsibilities for each initiative are set out in the table below.

Aims 5 years

Objectives 2 years

Strategic initiatives This year

Executive Director lead/s

DRAFT measures This year

PERFECT CARE A1 01 Ensure that our care is effective.

SI 01 Improve physical health of people in our care

Ray Walker

• Number of service users who receive an annual physical health check

• Recovery outcomes measures

• Number of service users on CPA; number of patients with a care plan

SI 02 Develop outcome measures for recovery

David Fearnley

SI 03 Develop a consistent approach to care planning

Ray Walker

A102 Ensure people's experience of our services is always positive.

SI 01 Improve patient experience in services identified through patient survey in 2013-14, and develop a

Ray Walker

• Patient experience scores

• Level of access to outside space by service

quality kite mark for teams/services

line • Score of 6 using ASPECT

tool

SI 02 Improve the patient environment to deliver privacy, dignity and better care.

Neil Smith

A103 Ensure people have timely access to care.

SI 01 Simplify access to local services through a single point of access and assessment

David Fearnley

• Waiting times for our services, by service line

SI 02 Understand waiting times and reduce them, including any hidden waits

David Fearnley

A1 04 Be the safest mental health provider in the country.

SI 01 Reduce suicides for those in our care

David Fearnley

• Number of suicides • Number of medication

led incidents of restraint • Number of violent

incidents and level of harm

• Number of service users with a safety improvement plan

SI 02 Reduce use of control and restraint through roll-out of 'No Force First' programme

David Fearnley

SI 03 Reduce violence and harm in inpatient settings

David Fearnley

SI 04 Reduce slips, trips and falls

David Fearnley

A1 06 Treat everyone fairly in our organisation.

SI 01 Investigate the processes that Mersey Care has in place in relation to MHA; use of seclusion; use of control and restraint; and length of stay for BME communities, and then develop regular systematic monitoring of these areas in all services.

David Fearnley

• Patient experience scores

• Use of medication-led incidents of restraint for service users from BME groups

• Use of seclusion for service users from BME groups

SI 02 Improve clinical outcomes re. access for BME communities, Dementia and Depression register, identification of people who have been on anti-psychotics long term

David Fearnley

BETTER SERVICES A2 01 A skilled and productive workforce.

SI 01 Increase mobile working and develop fit for purpose clinical support and information systems

Neil Smith

• Utilisation of mobile technology

• New clinical information system in operation

• Number of teams with development plans SI 02 Support high

performing teams Amanda Oates

SI 03 Enable a consultant-led service, with changes to medical workforce and roles.

David Fearnley/Amanda Oates

• Number of individuals with PDRs linked to service plans

A202 Develop integrated pathways.

SI 01 Create integrated community teams

David Fearnley

• Waiting times for local and secure services

• Perceived levels of clinical integration and MDT working

SI 02 Create integrated secure pathway that links to criminal justice system.

Ray Walker

SI 03 Publish clear 'perfect care' pathways for depression, psychosis and dementia care

David Fearnley/Ray Walker

A203 Grow our services based on our specialist expertise.

SI 01 Develop a consistent Trust-wide approach to dementia, in line with 'perfect care' pathway

David Fearnley

• Turnover/income • Number of successful

bids for new business

Si 02 Grow IAPT, eating disorders, alternatives to out of area treatment and personality disorder services in the local division.

Elaine Darbyshire

SI 03 Grow the secure campus and offender health services in the secure division.

Elaine Darbyshire

PARTNERSHIPS A301 Pursue high quality research and innovation.

SI 01 Through the new Centre for Perfect Care and Wellbeing strengthen our role in the Academic Health Science Research Network and the CHLARC; and pursue perfect care through bio psychosocial research and innovation.

David Fearnley

• Income generation from grants and commercial studies over 2 years

• Number of innovations brought to market through the Centre for Perfect Care and Wellbeing

• Number of active research projects

SI 02 Develop further service user and carer-led research

David Fearnley

A302 Create partnerships that support service delivery and recovery.

SI 01 Develop new service delivery models in partnership with the voluntary sector

Elaine Darbyshire

• Number of new partnerships with voluntary organisations linked to service delivery or participation

• Number of Recovery College courses and participants

SI 02 Further develop the Recovery College curriculum in partnerships with primary care, local

David Fearnley

authorities, voluntary sector, housing

A303 Work effectively with primary care.

SI 01 Extend primary care mental health liaison roles

David Fearnley

• Improved discharge summaries sent to GPs within 24 hours of discharge

• DNA rates SI 02 Increase capacity and capability of primary care to respond to mental health needs of their patients

David Fearnley

OUR ORGANISATION

A401 Work ‘side by side ‘with service users and carers

SI 01 Improve volunteering systems and processes, and develop new volunteering and employment pathways

Ray Walker

• Number of volunteers with the Trust

• Number of service users volunteering or in employment

• Carer survey SI 02 Increase local and secure division compliance with the Triangle of Care, and develop a Triangle of Care mandatory on-line training package for staff.

Ray Walker

SI 03 Develop a Centre for Participation and Inclusion with supporting programme of development

Ray Walker

A402 Be a great place to work.

SI 01 Further develop the role of service users and carers in staff development

Amanda Oates

• Staff survey results • Staff sickness rates • Turnover and bank

spend • Number of staff with

PDRs • Time to hire timeline

SI 02 Refresh and embed new values in Charter and PDR process

Amanda Oates

SI 03 Implement OD priorities including change and project management support

Amanda Oates

SI 04 Implement recommendations from HR systems review, including improvements to recruitment and selection processes

Amanda Oates

A403 Be an efficient organisation.

SI 01 Deliver cost improvements without impacting on quality

Neil Smith

• CIP plan delivery • EBITDA margin of at

least 7% • Monitor financial risk

rating of at least 3 • Return on investment for

assets

SI 02 Improve Trust environmental performance

Neil Smith

SI 03 Implement a new customer-focused

Neil Smith

structure for corporate services SI 04 Improve the Trust's understanding of the value for money provided by its services

Neil Smith

iii) Planning what we will do to implement the strategic initiatives The Programme Management Office is organising a series of planning drop-in sessions at the end of March for colleagues from local, secure and corporate services nominated to assist the Executive Leads in delivering the strategic initiatives. Plans and measures will be agreed during those sessions. The plans and measures will then be monitored through the accountability processes established as part of the Strategic Framework last year, with quarterly reports going to the Strategic Operations Reviews and delivery reported by exception to the Performance and Investment Committee and the Board through the Care at A Glance report.

iv) Refining how we will measure our effectiveness.

The Board agreed in January that it was important the Trust is better able to define and measure its effectiveness in terms of the outcomes of care, we have established an outcome measures group with representatives from across the two clinical divisions and supported by corporate services. With support from our Performance and Information colleagues, this group will decide the key outcome measures for effectiveness, which will then be cascaded down to division and team level in our organisation to assist team understanding of their effectiveness, and to assist them in identifying improvements in their practices and processes.

v) Developing our strategy ‘story’ so that colleagues and other

stakeholders understand our story of change As noted in previous Board updates on strategic planning, we have learned through the implementation of the Strategic Framework in 2013 that colleagues need a simple explanation of the Trust strategy and line managers require help in explaining how all colleagues regardless of their role or level within the organisation can contribute to delivering our vision. To coincide with the launch of the new PDR process, we are developing simple narrative and graphic tools to explain our strategy, including an article in the widely-read Mersey Cares newsletter, an animation that explains our story as a graphic ‘story’, and a short guide to the Strategic Framework written for all staff.

vi) Updating the appraisal (PDR) process in our organisation to enable cascade of the Strategic Framework to our colleagues

Our new PDR process launches on 1st April 2014. Through the Your Voice Your Change ‘Mega Conversation’ and 2012 Annual Staff Survey our staff told us that the PDR process felt like a ‘tick box’ exercise involving lengthy paperwork. A group of colleagues from across the Trust have revised the

process and paperwork so that it enables a more meaningful discussion between line managers and the people in their teams. Our four strategic aims of perfect care, better services, our organisation and partnerships, are translated to department and individual objectives to enable staff to understand the contribution they make in their daily roles to achieve our vision to be recognised as the leading organisation in mental health, addiction and learning disabilities services. As well as discussion about performance this new process facilitates conversations about values and behaviours. We have also recognised that for PDRs to be really useful and valuable they must be aligned to the business planning of the Trust so that the objectives and development plans you agreed with colleagues are aligned to our plans for the coming year. This means that PDRs are expected to be completed between 1st April 2014 and 30th June 2014.

2) Update on the Trust 2-year plan The Trust Development Authority issued planning guidance for all aspirant Foundation Trusts in December1, which set out a national requirement for every NHS Trust to develop ‘bold and transformational strategic plans’ that address the significantly tightened financial position of the sector and the impact of the 2015/16 Spending review whilst improving outcomes for patients. This guidance stipulates that all Trust Boards must agree plans that demonstrate how their Trust will continue to provide high quality, sustainable services, being explicit about the risks in the plan. We have already submitted draft financial plans and a series of checklists to the Trust Development Authority, and the plan being proposed to the Board in March is aligned and reflects these previous submissions. The two-year Operating Plan must be complete and signed off by the Board by 31st March 2014, followed by the submission of an aligned Integrated Business Plan by 20th June 2014. Our full two-year Operating Plan is set out in Appendix 1. Covering ‘quality, finance, workforce and delivery’2 it sets out how we will deliver our four strategic aims of perfect care, better services, partnerships and our organisation through transformational change programmes in our three divisions over the next two years. The Plan has been developed through engagement with the three divisions, with senior teams from local, secure and the corporate divisions coming together in December and January to articulate their priorities for clinical services in the coming two years. In the Operating Plan, we have aligned this with our overall Strategic Framework.

