DCHS Operational Plan 2017/18 – 2018/19

  1. Introduction & Strategic Approach

In November 2016, DCHS launched its new clinical strategy, which refreshes its established Integrated Business Plan (IBP) and reflects its position as an established Foundation Trust. This strategy reflects the significant strategic developments that have led to the formulation of theDerbyshire Sustainability and Transformation plan (STP), our continued close and effective relationships with our commissioners, partners and stakeholders; and with our staff and service users.

Our strategy isbuilt upon the foundation of high quality clinical care, as reflected in our recent Care Quality Commission (CQC) visit and the recognition of the outstanding level of caring delivered by our workforce. This will help to guide us on our on-going journey; from good to great and to maintain our category 1 status under the new NHSI regime. This Operational Plan details our approach to the delivery of the first 2 years of this strategy and has been written in accordance with NHSI planning guidance

Our clinical strategy follows the ‘Triple Aim’, developed by the Institute for Health Improvement (IHI) which will ensure that we work together, as an organisation and with our partners in the Derbyshire Health and Care Community to close the gaps and realise the Triple Aim vision of ‘simultaneously improving the health of the population, enhancing the experience and outcomes of the patient, and reducing the per capita cost of care for the benefit of communities. To ensure that, our plan willdeliver:

  • High quality services that our communities require now, defined around their needs and what is important to them.
  • Improvements to the health of our population and the resilience of our communities for the future.
  • A sustainable health and care system where our resources are used efficiently and responsibly, making the best use of the Derbyshire £

The financial climate within which the contract settlements, that underpin this plan, have been agreed has proved to be extremely challenging and this is reflected in section 6.3. This requires the Trust to deliver a stretched control total surplus of £5 million, and an efficiency programme of £9.8m (5.3%). This is well in excess of previous performance, and brings additional risk to the delivery of the financial plan.

The delivery of our plan will therefore require strong leadership to ensure that we are confident in our aspirations and create coherence across the organisation and wider system. We will need to work effectively with our partners in a shared environment to co-create solutions and manage out conflict whilst leading with courage and conviction. As such we understand the challenge ahead is great; but if effectively delivered the opportunities to transform care for the people of Derbyshire will more than justify the effort. To successfully address these challenges we will need to develop our leaders and our leadership behaviours; building upon the DCHS Way and the organisational models that underpin this.

  1. Strategic and Planning Context

The final version of the Derbyshire STP was submitted on the 21st October. The STP recognises the financial Challenges across the Derbyshire Health and Care system and is based upon the 5 priorities of:

This plan places significant emphasis on place based care and DCHS will work with its partners to develop the necessary services based on the investment available, which is reflected in section 4.3 below. We recognise that in delivering place based services our actions need to be universal, to address inequalities and improve outcomes, and to be delivered at a scale and with an intensity that is proportionate to the level of need.

2.1Better Care Closer to Home

We know that people do better mentally and physically if they can be cared for close to home by health and care staff based in the community. North Derbyshire and Hardwick Clinical Commissioning Groups launched the ‘Better Joined-Up Care Closer to Home’ consultation at the end of June. The proposals represent a collaborative approach to transforming care at a system level so that people can be supported in their own homes and communities more effectively.DCHS will work with other healthcare providers such as General Practice and Mental Health services to help implement the agreed outcomes. However no decisions about the proposals will be made until after an independent analysis, led by East Anglia University, has been concluded, and this plan reflects this position.

2.2Closer working with Derbyshire HealthCare Foundation Trust

DCHS and the Derbyshire Healthcare Foundation Trust (DHcFT) have been looking at the opportunities for closer working that would allow us to remove any organisational barriers to providing the very best clinical care for the benefit of the citizens of Derbyshire. On 27th October 2016 the Boards approved the Strategic Outline Case (SOC) that explored options for collaboration between the organisationsin response to a number of shared challenges outlined in the STP. The preferred option for both organisations has now been identified, which is for the two Trusts to pursue a merger through acquisition, with DCHS being the acquiring organisation.Work is now in hand to undertake a full business case to progress these proposals, with the outline business case to be completed by April 2017.

2.3Erewash Vanguard

DCHS continues to work with partners in Erewash to further develop the Vanguard Multispecialty Community Provider (MCP) model. All partners have committed to an Alliance contract to deliver the best outcomes for the people of Erewash and deliver care in a seamless way. The development of On-day services, for those patients who require an urgent appointment or same day access, will be a key priority within the vanguard and DCHS will continue to develop these throughout 2017 and 2018.

