Forward Plan Strategy Document for 2012/ /15 Camden & Islington NHS Foundation Trust

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Page 1 of 22

Forward Plan Strategy Document for 2012/13 – 2014/15

Camden & Islington NHS Foundation Trust

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Page 2 of 22 Section 1: Forward Plan

A. The Trust’s vision is summarised as:

Camden & Islington NHS Foundation Trust (C&I) will continue to be a Partner in Care and Improvement in delivering our vision of providing Excellence, Innovation and Growth.

We will be known as a high-quality, innovative and trustworthy organisation within and outside the field of mental health and recognised as such by our service users, staff, commissioners and public. We will rapidly adopt emerging best practice through scanning of the evidence base and

incorporating these approaches within C&I to improve outcomes. We will develop and implement new models of care and therapeutic approaches which will be evaluated and will contribute to the research and evidence base. There will be practice innovation across the full range of services evident year on year.

C&I will look for both organic and inorganic growth opportunities on a proactive basis whilst accepting that difficult market conditions may limit flexibility and opportunity. Our services will be extended to increase the range of mental health and associated services provided by the Trust where there is sufficient size to ensure the associated risks are mitigated. We will look for opportunities using our existing services outside our current geographic locations.

Our vision is underpinned by the following strategic objectives:

Excellence: Continuously improving the quality and safety of service delivery, service user and carer experience and improving outcomes;

Delivering the highest levels of performance;

Delivering strong financial performance;

Improve communication and enhance the Trust‟s brand and reputation. Innovation: Rapidly adopt best practice and maintain a culture of innovation;

Grow and support C&I‟s Research & Development capacity and capability; enhance the high quality of the Trust‟s training and extend innovation in workforce design and training.

Growth: Increase the Trust‟s capacity and capability in business development through a range of measures including strategic alliances and targeted marketing;

Maintain and develop environmental appraisal and analysis and a range of cross sector organisational relationships to better anticipate and respond to opportunities.

Seek both organic and inorganic growth opportunities which extend the range of mental health and associated services provided by the Trust within appropriate quality and risk parameters.

Our commitment to Inclusion and Equality

Tackling health inequalities and social exclusion is an important priority for C&I. We are committed to taking positive steps to ensure fair and equitable access to services for all. As a major provider of services we need to be pro-active so that we can meet the changing needs of diverse communities and provide fair access for all in an environment where dignity and individuality is respected and promoted. As an employer we will create an organisational culture in which diversity is valued and staff feel able to promote equality and challenge unlawful discrimination. We aim to develop a holistic view of equality, diversity and human rights across the organisation, building upon work that we have already completed in the promotion of Inclusion and Equality.

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Page 3 of 22 C&I has made good progress towards achieving its vision as summarised below:

 We have had three very positive Care Quality Commission (CQC) Assessments to three different locations, Queen Marys House, ageing mental health service, St Luke‟s Hospital, rehabilitation service and St Pancras Hospital, adult acute inpatient and crisis services. We are proud that for each assessment the CQC found us compliant with all sixteen essential standards with no areas for improvement identified;

 We have continued to modernise our inpatient provision. New wards have been created at both Highgate Mental Health Centre and St Pancras Hospital, with modern, fit for purpose facilities, to accommodate inpatients transferred across from Queen Mary's House and the Grove Centre. These offer better facilities, including specialist provision for older people and more ensuite rooms, as well as enabling us to operate more efficiently;

 We have improved access to our services and implemented a new assessment model in Camden which will be replicated in Islington in 2012/13;

 We have further developed our clinical care pathways to provide more seamless care from referral to discharge and we are the most effective in London in avoiding hospital admission and enabling service users to receive care in community settings in an area with the highest levels of psychosis in the country;

 In anticipation of restructuring of Primary Care Trust services in NHS Camden our previous estates and facilities management provider, C&I made alternative provision with Balfour Beatty Workplace to take over delivery of these services from the 1st October 2011. They were selected following an extensive procurement process on the basis of the quality of service and the flexibility and responsiveness of their approach. We expect service standards going forward to equal or exceed those received previously;

 We have sold the historic St Luke‟s Hospital site, releasing the capital to invest in improving our estate and buildings further in the future;

 A consortium led by C&I won the contract for the Psychological Therapy Services in Camden and continue to increase access to psychological therapies and extend access to them within a wide range of services including substance misuse, acute hospitals, long term conditions and primary care.;

 We are proactively developing and researching Dementia care and have the lowest prescribing rates for dementia medication (anti-psychotic) in London.

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Page 4 of 22 C&I’s high level objectives for 2012/13

The Board has agreed the following seven high level objectives for 2012/13:

Continuing our drive to improve quality

Our strategic priorities and high level annual objectives above, together with the associated plans set out in later sections of the document describe how we will continue to deliver against the key strands of our vision of excellence, innovation and growth.