1 ‘Securing Sustainability: Planning Guidance for NHS Trust Boards 2014/15 to 2018-19’, Trust Development Authority, December 2013 2 Ibid. page 18

Appendix 1 Appendix 1

Mersey Care NHS Trust OPERATIONAL PLAN

2014/15-2015/16

Contents 1. Introduction Page 4

2. Executive summary Page 6 3. About the Operational Plan Page 8 4. About Mersey Care NHS Trust Page 9 5. Overview of 2013/14 Page 22 6. Key challenges for 2014/15 and 2015/16 Page 24 7. Clinical and Business Excellence Page 34 8. Objectives with key deliverables Page 39

9. Resource implications for delivery Page 45

10. Key risks with mitigation Page 54

11. Monitoring this plan Page 55 12. Conclusion Page 56

1. Introduction I am delighted to introduce this Operational Plan for Mersey Care NHS Trust. The next two years are full of opportunities and challenges for our organisation. Our opportunities come from our passion for what we do, and our vision to become the leading provider of mental health, learning disabilities and substance misuse services with quality, recovery and wellbeing at the heart of everything that we do. We are passionate about mental health and wellbeing and we are passionate about delivering the best possible services for the people we serve. We have some national experts working in our organisation and we know that with the right support and focus our people can continuously improve our services and develop transformational new ways to meet people’s needs cost-effectively in the future. Our challenges come from the environment in which we operate. We are faced with more people with mental health needs yet with significantly less money in mental health and the wider NHS system to meet their needs. Despite well known, shocking statistics such as mental health being the single largest cause of disability in the UK3, and depression being associated with 50% increased mortality from all disease, there is a great deal of need that is currently unmet by NHS services. In fact, only 26% of adults with mental illness receive care. Demand for mental health services nationally, and locally for Mersey Care, is increasing but we are facing a commissioner funding gap of £45 million over the next five years. We need commitment from our staff to meet these challenges. Since we first opened our doors in 2001, our staff have always been committed to providing great care for the people we serve. We know this is what our staff care about. Even in this tough economic climate, we believe that we should all be striving to provide perfect care to those we serve, and that we should never lose focus on always finding ways to improve the care that we provide to people. The introduction of our Centre for Perfect Care and Wellbeing will be a key catalyst in shared commitment to “get it right first time, every time “for patients. It is also time for our people to get creative about developing new ways to meet increasing demand and unmet need for mental health services. We know we must show we are improving outcomes for the people we serve even in a tough financial environment. To make ‘more outcomes for less money’ we will need to apply the evidence and listening to ideas from staff and patients. The evidence suggests we will need to develop more services outside hospital settings, so that our specialists can help more people, prevent and treat mental ill health earlier, and so that we can safely reduce cost. Over the two years of this plan we are developing new models of care for secure and local services to maximise these opportunities and meet the challenges ahead. We are developing plans to review and design all our services that will deliver further

3 Making Mental Health services more effective and accessible 25th March 2013

improvements in our productivity and efficiency. We are one of three organisations nationally that provide high, medium and low secure services. Longer term, our aspirations are to develop high and medium services within a “Secure Campus” from a single site. We also need to innovate to meet unmet mental health need in the criminal justice system more effectively. In local services, our models of care will build on our experience of providing safe care through community teams and co-ordinated care that is tailored to the needs of the people we serve. We have a strategy to make these improvements in 2014/16 based on four aims:

• Perfect Care - to continuously improve the quality and productivity of our services;

• Better Services - to ensure our services meet people’s needs effectively, help people recover and are financially viable in the future;

• Partnerships - to develop partnerships that delivers improvements in quality, or enhance recovery and wellbeing for people with mental health needs;

• Our organisation - to become a highly effective organisation with empowered service users, fully engaged staff and good governance.

We do not underestimate the challenges ahead. The reorganisation into two clinical divisions will ensure a greater focus, and the redesign of corporate services will ensure all parts of the organisation are working towards the same thing, to strive for perfect care in our clinical services. Delivery of this plan will consolidate our position as a strong and credible provider of mental health, learning disability and addiction services. This plan will help us continuously strive for perfect care. This plan will also provide a firm platform on which our Foundation Trust application can be built. I commend this plan to you. Joe Rafferty Chief Executive

2. Executive Summary The next two years are both challenging and exciting for the Trust.

By the end of 2016 we will have very clear service models and pathways in both Divisions and a reputation for delivering quality every time that we can then confidently think about mobilising beyond current geographies in line with our Business Development Strategy.

Clinicians will lead this transformation through the continued development of our two clinical divisions. Their work will be underpinned and supported by a state of the art Corporate Hub that provides the required business intelligence and expertise to support service aspirations and deliver for our patients all that they need to achieve health and wellbeing.

At the heart of the work of clinical services over next two years will be the pursuit of perfect care. This means getting it right for our patients every time. It starts with the basics but we have ambitious goals to eradicate suicide, develop perfect depression and dementia pathways, and eradicate medication-led restraint in our services. This is being developed on a trust wide basis supported by the Centre of Perfect Care and Wellbeing. It will result in improved experiences for our patients by April 2016 in line with our goals. Unnecessary variations in care and treatment will have been eradicated. For staff, Mersey Care will be a better place to work and they will have more time to focus on activities that really improve patient care.

In local services our vision for a new model of care is now clear. There is a five year Care Strategy that by the end of 2015/16 will have a single point of access for all local services, 24 hour 7 day working and a streamlined assessment process that will be operating from purpose built facilities at Clock View. This will have reduced unnecessary A&E attendances and ensured that patients are seen quicker and start the right treatment more quickly. Community service teams will have been reduced to four and organised in local centres across the patch. There will also be a number of hubs to ensure care is delivered as close to home as possible. This will enable much closer working with our partners to ensure that all services are co-ordinated, designed around the patients and result in sustainable recovery and lives that are as full and independent as they can be.

Our secure services will continue to develop pathways that cross all levels of security to ensure standardised care and treatment and as fast a movement to lower secure settings as possible. This will fully happen when the secure campus opens on the Maghull site in late 2016 but will begin in 2014 through the new secure division and a more integrated care pathway between our low, medium and high secure services. A secure campus will vastly improve our estate and enable better care in medium secure services that is not possible in the current environment. The links and

growing expertise in offender health will continue to develop with the successful expansion into Manchester which will have been achieved by April 2016.

A theme through all our service delivery and business development is partnerships. These partners will work with us to enhance the overall service offer to patients. Our leadership in this work will enable us to shape service models and exploit our unique position as both a secure and local service provider.

Our estate will be transformed through the new community team hubs, the opening of Clock View and the secure campus. This will enable the selling off of the surplus land on the Maghull, Olive Mount and Wavertree Lodge sites.

We will have become the provider of choice for IAPT services in Sefton and Liverpool. We will have a clear dementia pathway and be the leading provider across our local services geography. We will have expanded in the area of eating disorders and our trust wide expertise in the treatment of people with Personality Disorders will have been acknowledged through growth across the Divisions.

This plan summarises the key priorities that will ensure the achievement of the objectives outlined within the Strategic Framework.

3. About the Operational Plan This plan describes the priorities for Mersey Care NHS Trust over the period 2014/15 to 2015/16. The Trust Development Authority (TDA) requires the Trust to submit a two year Operational plan for this period and a five year capital plan covering 2014-2019 by 20th June 2014. A summary of this two year plan and the following associated documents will be submitted by March 5th 2014:

• Activity plan • Financial plan • Workforce plan • Planning checklist • Planning process.

This two year plan summarises the priorities for the two clinical divisions - Local Services and Secure Services - and the support required from corporate services to enable this to happen. It sets out the key objectives and deliverables for Mersey Care NHS Trust as it continues to prepare for authorisation as a Foundation Trust and demonstrates our vision, underpinning plans and work programmes to build on our success to date. It brings together the key priorities and risks identified in Divisional plans. In response to national and local drivers, Mersey Care NHS Trust has established a strategic framework with four key aims for delivery in the next 2 years:

• Quality-To continuously improve the quality and productivity of our services • Better services-To ensure our services meet people’s needs effectively, help

people recover and are financially viable in the future • Partnerships-To develop partnerships that deliver improvements in quality, or

enhance recovery and wellbeing for people with mental health needs • High performing organisation-To become a highly effective organisation

with empowered service users, fully engaged staff and good governance. These aims reflect our focus in 2014/15 and 2015/16 on building our organisational and business competence to enhance and support the continued delivery of high quality clinical care to our catchment populations. This dual focus on clinical and business excellence is fundamental to both our Foundation Trust aspirations and our continued emphasis on quality improvement during a period of prolonged financial constraint and major system reform in the wider NHS. This two year Operational plan will be succeeded by our five year Integrated Business Plan (IBP) and Long Term Financial Model (LTFM) which underpin our Foundation Trust application and sets out how we will deliver the business of the organisation going forward. The resulting analysis of this and the views of the Chief Inspector of Hospitals will confirm our joining the Foundation Trust pipeline with a view to achieving Foundation Trust status by June 2015 in line with national requirements.

4. About Mersey Care NHS Trust Our Trust is located in Merseyside in the North West of England. We were established in April 2001 as a specialist provider of mental health, learning disabilities and substance misuse services. We are one of the largest mental health providers in the North West and are one of only three Trusts nationally to provide high secure services. We provide local services for Liverpool, Sefton and parts of Knowsley. We provide low and medium secure services for Merseyside and Cheshire and our catchment area for high secure services is the North West of England, West Midlands and Wales. We serve a population of 1,194,1654 for local services and in Cheshire and Merseyside for low and medium secure services a total weighted population of 2,992,385 (including a male only weighted population of 1,524,757 for low secure services) and male only weighted population of 6,718,305 for high secure services. We had an annual income of £207 325m in 2013/14 and are planning for an income of £200 895m in 2014/155. We employ 3777.8 wte. Following our establishment in April 2001 we have continued to adapt and evolve to the changing needs of our service users, commissioner requirements and market conditions. We have achieved continuous year on year improvement. We do recognise that people come into contact with our services at times of great distress, anxiety and confusion and for some this involves restriction of their liberty. We aspire to help each person to recover and live the fullest life possible. Equality and human rights are intrinsic to the care we provide. Delivering high quality care is at the heart of everything that we do. We have demonstrated progress in the delivery of quality priorities; we have published several Quality Accounts, and now have a Quality Dashboard used by both our Board and the Clinical Senate to have clear line of sight into quality from ward to Board in our organisation. The demand for our services has remained stable in recent years, but we understand how the pattern of need and demand for our services will change over the coming years and we have developed our plans on this basis. Our income comes predominantly from secure service commissioners and Liverpool and Sefton Clinical Commissioning Groups. We collaborate closely with commissioners but also with other providers to ensure that we are contributing to a well-functioning local health economy.