  1. Improving the health of the population

3.1Public Health Organisation

Prevention and Wellbeing are at the heart of the STP and DCHS is strongly committed to the delivery of a public health approach throughout the organisation. We have the potential to impact positively on the health and wellbeing of each person every time that we come into contact with them. If we do this well it will positively improve the health of our population in the future. Because the most effective way to spend public money is on preventing ill health or on identifying illness early, we want to ensure that all opportunities are taken by adopting a systematic population-based approach to improving health which will include our work to support the development of Wellness Hubs, within the context of the STP. This will be a new way of working for many of us, through which we will pursue the objectivesdetailed in Table 1

Table 1

Public Health Areas / Actions
Healthcare public health / Educate staff about maximising the use of finite commissioning resources and encourage conscious decision making from the ground up for best use of resources.
Delivery of clinical and cost effective care by reviewing and applying evidence based pathways of care and minimising variation in service delivery
Improving the wider determinants of health / Development of preventative approach to care, educating the wider workforce on what the wider determinants of public health are, the impact these can have on population health, and how adopting approaches such as Making Every Contact Count (MECC) across the organisation can improve outcomes for patients.
Health Improvement / Promote ‘brief intervention’ approaches ensuring staff are confident to take a holistic approach when discussing with the patient their health needs
Support staff wellbeing based on the findings of the staff health needs assessment (January 2017)
Health protection / Improving the vaccination and immunisation uptake rates
Refresh the Emergency Preparedness plan to reflect the potential merger with Derbyshire Healthcare Foundation Trust.
Ensure future flu campaigns meet the needs of our increasingly agile workforce

3.2 Supporting Research, Innovation and Growth

The DCHS Research and Innovation Group will ensure that research expertise within the Trust is used to support services to deliver improved outcomes for their patients and to develop research competencies in front line services. We will develop strategic partnerships with research networks, universities and other NHS providers to increase our research credibility and to ensure we are better positioned to undertake research studies generated nationally by academic or commercial organisations and by our own staff. We will engage our service users so that they can choose to be part of the development of the evidence base and have access to the latest emerging treatment. Through these steps DCHS will contribute to the development of clinically effective practice.

  1. Improving the experience of care - Quality and Satisfaction

4.1Approach to Quality Governance

4.1.1Named Executive Lead

Executive leadership is provided by Carolyn White, Chief Nurse and Director of Quality, in partnership with Rick Meredith, Medical Director

4.1.2From Good to Great – Our approach to achieving our ambition.

As a trust we are committed to our journey from ‘good to great’ and it is with this in mind that we will be using the output of our recent Care Quality Commission (CQC) inspection reported in August this year to identify and plan actions that will build on our overall ‘Good’ rating. DCHS has developed a comprehensive quality improvement and assurance framework over the last three years which has facilitated year on year improvements in the quality of our services and the underpinning governance arrangements.

Quality improvement is central to all that we do, with our patients being at the centre of all of our decisions. Through our Quality Always programme we have three components that we see as fundamental to continuous improvement:

  • Clinical standards across 13 domains which teams self-assess themselves against and which are peer reviewed on a regular basis, driving improvement towards overall accreditation as a Quality Always Gold accredited team.
  • Clinical leadership is supported through a bespoke personalised development assessment centre to equip our clinical leaders with the skills to transform and improve services
  • Clinical standards improvement is supported through the auspices of Safe Care Champions – individuals who are selected and trained to ensure that best practice is consistently delivered.

Our quality plans have been developed to ensure we deliver high quality person centred care and that we ensure that our staff are able to deliver services that meet the standards defined in the NHS Constitution and the CQC.To help us on our journey we will work to ensure that our Quality Always programme assessments are aligned to the expectations and standards of the CQC so that our ‘Gold’ accreditation corresponds to the ‘Outstanding’ measure.

4.1.3Patient Safety

DCHS is actively engaged with the national ‘Sign Up To Safety’ Campaign. We remain committed to the reduction of harm to patients through the continued delivery of high quality care and to ensure that 95% of patients receive care with no avoidable harm. To deliver this we will continue to implement our targeted reduction strategies such as those for pressure ulcers and the targeted interventions of our Safe Care Champions. Where serious harm does occur we will ensure that the Duty of Candour is exercised and that patients or their advocates are informed of any lessons learned.Our current patient safety objectives have been developed internally through the priorities and performance objectives identified through our Quality Service Committee.

