Derbyshire Community Health Services NHS Foundation Trust (DCHS FT)

Operational Plan for 2016/17

  1. Introduction

Derbyshire Community Health Services (DCHS) is strongly committed to the continuing provision of high quality and effective services that are increasingly delivered through a place based approach to innovative partnership working with all the relevant agencies that serve local communities. Through the delivery of its 15/16 operational plan DCHS has achieved its key Quality Service, People and Business targets and is in a strong position to continue to support the development of system wide transformation. This plan for 16/17 sets out the steps the organisation will take to both influence, lead and support the development of the Sustainability and Transformation Plans (STP) and underlying collaborative working, as well as the key delivery priorities which will underpin this.

Our approach continues to be underpinned by the DCHS Way which is based on the three key supporting strategies of Quality Service, Quality People and Quality Business and this plan is structured around thesekey sections . Throughout each of these we have identified our key organisational risks within our Board Assurance Framework (BAF), the key priorities of the board sub committees in response to these and for each committee the Big 3 priorities through which we seek to engage staff and measure our progress against them. Further detail is provided inappendix 1 and 2.

We know that our organisational success is very much dependent on engaging with our staff effectively, and indeed we have a track record of high engagement levels across our workforce. Therefore, in developing this plan the Trust has engaged withstaff, Governors and itsmembers to understand their views on the key development priorities for the organisation and where further work is required to improve the quality of our services and the experience for our staff and patients. This feedback identified the top 3 priorities as:

  • Developing innovative and responsive services which meet the needs of the communities they serve
  • Improving health and wellbeing so as to reduce the burden of ill health in later life
  • Making the best use of our facilities to ensure they are fit for purpose, support future service models and meet the needs of local people

Through a programme of ‘Our Clinical Vision’engagement sessions, staff have identified the implementation and promotion of Information technology and the delivery of our agile working and digitalisation strategy as key priority areasfor 16/17.

This feedback and associated actions, is shown in greater detail in Appendix 3 and 4,and will underpin the further development of this plan and the organisation’s overall priorities. These in turn will ensure that DCHS is well positioned to respond to the challenge of developing and maintaining its external relationships whilst maintaining the clinical and financial sustainability of its serviceswhich are built around the needs of local populations.

During 16/17 we will continue to hold these staff engagement events each month in different parts of the county to reach colleagues involved in on-going transformation programmes or periods of change in order to continue the meaningful dialogue we have started

  1. Context

DCHS will continue to seek to strengthen system integration through the leadership and development of effective patient pathways, collaborative working with all its key stakeholders and the management of complex patient flows with a wide variety of agencies. This involves critical interfaces with Primary Care, 9 acute organisations and key relationships with adult social care in both the county and city. As such, DCHS strives to be both the glue that keeps the system together and a public health organisation that seeks to promote improved health and wellbeing in all the communities it serves.

DCHS remains committed to the delivery of its strategic goals as set out in its Integrated Business Plan (IBP) which will be further refreshed for 2016. This will be based upon the board’s continuing commitment to:

  • A more inclusive approach to engaging our communities, building on models of integration of primary and community services with social care to co-create solutions to deliver better outcomes, improve health and address inequalities
  • Developing academic links to support leading edge service delivery, using innovation and driving best practice
  • Building on our success of engaging people and developing leadership to embrace a culture of high performance and service transformation
  • Embracing the use of technology and digital solutions to improve our practice, care and productivity
  • Defining our service and commercial aspirations to continue our journey of service integration and transformation

Through this we will refreshthe strategyto reflect the developments related to joined up working across our health and social care communities, the strategic shift of services, Primary Care developments and the continually challenging economic climate in which we operate. The delivery of this strategy will also be based on a strong commitment to excellence and to the development of DCHS as a teaching, learning, research and innovative organisation.

  1. DCHS – A Public Health Organisation – ‘Getting serious about prevention’

DCHS is committed to delivering the prevention agenda of the Five Year Forward View by embedding a population based approach to reduce inequalities in health. As a Community Provider across Derby, Derbyshire and Leicestershire, DCHS serves a population of around 1.9 milliondelivering 3500 patient contacts each day. Each contact represents an opportunity to ensure a holistic approach to care is provided, which not only considers the physical and mental health of the individual but also the wider determinantswhich contribute so significantly towards inequalities in health. By moving from a reactive towards a preventative approach, and by ensuring our treatment pathways and interventions are both cost and clinically effective DCHS can ensure that we achieve the greatest good for the greatest number of people with which we come into contact.

As such DCHS will aim to work across all the four key domains of public health:

•Healthcare public health

•Improving the wider determinants of health

•Health improvement

•Health protection

In order to do this we will continue to raise awareness amongst the workforce to ensure they adopt a public health approach to their practice. We will also aim to invest in IT infrastructures which allow staff to make efficient referrals at the earliest opportunity to a range of services including Integrated Wellbeing. The key aim will be to ensure that the most appropriate agency is contacted in order to meet the wider health and well-being needs of the individual, their family or their support network.