4 The Information Centre for Health and Social Care 2011: GP Registered Estimated Populations. The weighted population has been calculated by multiplying the actual population figures by the MINI 2000 scores. All population figures are based on people aged 18+ Welsh population figures have not been weighted as there are no MINI 2000 scores covering Wales 5 Subject to contract sign off

Table 1- Number of inpatients Division 2012/13

2013/14 2013/14 FOT

Local Services 3996 3725 4064 Hayes Court** 22 22 22 Total 4018 3747 4086 Secure Services 363 382 417 Trust Total 4381 4129 4503 ** Adult Mental Health Residence Table 2-Number of people seen by our community teams Division 2012/13 2013/14

Local Services 22687 24159 Secure Services 352 370 Total 23039 24529 Table 3-Number of beds open Division

2012/13 2013/14

Local Services 334 335 Hayes Court 16 16 Secure Services 323 323 Total 673 674 Table 4- Number of outpatients Division 2012/13 2013/14*

Local Services 40656 40770 Secure Services 677 769 Total 41333 41539 *Based on Month 10 forecast We have robust and effective performance and financial reporting arrangements in place. We have a strong track record of achieving financial plans including achievement of all statutory financial duties, contracted levels of activity and securing on-going improvements in quality, productivity and performance. Fit for purpose buildings are important both to service users and our staff, and through the implementation of our Estates strategy we will ensure our estate remains in a good state of repair and creates optimum value for commissioners. We provide a comprehensive range of services from 32 sites. These sites are geographically spread throughout the local authority areas of Liverpool, Sefton, Knowsley and St Helens. In the local services division, we provide a comprehensive range of adult mental health, older adults mental health, learning disabilities and substance misuse services. This includes liaison services with A&E in local acute hospitals and with the

criminal justice system. We provide these services at locations throughout central and south Liverpool, Sefton, Kirkby and North Liverpool. In the secure services division, we provide high secure, medium secure, low secure and offender health services. Ashworth Hospital serves the North West of England, West Midlands and Wales. The Hospital provides inpatient care and treatment for men who are deemed to be of grave danger to others in conditions of maximum security. We provide medium and low secure services to the people of Merseyside and Cheshire.

Table 5- Our Services What do we provide-Local Services Division Location

Acute inpatient services Broadoak Unit, Stoddart House, Hesketh Centre, Windsor House

Crisis resolution home treatment Stoddart House, Hesketh Centre, Broadoak Unit, Arundel House,

Acute hospital and care home liaison Aintree Hospital, Royal Liverpool and BroadGreen University Hospital,

Community mental health services Hesketh Centre, Moss House, Northwood House, Park Lodge, Arundel House, Windsor House, Merton Road Bootle, Haigh Road Waterloo,

Adult attention deficit and hyperactivity disorder service Merton Road

Family support service Moss House, Arundel House

Continuing care Heys Court

Psychiatric Intensive Care Unit Rathbone Hospital,

Early Intervention in Psychosis Service Hesketh Centre, Mossley Hill, Switch House

Eating disorder service Rathbone Hospital

ECT service Broadoak Unit

Psychotherapy Mossley House

Criminal justice liaison service Dale St Liverpool

Older People’s Inpatients Stoddart House, Mossley Hill, Southport General Hospital

Community drug teams and drug outpatients service Park Lodge, Rodney Street

Detoxification service – inpatient drug detoxification and alcohol detoxification service

Arundel House (Kevin White Unit), Windsor House

Prison-based drug and alcohol service HMP Liverpool

Community alcohol service Clinics across Liverpool

Brain injuries rehabilitation service: inpatient and community service

Mossley Hill,

Learning disabilities community residential service Morley Road Southport, Rufford Road Southport, Wavertree Bungalow

Specialist treatment, assessment and recovery unit for people with learning disabilities

Rathbone Hospital

Learning disability inpatients service Mossley Hill

Aspergers team Olive Mount

Personality Disorder Mossley House,

Assertive outreach Arundel House, Hesketh Centre, Oak House,

Older adults community mental health team Southport General Hospital , Mossley Hill

Homeless outreach service Park Lodge

Forensic psychology service outpatients Rodney Street

What do we provide-Secure Division Location

High secure services - mental health Ashworth Hospital

High secure services – personality disorder Ashworth Hospital

Medium secure Inpatient Scott Clinic

Forensic personality disorder assessment Scott Clinic

Forensic enhanced care Scott Clinic

Medium secure step down inpatients Scott Clinic

Low secure unit Rathbone Hospital

Low secure outreach service Rathbone Hospital

Resettle De Havilland Drive Speke

Figure 1- Map of services and locations

Our Strategic Framework Our vision is “To be recognised as the leading organisation in the provision of mental health, addiction and learning disability care. Quality, recovery and well-being will be at the heart of everything we do”. We have developed a Strategic Framework to capture our priorities for the next two years. From Board to ward our strategy will ensure that we stay focused on what matters most to those who work for Mersey Care and to those we serve. The aims and objectives in the Strategic Framework are cascaded through the planning and staff appraisal cycles so that they are embedded in the day to day work of everyone who works for the Mersey Care. The Strategic Framework is designed to give the Board a ‘line of sight’ from what we set out to achieve over the long term, through to outcome measures so that we know whether the objectives are being met and whether the strategic initiatives are being delivered. The goals and aims have a long-term timeframe, the objectives will be delivered over two years, and the initiatives and outcome measures will be delivered over one year. A set of smart targets ensures delivery and review of progress of the Strategic Framework. This is set out in the diagram below.

Figure 2: The structure of the Strategic Framework

24

The Strategic Framework was introduced gradually in 2013-14, as our operations have become more aligned with our strategy through our annual planning cycle and through our Board reporting processes. There were 21 objectives and 49 targets in the 2013 Strategic Framework, and delivery was monitored through the Trust Performance and Investment Committee and Trust Board. The Framework was never intended to be an endpoint, and has been used to create dialogue with colleagues, service users and carers and partner organisations about how best we can all contribute to deliver the vision. In 2014/15 as part of our pursuit of business excellence we have worked with key stakeholders to update and refine our strategic framework. With this in mind, as well as engaging colleagues in the development of the Framework for the coming year, we have developed a strategy ‘wheel’ (Figure 4) that is designed to help colleagues understand all the main elements of our strategy at a glance. The wheel is also designed to help managers and colleagues translate the strategy goals, aims and objectives for colleagues in the annual Personal Development Review (PDR) process. It will also be the basis of quarterly updates to the Board, the three Divisions and teams to track our progress in delivering the strategy. In addition, we will explain the objectives in easy to understand terms so that everyone in our organisation understands them and understands how they can take the initiative to help deliver the strategy. This is illustrated in the Figure 3 below, which sets out what a sample of the objectives ‘mean for me’.

Figure 3: Explaining our objectives to all colleagues

25

Each member of staff will be supported through the revised PDR process for 2014 to decide personal objectives that link to the objectives in our Strategic Framework. This will be supported by new web-based support for managers. As in 2013-14, we will be assigning Executive Director Leads for each strategic initiative, but to ensure alignment with our Divisional plans and to embed the Strategic Framework in our operational delivery, a Divisional lead will also be assigned for each initiative. From February, plans with trajectories will be developed for each initiative using the outcome measures proposed. As per 2013-14, this process will be run by the Programme Management Office (PMO), culminating in plans with trajectories for each initiative by the end of March 2014. Delivery of the plans will be reported to the Performance and Investment Committee and the Trust Board using the performance report and dashboard that has been developed in 2013. This year, to ensure we have a line of sight from what we say we will do, to measuring the outcomes of what we do, there will be an emphasis on whether the plans are on track to deliver the outcome measures rather than on track to deliver the actions set out in the plans.

Figure 4- Our Strategy 'Wheel'

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Our Staff Our staff are our greatest asset and are the key to the delivery of our objectives and the realisation of our vision. We employ 3518.95 full time equivalent (FTE) staff: Table 6-Current staff numbers and composition

Staff Group

Opening SiP Ap 2013 WTE

SiP Jan 2014 WTE

Budgeted wte Jan 2014 WTE

Variance WTE

Budgeted wte Planned for Y/End WTE

Consultants 73.8 66.6 75.3 (8.7) 74.3 Junior medical 94.1 66.8 94.3 (27.5) 93.3 Non clinical staff 1,184.1 1,146.7 1,294.5 (147.8) 1,256.7 Nursing, midwifery & health visitors 1,915.4 1,790.6 1,917.5 (126.8) 1,892.5 Other clinical staff 157.1 126.9 151.3 (24.4) 152.5 Scientific, therapeutic, & technical 344.5 310.0 333.3 (23.4) 308.5

Pay Cip (48.4) 0.0

Grand Total 3,720.4 3,507.7 3,866.2 (358.5) 3,777.8 Our Commissioners Under current arrangements, the key commissioners for Mersey Care NHS Trust are highlighted with contract values in Table 7 below.

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Mersey Care NHS Trust is committed to providing high quality, cost‐effective solutions to commissioner requirements and works collaboratively with a range of partner organisations to deliver integrated care designed around the needs of the patient. Key partners are highlighted in Table 8 below: Local Authorities

NHS Organisations Other Providers

Liverpool City Council Royal Liverpool and Broad Green University Hospitals NHS Trust

Capita HR

Sefton Metropolitan Borough Council

The Walton Centre Informatics Merseyside

Knowsley Council Liverpool Community Health Trust UCLAN Southport & Ormskirk Hospital NHS

Trust

University of Liverpool

Aintree University Hospitals NHS Trust Everton FC St Helens and Knowsley NHS Trust Imagine Mental Health

HMP Liverpool HMP Kennet HMP Manchester HMP Garth Liverpool John Moores University Edge Hill University The Reader Organisation National Museums Liverpool 5. Overview of 2013/14 Celebrating our success: Our key achievements for 2013-14 2013-14 has been a successful year for Mersey Care NHS Trust, with colleagues leading and participating in many change programmes that have led to tangible improvements in patient care. It is important to celebrate our successes and build on these in the forthcoming year. Our key achievements against our Aims in 2013-14 are set out below. Figure 6-Key successes in 2013/14 Aim 1 : Quality We have…

• Developed our Quality Dashboard and we are using this to report on quality on a quarterly basis and goes to every other Board meeting

• Developed a full register of all carers supporting our service users • Completed a comprehensive analysis of capacity and access to local services • Piloted the No Force First programme on 5 wards covering high secure services, learning disabilities,

medium secure, older people’s mental health and adult acute. Results so far show evidence of sustained reduction in physical restraint overall in 4 pilot wards, (data not yet available from HSS), with a 50% reduction from the mean achieved by the end of September:

• Engaged with nearly 1000 staff as part of Your Voice Your Change programme and have made many

practical improvements to care as a result of staff feedback. • Developed a community services version of the Triangle of Care, have developed a resource package

for staff and we are monitoring compliance in all service areas. • Have developed our information systems and processes so the Board and teams within the Trust can

see patient experience information down to ward level. Aim 2 : Better Services

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We have…

• Improved secure services by improving the existing secure estate • Developed an outline business case for the secure campus and are now progressing the full business

case • Created new divisional structures • Completed a full review of unmet mental health need in the communities served by our local division

and have used this to make submissions to the Mayoral Health Commission, the Joint Strategic Needs Assessment and Joint Health and Wellbeing Strategy, Liverpool CCG’s ‘Healthy Liverpool’ programme and Sefton CCG’s ‘Big Chat’ events.

