PART 1 – FORMAL MEETING IN PUBLIC...Jayne Moore Virginia Peneche Deb Riozzie Paul Smith Paul Taylor Maria Tyson Veronica Webster Chairman (Meeting Chair) (Left meeting for Item D1)

Page 1

AGENDA FOR Council of Governors Meeting

Date: Thursday, 25 April 2019 Time: 3.30pm – 5.30pm

Venue: Quaker Meeting House, 22 School Lane, Liverpool, L1 3BT

NOTE: There will be a pre-meet for Governors at 2.30 pm

No. Item Lead Details Timings

PART 1 – FORMAL MEETING IN PUBLIC

A Council Business

A1 Welcome B Fraenkel Verbal to note 3.30pm

A2 Apologies – Governors: Apologies – Attendees:

B Fraenkel Verbal to note

A3 Declarations of Interest B Fraenkel Verbal to note

A4 Minutes of the Previous Meeting: 17 January 2019 Minutes & Action Log

B Fraenkel Paper for decision

A5 Fraud Update N Smith Verbal to note

A6 Update from the Chairman B Fraenkel Verbal to note 3.40pm

A7 Update from the Chief Executive J Rafferty Verbal to note 3.45pm

B Our Services

B1 CQC Inspection of Mersey Care T Bennett

Verbal to note 4.00pm

B2 Performance Report N Smith / NED Paper for assurance 4.15pm

B3 Specialist Learning Disabilities Division Retraction Plan Update

P Williams / S Wrathall

Paper for assurance

4.30pm

B4 Update on Community Services Improvement Programme and Oversight Arrangements

M Freeman / T Bennett

Paper for assurance 4.40pm

B5 Draft Quality Account – to follow J Hurst paper for decision 4.50pm

C Our Future

C1 PROSPECT – New Care Model Update L Edwards Paper for assurance 5.05pm

D Governance

D1 Council of Governors - Governance Update S Jennings Paper for decision 5.15pm

D2 Chairman and Non-Executive Director Appraisal Process

S Jennings Paper for decision 5.20pm

E Information Items

Page 2

E1 Final 2019/20 Strategy and Operational Plan L Edwards Paper for information -

E2 Staff Survey Results A Oates Paper for information

G Any Other Business

G1 Any Other Business Governors Verbal 5.25pm

Dates of future meetings: Friday 2 August 2019 4pm-6pm – (venue to be confirmed)

Thursday 17 October 2019 4pm-6pm – (venue to be confirmed)

Agenda Item No: A4

Page 1 of 19

C Status of these minutes (check one box):

Report to:

Council of Governors Draft for Approval: ☒

Formally Approved: ☐ Meeting Date: 25 April 2019

MINUTES OF THE MEETING OF THE

Council of Governors Date: Thursday 17 January 2019 Time: 3:30pm-5:45pm

Venue: Park Hotel, The Aintree Suite, Dunningsbridge Road, Netherton L30 6YN

Name Job Title (Division/ Organisation*) *if not Mersey Care

Present: Beatrice Fraenkel Sayed Ahmed Clare Austin Cheryl Barber Johanna Birrell Matthew Copple Tracey Cummins Julie Dickinson Debra Doherty Mike Jones Vicky Keeley Mark McCarthy Susan Martin Jayne Moore Virginia Peneche Deb Riozzie Paul Smith Paul Taylor Maria Tyson Veronica Webster

Chairman (Meeting Chair) (Left meeting for Item D1) Staff, Medical Appointed, University Staff, Nursing Service Users & Carers Service User & Carers Staff, Nursing Service Users & Carers Service Users & Carers (Item A1 to Item D3) Staff, Non Clinical (Item A1 to Item B5) Appointed, Local Voluntary Service Users & Carers Public, Liverpool, Sefton and Knowsley Public, Liverpool, Sefton and Knowsley Staff, Other Clinical and Clinical Support Staff Service Users & Carers Public, Liverpool, Sefton and Knowsley Service Users & Carers (Chaired the meeting for Item D1) Staff, Nursing Appointed, Local Authority

In Attendance: Aislinn O’Dwyer Nick Williams Gerry O’Keeffe Joe Rafferty Trish Bennett Louise Edwards David Fearnley Neil Smith Jenny Hurst Helen Bennett Andy Meadows Sarah Jennings Paula Murphy Alison Bacon

Non-Executive Director Non-Executive Director (Left meeting for Items D1 and D2) Non-Executive Director (Item D1 only - joined the meeting by phone); Chief Executive (Item B1 to Item C1) Executive Director of Nursing & Operations Director of Strategy Medical Director (Item A1 to Item C1) Executive Director of Finance / Deputy Chief Executive Deputy Director of Nursing (Item B5 only) Deputy Director of Strategic Planning and Intelligence (Item C1 only) Trust Secretary Deputy Trust Secretary Corporate Governance Compliance Manager Membership & Engagement Manager

Apologies Received: Paul Allen Helen Casstles Sarah Finlayson

Staff, Other Clinical and Clinical Support; Public, Liverpool, Sefton and Knowsley Staff, Other Clinical and Clinical Support Staff;

Agenda Item No: A4

Page 2 of 19

Mandi Gregory Martin Murphy Garrick Prayogg Mary Sutton Alex Till

Appointed, Unions and Other Staff Representative Bodies; Service Users & Carers; Public, Rest of England and Wales; Public, Liverpool, Sefton and Knowsley; Public, Rest of England;

ISSUES CONSIDERED 2019

A1 WELCOME

1. Mrs Fraenkel welcomed all Governors to this meeting and introductions were made around the table.

A2 APOLOGIES

2. The apologies for absence received for the meeting were noted, as detailed above.

A3 DECLARATIONS OF INTEREST

3. There were no interests declared.

A4 MINUTES OF THE PREVIOUS MEETINGS HELD ON 18 OCTOBER 2018 (including Action Log)

4. The minutes of the meeting held on 18 October 2018 were accepted as an accurate record.

5. In response to a request from Mrs Moore, Mr N Smith provided an update in relation to the fraud incident previously reported to the Council of Governors at their October 2018 meeting. Mr N Smith confirmed that the Trust continued to work with the NHS Counter Fraud Agency, noting that this had been a wide and complex fraud with several individuals and organisations involved. Arrests had been made, however as investigations are still on-going it makes it difficult to comment in more detail at this time. Mr N Smith confirmed that a further update would be provided to the Council of Governors in due course.

6. Mr McCarthy queried the Trust’s processes and what improvements had been made to mitigate such an incident going forward. Mr N Smith advised Governors of a report provided to the Audit Committee providing assurance of the actions and safeguards put into place and agreed to provide a further update report to the April 2019 Council of Governors meeting.

7. In response to a question from Mr Copple, Mr N Smith confirmed that the investigation was holistic, including suppliers and the banking sector.

8. Mr Taylor referred to point 24 of the previous minutes in relation to the potential to seek greater financial cover from alternative insurers going forward. Mr N Smith confirmed that the Trust was considering the existing arrangements and any decisions in relation to this would be provided in the update reports going forward.

Agenda Item No: A4

Page 3 of 19

9. In response to a request from Mrs Moore, Miss Jennings confirmed that the presentation from the development session for Governors held on 12 December 2018 in relation to the operational plan/strategic priorities would be shared with all Governors via email.

10. Miss Jennings confirmed that in relation to the Action Log item in respect of Specialist Learning Disabilities Retraction (B2 from the October 2018 meeting), an audit was underway, led by NHS England and this would be discussed further under the Retraction Plan update on today’s agenda (item B3).

11.