The major transformational changes that we have undertaken in the last 2 years in relation to improving inpatient and community services has placed us in a strong position to continue with our drive to improve quality whilst continuing to reduce unnecessary costs.

Looking forward

Through 2012/13 we look forward to working closely with GPs, Clinical Commissioning Groups and our partners in developing future service provision with a key focus on embedding our care pathway model, developing new Integrated Care Pathways; Improving service user and carer experience and strengthening further our commitment towards recovery focused care and continuous quality improvement.

In relation to priority seven above, we are embarking on a programme of organisational development which will concentrate on engaging and supporting staff throughout the organisation to refocus our vision and values and equip staff with the tools and training to embed continuous quality improvement and LEAN methodology into everyday working. An example of this to date is our implementation of the inpatient „Productive Ward‟ work, which has been successful in eliminating wasteful activities and „Releasing time to Care‟. We aim to extend this model to our community services.

1. To implement the service transformation elements of the Clinical Strategy whilst maintaining high quality and safe services;

2. To meet the Trust‟s financial targets as set out in the forward plan and continue to deliver value for money and efficiencies;

3. To undertake development work in the introductory year of Payment by Results (PbR) currencies;

4. To further develop positive relationships to respond to the priorities and needs of emerging Clinical Commissioning Groups (CCGs);

5. To pursue a strategy of growth through strategic partnerships & alliances and prime service provider opportunities;

6. To develop and agree future plans to further rationalise our estate;

7. To undertake a programme of organisational development throughout the Trust in order to support our workforce through the major service transformation and redefine a shared vision and value base for the future.

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Page 5 of 22 B. C&I’s Strategic Position

C. The Trust’s strategic position is summarised as:

C&I is a strong performing, ambitious organisation with a focus on providing high quality, safe and innovative care to our service users and their families.

We sit within the North Central London (NCL) cluster, which covers the boroughs of Barnet, Enfield, Haringey, Camden and Islington The cluster has a combined population of around 1.27m and this is expected to grow to about 1.31m by 2014 – an increase of some 3.2%. The cluster exhibits significant variance both in terms of population demographics, migration, ethnicity, housing and deprivation. Demographics range from the inner urban areas of Camden and Islington, through to the suburban areas of Barnet and Enfield.

Service provision in NCL, unlike many other sectors, has a multiplicity of statutory providers. C&I is one of three mental health organisations. In total there are eight acute hospital providers and four providers of community services.

There are also several third sector providers of mental health services in the sector with significant experience and expertise including housing and employment focused organisations.

C&I deliver services across an inner urban area of London that exhibits all the significant

characteristics described above. With many of our services located towards the south of the sector there are wide differences in equality, with wealthy areas closely situated to areas of high deprivation. There is a high turnover of residents, with many in their 20s and early 30s often living alone in rented accommodation – a group which exhibits high levels of mental health problems. There is an aging population with increasing levels of dementia.

The area contains communities made up of a diversity of ethnic groups, including black Africans and Irish who experience a higher prevalence of psychosis compared with other ethnic groups.

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With four main rail terminals (Kings Cross, Euston, St Pancras, St Pancras International), there are a large number of new arrivals to London. These people arrive from across the UK and overseas, some have mental health and substance misuse problems and are picked up by the police, in hostels or present themselves at A&E in the major acute hospitals from where they are transferred to C&I for treatment and care.

The area is also host to two major prisons, HMP Holloway and HMP Pentonville.

The factors described above drive a very high level of need for mental health and substance misuse services. Young adults experiencing their first episode of mental illness is a demographic which is over-represented in Camden and Islington and they are also difficult to reach and treat. This group is also likely to be in rented accommodation, isolated from support networks and vulnerable to changes in circumstance.

C&I is the largest provider of mental health and substance misuse services to residents within the London Boroughs of Camden and Islington. We also provide substance misuse services in

Westminster as well as mental health and substance misuse services in HMP Pentonville. We have two inpatient facilities, at Highgate and St Pancras, as well as community based services throughout the two boroughs of Camden and Islington.

Whilst we face increasing competition from other Mental Health trusts and third sector providers in the London region, C&I will pursue opportunities to ensure the long term sustainability and development of the Trust. Within such an environment it is imperative that the trust remains focused on its core strategic objectives and retain our focus on quality.

In common with all providers across the NHS, we are constantly working to deliver better value in our services. During 2011/12 C&I delivered a total of £12m QIPP savings for local Commissioners. This equates to circa 9% of 2011/12 expenditure, which we understand to be one of the highest

percentage savings target achieved across all foundation trust providers in the country, and we continue to face pressure to deliver further efficiency and productivity improvements. Whilst the NCL financial pressures have had an impact on the Trusts in the sector during the contracting round for 2012/13, these pressures are not expected to impact on CCGs in 2013/14.