• Developed through consultation with 400 clinical and managerial colleagues from the local division a comprehensive care strategy, which includes proposals for a single point of access and assessment, integrated community teams, and acute inpatient bed capacity based on a full analysis of demand, cost and staff productivity.

• Completed an independent review of all research and development activity in the Trust and are developing the Centre for Perfect Care and Wellbeing to create a critical mass of people and resources to further develop our research and development and innovation work.

• Strengthened our role in Liverpool Health Partners and the CHLARC. • Won new business to deliver offender health, staff support, brain injury and criminal justice liaison

services. Aim 3: Partnerships We have…

• Liaised closely with commissioners in Liverpool and Sefton, and specialised commissioners throughout the year, playing a key role in the ‘Healthy Liverpool’ programme, the Mayoral Health Commission and ‘Big Chat’ programme in Sefton.

• Identified a range of public mental health programmes that we will progress through our leadership of the Self Help and Prevention stream of the ‘Healthy Liverpool’ programme.

• Launched a Recovery College which since September has just commenced the first accredited Peer Support Worker Programme with 16 students.

Aim 4: Our organisation We have…

• Engaged 300 service users and carers in our Your Voice Your Change programme and through our new service user and carer Assembly

• Created a Clinical Senate, which brings together senior clinicians from across the Trust to consider strategic issues every month, and which has had a key role in shaping plans for our new divisions.

• Provided open access to Trust Wi-Fi in all service areas • Enabled all service users and carers to leave feedback in real-time on any of our services • Reduced sickness absence in high secure services • Achieved cost improvement targets for 2013-14 • Delivered financial balance • Fully reviewed our corporate services and designed a new draft structure which will go out to

consultation in January

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6. Key Challenges in 2014-2016 National Drivers A significant challenge for all NHS organisations is the requirement to continue to develop and improve service quality at a time of reducing resources. This balance of the provision of safe services in light of Francis 2 and Transforming Care requires the Trust Cost Improvement Programme to deliver the required savings but not to place at risk service provision or reduce outcomes. This connectivity is now mirrored in the closer working between CQC inspections and an organisation’s progression to FT via Monitor. The pursuit of Foundation Trust status remains a key objective for this organisation and there is an expectation that this will be achieved in this planning period. The Department of Health has demonstrated its commitment to improving services for and the lives of people with mental illness. Two key documents highlight this commitment; No Health without Mental Health in 20116 and Closing the Gap in 20147. The main themes through both of these documents that our plans must reflect are highlighted below: Table 9-Trust response to national drivers Priority In our Plan More people will have good mental health

Care Strategy

More people with mental health problems will recover

Recovery College Secure pathway/campus

More people with mental health problems will have good physical health

Perfect Care

More people will have a positive experience of care and support

Perfect Care

Fewer people will suffer avoidable harm

Perfect Care

Give people with mental health problems help in the area where they live

Community service hubs/OATS

Increased provision of psychological services Bidding for Sefton and Liverpool IAPT tenders

Access to services must improve as waiting time targets by 2015

Perfect care/Single point of access/Assessment service improvements/Secure pathway

Further demonstration of government’s commitment to parity of esteem for people with mental health problems is demonstrated by the following priorities outlined in a recent policy paper8 Making better access to mental health services and shorter waiting times a priority for

NHS England Making reducing mental health problems a priority for Public Health Making mental health part of the new national measure for wellbeing so it is more likely

to be taken into account when government creates policy Providing £400m between 2011-15 to give more people access to psychological

therapies Providing up to £16m funding over 4 years for Time to Change –the campaign against

mental health stigma and discrimination.

6 No Health without Mental Health: a cross government mental health outcomes strategy for people of all ages-a call to action February 2011 7 Closing the Gap: Priorities for essential change in mental health January 2014 8 Making Mental Health Services more effective and responsive 18th February 2014

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Local Health and Wellbeing Boards to have a duty to reduce health inequalities in their

area including mental health. Offenders with mental health problems will be given the same access as everyone by

2014 through the establishment of the national liaison and diversion service which will identify problems earlier and ensure the right treatment.

More offenders with personality disorders will be given improved access to treatment by making it available in prisons rather than relying in secure units and hospitals.

Local Drivers The local commissioning framework Mersey Care NHS Trust primarily delivers local mental health, learning disability and addiction services to people living in Liverpool, Sefton and Kirkby. These services are in the main commissioned by three Clinical Commissioning Groups (CCGs): Liverpool CCG, Sefton CCGs and Knowsley CCG. Our commissioners’ priorities are presented below with our organisational response. Table 10-Commissioner Priorities Commissioner Priority MCT planning response/Links with Strategic

Framework Sefton CCGs (on behalf of Knowsley CCG and Council commissioners)

Development of an Aspergers service Reviewing the dementia services to gain a better understanding of current performance, investment and outcomes. Looking to increase detection rates, anti-dementia prescribing and facilitate support through better co-ordination and locality based services Improvements to urgent mental health care -Propose to extend the Streetcars 136 pilot beyond April 2014 Review of current support to people with PD and the possible development of a tailored local service Promotion and standardisation of physical checks for people with severed and enduring mental illness

We will grow our services based on our specialist expertise (A203) We will develop a consistent approach to dementia through the new Local Division and develop perfect dementia pathways through the Centre of Perfect Care and Wellbeing. (A203-SI02) We will ensure people have timely access to care (A103) We will simplify access to local services through a single point of access and assessment (A103-SI02) We will grow our services based on our specialist expertise (A203) We will grow IAPT, eating disorder, alternatives to OATS and PD services in the local division (A203-S101) We will ensure our care is effective (A101) We will improve the physical health of people in our care (A101-S101)

Liverpool CCG and LA Employment of people We will ensure that our care is effective (A101)

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with mental illness Improvements to access to and assessment of urgent mental health care Access to community mental health services from people in BME groups Access to psychological therapies and improved outcomes Ensuring that people have a positive experience of care Treating and caring for people in a safe environment and protecting them from avoidable harm Development of an integrated dementia care pathway Continue to develop an integrated model of mental health care Development of a plan for the decommissioning and reinvestment of resources equivalent to 6 beds in Rathbone Rehab. Within 2 years Management of OATS locally

We will develop outcome measures for recovery (A101-SI02) We will ensure that people have timely access to care (A103) We will simplify access to local services through a single point of access and assessment (A103-SI02) We will treat everyone fairly in our organisation (A106) We will investigate the processes that Mersey Care has in place in relation to length of stay for BME communities and develop regular systematic monitoring of these areas in all services (A106-S!02) We will ensure people have timely access to care (A103) We will simplify access to local services through a single point of access and assessment (A103-SI02) We will ensure that peoples’ experience of our services is always positive (A102) We will improve patient experience in services identified through patient survey in 2013/14, and develop a kite mark for teams/services (A102-SI01) We will be the safest mental health provider in the country (A104) We will grow our services based on our specialist expertise (A203) We will develop a consistent approach to dementia through the new Local Division and develop perfect dementia pathways through the Centre of Perfect Care and Wellbeing. (A203-SI02) We will develop integrated pathways (A202) We will create integrated community teams (A202-SI02) We will create partnerships that support service delivery and recovery (A302) We will develop new service delivery models in partnership with the voluntary sector (A302-S101) We will grow our services based on our specialist expertise (A203) We will grow IAPT, eating disorders, alternatives to out of area treatment and personality disorder services in the local division. (A203-S102)

NHS England No major changes intended for 2014/15 due to need for period of stability Patient at the heart of service design and delivery

Secure Division using this period to develop secure pathway, deliver required CIPs and pursue perfect care goals in readiness for any changes in 2015/16 We will work side by side with service users and carers (A303)

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Development of an evidence based forensic pathway for mental health services Development of currencies in 14/15 and 15/16 A capacity review of high secure services New contracts out to tender in 14/15 in prison health

We will develop integrated pathways (A202) We will create a secure pathway that links to criminal justice system (A202-SI02) We will be an efficient organisation (A403) We will improve our understanding of the value for money provided by our services (A403-SI04) We will develop an integrated pathway and pursue the development of a Secure Campus Grow our services based on our specialist expertise (A203) Grow the secure campus and offender health services in the secure division

Local Commissioner Quality and Innovation Plans (CQUINs) Commissioners are committed to the services that they commission continuing to improve quality and effectiveness. CQUIN targets are a method utilised to ensure that providers prioritise the right areas for quality improvement. It links outcomes and delivery with resources and organisations can attract up to 2.5% additional income if delivered. The Trust has a strong track record of delivery. There is a robust process of delivery and monitoring. The most up to date targets for 2014/15 are outlined below. They may be subject to minor change as part of final contract negotiations. CQUIN Table 11: Summary of goals-Liverpool, Sefton and Knowsley CCGs 2014/15 Goal Number

Goal Name Description of Goal

Goal weighting (% of CQUIN scheme available)

Expected financial value of Goal (£)

Quality Domain (Safety, Effectiveness, Patient Experience or Innovation)

1 Friends & Family Implementation and expansion of FFT

0.125% Safety, Effectiveness and Patient Experience

2 Physical Health of Mental Health Patients

Cardiometabolic assessment of patient with schizophrenia and GP communication

0.125% Safety, Effectiveness and Patient Experience

3 NHS Safety Thermometer

To reduce harm. The power of the NHS Safety Thermometer lies in allowing frontline teams to measure how safe their services are and to deliver improvement locally

0.125% TBC Safety, Effectiveness and Patient Experience

4 Advancing Quality Dementia

0.1% TBC Safety, Effectiveness and Patient Experience

5 Advancing Quality Psychosis

0.1% TBC Safety, Effectiveness and Patient Experience, Innovation

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6 Collaborative Working

Improving Collaborative Working between Primary and Secondary Mental Health Care.

TBC TBC Safety, Effectiveness and Patient Experience, Innovation

7 Communication To improve the quality and timeliness of communications between the trust, primary care and patients

TBC TBC Safety, Effectiveness and Patient Experience

8 Improving youth mental health and learning disability services

Improving youth mental health and learning disability services

0.375% TBC Safety, Effectiveness and Patient Experience

Totals: In addition Liverpool have added a CQUIN relating to Dementia and support to carers. 97% of carers of people with a diagnosis of dementia will have their needs assessed. Table 12- Low, Medium and High Secure Services CQUIN targets for 2014/15

New, updated, rejected

CQUIN description % of CQUIN scheme available

New

Improving physical healthcare to reduce premature mortality in people with severe mental illness (SMI). Physical Healthcare - will be mandatory for MH services (excluding gender).