Action Lead Timescale Status

Recommendations approved by the Council of Governors, namely: • Approve minutes from 12 September 2018.

Further actions required: • In respect of the Fraud, an update to be provided to

Governors at their next meeting which (i) provides an update on the investigation and the recovery if any monies, (ii) identifies if the trust has able to obtain additional insurance

• Circulate presentations from the 12 Dec-18 Governor Development Session around the Operational Plan/Strategic Priorities;

N Smith S Jennings

Apr-19 Jan-19

On Apr-19 CoGs Agenda By end Jan-19

A6 UPDATE FROM THE CHAIRMAN

12. Mrs Fraenkel highlighted the following:

a) on 30 April there will be 9 vacant seats on the Council of Governors as 8 Governors will conclude their terms of office, plus there was one existing vacant seat in the public constituency (Ribble Valley). The election process had now commenced and Miss Jennings would provide a full update under item D3;

b) the new Life Rooms in Bootle opened last week which had been developed as a joint project with Hugh Baird College. Two open days were held which were extremely well received. Mrs Fraenkel confirmed that location details will be circulated to Governors to enable visits. There has rightly been a lot of focus on prevention of ill health, both mental and physical, and the Government has highlighted the need for social prescribing. The Life Rooms in Bootle is perhaps the most ground-breaking of all the Life Rooms so far in that it will help young people and the students at Hugh Baird College. This will provide young people with real help to achieve emotional stability at a crucial time in their lives.

13.


Recommendations approved by the Council of Governors, namely: • Note the verbal update.

Further actions required: • Circulate details/location of Life Rooms, Bootle;

S Jennings

Jan-19

By end Jan-19

Agenda Item No: A4

Page 4 of 19

A7 UPDATE FROM THE CHIEF EXECUTIVE

NHS Long Term Plan

14. Mr Rafferty advised Governors of the NHS Long Term Plan published by NHS England following the announcement in June 2018 of circa £20 billion annual real terms uplift for the NHS by 2023/24 (available at https://www.longtermplan.nhs.uk/). The plan covers a ten year period and set out ambitions for ensuring the NHS if fit for the future, as follows: a) a new service model for the 21 century - based on guaranteed growth in

investment in primary medical and community services over the next five years, which will grow faster than the overall NHS budget, creating a protected fund of an additional £4.5 billion (as a minimum) a year in real terms by 2023/24;

b) more NHS action on presentation and health inequalities - in order to address the growing demand for health care attribute to a growing and ageing population. The Plan aims to focus on the top five causes of premature death in England (smoking, obesity, alcohol, air pollution, antimicrobial resistance

c) further progress on care quality and outcomes to enable better measurement of outcomes in both physical and mental health

d) improved backing for NHS Staff; e) mainstreaming of digitally enabled care across the NHS; f) effective use of taxpayers’ investment.

15. Following Mr Rafferty’s comments regarding increased morbidity, Mrs Doherty queried

if this was a result of lifestyle choices. Mr Rafferty confirmed that there was a correlation between austerity and health and poverty was a major driver. The financial cost of treating any condition was increased, along with mortality, when an individual also had a mental health illness. Care Quality Commission (CQC) calls for change in safety culture

16. Mr Rafferty informed Governors that the CQC have published a national report, Opening the Door to Change1, which examined the issues that contribute to the occurrence of never events and wider patient safety incidents in NHS trusts in England. The review was based on evidence gathered by inspectors during visits to 18 NHS trusts and via discussions with frontline staff, patients and experts from other safety critical industries.

17. Based on these findings, the CQC was calling on the NHS and its partners to promote a change in safety culture across the NHS; ensuring safety is given the priority it deserves. Mr Rafferty highlighted that the work undertaken by the Trust in respect of no force first and reducing restrictive practice were already well established in relation to this and demonstrating a positive impact.

1 Available on the CQC’s website by clicking here.

https://www.longtermplan.nhs.uk/

https://www.cqc.org.uk/publications/themed-work/opening-door-change

Agenda Item No: A4

Page 5 of 19

Care Quality Commission (CQC) Review in Restrictive Practice

18. Mr Rafferty stated that the CQC have also been commissioned by the Secretary of

State for Health and Social Care to review the use of restraint, prolonged seclusion and segregation in settings that provide care for people with mental health problems, a learning disability and/or autism. The review was set to examine the range of factors that lead to people being subject to restrictive interventions and assess the extent to which service follow best practice in minimising the need to use force. A report detailing interim findings will be published in May 2019 with a full report by March 2020.

19. Mr McCarthy referred to the additional funding announced by NHS England in 2018 and referred to in the NHS Long Term Plan and queried whether such funding would enable the provision of extra inpatient beds. In response, Mr Rafferty advised that the funding would be utilised to improve patient flow including crisis care services and reductions in delayed transfer of care, however the initial focus must be on moving people through the care system appropriately. Mr McCarthy noted the importance for service users being assured that there were inpatient facilities available when they were in crisis. Mr Rafferty concurred, adding that currently, there were occasions in which patients occupied beds due to lack of accommodation and it was vital to improve the flow.

20. Mrs Birrell referred to the Trust being a Global Digital Exemplar and the importance of

ensuring that digital services/communication facilities did not fail. Mr Rafferty assured Governors that the Trust had procured a new system following a robust options appraisal and had approved a technology upgrade to support use of this system. Mr Rafferty agreed to circulate the report outlining this technology upgrade with Governors, thanking Mrs Birrell for raising this issue.

21.



Further actions required: • Circulate paper in relation to technical upgrade to

Governors for information;

S Jennings

Feb-19

By end Feb-19

B1 CARE QUALITY COMMISSION (CQC) INSPECTION UPDATE

a) Update on Inspection of Core Services

22. Mrs T Bennett provided an update to Governors on the recent CQC Inspection which took place from 18 October, when visits to services commenced, and ended on 20 December with the CQC undertaking the Well-led component. The CQC had inspected 60 services in total, 40 of which were in the community. Initial feedback was largely positive although areas for improvement were identified. The Trust is

Agenda Item No: A4

Page 6 of 19

expecting the draft report, for factual accuracy checking, around15-20 February 2019 prior to the publication of the final report, anticipated at the end of March / beginning of April 2019.

23. Mrs T Bennett added that feedback noted that staff had been positive in terms of their manner, care and professionalism during the inspection

24.



Further actions required: • None identified.

b) HMP Liverpool Inspection Report

25. Mrs T Bennett updated Governors in relation to the report of the CQC Inspection of HMP Liverpool undertaken between 9 October 2018 and 12 October 2018, which had been circulated to Governors. Although the CQC do not rate any of their reports in respect of prisons, the inspection found: a) effective systems in place in relation to incidents and learning from adverse

events; b) a comprehensive programme of quality improvement activity; c) that most of the time, prisoners were involved in their care and were treated with

compassion, kindness, dignity and respect; d) that prisoners could access care and treatment within an appropriate timescale;

and e) a strong focus on continuous learning and improvement at all levels of the Trust.

26. According to the CQC, areas where the Trust should make improvements were

identified as follows: a) staff should consider involving prisoners in their Care Programme Approach (CPA)

review and the criteria / decision making for placing a prisoner on a CPA or non-CPA should be clarified;

b) staff from the Trust should continue to formally gather feedback from people who use the service and partner healthcare agencies; and

c) the Trust should work with partners to ensure that all concerns are recorded and to improve the consistency of complaint responses.

27. Mrs T Bennett confirmed this had been a very positive report just 6 months after the Trust had commenced providing mental health services at HMP Liverpool

28. In response to Mr P Smith, Mrs T Bennett confirmed that the positive report had lifted and motivated staff who had remained positive whilst undertaking a very difficult job. Mr P Smith welcomed the excellent report.