Whilst we recognise the need to continually improve efficiency and productivity, there is a risk that the rate of change requested by commissioners will exceed the ability of the organisation to respond quickly enough and safely enough to meet expectations.

The position of social work in mental health remains a strong and positive force with good relationships in place with our Local Authority partners. Plans are being drawn up to ensure that integration remains a central part of delivering high quality mental health services.

C&I continue to invest in new services, partnerships and research & development. We are working closely with third party providers to bring service users being treated out of area back into Camden and Islington, in the process developing community based services able to manage higher risk service users and more effectively managing service users through to recovery.

Our clinicians have an international reputation for research and innovation and the Trust has a crucial role to play as an executive partner of UCL Partners, one of only five Academic Health Science Centres (AHSCs) in the country. Indeed Camden and Islington NHS Foundation Trust is positioned at the forefront of mental health related research.

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Page 7 of 22 Clinical and Quality Strategy

The Clinical and Quality Strategy should set out how the Trust intends delivering its vision and should be consistent with information contained within the Trust‟s published Quality Account. It should also include:

(i) the key changes required to progress the Trust from its present position; and (ii) the sub strategies that need to be in place to support achievement.

C. The Trust’s Clinical and Quality strategy over the next three years is:

C&I has had a Clinical Strategy in place since early 2008, which set out the principles of agreeing and monitoring standards to improve the quality of clinical care and service user outcomes. This has been achieved through a programme of service innovation and transformation. We are now revisiting this original strategy and will be consulting on this between May and August 2012 and will launch a refreshed Clinical Quality Strategy following Board approval in September that will set out a renewed approach to the continuous improvement of service user outcomes and service users experience of care and treatment.

This three year strategy will reflect the new NHS operational landscape and will focus on the three core quality domains of Patient Safety, Clinical Effectiveness and Patient Experience as well as the National Institute for Clinical Excellence (NICE) quality standards.

The Clinical Quality Strategy will reflect our service line management and reporting structure, which supports our framework for clinical care pathways that are based on nationally agreed clusters of care. As is currently the case, the strategy will be clearly linked to our strategic objectives of Excellence and Innovation as detailed above, driven by our re-defined values and will be fully embedded into service line plans, team plans, and delivered through performance management.

Clinical quality improvement is reported and monitored in a number of ways, including:

 Each service line has an agreed annual programme of clinical and quality improvements which are approved by the Trust Executive and monitored through the year using a well established Balanced Scorecard process and individual service line performance meetings;  The Trust Board receives a quarterly integrated performance report which covers all national

indicators, agreed commissioner quality indicators and locally agreed quality measures. This is further supported by Electronic Performance Dashboards, which allow staff to monitor performance in a more dynamic way;

 Clinical audit plans are in place for each service line as well as an overarching annual clinical audit plan overseen and supported by the Clinical Outcomes Group;

 A programme of Patient Experience Tracking (PET) is in place across all services using hand-held touch-screen devices, which give service users more opportunities to influence

improvements in their care and treatment, as well as providing the trust with comprehensive measurement of service user experience ;

 Through our service user alliance model, which is embedded within service lines, we receive important feedback about service user experience in all our services and the model ensures service users are involved in planning and shaping service developments and quality

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The Quality Committee, chaired by a Non-Executive Director monitors the delivery of the clinical and quality priorities and is further supported and informed by a Clinical & Quality Outcomes Group, which is co-chaired by two senior clinicians.

The QIPP programme has a specific quality monitoring report that monitors identified potential quality impacts from major QIPP projects and particularly the early warning signs of service degradation due to change processes, so that mitigating actions are taken.

Board Seminar on Quality Governance

The Board of Directors is committed to delivering high quality services and in keeping with this key priority held a Board Seminar in April 2012 to specifically undertake a self assessment against the Board Governance Assurance Framework (Quality Governance Module). This followed an internal audit completed by KPMG on Quality Governance, which focused on our compliance against

Monitor‟s Quality Governance Framework. This assurance plus the Board seminar was very valuable and will help shape our refocused Clinical Quality Strategy.

In summary, the Board self assessment resulted in a “green” rating in 80% of the categories. 14% were amber / green and only 6% (3 areas) were amber / red. In response to the findings, the Board recommended specific actions in the areas of revisiting the organisation‟s vision and values, the Non Executive Directors having a better understanding of the work on developing outcomes data,

improving incident and near-miss reporting rates, better staff engagement and more work on benchmarking performance with other providers.