We will also seek every opportunity to promote ongoing dialogue with commissioners and partners to agree how service specifications and contracts could be shaped to compliment this new approach in the future.Details of the action plan to embed and deliver the public health agenda are detailed in Appendix 5.

  1. The Emerging Sustainability and Transformation Plan (STP)

DCHS is working at the forefront of transformation across the north and south of the county and within the Erewash Multi-specialty Community Provider (MCP) Vanguard. Each of these initiatives is underpinned by a place based approach to the design, commissioning and provision of integrated services through a multi-agency approach to new models of care. The development of a Derbyshire and Derby City STP will be based on the service models developed through this work. DCHS is fully committed to the development and delivery of the STP, with the Chief Executive and Director of Finance, providing executive strategic leadership, working in partnership across organisational boundaries and sectors. Senior managers and clinicians from the Trust are fully engaged and committed to this collaborative approach; providing specialist input and expertise across the STP footprint

This work has led to the development of a DCHS service model which supports an integrated service approach but which can be adapted to suit local requirements.This operational plan, shared with our provider organisations and commissioners,sets out the most locally critical milestones for DCHS to be able toaccelerate progress in 2016/17 towards achieving the triple aim as set out in the Forward View.

4.1 Joined Up Care

In the north a business case is being finalised which has been strongly supported by DCHS and for which it will have significant implications as care is increasingly delivered within the community rather than institutional settings. This will reflect key service changes in relation to elderly rehabilitation, Older Peoples Mental Health and Learning Disability care and will be subject to consultation across the summer of 2016.The detailed DCHS service and capital plans below reflect the delivery requirements of this plan.

In the south work is in hand to fulfil the commitments made to the public regarding the future development of Heanor Hospital and in preparation for the consultation around health and social care in Belper, which will have an impact on the future of services currently provided at Babington Hospital. This is based on the development of responsive integrated locality teams, support to the whole system review of relevant pathways, such as diabetes and musculoskeletal servicesand the further development of the community based services. This will includethe community services in Derby City, which DCHS has hadthe responsibility for providing since October 2015.

4.2 Erewash Vanguard

Within Erewash work continues to develop the Vanguard MCP approach for which DCHS is one of the partners. The MCP provides the opportunity for rapid transformation across partner organisations and the whole system with financial and practical support from NHS England. The MCP vision is for thriving communities within Erewash, where people feel confident and supported to choose a healthier lifestyle, stay well, and know how to get help and support when they need it. The mission is to develop these around neighbourhoods and geographical communities each of which may have differing requirements. Work is continuing to developcommunity resilience, self and shared decision making, and the development of an integrated primary and community care service. Success is dependent on developing a capable workforce, a robust information technology infrastructure and consolidating estate, whilst maintaining effective engagement with all residents and stakeholders. The learning from the MCP will continue to be shared across the health economy to inform future plans.

4.3 Right Care

DCHS are actively engaging with partners and commissioners to ensure alignment with local adoption of the RightCare programme. This will lead to the identification of key priorities across the county that will underpin both the STP as well as our own service plans. Initial discussions have identified thesepotential prioritiesas Diabetes, Musculoskeletal services (MSK), Chronic Obstructive Pulmonary Disease (COPD), Falls and Complex elderly care. Further work is in hand across the county to finalise these priorities, for each of which DCHS will be able to make a significant contribution

  1. Quality Services

5.1.Approach to Quality Improvement

The quality of services provided to our patients and local population are of utmost concern to the Trust and a focus on quality runs through all of our planning and business like a golden thread underpinned by the DCHS Way. In order to ensure we deliver high quality and sustainable services that echo the values and aspirations of the community we serve the Quality Service Committee has agreed the following Big 3key performance indicators for 2016/17:

Indicators for 2016/17 / Target
Patient Safety - Reducing the number of patients who incur grade 3 and 4 pressure damage / 20% reduction on 15/16 actual numbers for grade 3 and 4 pressure damage
Clinical Effectiveness - Assessing frailty in our over 75 years population by the introduction of a frailty screening tool – Prisma 7 / To assess 95%of patients 75 years and older using our services
Patient Experience - Improving the time to respond to complaints / 80% of complaint responses are sent within 40 days of receipt.

5.1.1 Organisational-wide improvement methodology and governance systems

Our quality improvement and assurance framework describes how as an organisation we will maintain and improve quality standards and drive a culture of continuous improvement.

This model is supported by:

  • Quality Always Programme for clinical assessment and accreditation, based on the fundamental standards of care.
  • Service line self-assessment against agreed performance indicators.
  • Unannounced peer review visits triangulated with performance data and staff information.
  • Board level quality visits or ‘Insight visits’ consisting of board members, Council of Governor representatives and local managers.