29. Following a question from Mrs Webster in relation to the condition of the building and the importance of this, Mr Williams referred to his recent visit to the service (November

Agenda Item No: A4

Page 7 of 19

2018) and confirmed that staff’s pride in supporting prisoners in terms of their wellbeing was evident, adding that the environment was incredibly clean and tidy. The age of the building was an issue; however the quality and cleanliness of the building along with recent improvements were significant. Mrs O’Dwyer concurred and also referred to a recent service visit undertaken (November 2018), noting the recent refurbishment of 2 wings, and that the Trust were looking to improve the fabric of the building and staff were working hard to ensure a better environment.

30. Mrs Fraenkel highlighted her visit to HMP Liverpool and acknowledged Mrs Webster’s

comments in respect of the prison environment, confirming that issues around the building had been discussed by the Board of Directors at the time the Trust were considering the proposed contract. The Board had agreed that the improvements to be made by Mersey Care must supported by the physical environment to ensure these would be effective. Mrs Fraenkel welcomed the outstanding report, highlighting the short timescale in which these significant improvements had been achieved, adding that the Board would welcome Governors seeing regular updates (twice yearly) with regard to progress and confirming that the Board of Directors would continue to monitor the service going forward.

31. Mrs T Bennett confirmed that although this first report was positive, the Trust were not

complacent and work would continue in line with the improvement plan, adding that it was important to ensure recognition of the staff who had facilitated many improvements. Mrs T Bennett noted staff had reported that this was the first time they had felt part of an organisation.

32. Mrs Edwards noted the importance of the Executive Performance Report and the

measures of the prison service, to ensure continued oversight.

33. Mrs Moore offered congratulations to the team for all their hard work, and welcomed the fantastic achievement.

34.


Recommendations approved by the Council of Governors, namely: • Note the Care Quality Commission Report;

Further actions required: • HMP Liverpool twice yearly update reports to be

provided to Council of Governor meetings.

T Bennett

Jul-19 and on-going

On Jul-19 CoG Agenda and 6 monthly thereafter

B2 TRUST PERFORMANCE REPORT

35. Mr Williams provided a summary of Trust performance to 30 November 2018 against regulatory and operational plan key performance metrics, highlighting the following:

Agenda Item No: A4

Page 8 of 19

• Care Quality Commission (CQC) – as previously reported, in 2017 the Trust achieved an overall rating by the CQC of Good with a Requires Improvement for the Safe Domain. The Well Led Review took place as planned and core service inspections were completed by the CQC prior to this review. A draft report was expected in February 2019 which would provide feedback on both the Well-Led Review and inspections;

• Single Oversight Framework – The Trust performance within the Single Oversight Framework was ‘segment 2’ (targeted support) and the Finance and Use of Resources score was 2 (low risk). This was a deterioration when compared with October 2018 due to the Income and Expenditure Margin: Distance from Plan not being on target in November 2018. A total of 66.67% of metrics (42) within the Single Oversight Framework have been achieved. This is an improvement compared with October 2018. Mr Williams clarified that annual metrics did not change until outcomes of the next annual review were provided.

• Operational Plan 2018/19 o Our Services – 57% of the Operational Plan Metrics (23) had been achieved; o Our People – 33% of the Operational Plan Metrics (15) had been achieved; o Our Resources – 50% of the Operational Plan Metrics (4) had been

achieved; o Transformation Programme 2018/19 – 63% of the Transformation

Programme Metrics (24) had been achieved. The metric which had moved from Green to Red in November 2018 was: % of Incidents that result in harm – Local Division;

36. Mr Williams stated that it was notable that integration was important to the Trust and work continued to ensure that clients were settling in to accommodation and employment.

37. Mr McCarthy referred to page 5 of the report, querying the red ratings. Mr N Smith confirmed that the narrative provided in the report identified these red ratings (from page 8 onwards), detailing the target for each metric and the percentage achieved.

38. Mr Taylor referred to page 9 of the report in relation to staff sickness levels and the Trust working with Edge Hill University, querying when these results will be available. Mrs T Bennett confirmed that results were anticipated in March 219 and details of the outcomes would be reported to the April 2019 Council of Governors.

39. In response to Mr McCarthy’s question around the proportion of service users in

employment, Mr Rafferty confirmed that conversations had taken place with the Metro Mayor’s office to drive improvement and a meeting was being sought, confirming an update on this would be provided to the April 2019 meeting.

40. In response to Mrs Doherty’s question around how the Trust tried to improve the

number of service users in employment, Mr Rafferty confirmed that the Life Rooms provided employment opportunities and progress was evident in that area, however

Agenda Item No: A4

Page 9 of 19

there was a natural limit on what the Trust could achieve as improvement required a more integrated approach with partners.

41. Following discussion, Mrs Fraenkel requested a report be provided to both the Council

of Governors and the Board of Directors with regard the impact of the Life Rooms.

42. Mrs Austin requested that future reports provide numbers alongside percentages where targets were missed, to ensure clarity on the scale of the issue.

43. Mrs Doherty raised a concern around the limited time available for questions from

Governors. Mrs Fraenkel acknowledged these concerns, stating that the meeting had a tight schedule and some attendees/Governors had other commitments following this meeting and balancing these obligations was important. Miss Jennings acknowledged that today’s agenda was particularly lengthy and as requested, attempts had been made to keep the meeting to the agreed 2 hour duration where possible. Mrs Fraenkel reiterated that Governors were welcome to raise any concerns or questions at any time via Sarah Jennings rather than to wait for the next formal meeting.

44. Mr Taylor referred to the extensive discussions held in the Governor pre-meet and

confirmed that the issues and ideas raised in this meeting would be discussed with Miss Jennings outside of the meeting.

45.


Recommendations approved by the Council of Governors, namely: • Note the assessment of performance against

Regulatory and Operational Plan targets. • Note that Performance Improvement Plans have

been presented to the quarterly review meetings to provide assurance that improvement plans are in place for areas of underperformance.

Further actions required: • Outcomes of work with Edge Hill University (Staff

sickness) to be included in next report;

• Update regarding employment/discussions with Metro Mayor to be provided to next meeting via CEO update;

• Future reports to provide numbers alongside percentages where targets were missed;

• Meet to discuss issues/ideas raised in Governor pre-meet;

T Bennett/ A Patel J Rafferty A Patel P Taylor / S Jennings

Apr-19 Apr-19 Apr-19 Jan-19

On Apr-19 CoGs Agenda On Apr-19 CoGs Agenda

Future reports from Apr-19 Completed

B3 SPECIALIST LEARNING DISABILITIES DIVISION RETRACTION PLAN UPDATE

46. Mrs Wrathall provided an update on the transformation programme progress for the Specialist Learning Disability Division, highlighting the following:

Agenda Item No: A4

Page 10 of 19

a) there were currently 103 (25 female and 78 male) resident service users on the Whalley site, of whom 26 service users were actively in the transfer / discharge process and were anticipated to transfer by the end of March 2019;

b) the focus remained on discharging all 16 stepdown and Enhanced Support Service (ESS) patients and reducing the number of male low secure patients to 20, which was line with future commissioning arrangements;

c) 11 service users had transferred to The Spinney in Manchester, a service provided by Elysium Healthcare Limited, as part of the Legacy project;

d) that the West Drive Low Secure Unit was decommissioned at the beginning of November 2018; and that

e) the Autistic Spectrum Disorder Group, with NHS England and Cheshire & Wirral Partnership NHS Foundation Trust (CWP), continues to meet to agree the clinical model and transition process for the transfer of autistic forensic patients to a service provided by CWP.