4.1.4Measures being used to demonstrate and evidence the impact of investment in quality improvement

Our Quality Always programme is led by the Chief Nurse and overseen by a programme management approach. Key performance indicators for the programme have been developed and are reviewed regularly. In addition the programme is supported by our research team who are undertaking its formal evaluation and the benefits this has realised.

In addition the trust has developed an interactive real time clinical dashboard for clinical managers to assess and monitor their own performance and compare and contrast this with similar trust services.

4.2Quality Improvement Plan

Table 2

Initiative / Quality Improvement Plans
National clinical audits / The trust participates in those national audits relevant to our services which currently include: sentinel stroke, national audit of diabetic foot care, national audit of dementia, learning disability mortality and the review of Young People’s Mental Health study
The 4 priority standards for seven-day hospital services / DCHS is working with the wider health and social care community on STP plans to ensure care is delivered as close to home as possible and is provided equitably over 7 days in accordance with these standards
Safe staffing / DCHS will be reviewing its safe staffing requirements in line with STP place based care proposals going forwards
Improving the quality of mortality review and Serious Incident Investigation and subsequent learning and action / All unexpected deaths are peer reviewed and all serious incidents undergo root cause analysis. We will be reviewing our processes for sharing learning going forward. Our End of Life Strategy, to be launched early in 2017 details our robust audit and assurance process. We will respond to the recommendations and actions as detailed in the CQC review into Learning, Candour and Accountability (December 2016) to ensure we deliver good practice across all areas.
Anti-microbial resistance / All inpatient antimicrobial prescribing is audited and reported through our infection prevention and control group. In the coming year we will be strengthening our systems for monitoring prescribing in the wider community
Infection prevention and control / DCHS has a strong track record for good infection prevention and control. We will continue to monitor this through regular IPC audit
Falls / Our falls working group will continue to work towards reducing falls in hospital and in patients own homes and have set clear objectives to achieve this
Sepsis / Sepsis education forms a key part of our staff training programme as part of our recognising the deteriorating patient. This will continue to be delivered and its impact monitored
Pressure ulcers / Pressure ulcers remain our single greatest challenge and DCHS have set an ambitious 20% reduction target this year which will be achieved through greater focus on:
  • Exploiting technological support solutions
  • Improved clinical care through greater staff awareness and training
  • Patient/carer engagement

End of Life Care / Our end of life governance group reviews ensures robust audit of end of life care and we continue to implement changes from the new Derbyshire end of Life Care pathway. We will launch our new End of Life strategy in 2017 and work to implement this across the organisation and in our work with our partners.
Patient experience / We will continue to engage with and learn from our patients and carers through our network of patient engagement. As we work to deliver more services in and close to home we recognise the importance of the development of social capital and person centred goals in improving the experience of care and wellbeing and avoiding social isolation. Our commitment to driving improvements is reflected in our complaints management process, by improving the timeliness and quality of our responses and ensuring that we share and act on our learning.
National CQUINS / Through the implementation of our operational plan we will deliver our CQUIN targets across the following key areas: Improving Staff Health and Wellbeing, Supporting proactive and safe discharge, Preventing ill health by high risk behaviour e.g. in relation to alcohol and tobacco, Improving assessment of wounds and Personalised care and support planning
The delivery and monitoring of the actions associated with the delivery of these will be included through the on-going development and governance of our delivery plan (appendix 1)

The Trust’s measure of compliance against these standards will be monitored through the Quality Schedule which will be reported to the Quality and Performance group of the STP

4.2.1QualityPlanning – creation, assessment, governance and monitoring

Schemes for service and cost improvements are developed at an operational level and assessed for feasibility by the Executive led Plan Delivery Group. Each project plan includes a quality impact assessment (QIA), equality impact assessment, risk assessment and financial profile. Schemes deemed viable by the Plan Delivery Group are independently assessed for its potential impact on quality by a panel consisting of the Chief Nurse, Medical Director and a Non-executive Director. The process is facilitated by the Programme Management Office which also provides progress reports to the Plan Delivery Group and Quality Business Committee of the Board. Our Governance process was developed using Birmingham Children’s hospital framework illustrated as best practice in the NQB Quality Impact Assess provider Cost Improvement plan Guidance 2013. It can be summarised as follows: