COG34/2013
Council of Governors
Draft Annual Plan
20th March 2013
SUMMARY
The Annual Plan is produced each year by CNWL and looks forward to the next three years. This annual plan is for 2013-2016.
While the form of the plan, set by Monitor each year, may vary, there are core components which are consistent. These help CNWL to track our progress and plan our future based on what we have achieved in the previous year(s).
Central to our Plan are our Priorities. These have been identified from data gathered from staff, service users, carers and others involved in our services. For example, the Service Lines have all updated their three year strategies and meet with us each quarter to report on their progress; the Council of Governors Annual Plan sub-group have provided feedback on two occasions and we have one more session.
The Priorities are illustrated throughout the Plan in terms of how they relate to Quality; the plans of the Service Lines; our strategies for Workforce and Estates, and of course our planned CIPs and QIPPs – cost improvements that we must make internally and externally to meet our commissioners’ requirements and statutory obligations.
This paper sets out the Priorities at this time, a brief note on what the contents of the final plan will look like and our timescales for this year. Governors are asked for their feedback around the Priorities as identified.
Next steps:
There is further work underway to identify CIPs and financial plans for the final plan – the current position for the Plan was discussed with Governors on the sub-group on 12th March 2013
The plan will now be written to the new Monitor template, using the Priority workstreams set out in this paper. The final plan will be discussed with the Annual Plan Governors sub-group prior to submission on 3rd June 2013
RESPONSIBLE DIRECTOR: John Vaughan, Director of Strategic Developments and Community Partnerships
DATE: 5th March 2013
Forward Plan Strategy Document for 2013-14
Central North West London
NHS foundation trust
A. The Trust’s vision:
Executive Summary:
Central North West London NHS Foundation Trust provides both mental health and community services. Our core five boroughs for mental health delivery are Westminster, Kensington and Chelsea, Harrow, Hillingdon and Brent. For community services we cover Hillingdon, Camden and, as of 1st April 2013, Milton Keynes which provides both mental health and community services.
The Trust is currently divided into eleven mental health service lines, a community service line and corporate services. Each has its own business development plan, priorities planned over three years, and an associated Quality and CIP plans which underpin the Trust Annual Plan. These are set out in more detail later in this document.
CNWL’s strategic direction is based on our vision to provide ‘Wellbeing for Life’ and is expressed as the following aspiration:
We help people to improve their physical and mental health and wellbeing. We support people on a shared journey to recovery and an improved standard of life through high-quality care and individual support.
Our vision was identified through our experience as providers and users of services and was first agreed by a stakeholder group of service users, carers, commissioners, staff and the Board in 2010. Seven enablers for the vision were identified as CNWL’s strategic objectives. The vision and strategic objectives have been reviewed again this year by our Board and Council of Governors and found to be a robust expression of our intent.
Strategic Overview and Corporate Objectives:
As above in order to deliver our vision, we have a set of strategic objectives which underpin our work priorities year on year.
These seven strategic objectives provide a framework for realising our vision. These are reflected in our refreshed plans each year and are:
1. Provision of integrated, high quality, timely services based on the needs of the individual.
2. Engaging meaningfully with service users, carers and the local community to improve and align our services to meet needs, and to ensure effective local accountability to the populations we serve.
3. Improving and maintaining to a high standard the physical environments in which we provide services.
4. Recruiting, retaining and developing a skilled and motivated workforce that is proud to work for the Trust and that the Trust is proud to employ.
5. Providing a financial base that is robust for the future development of the Trust and to provide economic and efficient services.
6. Improving Trust information systems to support improvement in patient care and performance management.
7. Seeking and developing new business and partnership opportunities consistent with our vision.
Priority Workstreams
As above, each of the service lines has its own set of local priorities related to Quality and CIP plans. These reflect the central vision and have a role in defining CNWL’s strategic direction. Summarising these at a high level, we are able to identify a number of priority workstreams for the Trust which are refreshed each year against local delivery. Each is allocated to Executive Director leads, who are responsible for delivery.
Table 1: CNWL’s Priority Workstreams for 2013 – 16
2013 - 2016 Priority Workstreams / Executive LeadCorporate Development / 1 / Services designed to provide the best outcomes and experience for patients:
- Service Lines in place, focussed on the recovery needs of our service users, carers and others
- Which support delivering our principles of quality, safety and financial stability
- Deriving maximum benefit from having mental and community health provision in one Trust
- Providing safe, excellent and valued services for those who use them and our commissioners, and which are sought after places to work
- Supporting integration and the interface across CNWL and with external partners
- Are able to deliver CIPs and QIPPs – eg through rationalisation of estates or through greater sharing of administrative costs
- Are subject to regular review at local and Trust level to ensure they remain fit for purpose / Robyn Doran *
Andy Mattin
Alex Lewis
John Vaughan
2 / Maintaining financial stability:
- A Trust able to manage growth and meet demands of QIPP and CIPs[1] over three years and beyond in order to ensure our sustainability going forward / Trevor Shipman
3 / Actively engaged in responding to new commissioning environment:
- Establishing new ways of working with the new CCGs[2] and other commissioning structures
- Developing services and partnerships to meet need and commissioner requirements – eg with mental health, acute, private and third sector providers
- To advocate for mental health services and those who use them with commissioners, particularly in an environment of reducing costs.