47. Mrs Wrathall also referred to staffing, noting the improved position, adding that work

continued to support teams to make appropriate appointments.

48. Following the Council of Governors’ request for an assurance report subsequent to the relocation of patients from Whalley, Mrs Wrathall confirmed that NHS England had been approached several times in respect of the outcomes of their Quality of Life review, however this had not been made available to the Trust. Mrs Wrathall assured Governors that this would be further pursued and made available to Governors as soon as it was received. Mr Rafferty proposed to write to Sir Simon Stevens seeking a response on behalf of the Council of Governors. Governors agreed unanimously to this course of action. Mrs Wrathall confirmed that if a response from her recent request was not received within two weeks, a letter would be sent from Mr Rafferty on behalf of the Governors.

49. Mrs Keeley queried the support offered to service users at the Life Rooms. Mrs Fraenkel requested that this question was referred to Sarah Jennings outside of the meeting (via email) as this did not relate to the retraction of the Whalley Site. Mrs Keeley agreed to contact Miss Jennings directly.

50. In response to Mrs Birrell, Mrs Wrathall confirmed that the services at Whalley expected to continue to receive admissions. Mrs Wrathall advised Governors that NHS England would continue to commission these services in the future, however the Whalley site would close and services would be relocated as NHS England is not prepared to commission services on the Whalley site in future. Mrs Birrell queried where the current service users at Whalley would be relocated to. Mrs Wrathall clarified that the individuals continue with their treatment in line with their individual care plans and would be discharged appropriately, noting that some will be replaced by other service users within the timeframe, however the service continued to be offered.

Agenda Item No: A4

Page 11 of 19

51.


Recommendations approved by the Council of Governors, namely: • To note progress to date • To note the content of the report

Further actions required: • Should no response be received within two weeks

from today’s date from NHS England with regard to the Quality of Care issues raised previously, Mr Rafferty to write to Sir Simon Stevens, NHS England, at the Council of Governors request seeking the outcomes of the Quality of Care review undertaken;

• Question around support offered to service users at the Life Rooms to be raised with Miss Jennings outside of the meeting;

S Wrathall / J Rafferty V Keeley

By 31 Jan-19 By end Feb-19

By 31 Jan-19 By end Feb-19

B4 UPDATE ON COMMUNITY SERVICES IMPROVEMENT PROGRAMME

52. Mrs O’Dwyer provided an update regarding the programme which was established in April 2018 to address a wide range of quality issues, including those identified in the Kirkup Review, associated with the provision of physical community services in Liverpool and South Sefton. Mrs O’Dwyer noted that the key objective of the programme was to enable achievement of a rating of ‘Good’ by the Care Quality Commission after an initial period of 12 months (i.e. any date after 1 April 2019 for community services).

53. The Transition Sub-Committee, which is chaired by Mr O’Keeffe, was set up in April 2018 and meets monthly in order to: a) to gain assurance on the quality of care and the delivery of the Post Transaction

Implementation Plan for those services acquired from Liverpool Community Health NHS Trust;

b) through the activities of the Transition Sub Committee, to help develop the assurance reporting of the Liverpool and South Sefton Community Division as it becomes embedded within the Trust;

c) identify risks and gain assurance on the mitigation of risks to the quality of care.

54. Mrs O’Dwyer confirmed that a programme plan and milestone tracker were being used to monitor performance against the Kirkup recommendations, with a status update on all 44 identified issues presented to the Transition Sub-Committee on a monthly basis. All of the issues identified had been grouped into four work streams and reporting to the Sub Committee was done so on the basis of these work streams.

55. Mrs O’Dwyer confirmed that as of January 2019, 50% of the issues identified were rated as ‘Green’ on the status update, indicating that either the issues had been resolved in full or that the initial milestone had been completed and further action was now required. Some actions would be on-going for some time and considered to be ‘business as usual’ for example, management of pressure ulcers.

56. Mrs O’Dwyer confirmed that the final meeting of the Sub-Committee would take place in March 2019 and therefore the continued reporting arrangements would be

Agenda Item No: A4

Page 12 of 19

discussed at the February 2019 meeting. Following a request for clarification from Mrs Moore, Mrs O’Dwyer clarified that the February meeting of the Sub-Committee would discuss and establish the onward reporting arrangements and a formal plan for this would be reported to the Sub-Committee in March 2019. These arrangements would be reported to the Council of Governors for completeness.

57. Mr McCarthy queried the detail underpinning the indicators provided on the dashboard and Miss Jennings clarified that all the supporting information was available upon request and agreed to circulate this full report to Governors.

58. Mr Rafferty confirmed that of the 44 issues identified on the report, a number of these were now in the process of being closed and this transition would be managed via business as usual.

59. Mr Taylor noted a discussion held in the Governor’s pre-meet around a process for being updated between formal meetings and agreed to discuss this further with Miss Jennings outside of today’s meeting.

60.


Recommendations approved by the Council of Governors, namely: • Note the progress to date and to provide their

continued support;

Further actions required: • Circulate the full LCS Transition Sub-Committee

report/dashboard including supporting information to Governors;

• Arrangements around onward reporting agreed at the March 2019 LCS Transition Sub-Committee to be reported to the Council of Governors;

• Process around updating Governors between formal meetings to be discussed/agreed;

S Jennings S Jennings

P Taylor/ S Jennings

Jan-19 Apr-19 Feb-19

By end Jan-19 On Apr-19 CoGs agenda Feb-19

B5 QUALITY ACCOUNT – INDICATOR TESTING

61. Mr P Taylor confirmed that during the pre-meet with Governors, this item had been discussed at length and Governors had selected option d) Early Intervention in psychosis as their preferred indicator.

62. Mrs Hurst provided a short presentation and a report which aimed to update Governors on the obligation of all Foundation Trusts to publish a Quality Account each year along with the requirement of the Council of Governors to choose an indicator from those included in our Quality Account which they would like the Trust’s auditors to test. The chosen indicator would be sent to the auditors who would commence testing in February 2019.

63. Mrs Hurst stated that indicator testing by our external auditors must be completed before the Board could formally approve the Quality Account on 29 May 2019, therefore sought confirmation that all Governors still wished to pursue opinion d.

Agenda Item No: A4

Page 13 of 19

64. Mrs Moore noted that it would be helpful to understand current progress with regard each indicator to enable a decision to be made going forward. Miss Jennings assured Governors that the indicator was not tested on how the Trust were performing, instead this involved a review of the robustness of data. Mrs Moore acknowledged this, however reiterated that the current status of each would be helpful when Governors were selecting the indictor to be tested.

65. Mrs Riozzie advised Governors of an issue she had been made aware of, where medicines available to a particular patient had been limited in order to reduce the risk of overdose, however communication around this change had not been sufficient and the patient was still issued with a full complement of medicines. Mrs Hurst stated that a discharge letter would be issued from the Trust to the GP regarding follow on prescriptions, however acknowledged the concern raised and the need for a review of how this was managed. Dr Fearnley confirmed that communication was improved when technology was utilised correctly and it was important to ensure that this was undertaken.

66. In response to clarification sought by Governors, Mrs Hurst confirmed that the Trust measured the use of rapid tranquillisation and supportive observations, which was an objective in the Trust’s Quality Account. Dr Fearnley confirmed that the new electronic prescribing system was much more accurate, adding that common practice was not to use rapid tranquilisation in a violent incident. The measurement of the use of restraints and medicines was also undertaken.

67. The Council of Governors clarified their choice of indicator remained d) Early intervention in psychosis (EIP):- people experiencing a first episode of psychosis treated with a NICE-approved care package within two weeks of referral.

68.


Recommendations approved by the Council of Governors, namely: • note this report; • consider and discuss the indicators outlined within

the report and identify the preferred indicator for testing by our External Auditors.

Further actions required: • Future reports to include current status of each

indicator for clarity;

J Hurst

All reports going forward

On-going – all reports going forward.

C1 STRATEGY AND 2019/20 OPERATIONAL PLAN UPDATE & DRAFT PRIORITIES - presentation

69. Mrs H Bennett provided a short presentation around the review of the Trust’s strategy and operational plan, both of which have to be approved by the Board of Directors at the end of March 2019. Mrs H Bennett confirmed that work continued in relation to development of the plan and it was intended to provide a bespoke session for Governors in February 2019 to seek any feedback which would then be taken into account by the Board. Miss Jennings confirmed that this session would also

Agenda Item No: A4

Page 14 of 19

incorporate discussions around the NHS Long Term Plan and the implications of this. Mrs Fraenkel requested that Digital Inclusion also be discussed at the session, noting that this would be a significant and important development session for Governors to attend.

70. Mrs Fraenkel requested that the slides from today’s presentation were circulated to Governors for information and any feedback to be provided to Miss Jennings at the earliest opportunity.

71. Mrs Keeley referred to the national action plan for carers, noting the importance that family carers were identified, supported and incorporated throughout the system. Mrs H Bennett concurred, confirming that this was recognised and would be incorporated into the Trust’s plans explicitly.

72.


Recommendations approved by the Council of Governors, namely: • Note the presentation

Further actions required: • Presentation to be circulated to Governors following

today’s meeting; • Session in February 2019 to also include the NHS

Long Term Plan and the Digital Inclusion; • All paperwork/presentations from the development

session to be circulated to all Governors following the session;

• Ensure family carers are incorporated into the Trust’s plans explicitly;

S Jennings

S Jennings S Jennings H Bennett

Jan-19 Feb-19 Feb-19 Feb-19

By end Jan-19 Feb-19 session By end Feb-19 By end Feb-19

D1 REAPPOINTMENT OF CHAIRMAN

73. Mrs Fraenkel left the meeting for this agenda item (D1), and Mr Williams left the meeting for items D1 and D2. Mr Taylor, as Lead Governor, took over as Chair of the meeting.

74. Mr O’Keeffe joined the meeting by teleconference in order to seek the Council of Governors’ approval of the proposed re-appointment of Beatrice Fraenkel, Chairman, from 3 November 2019 (expiry of the current term), for a further 2 years and 4 months to April 2022, noting that this was a statutory function of Governors to approve the re-appointment of the Chair. Mr O’Keeffe confirmed that an appraisal of the Chairman had been undertaken by himself and the previous Lead Governor (Mrs Hilary Tetlow), using the process approved by the Council. Mr O’Keeffe stated that following consideration of the completed appraisal, it was considered to be in the best interests of the Trust to ensure reappointment of the current Chairman.

75. In response to a question from Mrs Doherty, Mr O’Keeffe confirmed that as part of the appraisal process, feedback was sought from external organisations and partners.

76. Mr McCarthy queried why approval of reappointment was being sought so far in advance. Mr O’Keeffe confirmed that it was good practice to undertake this process

Agenda Item No: A4

Page 15 of 19

between 6-12 months ahead of the end of a term of office to allow sufficient time to recruit a replacement should this be necessary.

77. Mrs Doherty noted that the Chairman’s next appraisal was due in April 2019 and proposed that a decision was sought following the outcomes of that appraisal. Miss Jennings confirmed that this would not provide sufficient time to ensure an appropriate candidate to fill the role, should Governors not reappoint the current Chairman.

78. Mrs Birrell queried the process should the Council of Governors not agree to reappoint the current Chairman. Miss Jennings clarified that the post would be advertised externally for a Chairman. Mr Meadows added that as per the guidelines, the post would be advertised widely, applications would be received and the Council of Governors Nomination and Remuneration Committee would shortlist and interview candidates prior to approving the new appointment. This would be against a job description and person specification approved by the Council of Governors prior to the post being advertised.

79. Mrs Peneche queried whether every Governor was expected to vote, noting that as a new Governor, she did not feel in a position to make a judgement on the performance of the Chairman. Several Governors concurred with this point of view.

80. Miss Jennings clarified that the decision regarding reappointment should be based upon the appraisal, confirming that the appraisal process was agreed by the Council of Governors at their January 2018 meeting. The outcomes of the Chairman’s appraisal were reviewed by Mr O’Keeffe, as the Senior Independent Director and Mrs H Tetlow, as the then Lead Governor and subsequently provided to the April 2018 Council of Governors meeting. These outcomes demonstrated Mrs Fraenkel to be performing to a high standard and Mr O’Keeffe was therefore making a recommendation to the Council of Governors that the appointment should be extended.

81. Robust discussion followed in relation to the timing of the request to re-appoint, with the majority of Governors agreeing that they had no concerns re-appointing Mrs Fraenkel, however some Governors has concerns with the timetable for making such a decision and would have preferred to make the decision at a later date.

82. Mr Taylor, noting the robust discussions that had taken place and asked Governors whether or not they would be prepared to consider this matter and proposed that a formal vote should be taken. Mr Taylor sought advice from Mr Meadows and Miss Jennings. Governors agreed a paper ballot would be undertaken. Mr Meadows confirmed that Governors were being asked when voting to indicate their support for the recommendation of the paper supporting this item, namely

“That the Council of Governors is asked to consider and approve the proposed term of office for the Chairman, namely a 2-year and 4 months extension to 30 April 2020”

83. Governors were then asked to vote using a piece of paper and indicating their preference. The ballots were first counted by Mrs O’Dwyer then Miss Jennings. The ballots were then checked by Mr Meadows prior to Mr Taylor undertaking the final check. All four counts resulted in the same result.

Agenda Item No: A4

Page 16 of 19

84. With the permission of Mr Taylor, Mr Meadows then announced the result of the ballot as follows: a) Yes – 12 votes; b) No – 1 vote; c) Abstentions – 2 votes.

85. Confirming that the meeting was quorate and all Governors present had voted, Mr Meadows confirmed that the recommendation to re-appoint the Chairman to 30 April 2022 had been agreed. Mr Taylor confirmed this. Mr Meadows was requested by Mr Taylor to ask Mrs Fraenkel to re-join the meeting.

86.


Recommendations approved by the Council of Governors, namely: • Consider and approve the proposed term of office for

the Chairman, namely a 2-year and 4 month extension to 30 April 2022;


87. Mrs Fraenkel re-joined the meeting and following confirmation of the decision by Miss Jennings, Mrs Fraenkel thanked Governors for their support.

D2 REAPPOINTMENT OF NON-EXECUTIVE DIRECTOR

88. Mrs Fraenkel sought approval in relation to extending the terms of office for the Non-Executive Director (NED), Nick Williams whose current term ends on 31 December 2019. Mrs Fraenkel noted that in line with the Foundation Trust Code of Governance, the Council of Governors were responsible for the appointment and re-appointment of Non-Executive Directors.

89. Mrs Fraenkel confirmed that Nick Williams had undertaken the appraisal process approved by the Council of Governors in early 2018 and the outcomes of this appraisal was subsequently reported to the Governors in October 2018. The process confirmed that Mr Williams continued to perform at a high level. Mr Williams was a member of the Audit Committee, the Performance, Investment and Finance Committee and the Remuneration Committee as well as a Board Member.