0.25%

New Friends and Family Test - Only one element further implementation of patient FFT and staff FFT. 0.25%

New Collaborative risk assessment 0.20%

New Supporting carer involvement 0.20%

New Pre-admission formula 0.20%

New Outcome measures in specification on admissions/discharge x

New Focused analysis of individuals with LOS at 9 months + with plan to "unblock" x

New Mother/infant relationship x

New Training and supervision of clinical staff to deliver intentions to improve mother/infant interaction and care x

New Admission discharge review leading to service change 0.25%

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New Promoting consistency and improved practice across three hospitals in the management of long term segregation 0.25%

New Better ways of involving carers 0.25%

New Promotion of recovery 0.25%

New Supportive Observations 0.25%

New Improving pathway in and out of secure services x

New Enhancing family support x

New Innovative practice in observation of complex high risk patients x

New Review of unplanned admissions x

Development of access assessment process x

New IAPT outcome measures x

New Input from deaf people with mental illness experience aide recovery - 2 year CQUIN x

New Development of national service user satisfaction process allowing benchmarking and service improvement x

Updated Dashboard 0.15%

2.50%

Local Health Needs The above CCGs support the health needs of around 1,194,165 people covering a relatively small geographic area with significant health inequalities and needs generally worse than the England average. An overview of the key mental health needs of these populations is presented overleaf (Tables 13, 14 and 15) and there are some consistent health issues which are priority areas for our commissioners and impact on demand for our services:

• There are persistently high levels of deprivation in the North West and, despite some improvements, Liverpool remains ranked as the most deprived local authority area in England on the Indices of Deprivation 2010, with its position unchanged from earlier indicators. Knowsley has similar challenges and is ranked at 5. It is generally accepted that deprivation is closely linked to the prevalence of mental illness.

• The unemployment rates in Liverpool and Knowsley are significantly higher than the

national and North West average, with some areas such as Everton, Anfield and Kirkby at more than twice the average for Great Britain. Sefton unemployment rates are lower but still 35% above the national average as of June 20119. People who are unemployed are twice as likely to suffer from depression10.

9 NOMIS 2011 JSA claimants www.nomisweb.co.uk/reports/lmp/ward 10 Department of Health, September 1999, A National Service Framework for Mental Health

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• As at the end of March 2010, 1,295 asylum seekers were living in supported accommodation in Liverpool, 5.7% of the UK total11. Asylum seekers and refugees are at a high risk of mental health problems12.

• The region has the highest prevalence of inpatient admissions per 1,000 population for

mental health, 30% above the national average and trending flat rather than reducing as is the national trend.

• The incidence of drug abuse and excessive alcohol consumption is higher in the North West than the national average13/14.

• There are three prisons within our catchment area. A comparison of the prevalence of

mental health conditions indicates that members of the prison population are more likely to have a mental disorder and / or drug and alcohol misuse problems than the general population15.

In addition, poor coordination of services and entrenched patterns of health sector behaviour has led to an escalation in use of urgent care to unsustainable levels. These priorities need to be addressed at a time when there is a requirement to make substantial reductions in public sector expenditure. This will require a fundamental change to the way in which health and social care services are delivered, with a need to significantly reduce acute hospital activity, reconfigure local services to provide more care in the community and instigate significant quality improvements and innovation which will enable cost reduction. This will include improved integrated care pathways that maximise opportunities for rapid throughput, recovery and keeping people well at home. This also includes ensuring appropriate access to planned care and transforming chaotic use of unplanned care into appropriate and timely planned care. Tables 13- Prevalence of Mental Health Conditions in the Offender Population16

Mental Health IssuePrevalence

among prisoners (16+ years)

Prevalence among general population

(16-64 years)Psychosis (Schizophrenia/Bipolar disorder) 8% 0.4%

Personality disorder 66% 0.4%

Depression and anxiety 45% 17.6%

Drug dependency 45% 3.4%

Alcohol dependency 30% 5.9% Table 14-Projected Change in Population by Number and Profile 2012/2018 and 2012/203517

11 Home Office, Control of Immigration: Quarterly Statistical Summary, United Kingdom January – March 2010 12 Health Inequalities, British Medical Association, 2006, http://www.bma.org.uk/health_promotion_ethics/child_health/ Childadolescentmentalhealth.jsp?page=5 13 Measuring different aspects of problem drug use: methodological developments, Home Office Online Report 16/06 2006 14 The Information Centre for Health and social Care 2007, Office for National Statistics, General Household Survey 2005 15 ‘Pathways to unlocking secure mental health care’ (2011), Centre for Mental Health 16 ‘Pathways to unlocking secure mental health care’ (2011), Centre for Mental Health 17

Office for National Statistics. 2010-based Subnational Population Projections by Sex and Quinary Age: Primary Care Organisations and Strategic Health Authorities based on 2010 mid-year populations, published March 2012. Actual population (un-weighted by MINI 2000) and including all of Knowsley

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Population 2012 (000)

Population 2018 (000)

Population 2035 (000)

% change2012-2018

% change2012-2035

15-64 years 309.2 309.4 319.5 0.1% 3.3%

65+ 64.1 68.1 88.0 6.2% 37.3%

15-64 years 173.2 168.6 160.9 -2.7% -7.1%

65+ 58.6 63.7 82.9 8.7% 41.5%

15-64 years 98.6 96.6 92.3 -2.0% -6.4%

65+ 23.9 26.0 36.3 8.8% 51.9%

15-64 years 581.0 574.6 572.7 -1.1% -1.4%

65+ 146.6 157.8 207.2 7.6% 41.3%

All Ages 727.6 732.4 779.9 0.7% 7.2%

Liverpool

Sefton

Knowsley

Total Mersey Care Catchment

The North East Public Health Observatory forecasts a significant increase in the incidence of dementia by 202518 see Table 15. Table 15- People aged 65 and over predicted to have Dementia by Gender projected to 2025

2010 2025 2010 2025 2010 2025Females 2,723 3,066 972 1,210 2,585 3,317 Males 1,441 1,902 519 742 1,357 2,053 Total 4,164 4,968 1,491 1,952 3,942 5,370

Liverpool Knowsley Sefton

The NHS as a whole continues to face a huge financial challenge whilst continuing to deliver improvements in clinical quality. This is shortly after a significant restructuring of the commissioning and provider landscape has taken place. As both a proactive partner in the local health economy and an aspirant Foundation Trust, Mersey Care NHS Trust is committed to meeting this challenge and see clinical and business excellence as our core levers for achieving this.

18 Source; North East Public Health Observatory @ http://www.nepho.org.uk/mho/briefs#b3 37

7. Delivering Clinical and Business Excellence Implementation of “Liberating the NHS”19 requires a significant shift away from traditional models of healthcare delivery built around major hospitals and delivered in silos, towards a model built around individuals and communities in which the need for health and social care are assessed in an integrated way. As a large established community and mental health provider, Mersey Care NHS Trust is well placed to respond by focusing on the delivery of excellent, cost effective community solutions in the following ways:

• Increase in community provision • Development of integrated pathways • Streamlined access • 24 hour/7 day a week access • Pursuit of Perfect Care • Focus on sustainable recovery.

We do recognise that having the right plans is only part of the picture. We also need the leadership and workforce, underpinned by best practice in service and technology terms to ensure the right outcomes. Our approach is to ensure that our clinicians are driving the organisation in partnership with exceptional managers and with common values and goals. A strong Board and governance infrastructure is also essential. There are a number of key Board Committees in addition to the Members Council that support our board in the delivery of its duties. Quality Assurance Committee - provides assurance to our Trust Board that the quality of services we provide are of the highest standard. Voting membership comprises three non-executive directors and three executive directors, with the chair having a second casting vote should this prove necessary. Audit Committee - acts as the central means by which our Trust Board is assured that effective internal control arrangements are in place and provide an independent check on the executive arm of our Trust Board. Membership consists of three non-executive directors, to include the chairs of the quality assurance and performance and investment committees, with an open invitation for other non-executives to attend and when appropriate for a non-executive director to deputise for a voting member of the committee. Executive Committee - supports our Trust Board in setting and delivering the organisation’s strategic direction and priorities; oversees our effective operational management and the delivery of continuous improvement in the quality of care and outcomes for service users. The committee assesses and establishes controls to manage risk. Performance and Investment Committee - provides assurance that the key performance and outcome measures for assessing delivery of our Strategy and annual Operational plans are appropriate and that performance is consistent with those measures; that financial plans, investment policy and major investment proposals are robust and that there are measures in place to identify and mitigate the risks and keep under review the management and status of those risks. Voting membership comprises three non-executive directors and three executive directors, with the chair having a second casting vote should this prove necessary.

19 Equity and Excellence :Liberating the NHS August 2010

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8a. Clinical Excellence One of our key organisational priorities in this planning period is the development of a Centre for Perfect Care and Wellbeing. This will make the best use of resources currently deployed for quality governance, quality improvement, innovation and research and development. This will build on and integrate good work already commenced such as better use of CQUIN resources and an independent review of our R&D processes. The main benefits of the centre will be the delivery of perfect outcomes of care by learning from when things go wrong. Through this positive approach to learning and the development of perfect care pathways based upon most effective treatments, we will raise standards to a new level of perfect care and wellbeing-“Getting key things right every time. Our thinking about the 2014/15 Strategic Framework has also been strongly influenced by the visit to Mersey Care by Dr. Edward Coffey, of the Henry Ford Health Care system in Detroit. In 2001, the Division of Behavioural Health Services of the Henry Ford Health System (Detroit) launched the "Perfect Depression Care" initiative, which reduced the rate of suicide by 75% (p = .007), from 89 per 100,000 at baseline (2000) to 22 per 100,000 for the four-year follow-up interval (the average rate for 2002–2005). This recent visit has renewed clinicians commitment to deliver perfect care. We know that health care in the future has to create value rather than volume and that new models of care that improve quality and outcomes and reduce cost must be urgently incubated. We have established a working group of 30 clinical colleagues from across the Trust who have volunteered to help define what perfect care means for Mersey Care and, more precisely, to agree the long term outcome goals and core processes we would need to achieve these perfect care outcomes. Figure 7-The link between the Centre for Perfect Care and Well-being, the Advisory Committee (a board committee linked to the |Centre), and the holistic programmes of quality improvement, research and innovation that lead to perfect care.