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D. Clinical and Quality priorities and milestones over the next three years are:

At the time of preparing this plan, the Trust has been assessed by the Care Quality Commission (CQC) on three occasions with visits to three different locations. We are proud that on each occasion, the CQC found the Trust fully compliant with all sixteen quality standards

The key clinical and quality priorities for 2012-15 are detailed below:

Clinical/Quality Priorities Key actions

required

Risks to delivery Key Milestones

2012-2015

Safety

1. To deliver the highest quality safe care in the most appropriate, least restrictive setting. Implementation of inpatient and community changes and linked transformation plans

Deliver team leader training and development programme

Ensure adherence to the Trust‟s Practice Supervision Framework

Deliver other training to staff as appropriate to consolidate new models of working and enhance specialist skills

During the implementation and transformation period there could be an increase in the number of patients admitted to private beds

During the transformation period, staff morale could be reduced resulting in lack of motivation and fidelity to new ways of working

Transformation of team grade and skill mix requires rapid adaptation of

supervision approach which could be delayed.

Inpatient and Community changes and transformation to take place by July 2012

Training for Team leaders in 3 modules during 2012/13

Continue with monthly sampling of 200 staff as part of our monitoring of staff morale

Audit of supervision practice in 2012/13

Introduction of electronic supervision monitoring dashboard

2. Ensure that our estate is fit for purpose and maintained to a high standard to support the delivery of safe care in our front line services Ensure a rolling programme of backlog maintenance Monitor estate refurbishment plan and capital expenditure in Finance and Estates Committee

Respond to needs in relation to PEAT Assessments and action plans

No major risks noted On-going as per Capital Expenditure Plan.

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Page 10 of 22

Clinical/Quality Priorities Key actions

required

Risks to delivery Key Milestones

2012-2015

Safety

3. Implement the Mental Health Harm Free Care programme

Trust Participation in the NHS London led piloting of the mental health Safety Thermometer (ST) Initiation of clinical initiatives aimed at reducing harm (specifically medication assessment for all qualified staff to reduce medication errors, and improved risk assessment to include formalised tool) Group of 8 staff to attend NHS London learning events in 2012 in preparation for implementation of safety thermometer post piloting. Programme implementation to take place linked with introduction of nursing metrics and

productive ward programme in all inpatient areas.

No risks identified Data collection for CQUIN target safety thermometer to be carried out in 2012-2013 based on general tool, not mental health specific, and only in SAMH and prison areas.

Piloting of safety thermometer June-September 2012

Safety thermometer in final form to be implemented for monthly point-prevalence data collection by end 2012 in all inpatient wards and some community services.

Mental health Safety thermometer to complement introduction of other mental health nursing metrics, in development by DoH

Revision of CQUIN target in 2013-2014 to be based on mental health ST and to include acute adult wards.

4. To further improve the physical health and wellbeing of service users

Meet the

requirements of the 2012/13 physical health CQUINs

Refresh and re-launch the Physical Health & Wellbeing Strategy with stretch targets

Successful achievement of the CQUIN targets requires input from general practices and if this co-operation is not received, our ability to succeed is impaired.

Quarterly reporting to commissioners

5. Improve incident and near miss reporting rates across the Trust

Use of DATIX to monitor

Staff training and education

Use of staff induction programmes

Risk of low levels of reporting due to different perception of threshold within staff groups

Quarterly monitoring and reporting to Board

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Page 11 of 22

Clinical/Quality Priorities Key actions

required

Risks to delivery Key Milestones

2012-2015

Safety

6. To implement a refocused Clinical Quality Strategy with robust quality governance structures which includes a performance framework - Complete development of Service Line performance framework component of the strategy - Consult on draft document - Launch updated strategy

Lack of capacity within performance and business functions.

Performance framework seen as too “top-down” and not accepted by clinicians.

May 2012 – discussion at Clinical Quality Service Outcomes Group (CQSOG)

July 2012 – Quality Committee

Sept 2012 – Governor discussion and Board of Directors approval

Oct 2012 – launch event

Clinical/Quality Priorities Key actions

required

Risks to delivery Key Milestones

2012-2015

Clinical Effectiveness 7. To further embed our

care pathway model to deliver more specialised needs based care in line with PbR for mental health

Implement the workforce & team changes following the inpatient and community services consultation in order to deliver the interventions defined by evidence base.

All service lines to further consolidate and develop their needs based care pathways following the establishment of new teams in line with the Transition Plan

Implement assessment team in Islington following successful implementation in Camden Deliver further competency based training to front line staff and senior managers to enhance expertise in relation to evidence based interventions.