- Defending and developing CNWL over the next 3 – 5 years
- Ready to launch and use PbR
- / Robyn Doran
4 / Information technology able to support the business:
- Providing the basis for sound decision-making around clinical care and financial management
- To provide information for our commissioners and the public about the quality of our services
- Flagging up early signs of risks to quality of care
- Supporting transparency and benchmarking of CNWL’s performance
- Facilitating agile working for staff so that more time can be spent with patients
- To enable choice and self-management eg a website with information on benefits, Recovery College, medication, conditions / Larry Murphy
Andy Mattin
5 / A workforce aligned around the requirements of service lines:
- Led by compassion and an understanding of patients
- With the agility and flexibility to cope with change. Including new roles and skills.
- With clear performance and productivity management
- Supported by effective training and development programmes / David Brettle
Growth / 6 / A growth strategy to include:
- Marketing for the centre and Service Lines to defend and develop services
- Increased communication across CNWL and beyond
- Further acquisitions, new services and defence of existing provision
- Supported by clinicians and those who use our services
- Meeting our objectives to improve interfaces and access while improving quality / Ian McIntyre
John Vaughan
*Executive Director roles:
Trevor Shipman – Director of Finance
Robyn Doran - Director of Operations and Partnerships (Adult and Older Adult Service Lines)
Andy Mattin – Director Operations and Nursing (Specialist Service Lines)
John Vaughan – Director of Strategic Developments and Community Partnerships
Alex Lewis – Medical Director
Ian McIntyre – Director of Commercial Development
David Brettle – Director of HR
Larry Murphy – Director of ICT
As in previous years, we have divided our workstreams into two areas –corporate development as an organisation, and our growth strategy:
Corporate development:
The key identified priority is to design services for our service users, while meeting the demands of reducing funding.
Therefore to underpin this priority, we need to ensure our financial stability, work with our commissioners around service development, and reach the point where our ICT meets our needs now and into the future.
Growth:
CNWL needs to operate in a market of competition and to counter ongoing CIPs with business development which contributes to our financial and clinical priorities.
These are further discussed at (C), (D) and (3b)
D. Clinical and Quality priorities and milestones
As above, CNWL’s strategic planning is around a number of priority workstreams, each designed to delivery our quality objectives. In this section, plans to progress each area are looked at over three years with quality implications.
Table 3
Quality measure/QP/CNWL Priority / Key Actions and Delivery Risk / 3 year targets/ measures for progress 2013-2016 /1. Services designed to provide the best outcomes and experience for patients
Quality Framework
· Service user experience
· Patient Safety
· Quality and Clinical Effectiveness
QP
· Physical and mental health care
· Access
CNWL Priority
· 1-5 and 7 / · Due diligence complete and Milton Keynes CS joins CNWL
· Establishment of Hillingdon and Camden Community Services as a single service line with a combined strategy and leadership
· Review of mental health service lines:
o efficiency focus to support delivery of ongoing CIPs and QIPPs and market potential
o clinical quality focus to improve patient experience
o responding to Trustwide strategic forum Jan 2013
· Modernisation discussions with CCGs around identified service changes from contract round 2013-14. These likely to include:
o ability to Shift Settings of Care down the system
o development of IAPT and Psychological Liaison around Long Term Conditions
· Modernisation implementation. Anticipated ongoing challenge to current funding of services and which may impact on service line structures
· Quarterly review of all Service Lines for assurance
· Quarterly/bi-annual LINKs/HealthWatch processes
· Establishment of Carer Council
· Ongoing local processes with service users, carers
Service developments include:
· Services for people with LTCs
· Provision for people with short- and long-term Recovery/Rehabilitation needs
· Further work to support Shifting Settings of Care – to reduce bed use and enable care to be delivered in primary care where possible. Including review of HTT
· Memory Services to be established in Outer Boroughs (funding agreed)
· Continued development of psychiatric liaison model
· Focus on bringing people back from LD out of area placements
Risk/mitigation
· Ongoing QIPPs make service and service lines no longer viable
· Impact assessment and communication with commissioners and partners
· Commissioner requirements are in excess of what CNWL can safely deliver or support
· Commitment of senior resource to work with commissioners around proposed QIPPs
· ICT alignment to Service Lines and future changes
· ICT strategy – including modernised infrastructure, QIS and participation in 2015 planning
· Inability to deliver QIPPs and CIPs
· Review of lines for efficiency including merger and shared services/estates / 2013-14 Q1.
2013-14 Q1-3
2013-14 Q1-2
2013-2014
2013-2015
2013-2016
2013-16
2013-14 Q1
2013-2016
2. Maintaining financial stability:
Quality Framework
- Quality and Clinical Effectiveness
QP
- Service User Experience
- Access
CNWL Priority
5 / · Identifying and delivering CIPs is critical to CNWL’s financial stability.
· Integration of Milton Keynes finance structures
· Investment in key areas for MK for ongoing stability – estates, IT
· Ongoing identification of CIPs and redesign options from Service lines
· Programme of service redesign to meet QIPPs with commissioners for yrs 2 and 3 of NWL Mental Health Strategy
· Review of Service Lines for efficiency and quality (linked to 1)
· Identification of further growth opportunities on basis of financial benefits and quality development (linked to 6)
· Significant investment in ICT over 5 years to meet internal and external needs including patient accessible records and shared information with GPs
· Launch of PbR as basis for payment
Risk/mitigation
· Inability to maintain Financial risk rating of 4 against CIP demands
· Forward planning, marketing strategy, constant Board level review
· Inability to delivery QIPPs and CIPs while maintaining quality services – major disruption to services, staff and service user
· Work with commissioners; service redesign; governance processes to track change; clinically-led impact assessment of all QIPPs and CIPs
· Commissioners do not understand need for Trusts to find CIPs and expect all savings to be counted as QIPP
· As above, working with commissioners and through this helping them to understand this requirement for Trusts
· PbR redesigned as NHS payment mechanism for mental health.
· Use the tariff identification to improve services and efficiency / Ongoing and linked to modernisation
2013-14 Q1-3
2013-14
Ongoing
2013-15 – potentially ongoing
2013-14 Q3
2014-15 Q1
2012-2019
2014-15
3. Actively engaged in responding to new commissioning environment:
Quality Framework
- Service user experience
- Patient Safety
- Quality and Clinical Effectiveness
QP
- Access
CNWL Priority
1,5 / · Finalisation of any outstanding elements of contracts including CQUINs for 2013-14
· Implementation of new one year contract – Mental Health and Community Services
· Establishment of new ongoing SLA management with move to CCGs – working with CSU/successor, SCG and local authorities
· Retirement of existing Head of Contracts and recruitment for new appointment
· Modernisation plan in line with NWL mental health strategy across all CCGs and local authorities (yrs 2-3)
· Implementation of new quality and performance KPI reporting – MH (dependency on ICT)
· Specialist commissioning – shift of specified service to SCG under new NCB guidance
· New contract negotiation round
Risk/mitigation
· Loss of stability with changing processes
· Investment in commissioner relations at service line and borough level
Loss of business through competition
· Improved access to business intelligence around CNWL’s performance and market position
· Marketing and business strategy
· Expectations of commissioners around move of resources to primary care
· Build on history of partnership to work with commissioners to clarify implications for service users, staff and GPs so that transformation is as efficient as possible / Q1 2013-14
2013-14
2013-14 Q1-4
2013-14 Q1 – Q3
2013-2015
2013-14 Q1-3
2013-14 Q1 ongoing
2013-14 Q3; 2014-15 Q3; 2015-16 Q3
4. Information technology able to support the business:
Quality Framework
- Service user experience
- Patient Safety
- Quality and Clinical Effectiveness
QP
- Carer Involvement
- Care Planning
CNWL priority
6 / ICT to be asked to write/add to this section
BAU:
· Final migration of data on Jade to new structure
· QIS system fully functional to support integrated information management. Includes 2 or 3 x weekly refresh
· Integrated scorecard replaces quality and performance report
· Integration of HR and finance across CNWL through QIS
· The Rio patient record system reaches end of life span and will be updated/replaced through RiO 2015 process. This could incorporate other systems used by the Trust as well as RiO
· Working towards/achieving direct service user access
Risk/Mitigation:
Risks around BAU and data transfer
Careful programme planning including clinical services
Future proofing ICT requirements
Participation in national networks and retention of strategic partner to advise and support transition
Cost of ICT investment
Informatics Board to oversee costs and report to the Board. Continuous scrutiny by Board / 2013-14 Q1
2013-14 Q1-2
2013-14 Q1
2015-16
2015-16 and beyond
2014-16
5. workforce aligned around the requirements of service lines:
-
QP
Carer engagement
CNWL Strategy
4 / HR to asked to write this section
6. A growth strategy to include:
- Patient Safety
- Quality and Clinical Effectiveness
QP
Access
CNWL Strategy
7 / · Further development with Business and Marketing Team, HCH, CPS and MKCHS
Progress on the Marketing strategy workstreams to be updated and projected over 2013-6
· Continued roll out of Marketing and Business Development Strategy (year 2)
· MK – what say on this over next 2-3 years?
· Roll out of relationship management software to improve interface with partners across an increasingly complex organisation
· Allocated business support role to each Service Line – for development, tendering support and efficiency management
· Establishment of programme office/criteria to coordinate service and business development across CNWL, with established ways of working and checking against vision and priorities
1