5.1.2Named Executive Lead

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

5.1.3Quality Priorities for 2016/17

The key 3 quality priorities for 2016/17 are:

Quality Improvement Targets
Priority Area / Target / 16/17 Actions
Patient safety - To reduce harm to patients through the delivery of high quality patient care / To improve our Patient safety thermometer performance to 95% achievement of patients receiving care with no harm / Implementation of reduction strategies for pressure ulcers and falls, supported by development plans and KPIs
Clinical effectiveness – To review our care pathways in a systematic manner to ensure they are being delivered in an evidence based manner in accordance with the latest national guidance /directives
To implement our clinical research strategy and through staff engagement establish a research culture across the organisation / To provide assurance that a systematic process is in place to continually review care pathways to ensure compliance with nationally agreed evidence based practice.
To establish 5 clinical research projects across the Trust / Through the clinical effectiveness group, to agree and implement systematic reviews of named care pathways to ensure delivery is both clinically and cost effective and in accordance with the evidence base.
Implementation of the newly approved Clinical Research Strategy through the Research Task and Finish Group
Develop workforce in research methodology to enable them to engage in local and national projects relevant to their area of specialism
Patient Experience –
We welcome all patient feedback which enables us to make quality improvements. Where patients’ experience is not positive we need to resolve their concern in a timely way. By reducing the response time to complaints we can prevent further escalation andimprovelearning. / To improve the timeliness and quality of our complaint responses / To improve the effectiveness and objectivity of complaint investigations and improve the response time to patients.

5.1.4 Commissioning for Quality and Innovation (CQUIN)

DCHS will continue to work with commissioners to deliver local and national CQUIN priorities throughout 2016-17. Nationally there will be a focus on staff health and wellbeing, looking at improvements in reducing work-related stress and increasing access to MSK services. Local CQUINs have been commissioned by NDCCG and it is proposed that they will support the roll-out of the Delirium pathway as part of the wider Frailty workstream, as well as further work to improve patient flow between Stockport FT and DCHS community services, and a proposal to provide dedicated Tissue Viability support into a number of identified care homes. DCHS will continue to work with commissioners in the north to finalise these. Commissioners in the south of the county have identified a Transformation Programme which will replace local CQUINs, with an aim to support the service change required across the local community as part of the wider Joined Up Care workstreams

5.1.5Quality Risks and Mitigation Plans

DCHS has no outstanding actions with regard to the CQC’s fundamentals of care. The Trust will receive a CQC inspection between 9th – 13th May 2016; to which the Trust will respond accordingly to further develop services for patients and staff.Prior to the transfer of Derby City Community Services to DCHS there were three CQC compliance actions attributable to Royal Derby Hospitals. Although these compliance actions are not transferable to DCHS the Trust continues to provide on-going support and development to address these through the DCHS governance processes and in detailed action plans monitored by the Operational and Quality Divisions, with oversight from the Quality Service Committee.

The organisation is faced with a period of significant change. System wide transformation plans are predicated on community services being able to lead the way in providing care closer to home. Clinical colleagues will be challenged to work in new more integrated teams where new systems of management and governance are yet to be tested. As systems change risks will be assessed and mitigated. Key risks, in relation to these transformation plans, are currently identified as:

Risk / Mitigation Plans
Staffing – having sufficient numbers of qualified and suitably experienced staff to be able to lead and manage the proposed system wide changes. /
  • System wide workforce plans linked into higher education establishments.
  • Ensuring that workforce commissions are aligned with service needs and changes.
  • Effective and continuous communication with staff on proposals.
  • Ensuring that DCHS is recognised as a good employer and an attractive place to work.
  • Programmes of clinical and managerial leadership.

Governance- developing new models of governance that embrace system wide change and integrated models of care whilst ensuring existing systems have robust assurance mechanisms. /
  • Development of Quality Always our clinical quality. assurance model of assessment and accreditation
  • Reference to our quality assurance and improvement framework.
  • Appropriate and thorough quality, equality and risk impact assessments.
  • Development of our staff in self-assessment and peer review.
  • Engagement with clinical reference groups comprising lead clinician from across the health and social care network.
  • Pan community working through Vanguard, Joined up care and STP to implement effective system wide governance systems to support new care models

Resources- having sufficient resource to meet the increasing demand on our services and ensuring that staff have time to examine the way in which they work and to adapt to new ways of working. /
  • Robust negotiation and contract agreement with commissioners.
  • Efficient and effective use of resources.
  • Continual focus on service improvement and transformation – working smarter.
  • Exploiting the benefits of information technology.
  • Adopting and adapting new ways of working.

5.1.6 Well-Led