Risk of negative impact on staff satisfaction during transition

By July 2012

During 2012/13

Conduct a GP satisfaction survey in Quarter 1 2012/13

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Page 12 of 22

Clinical/Quality Priorities Key actions

required

Risks to delivery Key Milestones

2012-2015

Clinical Effectiveness 8. To implement the Trust

outcomes framework in line with the NHS Outcomes Framework

Agree relevant proposed outcome measurements for C&I

Ensure data collection mechanisms are in place in line with our Data Quality Strategy

Update framework as new guidance is issued

Poor data quality

No having sufficient data capture capability

National guidance mandates different measures

May 2012 – proposal and discussion at CQSOG

June 2012 – ensure delivery of HoNOS data collection

Quality Committee ratification of framework

9. To provide the highest standards of care based on recovery principles focusing on clearly identified personal outcomes Meet the requirements of the 2012/13 recovery CQUINs Develop personalised care plans that incorporate evidence based interventions and include education, training and employment goals. Carry out regular Audit of recovery practice, Implement Peer Support Worker programme in service lines Training to staff in recovery areas to deliver collaborative recovery focused plans

Agree shared care guidance with GPs in order to safely discharge from secondary to primary care. Performance on the 2011/12 CQUIN relating to collaborative care planning was below the new target for 12/13.

Quarterly reporting to commissioners

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Clinical/Quality Priorities Key actions

required

Risks to delivery Key Milestones

2012-2015

Service User Experience 10. To improve patient

reported measures of care through the annual service user survey and other internal

mechanisms

Develop an aggregated action plan for all service user experience surveys and audits

Review service user experience of the CPA Process and address the findings from the survey

The transformation required by the Community and Inpatient changes may result in low staff morale during the change process. This could affect the implementation of agreed actions.

Community Team and Inpatient Transition to take place between May and July 2012

Patient Experience Tracking (PETs) to be extended to cover Carer experience/feedback in 2012/13 11. To make improvements to services in response to feedback received from service users and carers.

Consolidate the work of the Service User Involvement and Experience Group (SUIEG) to ensure delivery of the service user aggregated action plan who will monitor progress against this priority

Ensure Board or Director visits to front line services

incorporate an opportunity to hear directly from service users and/or carers

Formalise „service user stories‟ into the Board meetings

Continue with „mystery shopper‟ programme

The transformation required by the Community and Inpatient changes may result in low staff morale during the change process. This could affect the implementation of agreed actions.

Insufficient feedback to contribute to service improvements

Bi-Annual report to the Council of Governors and Board of Directors.

Programme of mystery shopper visits to services during 2012/13

12. To increase service user involvement in care and decision making

systematically across the Trust by fully embedding the service user alliance model in all service lines.

Ensure each service line has appointed both staff and service user leads

Develop service user forums for each service line

Ensure the work of the service user alliance is

communicated and accountable to the SUIEG

There could be a lack of consistency in approach during the developmental stages of the reconfigured teams

All leads to be appointed by August 2012

Forums to be implemented by October 2012

Review Service User Involvement Strategy by September 2012

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Clinical/Quality Priorities Key actions

required

Risks to delivery Key Milestones

2012-2015 Patient Experience 13. Ensure access to services is monitored by the „protected characteristics‟ in line with the Equality Act 2010.

Implement the Equality Objective Action Plan for Patient Experience

Monitor

implementation via the Equality & Diversity Group

Joint training event for BoD and COG

A delay in recruiting an Equality and Community Engagement lead could result in a gap in the monitoring of this action plan

Equality & Diversity Group re-launched in May 2012

Recruiting an Equality and Community Engagement lead by July 2012

July 2012

14. Improve Dementia Care and prescribing in Mental Health Trusts Meet the requirements of the 2012/13 dementia CQUINs: Increase dementia assessment rate

Increase joint work with nursing homes to improve care of people with dementia

Successful achievement of the CQUIN targets requires input from partner agencies and if this co-operation is not received, our ability to succeed is impaired.

Quarterly reporting to commissioners

2 monthly reporting to Board and Performance Committee

15. Monitor QIPP change process impact on quality

Board reporting of quality indicators aligned to QIPP programmes

Delays in reporting impact on timeliness of quality degradation and inability to intervene early

Operational groups to monitor dashboards

Morale survey to be reported to FTE and operational groups on a 2 monthly basis

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Page 15 of 22 Financial Strategy

E. The Trust’s financial strategy and goals over the next three years:

Financial commentary:

The outturn financial position of the Trust for 2011/12 shows our surplus position to be £2.0m. The Trust has, however, also accounted for a number of expected, non recurrent transactions. These are

1. Planned impairment of fixed assets resulting primarily due to the move off the Grove Centre and Queen Mary‟s Hospital sites as part of the Trust‟s inpatient reconfiguration. These impairments had a total revenue impact of £3.0m;

2. A profit on sale from the disposal of St Luke‟s Hospital of £6.0m. There was also an impairment associated with the disposal of £0.4m, which is in addition to the planned impairments;

3. The Trust has made provisions for costs associated with the Trust‟s on-going transformational, organisational restructuring processes, totalling £2.1m.

After the above transactions are considered, the Trust made an underlying surplus of £1.6m, which was in line with expectations, and reflects a positive financial performance.

Cash balances are healthy at £39.0m (as at 31st March 2012, all of which was held as cash and at bank). The in year liquidity profile was as per expectations, but the Trust received capital proceeds from the disposal of St Luke‟s of £26.2m in March 2012, which boosted the year end cash balances. The Trust‟s CIP programme remains broadly on target, despite the ambitious size of programme required. While some schemes, most notably the community consultation (due to delays in the consultation process) have not, to date, delivered as quickly as anticipated, the Trust has managed to deliver sufficient savings and mitigations to deliver financial balance.

The 2011/12 outturn results, and the savings that will accrue in 2012/13, from changes enacted during 2011/12, put the Trust in good position to deliver the necessary actions to take the organisation forward within the context of a financially challenged climate.

Both of the Trust‟s main commissioners, NHS Camden and NHS Islington reduced the Trust‟s contract value in excess of the national deflator in 2011/12, and will be making similar reductions over the period 2012/13 to 2013/14, over and above the national efficiency targets of 4%, which is necessitated by the sector position. While these have been accepted with great reluctance by the Trust, it remains an issue that there is a significant financial gap relating to the acute sector that requires some urgent action.

This, plus other cost pressures within the system results in a significant increase in the annual efficiency savings target to a level in excess of 5% in 2012/13.

The Trust has also been passed on reductions to our pooled budget and delegated management income with the London Boroughs of Islington and Camden respectively. These have been offset with reductions in expenditure agreed with the two local authorities, resulting in a neutral overall position.

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Page 16 of 22

The Trust has identified and is implementing service redesign programmes which will address the savings requirement. Where these programmes require consultation, delays to the savings have been factored into the programme as appropriate.

The Trust has identified a savings requirement of £6.6m in 2012/13, and an equivalent amount in 2013/14 This level of savings is based on the national efficiency targets and the further savings requirements from our commissioners in excess of those delivered in 2012/13.

To address this savings requirement, the Trust has two main strategic programmes:

1. the systematic and managed reduction in inpatients beds including the reduction of inpatient sites used, and

2. the redesign of care pathways in relation to community treatment and teams.

The reduction in inpatient beds successfully occurred during 2011/12, and the next stage, the associated skill mix changes, is underway and will be completed in early 2012/13. This follows the Trust‟s strategic direction of treating our patients much closer to their homes, rather than in a ward setting.

The community consultation is currently in the process of being implemented. This scheme remodels community mental health services, using central expert assessment teams to address primary diagnosis .This will result in significant reduction in the number of community mental health teams. Additionally this remodelling process looks at the appropriate skills required within the new teams, which will lead to a significant skill mix reduction.

As consequence of both of these main strategies the Trust is able to continue to achieve significant back office efficiencies in estates and facilities, delivered through the reduced inpatient and

community estate. Additionally, an estates and facilities market testing exercise concluded during 2011/12 and will continue to bring significant benefits from a more detailed, targeted specification, as well as delivering significant savings.

The Trust however recognises that in delivering a CIP programme of this size within the financial year will inevitably result in some form of slippage and potential redundancy payments. As a result, the Trust has prudently identified an overall CIP programme of £9.1m, which is comfortably in excess of the Trust‟s CIP requirement. Therefore there is a sufficient element of in-built headroom within the current programme, and the Trust has created a prudent provision for redundancy payments associated with this change programme.

As indicated above, part of the Trust estates strategy is to reduce both the number of inpatient and community sites. The bed reduction programme has seen the Trust move off two inpatient sites (the Grove Centre and Queen Mary‟s Hospital) and consolidate its beds at Highgate and St Pancras. The next stage, which involves the consolidation and development of community sites, in support of our community consultation, is underway, and will be completed during the first half of 2012/13. A significant part of the Estates strategy has been to reduce to two and if possible one inpatient site. That being the case the Trust has taken the strategic decision that it sees no need for the

continuation of the occupation of the St Luke‟s site, where mainstream services have been re- provided for some considerable time.

The Trust completed the sale of the site in March 2012, which has resulted in a significant reduction in capital charges and on-going estates management costs and security costs.

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The capital budget for 2011/12 is set at £5m. This will be sufficient to address community reconfiguration works as well as other projects which are linked to the Trust CIP programme.

The Trust will continue to deliver innovative ways of delivering mental health services, which produce savings without compromising quality or safety.

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Page 18 of 22 Leadership and Organisational Development

F. The Trust’s approach to ensuring effective leadership and adequate management processes and structures over the next three years is:

At the time of preparing this plan, there is one Non-Executive Director (NED) vacancy for which recruitment is underway. Interviews are planned for May 2012, aiming for approval at the Council of Governors meeting on 19th June. In addition to this vacancy, on 31 January this year, the Director of Finance announced his intention to retire this summer.

The respective Board of Directors and Council of Governors Nominations‟ Committee‟s reviewed the composition and mapped the skill mix of the Board of Directors and concluded that with respect to the current NED vacancy, that a focus should be placed on recruiting someone with current knowledge of the NHS Quality agenda who will be able to confidently chair the Quality Committee. This was given high priority and significance in response to the increasing focus on quality and the assurance required by the Board with regards to the Quality Governance

Framework and the NHS Outcomes Framework.

With regards to the Director of Finance, a recruitment process using an external agency is underway to find an experienced successor and ensure a thorough handover and smooth

transition. The Chief Executive has also reviewed and agreed a new Executive Director structure with the Board of Directors‟ Nominations Committee. The new Executive Structure will see an additional Executive Director position introduced during 2012 and the formalisation of a Deputy Chief Executive role from within the existing structure.

The new Executive role sees the introduction of a Chief Operating Officer and a move away from the current Borough Management model. This role will focus on further improving our efficiency, will bring consistency to performance management and enhance our monitoring of delivery against our clinical and quality priorities. An additional director level position is also proposed. This position, Director of Integrated Care, is introduced to the structure in order to focus on the important relationships with Clinical Commissioning Groups (CCGs) and to drive forward opportunities to develop partnership working, integrated models of care and strategic alliances.

Service Line Management Structure

With regards to the service line management structure which we put in place during 2010/11, a further review of this structure is planned during 2012/13 with a view to reducing the number of service lines in response to changes such as improved and streamlined models of care, a move away from a borough management model and a reduction in the number of large sites from which we operate. The Trust will continue to support and develop the Associate Directors and Associate Clinical Directors who manage these operational services to further enhance their leadership skills through on-going programmes of added-value leadership development and talent management.

Corporate Structure and Functions

In preparing for the introduction of Payment by Results currencies we will need to undertake further corporate structure development in relation to service line reporting and review how a number of other corporate functions will report to the Chief Operating Officer.

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Page 19 of 22 Reviewing Board Effectiveness

C&I‟‟s Board of Directors invited the King‟s Fund to undertake a review of its board meetings during 2011/12. This involved attending board meetings and interviews with Executive and Non-Executive Directors. The feedback from this review was that the C&I Trust Board was a strong performing Board. This feedback will be considered as part of our annual Board self-assessment.

McKinsey & Company carried out a second stage APR during 2011 and commented that in relation to Board performance that C&I had a strong management team.

In relation to internal processes and review, In 2010/11, following consultation with the then Board of Governors, arrangements were put in place to evaluate the performance of the Chair and

Non-Executive Directors. The Chief Non-Executive carries out regular evaluation of the performance of the Executive Directors. The performance of Board committees is subject to annual review.

The overall approach that is followed between April and June each year includes:

 The collective performance of the Board is evaluated by each Board Member and the Board agrees a development plan for the year based on the outcome of this evaluation;

 The performance of the Chair is evaluated by self-assessment and each Board Member and the Council of Governors are asked to complete an evaluation questionnaire and rate the performance of the Chair against agreed criteria and performance objectives. This process is facilitated by the Senior Independent Director;

 The performance of each Non-Executive Director is evaluated by self-assessment and assessment by the Chair. This is further monitored by the Council of Governors' Nominations Committee;

 The appraisal of the performance of the Executive Directors is carried out by the Chief Executive who in turn is appraised by the Chair;

 Personal development plans and objectives are agreed for all Board Members and monitored during the year.

Our Commitment to Organisational Development and Quality Improvement

In recognition of the significant amount of service transformation that the Trust is undergoing, the Board has identified as one of its seven top priorities to undertake a programme of organisational development in order to support staff and retain a focus of quality. This will include support to individuals and teams in new roles and services as well as training and competency development to meet future developments such as Payment by Results. In order to take this forward and engage staff, service users and other stakeholders will be involved in a programme of re-defining our vision and values as we move forward. We will commission external expertise during the early part of 2012 to support this objective.

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Page 20 of 22 Other Strategic and Operational plans

G. The Trust’s other strategic and operational plans over the next three years:

Regard to the views of Trust Governors Integrated Care Pathways

Since October 2011, a multi-organisational partnership group in Camden has been working on the delivery of an integrated model of care for those with complex medical conditions defined as frail. The integrated model proposes an integrated health and social care process between primary, secondary and tertiary care and council services for 3000 frail Camden service users who are currently receiving care in a fragmented manner. The model proposes working with a new population of unidentified people with dementia and depressions where the undiagnosed mental illness is impacting on the management of their physical healthcare or medication management and therefore causing an increased use of acute trust emergency services, unplanned care and community services. This pilot is in progress and will be evaluated over the next two years. C&I will seek to build on this model for work in partnership to enhance and develop other integrated care pathways over the next 3 years with the Clinical Commissioning Groups.

C&I has proposed working with acute trusts to deliver a more integrated model of mental health care diagnosis and management in the acute hospitals, particularly focusing on the early diagnosis and management of people with dementia, depression and confusional states who currently occupy about 40% or more of acute beds in local hospitals. Early diagnosis and intervention will mean that 40% who would otherwise have gone into residential or nursing care will return home. Lengths of stay for these patients will decrease therefore reducing costs for the local health economy. Negotiations are progressing with all three local acute trusts. The evidence for these services has been evaluated through the London School of Economics in conjunction with Birmingham services with regards to the Rapid Assessment Interface and Discharge model (RAID).

Sustainability & Energy Efficiency

There are many drivers and benefits for the Trust in developing a Sustainability and Energy Efficiency Strategy that will contribute to C&I‟s overall QIPP scheme. This work will commence in 2012/13 with the strategic aim of providing a roadmap for increasing sustainability and reducing carbon impact across our sites over the next 5 years. This is included within our capital programme and estates strategy and we will use the expertise of external consultants to develop this strategy. In particular, this work will focus on procurement, food, waste disposal, energy consumption, transport, buildings and the natural environment. This work will be led by the Assistant Director for Estates and Facilities and monitored by a sub-committee of the Board, (Finance and Estates Committee).

Refreshing our partnership working with Social Care

The position of social work in mental health remains a strong and positive force with good relationships in place with our Local Authority partners. Plans are being drawn up to ensure that integration remains a central part of delivering high quality mental health services. The Trust

continues to be committed to delivering on the Local Authority delegated functions and to ensure that outcomes for service users are enhanced. A strategy to better support this with emphasis on the important role social workers have to play in leading on personalisation, safeguarding issues and mental health act work will be presented to board in September 2012.

The Trust is also exploring ways in which PbR and personalisation might be looked at in tandem and we will be holding a think tank to reflect and explore the value of this approach, seeking evidence from other areas where this has been piloted.

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Page 21 of 22 Growing our Membership

In 2012/13, we plan to refresh and refocus our Membership Strategy.

During 2011/12 the number of public and service user members has fallen slightly from 3182 to 3116. We work hard to recruit and retain our members, and have continued to work closely with 'Time to Change' throughout the year to reduce the stigma of mental ill health. We hosted their national Road show in June, engaging over 1500 local people, and celebrated World Mental Health Day at the O2 Centre in Finchley. We also held an event for carers in January 2011, in which we highlighted the Triangle of Care initiative to involve carers more in service user care. In April, we hosted a “Meet your Governors event” for members. We were successful in recruiting new members at all these events. Our Annual Members' Meeting, held at the Emirates Stadium in October, attracted almost 300

members. This allowed members to meet their governors, local carers' groups, support organisations and Trust staff.

We have started to refresh and refocus our membership strategy, which will see an increased focus on growing our membership and engagement during 2012-13. Additional resources have been allocated to focus on membership governance and the Council of Governors‟ Training, Development and Membership Subgroup will concentrate on implementing the membership strategy and

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Page 22 of 22

H. The Trust has had regard to the views of Trust Governors by:

The Trust reviewed its Annual Planning Cycle during 2011/12 and agreed its approach to involving Governors in the review and development of the annual plan at the Council of Governor meeting on 8th December 2011. It was agreed that a sub-group of the Council of Governors be established to work with the Associate Director for Strategy and Corporate Development to contribute to the development of the plans and feed in views on the top priorities of the Trust.

An information leaflet setting out the role of Governors in relation to the development of the Trust‟s forward plans was sent to all Governors. This emphasised the importance of Governors engaging with and representing the views of the members they represent.

Six Governors formed the sub-group including representation from service user, public, nominated and staff constituencies.

The sub-group met on two occasions and were given a briefing on the emerging top priorities of the Trust for 2012/13 and an explanation about C&I‟s annual planning cycle and how this was

implemented throughout all the services and linked to service line and team plans as well as national and local commissioning priorities and the NHS Operating Framework.

The sub-group planned a Governor and member engagement event to focus on hearing directly from members what they felt should be included in the annual plan. This event took place on Tuesday 17 April 2012 and the plans were further presented to a full Council of Governors meeting on 1st May 2012.

A further meeting was arranged for Governors on 9th May 2012 to meet with the Chief Executive in order to have further discussions and form a collective view as to what to recommend to the Board of Directors for inclusion in the annual plan.

Overall, the Council of Governors were supportive of the Board of Directors high level objectives and linked projects for the year ahead. They asked the Board to retain a focus on the following;

 Quality of care and engaging staff in quality development;

 Obtaining Service User feedback and making changes as a result of this;  Carer involvement and support;

Figure

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References

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