90. In light of this, approval was sought to reappoint Nick Williams with the new proposed term to end on 30 April 2022.

91. Mrs Birrell asked Mrs Fraenkel for commentary on her decision to appoint Mr Williams initially. Mrs Fraenkel confirmed that Mr Williams had significant expertise around digital developments and noted it was important to ensure the Board was shaped with Non Executive Directors with the best and varied skills to assist the Trust going forward. Mr Williams also sat on the Digital Board, where his networking and support for the Trust was invaluable. Mr Williams was an ambassador for the whole of the north of England across Digital Inclusion and his networking was essential to the organisation.

Agenda Item No: A4

Page 17 of 19

92. Mr Taylor recommended that Governors approved the re-appointment of Nick Williams on Mrs Fraenkel’s recommendation.

93.


Recommendations approved by the Council of Governors, namely: • Consider and approve the proposed terms of office

for the NED outlined in this paper;


D3 COUNCIL OF GOVERNORS – GOVERNANCE UPDATE

94. Miss Jennings provided an update in relation to governance, highlighting the following issues: a) there were a number of Governors whose terms of office would end on 30 April

2019 and as such, 8 seats would become vacant. There was also one existing vacant seat in the public constituency (Ribble Valley). The nominations process had commenced today (17 January 2019) to fill these seats;

b) the Trust has a duty to engage the wider membership and keep members informed about services. As such, a series of Members Events were being scheduled, the first of which would take place 5 February 2019 and would provide an excellent opportunity for Governors to network with the membership (see Appendix A of the paper supporting this item for further information);

c) it is good practice for a Council of Governors to produce an annual report to update its members on its recent activities. The Council of Governors Annual Report (see Appendix B of the paper supporting this item) had therefore been prepared to provide a brief overview of the activities undertaken by the Council of Governors over 2017/18;

d) Chairman and Non-Executive Director appraisals would be undertaken in April-July 2019 and a revised process would be considered by the Nomination and Remuneration Committee prior to presentation to the Council in April 2019;

e) in October 2018, Governors were provided with an update on the Trust’s Fit and Proper Persons Test (FPPT) arrangements for Non Executive Directors, Executive Directors and direct reports. The papers supporting this item provides a further update following the identification of gaps; and

f) the Membership and Engagement Committee met on Friday 9 November 2019. The minutes of the meeting were attached for information (see Appendix C of the paper supporting this item).

95. Miss Jennings referred to the upcoming elections for new Governors and advised that as per previous election, a number of Governor Awareness Sessions were planned. All Governors are invited to attend these sessions to meet potential new Governors / applicants and discuss the work of the Trust.

Agenda Item No: A4

Page 18 of 19

96.


Recommendations approved by the Council of Governors, namely: • Note the arrangements for the 2019 Council of

Governors elections to fill 9 seats that will become vacant on 30 April 2019;

• Note the Members Event scheduled for 5 February and the agenda set out in Appendix A;

• Consider and approve the Council of Governors Annual Report (Appendix B);

• Note the arrangements for the review of the Chairman and Non-Executive Director appraisal processes;

• Note the update in respect of implementation of the Fit and Proper Persons Test and development of the associated policy;

• Note the issues discussed at the last Membership and Engagement Committee meeting and the associated minutes at Appendix C.


D4 CHANGES TO THE CONSTITUTION

97. Miss Jennings sought Governors approval to proposed changes to the Trust’s Constitution in respect of references to the Standing Committee of the Service User and Carer Assembly, which had been abolished. Miss Jennings advised that in line with procedure, both the Board of Directors and the Council of Governors must agree changes to the Trust’s Constitution and this proposal will be put before the Board at their meeting on 27 March 2019.

98. In response to Mrs Moore, Mr Meadows explained the rationale behind the Service User and Carer Assembly Standing Committee being stood down, following Board of Directors’ approval of a new approach for service users, carers, staff, Foundation Trust members and the wider communities to work side by side in order to improve engagement, participation and services. Mrs Fraenkel confirmed that this action had been taken with the full approval of the Committee and following engagement with a range of service user and carer representatives, including Governors.

99.


Recommendations approved by the Council of Governors, namely: • consider and approve changes to the Trust’s

Constitution to reflect the abolition of the Service User and Carer Standing Committee;


Agenda Item No: A4

Page 19 of 19

E1 ANY OTHER BUSINESS

a) Mrs O’Dwyer referred the Non-Executive Director induction she had undertaken with NHS Providers recently which had been very informative. Miss Jennings advised that a Governor training session led by NHS Providers had been arranged for the end of January 2019, following the success of an earlier session held for Governors.

b) Mr Copple referred to Digital Inclusion and requested more information be provided to Governors. Miss Jennings confirmed that following conversations earlier in the meeting, this would be incorporated into the upcoming development session being held in February 2019.

c) Miss Jennings reiterated to Governors that they may contact her directly or any member of the Corporate Governance team via email or telephone with any questions at any time. Mr Copple thanked the Corporate Governance team for the information flow provided to Governors which was fantastic, proposing that Outlook calendar invitations were routinely sent to all Governors to ensure all meetings and events were in diaries. Miss Jennings agreed to review the potential of issuing Outlook invitations to all Governors for meetings/events.

d) Mrs Fraenkel advised that due to the overrun of today’s meeting, the Kirkup Update item would be deferred, however Mrs Fraenkel noted that Mrs O’Dwyer had previously provided an update on progress in respect of delivery of the Kirkup recommendations.

100.


Further actions required: • Review potential to issue outlook calendar invitations

to all Governors for meetings/events; • Meeting to be arranged to discuss comments by

Governors made in today’s pre-meet; • Development session for Governors to be arranged

to include Digital Inclusion;

S Jennings P Taylor / S Jennings S Jennings

Mar-19 Feb-19 Feb-19

Mar-19 Feb-19 Feb-19

101. No further business was raised.

102. The meeting closed.

Council of Governors - Actions from meetingsPage Agenda Item Action Owner Status Due Date Comments

Jan-19 CoGsA4-Minutes of the previous meeting - 18 Oct-18

In respect of the Fraud, an update to be provided to Governors at their next meeting which (i) provides an update on the investigation and the recovery if any monies, (ii) identifies if the trust has able to obtain additional insurance

N Smith Apr-19 Verbl updateOn Apr-19 CoGs Agenda

Jan-19 CoGsA4-Minutes of the previous meeting - 18 Oct-18

Circulate presentations from the 12 Dec-18 Governor Development Session around the Operational Plan/Strategic Priorities

S Jennings Jan-19 Issued to Governors electronically on 6 Feb 2019

Jan-19 CoGs A6-Update from the Chairman

Circulate details/location of Life Rooms, Bootle S Jennings Jan-19 Issued to Governors electronically

on 6 Feb 2019

Jan-19 CoGs B1b-HMP Liverpool Inspection Report

HMP Liverpool twice yearly update reports to be provided to Council of Governor meetings

T Bennett Jul-19 and on-going

On Jul-19 CoG Agenda and 6 monthly thereafter

Jan-19 CoGs B2-Trust Performance Report

Outcomes of work with Edge Hill University (Staff sickness) to be included in next report

T Bennett/ A Patel Apr-19 On Apr-19 CoGs Agenda


Update regarding employment/ discussions with Metro Mayor to be provided to the next meeting via CEO update

J Rafferty Apr-19 On Apr-19 CoGs Agenda


Future reports to provide numbers alongside percentages where targets were missed

A Patel Apr-19 Future reports from Apr-19


Meet to discuss issues/ideas raised in Governor pre-meet

P Taylor/ S Jennings Jan-19 Meeting held in January 2019

Meeting held on 17 January 2019

Agenda Item - A4

Jan-19 CoGs

B3-Specialist Learning Disabilities Division Retraction Plan Update

Should no response be received within two weeks from today's date from NHS England with regard to the Quality of Care issues raised previously, Mr Rafferty to write to Sir Simon Stevens, NHS England, at the Council of Governors request seeking the outcomes of the Quality of Care review undertaken

S Wrathall / J Rafferty by 31 Jan-19

Concerns escalated to NHS England in January 2019 as requested by Governors. Update circulated to Governors via email on 6 Feb 2019

Jan-19 CoGs

B4-Update on Community Services Improvement Programme

Circulate the full LCS Transition Sub-Committee report/dashboard including supporting information to Governors

S Jennings Jan-19Full Community Services Improvement Plan circulate to Governors via email on 6 Feb 2019

Jan-19 CoGs


Arrangements around onward reporting agreed at the March 2019 LCS Transition Sub-Committee to be reported to the Council of Governors

S Jennings Apr-19 On Apr-19 CoGs Agenda

Jan-19 CoGs


Process around updating Governors between formal meetings to be discussed/agreed

P Taylor/ S Jennings Jan-19

Completed. Meeting between Paul T and Sarah J held in Jan 2019 to take ideas forward.

Jan-19 CoGs B5-Quality Account - Indicator Testing

Future reports to include current status of each indicator for clarity J Hurst

All reports going forward

On-going - all reports going forward and current status submited via a report sent ot Governors via email in Jan 2019

Jan-19 CoGs

C1-Strategy and 2019/20 Operational Plan Update & Draft Priorities - Presentation

Presentation to be circulated to Governors following today's meeting S Jennings Jan-19 & on-

goingPresentation circulated to Governors on 6 Feb 2019

Agenda Item - A4

Jan-19 CoGs


Session in February 2019 to also include the NHS Long Term Plan and the Digital Inclusion

S Jennings Feb-19Development Session on Strategy and Long Term Plan arranged for 28 February 2019

Jan-19 CoGs


Ensure family carers are incorporated into the Trust's plans explicitly H Bennett Feb-19 By end Feb-19

Jan-19 CoGs E1-AOBReview potential to issue outlook calendar invitations to all Governors for meetings/events

S Jennings Mar-19 Mar-19

Jan-19 CoGs E1-AOB Development session for Governors to be arranged to include Digital Inclusion S Jennings Feb-19 Feb-19

KEYTO BE ACTIONED

COMPLETEDONGOING

Agenda Item - A4

Agenda Item No: B2

COUNCIL OF GOVERNORS Report provided (check necessary boxes): Agenda Item No. B2

To Note: ☐ For Assurance: ☐ Report to: Council of Governors

For Decision: ☒ For Consent: ☐ Meeting Date: 25 April 2019

Financial and Activity Performance Report

Accountable Director(s):

Neil Smith, Executive Director of Finance 0151 471 2205

Report Author(s): Asim Patel, Joint Chief Information Officer 0151 473 2982

Purpose of Report To provide a summary of Trust performance to 28 February 2019 against Regulatory and Operational Plan key performance metrics.

Summary of Key Issues for Consideration of Governors :

Care Quality Commission

As previously reported, in 2017 the Trust achieved an overall rating by the Care Quality Commission of Good, with a Requires Improvement for the Safe domain. The Trust has completed its first self-assessment and is rating itself as Good at Trust level across all five domains. The well-led review took place as planned and core service visits were all completed by the Care Quality Commission. The Trust received the draft report as expected in February 2019 and this has been subject to Factual Accuracy checking. The Factual Accuracy return was submitted on 13 March 2019 and it is anticipated that the final report is likely to be published by the end of March / early April 2019.

Single Oversight Framework

The trust performance within the Single Oversight Framework is ‘segment score 2’ (targeted support).

The Single Oversight Framework Finance and Use of Resources Score is 2 (low risk).

65% of metrics (40) within the Single Oversight Framework have been achieved and this is an improvement when compared with January 2019 (62.50%).

There were two metrics achieved in February 2019, which were previously under performing in January 2019: Annual Staff Survey 2018 and Proportion of StEIS Incidents reported within 2 days (community). One metric that was achieved in January 2019 did not achieve in February 2019: Income and Expenditure Margin

Agenda Item No: B2

Variance (based on original plan).

The eight metrics which are underperforming are:

Metrics Trend compared with Previous Position

Clients in Settled Accommodation % (Monthly)

Clients in Employment % (Monthly)

Staff Sickness (Monthly) IAPT - Proportion of people completing treatment who move to recovery (from IAPT minimum dataset) – Quarterly

Quarterly Metric

Cardio-Metabolic Assessment and Treatment – Inpatient Wards (Annual) Annual Metric

Cardio Metabolic Assessment and Treatment – Early Intervention in Psychosis (Annual) Annual Metric

Cardio Metabolic Assessment and Treatment – Community Mental Health Services (Annual) Annual Metric

Income and Expenditure Margin Variance (based on original plan)* Actual 2/Plan 1

Operational Plan 2018/19

Our Services - 48% of the Operational Plan Metrics (25) within Our Services have been achieved. There are no metrics which have moved from Green to Red in February 2019.

Our People - 40% of the Operational Plan Metrics (15) within Our People have been achieved.

Our Resources - 50% of the Operational Plan Metrics (4) within Our Resources have been achieved.

Transformation Programme 2018/19 71% of the Transformation Programme Metrics (24) have been achieved. Metrics which have moved from Green to Red in February 2019 are:

• % Incidents that result in harm (excluding HMP Liverpool) –Secure Division

• Community Scores Friends and Family Test % Positive -Liverpool Community (Internal Reporting)

Recommendation: The Council of Governors is asked to:

1) Note the assessment of performance against Regulatory andOperational Plan targets.

2) Note that Performance Improvement Plans have beenpresented at the quarterly review meetings to provide

Agenda Item No: B2

assurance that improvement plans are in place for areas of underperformance.

Previously Presented to:

Committee Name Date (Ref) Title of Report Outcome / Action

Executive Committee 21.03.2019 Executive Performance Report – Month 11 2018/19

Board of Directors 27.03.2019 Executive Performance Report – Month 11 2018/19

......Trust Performance Overview - February 2019

25 4On track On track19 (76%) 3 (75%)

25 15On track On track12 (48%) 6 (40%)

24On track17 (71%)

5On track 4 (80%)

4On track2 (50%)

2014/1 2015/16 2016/17 2017/12018/19 2015/16 2016/17 2017/182018/19### £213 £248 ### ### £213 £248 ### ###

Key Improved compared with previous month Deteriorated compared with previous month Remained the same compared with previous month

Single Oversight Framework Segment Score: 21234

Maximum AutonomyTargeted SupportMandated SupportSpecial Measures

Effective

Care Quality Commission Rating:Safe

Overall GoodRequires Improvement

Good


CaringResponsive

Well-led

GoodGoodGood

Our PeopleOur Services


Operational Plan2018/19 Metrics Trend

Off track 9 (60%)

TrendOff track Off track 6 (24%) 1 (25%)

2018/19 Metrics Trend 2018/19 Metrics

Our Future

Please Note: Metrics for which a judgement of performance is not appropriate or are not currently reported on within the report have been excluded.