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Mersey Care established clinical business units (CBU) in July 2009 to strengthen clinical leadership, devolve decision making and strengthen clinical engagement in the management, planning and delivery of services. Whilst the CBU structure delivered many benefits there is a clear need for a more consistent approach across our secure and local services. Our pursuit of perfect care means that we will ensure our core processes and practices are consistent across all care settings, and that our clinicians will hold each other to account on this consistency for the fundamentals of the care we provide. To enable this consistency of approach, we have created three divisions, two clinical divisions – Secure Services and Local Services and a corporate services division. Our new clinical division structure has the potential to deliver significant improvements in the quality of the care we provide for service users to ensure consistency in the fundamentals of the care we provide, clearer, joined-up pathways and simpler access to our services. Governance Boards have been established for both local and secure services, to ensure that the divisions:

• Deliver the best possible care, experience and outcomes for service users in the most efficient way

• Deliver the annual plan and in doing so operate within the available resources and promote a positive experience for people working in the Divisions

• Actively encourage participation and feedback from service users and carers, commissioners and other key stakeholders in informing the best possible arrangements for delivering their services

• Operate in accordance with good governance practice • Operate as programme management boards in ensuring that strategic change

programmes are managed in accordance with trust wide programme management arrangements.

Both divisions contributed to the development of the Strategic Framework and the strategic programmes will be implemented through the divisions. The programmes of work overseen by the Secure and Local Governance Boards include but are not limited to:

• Transforming the secure pathway • Strengthening the pathways between our services and the criminal justice system • Developing a new assessment service for local services • Developing new integrated community teams • Reviewing bed capacity and stratifying beds in local services • The development of Clock View.

We have aligned our clinical division structure to drive our commitment to the provision of high quality, cost effective, patient‐centred care delivered through building on existing good practice, effecting internal and whole systems transformation and responding to business and market development opportunities as they arise. Both Clinical Divisions are led by experienced directors with a wider trust portfolio for all clinical staff and functions. We have established a Clinical Senate to ensure that all key decisions and risks have at their heart the advice and expertise of our clinical experts. We will underpin this clinical leadership with the establishment of a Research and Innovation Centre that will search for best practice and latest thinking. Our key clinical priorities for 2014/16 are set out later in the plan and establish our vision for community and mental health services to the populations we serve and describe how we intend to deliver care in the future. This work will form the heart of our 5‐year Integrated Business Plan. Much of the work has already commenced or is planned for implementation over the next 12--24 months. The planning priorities from the Clinical Divisions and the Corporate Services Division are later aligned against the Strategic Framework to ensure that the work we are doing has the required impact.

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8b. Delivering Business Excellence The delivery of high quality clinical care through the operating models described above necessitates a robust and effective infrastructure that will support the delivery of business excellence alongside clinical excellence. Traditionally, the NHS has not had to compete, which means NHS organisations have not developed a commercial perspective and orientation towards the market and the customers they serve. We have assessed and acknowledged the changing climate and market in which it operates. Our position as a monopoly provider in a defined market is increasingly being challenged by competition, rising demand, flat income and commissioner expectations of improved quality and outcomes. It is no longer enough to rely on old relationships or a previous reputation. Being commercial means we will need to be patient and profit focused and means that we must be clear what we offer, and what we are great at. We will also need to be more forward thinking and develop innovative service models, and strike a balance between knowing when it is the best so should compete to win, and recognising when working in partnership with others would add more value for patients and commissioners. Mersey Care provides services in two relatively distinct markets: a local market for inpatient and community based mental health, learning disabilities and substance misuse services commissioned by clinical commissioning groups; and a wider market for secure services commissioned by NHS England. We need to defend and retain our current contracts and at the same time identify and quantify perceived market opportunities for growth. This is strongly linked to our quality agenda. Doing the basics better than our competitors, designing and delivering integrated pathways that deliver care efficiently without clinical compromise and accumulating the endorsement of current customers will help us win the trust of new customers.

• Across local and secure services we will build on our existing role as a ‘gatekeeper’ for mental health service pathways in our core geographies, working to integrate and co-ordinate the pathway more effectively. This will also clarify where partnerships or sub-contracting arrangements would strengthen the total offer, reduce costs to commissioners, and enhance Mersey Care’s reputation as an expert local provider.

• The creation of two clinical divisions enables the development of more integrated pathways, both within our existing core services but also for new business to maximise internal expertise. Building on internal expertise within the two divisions, we will pursue: growing our dementia offer; growing our offender health services in the North West region; integration of our expertise in forensic psychiatry.

• In adult mental health and older adult mental health services, we will ensure the quality of tiers 3 and 4 services is maintained at a high level, and build effective pathways of care across all tiers by providing integrated community mental health services. As part of our new access and assessment arrangements, we are integrating learning disabilities and substance misuse in pathways where there is currently unmet need, e.g. dual diagnosis for mental health and substance misuse. We will prepare for IAPT tenders in order to win back this important part of the treatment pathway in our core geographies of Liverpool and Sefton. We will also focus on growing our dementia services, making the most of applying the research and development generated by our Innovate Dementia project to develop genuinely innovative dementia services in our core geographies but also to a wider market.

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• In learning disabilities, rehabilitation and acquired brain injury services, we will ensure the quality of provision is maintained. We will agree a strategy with commissioners for the provision of supported living schemes. We will develop a new brain injuries offer with the acute sector. We will develop new models of consultation rather than provision in learning disabilities and rehabilitation services. We will build on our pilot with Walton and exploit opportunities through the local trauma networks.

• In substance misuse services, we will ensure that the quality of provision is maintained. Through cost improvement plans we will reduce our costs in lower tiers of care and inpatient services. We will build on our reputation as a good quality provider of treatment services, but develop more partnerships with voluntary sector organisations with a strong recovery ethos in order to change our organisational culture but also change perceptions of our organisation.

• In low and medium secure services, we will ensure quality of provision is maintained, and deliver cost improvements in our low secure services. We will develop our expertise on offender health and bid for tenders in our core and neighbouring geographies as opportunities arise. We will develop plans for a secure campus and the associated expansion of our medium secure offer. We will continue to provide a gatekeeping role for commissioners.

• In high secure services, we will ensure the quality of provision is maintained. We will

invest in estate improvements, including the development of a secure campus. We will enhance our reputation as a centre for forensic research, and continue to work in partnership with the other two providers of high secure services.

• In offender health, we will ensure the quality of our existing mental health service

provision in HMP Liverpool, Kennett and Garth is consistently high. We will pursue opportunities to apply our specialist knowledge and expertise in other prisons, in order to extend the reach of our specialists to people whose mental health needs are currently completely unmet or met inadequately.

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Our Foundation Trust programme will help drive this business transformation as we progress on a rapid trajectory to planned authorisation in June 2015. The achievement of Foundation Trust status is a milestone in our transformation journey, rather than an end‐point. The benefits of the Foundation Trust model are far reaching and importantly, are directly relevant to patients and to attaining the ambitions of the NHS Outcomes Framework, which is designed to shift the focus away from centrally driven targets to a relentless focus on the outcomes that matter the most to patients. The benefits of achieving Foundation Trust authorisation cover four broad areas: • The membership model promotes greater involvement of local people, patients and service users, so that the services and priorities of the Trust will more closely reflect those of the communities they serve. • The authorisation process mandates robust business operations and accountability, ensuring that public funds are used in the most prudent and efficacious way to benefit local people and the running costs of the organisation are minimised. • The role of the Board of Governors adds democratic legitimacy to senior appointments and greater accountability of individual executives for the decisions they make. • Greater financial freedoms will allow the Foundation Trust to invest and borrow, within safe limits, to take a long term view and develop services in response to local need and ambition. We are clear that the above benefits build on our solid foundations and plans for the next two years to refocus our strategic on a number of key deliverables that will transform how we do things and further improve the quality of what we provide. To support our aspiration for clinical and business excellence and to underpin the work of the Clinical Divisions, the Trust is redesigning its corporate services into a single division or hub. This will enable the generation of over £5.6m (in scope) savings by 2016/17 but also provides an opportunity to deliver a more customer focussed and outward facing service offer. The priorities for this Division for 2014/16 are also described later in the plan and align with the support required for Clinical Divisions to deliver their planned improvements and developments and to minimise risk.

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8. Objectives with key deliverables This section describes the overall Trust strategic objectives that underpin the Strategic Framework. It highlights main priorities from the two Clinical Divisions and how they will deliver the requirements of the Framework. The critical work programmes required to be delivered by the Corporate Services are summarised in Chapter 9 to ensure that the supporting infrastructure is in place to deliver the new models of care and integrated pathways. The next critical piece of work is to map all the identified priorities across the three Divisions to the Strategic Framework to ensure delivery and enable performance management. Trust Objectives 2014-16 Our 2014/16 aims and objectives reflect both the challenges and the opportunities for Mersey Care NHS Trust in the next two years. They build on achievements of the last year. Our overarching philosophy is to deliver innovative service solutions which meet the health needs of the populations we serve and the requirements of our commissioners. We will achieve this by achieving our four main aims. These aims are longer term: 1. QUALITY- to continuously improve the quality and productivity of our services 2. BETTER SERVICES- to ensure our services meet the needs of people effectively help people recover and are financially viable in the future 3. BETTER PARTNERSHIPS-to develop partnerships that deliver improvements in quality, or enhance recovery and wellbeing for people with mental health needs 4. OUR ORGANISATION-to become a highly effective organisation, with empowered service users fully engaged staff and good governance. The Trust has 14 strategic objectives to underpin the above aims. These objectives are focused on the next two years and underpinned by work programmes and key deliverables that are discussed later in the plan.

• A101-To ensure that our care is effective • A102- To ensure that peoples experiences of our services is always positive • A103-To ensure that people have timely access to care • A104-To be the safest mental health provider in the country • A105-To treat everyone fairly in our organisation • A201-To enable our staff to develop the right skills and be productive • A202-To develop integrated pathways • A203-To grow services based on our specialist expertise • A301-To pursue high quality research and innovation • A302-To create partnerships that support service delivery and recovery • A303-To collaborate effectively with primary care • A401-To work side by side with service users and carers • A402-To be a great place to work • A403-To be an efficient organisation.

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DIVISIONAL PRIORITIES KEY MILESTONES FOR THE

DIVISIONAL PRIORITIES LINKS TO STRATEGIC FRAMEWORK OBJECTIVES AND INITIATIVES

LOCAL DIVISION To develop and implement the Care Strategy by: To develop, agree and implement the local services divisional structure/governance/accountability arrangements by:

• Implementing a new community and recovery and well-being service

• Implementing a new division wide assessment and immediate care service and a new assessment suite for adults with mental health problems

• Move into Clock View and implement the new assessment ward and recovery wards

• Pursue perfect care in local services

• Revised Divisional governance arrangements

Ensure people's experience of our services is always positive SI01 Improve patient experience in services identified through the patient survey SI02 Improve the patient environment to deliver privacy, dignity and better care Ensure people have timely access to care SI01 Simplify access to local services through a single point of access and assessment SI02 Understand waiting times and reduce them, including any hidden waits Ensure that our care is effective SI02 Develop outcome measures for recovery A skilled and productive workforce SI01 Increase mobile working and develop fit for purpose clinical support and information systems SI02 Support high performing teams SI03 Enable a consultant-led service with changes to medical workforce and roles Develop integrated pathways SI01 Create integrated community teams Si02 Publish perfect care pathways for depression, psychosis and dementia

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To increase market share in a number of identified priority business areas by: SECURE DIVISION To provide perfect care for schizophrenia and PD by:

• Growing IAPT in Sefton and

Liverpool • Implementing the repatriation of

Liverpool (OATS) • Retaining and growing PD services • Growing eating disorder services • Developing local services for West

Lancashire • Improving and expanding current

dementia services

• Developing an evidence based model of perfect care with clear outcomes and improvements for patients

Grow our services based on our specialist expertise SI01 Develop a consistent Trust-wide approach to dementia in line with perfect care pathway SI02 Grow IAPT, eating disorders, alternatives to OATs, and personality disorder services in the local division Ensure that our care is effective SI01 Improve the physical health of people in our care SI02 Develop outcome measures for recovery Ensure people's experience of our services is always positive SI01 Improve patient experience in services identified through the patient survey SI02 Improve the patient environment to deliver privacy, dignity and better care Be the safest mental health provider in the country SI01 Reduce suicides for those in our care SI02 Reduce use of control and restraint SI03 Reduce violence and harm in inpatient settings SI04 Reduce slips, trips and falls Treat everyone fairly in our organisation SI01 Investigate processes in place in relation to MHS, use of seclusion, use of control and restraint; and length of stay for BME groups

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To develop a secure campus by: To continue to improve quality whilst reducing costs by: To identify commercial opportunities to develop new income with partners where necessary by:

• Developing a transformed and integrated secure services pathway

• Implementing the above into a new campus and continue to develop the pathway

• Developing a robust CIP that delivers required savings

• Implementing the CIP plans to agreed timeframes

• Monitoring and managing the maintenance of agreed quality standards with a reduced budget

• Increasing market share and income for PD services

• Increasing market share and income for offender health services

• Developing a long term low secure service

Develop integrated pathways SI02 Create integrated secure pathway that links to the criminal justice system SI02 Publish clear perfect care pathways for depression, psychosis and dementia Grow our services based on our specialist expertise SI03 Grow the secure campus and offender health services in the secure division Be an efficient organisation SI01 Deliver cost improvements without impacting on quality SI04 Improve the Trust's understanding of the value for money of its services Develop integrated pathways SI02 Create integrated secure pathway that links to the criminal justice system SI02 Publish clear perfect care pathways for depression, psychosis and dementia Grow our services based on our specialist expertise SI03 Grow the secure campus and offender health services in the secure division

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To enhance patient experience by:

• Establishing ways of working and models of care that improve patient experience

• Developing systems and processes that enhance patient involvement and influence

• Establishing increased opportunities for meaningful activity as part of the overall recovery programmes

• Collecting relevant information on patients via a new clinical information system

Ensure people's experience of our services is always positive SI01 Improve patient experience in services identified through the patient survey SI02 Improve the patient environment to deliver privacy, dignity and better care

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9. Resource implications to deliver the Operational Plan

Corporate services consist of key functions that provide a number of services to help ensure that the Trust and all its key stakeholders have access to the information and advice they need. The key enablers are described in turn below and key priorities and assumptions are also summarised from their individual business plans. Effective corporate services provide vital skills, intelligence and resources that will enable the delivery of this two year operational plan. This also includes commercial development which looks for and develops commercial opportunities for the Trust and ensures that service developments have the appropriate governance arrangements to protect the organisation. The Resources team consists of a number of key functions. The main ones are described below and the key objectives for these teams are summarised to demonstrate connections with Divisional priorities.

• To support the implementation of the Divisional Care Strategies • To implement the Corporate Services Review • To ensure authorisation as a Foundation Trust • To integrate the estates and facilities services • To negotiate a new Building and Engineering Services contract • To develop a single laundry contract • To introduce a single process framework for capital schemes • To implement a backlog maintenance programme • To implement a building disposal programme • To recruit and retain our workforce, in line with service plans, that meet our

need today and in the future • To develop a healthy workplace • To reward and recognize the efforts of our people • To improve staff satisfaction and engagement • To implement patient based contracting and information systems.

Finance, Performance and Procurement Finance Performance Procurement Budgetary Control Budget Setting Financial Support to Divisions Financial Reporting Financial Forecasting Contracting Support Long Term Financial Model Capital Forecasting and Monitoring Treasury Management Costing

Performance Assurance Framework Performance Reporting Performance Advice to CBUs Strategic Procurement Advice

Strategic Procurement Advice Tender Management Purchase Order Management Patient Purchasing Receipt and Distribution Supplier Negotiation

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Final Accounts Accounts Payable Accounts Receivable Patients Cash Payroll SLA

The Trust is in a good financial position and the LTFM is being updated to reflect that priorities identified in this plan.

The Trust is planning a surplus of £4.250m in 2014/15 and 2015/16. This includes Informatics Merseyside delivering a 2% surplus and the Trust receiving the TIME quality premium for Clock View which opens in 2014. The table below summarises the planning uplifts applied for next two years as per 2014/15 planning guidance. Table 16- Planning Uplifts 2014/15-2015/16 Category 2014-15 2015-16 Tariff Deflator *

-1.8% or -1.5%

-1.1%

Pay and Prices *

2.5% or 2.2% 3.4%

Efficiency Target Required

4.0% 4.5%

Trust Planned Efficiency

5.0% 4.2%

*0.3% of the uplift relates to costs incurred due to the Francis and Keogh report recommendations The Trust has recurrent plans of £9.718m in place for 2014/15, this is higher than the revised target (4%) released by Monitor and the TDA. The additional CIP generated will provide the trust with a sound financial position in 2014/15 and enable the creation of £1.000m contingency as per TDA guidance and will fund cost pressures and a MARS scheme. The planned SoCI position for the next two years is shown in Table 17 below Table 17-Statement of Comprehensive Income 2014/15-2015/16 Statement of Comprehensive Income

2014/15 £’000 2015/16 £’000

Income 200,896 201,145 Expenditure 206,497 199,259 Retained Surplus/(Deficit) (5,601) 1,886 Impairment 9,851 2,364 Adjusted Normalised Surplus/(Deficit)

4,250 4,250

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Within the Statement of Comprehensive Income are the following-

• Informatics Merseyside are making a 2% (£0.250m) contribution towards the Trust surplus

• The TIME project (Clock View) will be completed in December 2014, the unitary charge will be £0.690m for the three months of 2014/15 and £2.760m for 2015/16. This will be funded by the commissioners. The trust’s income will increase accordingly

• A 0.5% contingency of £1.000m is within the expenditure position as per the required guidance.

• The Trust is planning for a normalised surplus of £4.250m in both 2014/15 and 2015/16.

• Impairments for 2014/15 relate to the refurbishment of Owen ward (£2.6m) and windows (£0.3m) within HSS, Clock View (£6.6m) and Haigh Rd (£0.4m).

• Impairments for 2015/16 relate to the refurbishment of Newman ward (£2.2m) and windows within HSS (£0.2m).

Cost Improvement programmes of £17.963m over next two years are required to ensure the Trust continues to achieve financial duties and the requirements of FT status. These have been tested out by the Clinical Senate to ensure that they do not jeopardise the Trust service and development priorities. Table 18 summarises the CIPs for 2014-16 in financial and high level programme terms. Table 18-Cost Improvement Programmes 2014-2016

In order to facilitate the transformation required to deliver the establishment of high performing divisions, the implementation of the Care Strategy and further development of the Secure Campus business case. The Board is considering/has approved changes to the Investment Framework. This will mean that instead of 20% underspends being made available in the following year and 80% used for capital this would change to 60% revenue and 40% available for capital over next two years. This would act as catalyst for change and enable the required non recurrent skills and resources to be sourced to support delivery of the objectives in this plan. A five year capital programme including disposals is required by March. This will cover the period 2014/15-2018/19. The capital programme will be a combination of operational and strategic capital. Operational capital relates to maintaining the trust’s current estate and is funded through depreciation. Strategic capital is funded from internal cash resources or new borrowings.

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The TDA require a detailed capital plan for 2014/15 and 2015/16 and a high level plan for the remaining three years. The strategic capital requirements of the two Clinical Divisions are summarised below in Table 19: Table 19- Proposed Five Year Capital Programme

The capital projects are consistent with the current investment framework. However following the approval of the Care Strategy in January 2014 and an updated Estates Strategy being presented to the Trust Board in May 2014 the capital projects will change as the capital requirements are not finalised at this stage. Any receipts from disposals will be reinvested into future capital schemes as per the Investment Framework.

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Workforce Workforce Human Resources Workforce Planning & Development Learning & Development Occupational Health Staff Support Service User/Carer and Volunteer Support Additional Staffing Health Roster

A draft People Plan, the enabling plan that draws together strategically all that the Trust does to attract, retain, support and reward its staff to meet its priorities, has been developed. It has been developed through staff and patient feedback gathered through the many Your Voice Your Change engagement initiatives and working with the divisions on what support is needed for them to achieve perfect care and better services for patients. Staff engagement, development and support is a key priority for the Trust in 2014-16, and this is reflected in the creation of the Your Voice Your Change and staff engagement group, which will have a direct line of sight into the clinical divisions and which will have Board input. We have organisational effectiveness plan and have appointed non-recurrent OD specialists to support the cultural transition required in our organisation over the next two years. The People Plan covers four main strategic objectives. These are to:

• Recruit and retain our workforce in accordance with service plans that meet our needs today and in the future

• Develop a healthy workplace – pursuing perfect care for staff

• Reward and recognise the efforts and performance of our people

• Improve staff satisfaction and engagement

In addition to these strategic objectives there is great deal of operational activity that is required from the workforce directorate to help Mersey Care become a great place to work, treating people fairly and having the available staff with the right skills to deliver perfect care. These functions, such as training and employee relations casework, will always be needed but have less correlation to the four strategic objectives. As an enabling directorate, delivery of the business plans for the local and secure divisions will require accurate workforce planning and significant organisational change workload so that they can achieve their objectives. Technology to introduce more self-serve access to workforce data and performance reports, sharing information and learning through share point and e-learning will be required.

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Due to the amount of organisational change happening in the creation of the three divisions and in order to deliver the three major transformational programmes, we would expect there to be a short-term impact on staff satisfaction levels which will make communication and engagement even more of a priority for the directorate. .Estates and Facilities Estates Facilities Estates Management Strategic estate planning Management of the Building Engineering contract with the Building Engineering Services (BES) Contract. Compliance with building and environmental legislation, including control of Legionella, asbestos management, and environmental carbon management. Delivery of the Capital Building Programme

Professional support to facilities services in the operating Divisions Domestic services Pottering services Catering services Monitoring of the facilities services provided by Aintree FT

The priorities for these services over the next two years will be a combination of operational reorganisation to ensure value for money through procurement and strategic estates planning to ensure that the capital programme is implemented and the clinical divisions have the right expertise and information to deliver the capital requirements of the Care Strategy and Secure Pathway improvements. Information, Performance Reporting, Knowledge and Programme Management Information performance reporting, Knowledge management

Programme Management

Information Analysis Information Reporting Data Warehouse/EIS Business Intelligence Data Quality Information Quality Performance Reporting

Strategic/Major Programmes and Projects Business Cases Monitoring and reporting on strategic framework action plans

Information, performance reporting and knowledge management The Trust Information Management and IT (IM&T) framework 2013-2016 was presented to the rust Board in May 2013 with a key ambition for for the use and exploitation of data, information, knowledge and technology to enable intelligence led decision making and to support the provision of excellent care. That is to become

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an intelligence and technology driven organisation. The Trust is well placed as high performing and its systems for the collection and use of data; extensive use of clinical information systems and its paperless culture. The enabling relationship to achieve the ambition will be that between the Trust and the ICT provider – Informatics Merseyside (IM). IM is an NHS ICT shared service hosted by Mersey Care NHS Trust and it provides ICT services to several other provider Trusts and commissioners in the local health economy. This scope of partner and customer base for IM will be critical in the development of data and information on common IT infrastructure platforms. The main objectives of this enabling function are

Supporting quality and service improvement Enabling the extent to which clinical information together with information from authoritative local and national sources can be combined to inform the service improvement and quality imperatives. A clinical information system is the central piece of such an arrangement and the major system is scheduled for a new procurement in 2014.. Excellent information and intelligence systems will create synergy between business development and the delivery of care, using existing Business Intelligence technologies together with real time service information to enhance user experience and clinical effectiveness through an evidence based approach to service improvement. It will also add the potential to develop electronic workflow to support integrated care pathways and systems. Data sharing Another element of this approach is the sharing of data with other stakeholders and in particular with Primary Care. To follow the path set by the Government Health Bill on integration of services the sharing of data (interoperability) will provide an opportunity to use sophisticated predictive risk models along the supply chain of an integrated system. These models enable an integrated provider / commissioner to develop comprehensive financial analysis, resource allocation, demand management and supply management. The data sharing with primary care will also include communication with GPs in three key ways. The aim is to develop interfacing systems to provide a standard format for electronic discharge summaries and the ability to monitor and improve the timeliness of transfer to a GP. Secondly through electronic prescribing to allow changes in medication to be more easily identified and communicated to GPs and thirdly the sharing of ‘test results’ associated with Physical Health Checks will avoid test duplication and drive down costs and improve efficiency. Supporting service users

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A key part of supporting service users will be in the provision of transparent information to enable service users and their carers make informed choices about their care. We will seek to do this across all of our service areas. In addition to this plans are already in place to capture patient experience at source and to feed this into the Quality Dashboard for the Trust Board. Supporting payment by results The procurement of a new Clinical Information System has been predicated on the functionality required to enable the standardisation of care and increased quality of care. A new system together with electronic prescribing management and order communications reporting and recording will support the introduction and subsequent expansion of payment by results linking activity costing through standard templates and forms to the delivery of high quality care.

Programme Management Office In January 2013 a Programme Management Office (PMO) was established. The PMO provides a consistent and aligned approach to the major strategic programmes and projects. Additionally it systematizes the way that programmes and projects report and are monitored. The same approach is taken for the monitoring and reporting of the action plans from the strategic framework to enable to Board and the Executive to have transparency on its position against delivery plans and to understand mitigating actions where issues arise Nursing and People Participation Nursing People Participation Monitoring and supporting Standards in Practice ( CQC Standards) Bi annual review of Staffing levels Mock CQC Programme Francis Action planning NMC referrals/advice Physical Health Care/ Dieticians’; Training, advice, standards Infection Prevention and Control; Advice, training monitoring standards

Carers Involvement/experience Service Users Involvement/Experience Spiritual and Pastoral Care Social inclusion, cultural and creative partnerships Volunteer programmes

The implementation of this plan will enhance Mersey Care’s reputation by supporting the monitoring of, and enhancement of fundamental standards of care. The Nurse Executive Team will further develop key relationships both internally across the newly formed Divisions and externally with key stakeholders. Achievement of the objectives outlined in the business plan will further provide assurance that

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fundamental standards are constantly monitored and enhanced with a robust approach. Key priorities are listed below:

• To develop and market the model of staff health and well being retreats internally and externally, so as to ensure sustainability and income generation

• To develop and enhance systems for monitoring compliance with CQC standards in relation to infection prevention and control standards

• To develop a carers survey to reach a wider cross section of carers and develop action plans based on feedback

• To develop a patient experience quality kite standard for teams/services • To establish a new People Participation Programme based on the principles

of volunteerism, recovery and social inclusion • To develop and enhance standards of physical health care in practice.

Communication Communication Marketing Foundation

Trust Corporate Governance

Media management

Digital management

Internal comms

Events

FoI

Fundraising

Consultation

Stakeholder management

Market assessment

Competitor analysis

Campaigns

Corporate ID

Customer feedback

Membership strategy

Membership management

Strategic development

Trust constitution and governance framework

Management of Board, Council of Governors, Committees

NED appointment and development

Effective communication is crucial to informed decision making and to building and maintaining staff and public confidence in the trust. Successful implementation of our plans to position the trust publically as a world-class provider of mental health, learning disability care and addiction management, increase positive perceptions of Mersey Care within the local community, develop a market-focussed approach to the provision of mental health services, manage the board and its corporate governance and committees and manage and grow charitable funding for the organisation, will ensure we’re moving in the right direction.

The communications and marketing teams have a number of key objectives that will support the delivery of this plan and strengthen the FT application process. They are committed to launching the Centre of Perfect Care and Wellbeing, growing membership to ensure a database of people who can be involved in testing new ideas and gathering intelligence. They will further develop the profile of the Recovery College and strengthen our profile as a leader in mental health innovation with the Academic Health Science network and others. Finally they will prioritise improving

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relationships with primary care providers and commissioners to ensure we are the provider of choice. Specific objectives are:

• To position the trust publically as a world class provider of mental health care, Learning Disability Care and addiction management and support by managing the Mersey Care brand and achieving 70% + positive media coverage and 80%+ good or very good public perception ratings.

• To increase positive perceptions of Mersey Care within the local community through a managed programme of community engagement to explain and showcase the work of Mersey Care.

• To develop a market focussed approach to the provision of mental health services by Mersey Care ensuring that accurate and timely information and insight into local markets is provided and upon which the trust can base its strategic decision making.

• To manage the Board and its corporate governance and committees to ensure that we fulfil our statutory duties, are locally accountable and act as a responsible member of the NHS.

• To manage and grow charitable funding for the organisation to support investment across the Trust and also around the world.

10. Key risks and mitigation The risks highlighted in Table 20 below relate to the delivery of this plan but have been cross checked against the top 10 organisational risks on the Risk Register. Table 20 -Key risks to delivering this plan Risk Mitigation plans

Impact of delivering CIPs on service delivery and development

Staff and patient surveys Quality Account Clinically led impact assessments completed

Impact of Local Authority financial pressures on service delivery and development

Partnerships to develop discharge solutions Further development of the Recovery College

Impact of Divisional Restructure at the same time as service transformation

Critical connections mapped and understood Robust programme management Resource identified for non-recurrent expertise and capacity

Failure to achieve FT status Refined IBP in development Refined LTFM in development

Failure to develop business in identified priority areas due to competition

Robust business development processes and capacity

Inability to modernise the workforce and recruit and retain right skills

People Plan developed through robust engagement

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Comprehensive and sustained communications

Secure campus does not receive commissioner support

Robust business and clinical case development, close working with commissioners, evidence from service users of the benefits to patient experience and quality.

Care Strategy does not result in benefits to patients

Development of clear KPIs and outcome measures and on-going and robust performance monitoring

11. How the plan will be monitored Once this Business Plan has been formally agreed and implementation is underway it is necessary to monitor and report on progress in-year. An assessment of progress using the performance metrics identified by the Divisions will be completed quarterly. Progress will be reported to the Trust Board, as part of the Integrated Corporate Assurance Report. Monitoring of these plans will continue to be on a quarterly basis and reported to Trust Board as part of the Integrated Performance Report for 2014/15.

The Divisions need to demonstrate their understanding of whether or not:

1. They have achieved what was planned

2. The work is having the anticipated impact

3. Any changes to the plans are needed

Reporting to the Trust Board will be on an exception basis only i.e. where the Divisions are not achieving the Business Plan Objectives as planned based on the scale outlined in Table 21.

However, there will also be a quarterly strategic service review with the Executive Committee when there will be a Deep Dive into progress and risks based on data submitted and other key indicators.

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Table 21: Division Business Plan Objective Measurement Criteria

Red There are significant problems and urgent decisive action is required

Amber

There are some problems where action is needed and mitigating actions are described in an exception report

Green Progress is to plan, no areas for concern

Blue Objective Completed

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12. Concluding Statement This Operational plan presents both challenges and opportunities for Mersey Care NHS Trust as we embark on a rapid development programme towards Foundation Trust status in June 2015. Throughout this period of transition for the Trust and our partners in the local health economy, we remain committed to the delivery of excellent clinical services that meet the needs of our patients, the requirements of our commissioners and support sustainability in the local health economy. This will only be delivered through the continued commitment, dedication and skills of our staff to achieve the objectives set out in this plan and deliver our clinical and business excellence aspirations.

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