Grow Our Services - Changes in Trust Turnover 2014/15 to 2018/19 £m

Off track

Grow Our Services - Changes in Trust Expenditure 2014/15 to 2018/19 £m

Single Oversight Framework 2018/19 Metrics Trend

Off track 1 (20%)


2 (50%)

Our Resources

Transformation Plans2018/19 Metrics Trend

Off track 7 (29%)


Off track13 (52%)

£207 £213 £248 £277 £370

2014/15 2015/16 2016/17 2017/18 2018/19

£199 £206 £235 £263£365

2014/15 2015/16 2016/17 2017/18 2018/19

6.83% 6.92% 6.97% 7.63% 7.69% 6.97%

Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19

Staff Sickness - Single Oversight Framework

1.32% 0.88% 0.78% 0.71% 0.70% 0.40%

Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19

Staff Turnover (In-Month) - Single Oversight Framework

Metric Rating Metric RatingOccurrence of any Never Event G Written Complaints GPatient Safety Alerts not completed by deadline G Staff Friends and Family Test 73.78%Under-Reporting of Patient Safety Incidents 32.77 Community Friends and Family Test 94.48%Proportion of StEIS Incidents reported within 2 days - Community G Mental Health Friends and Family Test 88.96%% of Harm Free Care Safety Thermometer - Liverpool Community 94.39% Under 16 Admissions G% of Harm Free Care Safety Thermometer - Sefton Community 96.09% Inappropriate Out of Area Placements G

Care Quality Commission - Community Mental Health Survey G

Metric RatingCare Programme Approach 7 day Follow Up G Metric Rating% Clients in Settled Accommodation* R Early Intervention Treatment start within 2 weeks of referral - Unify G% Clients in Employment* R Early Intervention Treatment start within 2 weeks of referral - MHSDS GData Quality Maturity Index (DQMI) - MHSDS Dataset Score G Cardio Metabolic Assessment and Treatment - Inpatient Ward RWalk In Centre Unplanned Re-attendance within 7 days - Liverpool Community G Cardio Metabolic Assessment and Treatment - EIP Services RWalk In Centre Left Without Being Seen - Liverpool Community G Cardio Metabolic Assessment and Treatment - Community MH Services R

IAPT - Waiting time to begin treatment within 6 weeks GIAPT - Waiting time to begin treatment within 18 weeks G

Metric Rating IAPT - Proportion of people completing treatment who move to recovery - M GStaff Sickness R IAPT - Proportion of people completing treatment who move to recovery - Q RStaff Turnover G A&E Max waiting time of 4 hours from arrival to admission/transfer/discharge GProportion of Temporary Staff G Provider Cancellation Rates - Liverpool Community GStaff Survey G Provider Cancellation Rates - Sefton Community GAgency Spend YLiquidity Days GCapital Services Capacity YIncome and Expenditure Margin G % Metrics Not Achieved/ Performance worse than National Median/ Benchmark 20.00%Income and Expenditure Margin Variance (based on original plan) R % Metrics for which a judgement of Performance is not appropriate 15.00%


RESPONSIVE

CARING

EFFECTIVE

SAFE

* The Data Completeness Metrics for Accommodation and Employment Status do not form part of the Single Oversight Framework due to the data quality metrics being removed in 2018.

Monitoring of these metrics will now be done through the Operational Plan.

WELL LED

% Metrics Achieved/ Performance better than National Median/ Benchmark (includes Finance Metrics reported as "Y" as per NHSi Reporting)

65.00%

Overall GoodRequires Improvement

GoodGoodGoodGood

Trust Self-AssessmentCompleteCompleteCompleteCompleteCompleteComplete

ResponsiveWell-Led

Care Quality Commission Rating:Safe

EffectiveCaring

Care Quality Commission

Further detail can be found at:

2. Safe Care and Treatment3. Premises and Equipment

4. Good Governance5. Staffing

6. Notification of Other Incidents

https://www.cqc.org.uk/sites/default/files/new_reports/AAAG3923.pdf

*The trust has assessed all Requirement Notices as complete.

1. Dignity and RespectSafe: Requirements Notices

Agenda Item No: B2

PURPOSE

To provide a summary of trust performance to 28 February 2019 against regulatory and operational plan key performance metrics.

BACKGROUND/ CONTEXT

1. The trust’s approach to performance reporting enables scrutiny of performancein the following areas:

a) Regulatory – this includes information relating to the trust’s compliance withCare Quality Commission requirements and performance against indicator inthe NHS Improvement Single Oversight Framework.

b) Our services – this looks at saving time and money and improving quality (safe,timely, effective, equitable, efficient and patient centred care).

c) Our people – this looks at whether we have great managers and teams, aproductive workforce with the right skills and the extent to which we are workingside by side with service users and carers.

d) Our resources – this looks at our investment in technology to help us providebetter care and ensure that we have buildings that work for us.

e) Our future – this includes measures that show the benefits of research andinnovation, our progress in growing our services and how we work effectivelywith primary care and other organisations.

A. CARE QUALITY COMMISSION

Accountable Director: Trish Bennett

As previously reported, in 2017 the Trust achieved an overall rating by the Care Quality Commission of Good, with a Requires Improvement for the Safe domain. The Trust has completed its first self-assessment and is rating itself as Good at Trust level across all five domains. The well-led review took place as planned and core service visits were all completed by the Care Quality Commission. The Trust received the draft report as expected in February 2019 and this is currently subject to Factual Accuracy checking. The Factual Accuracy return was submitted on 13 March 2019 and it is anticipated that the final report is likely to be published by the end of March / early April 2019.

B. SINGLE OVERSIGHT FRAMEWORK

The Trust is achieving a Single Oversight Framework Segment Score of 2 (Targeted Support) and is achieving 65% of all Single Oversight Framework Metrics (40).

The performance improvement team continue to support clinical divisions and subject matter experts in the development of performance improvement plans relating to the indicators within the single oversight framework and other priority areas identified through the divisional quarterly performance review meetings. These plans are expected to be finalised during Q4 2018/19.

Agenda Item No: B2

The 8 metrics which are underperforming are detailed below:

1. Clients in Settled Accommodation (%) Target 62% Actual 33% 2. Clients in Employment (%) Target 7% Actual 2%

The data sources for these metrics are derived from the published Mental Health Services Minimum Dataset which has a two month time lag. The latest data published relates to December 2018.

The data completeness for February 2019 for both accommodation status and employment status which underpin the above metrics has improved and is now 67% for the Trust. Therefore, due to the improvement in data completeness, the Trust is optimistic that an improvement in the metrics above will be observed over the coming months.

The Trust Board approved the recent draft Trust Level Recovery Plan concerning Clients in Settled Accommodation which the Local Division produced in collaboration with Senior Managers across the Trust. Future updates with regards to Clients in Employment (Target 7%) will be provided by Michael Crilly, Director of Social Inclusion.

The recovery plan was approved the Quarterly Performance Review Meeting February 2019 and subsequent Trust Board meeting. Below are the updated actions from the recovery trajectory and plan.

Division Action(s) Progress Expected Improveme

nt Start Date

Local Presentation of draft collaboration recovery plan for discussion at the Q3 Quarterly Performance Review meeting.

10.03.2019 – Draft Recovery Plan was presented and approved at the Q3 2018-19 Executive Performance Review Meeting. The plan was presented and approved by the Trust Board on 27 February 2019.

28.02.2019 - Completed

Local To implement the recovery plan to improve the data completeness metrics.

10.03.19 Links with the Local Authority have been made and a meeting was arranged for the end of February 2019 with Mersey Care’s Head of Commissioning to discuss with the Local Authority their accommodation strategy plans. This had to be rearranged at the request of the Local Authority. A future date is currently being arranged in diaries.

30.07.2019

Trust Map out whole system need for % of Clients in Settled Accommodation and % of Clients in Employment to produce Trust

30.06.2019

Agenda Item No: B2

Level baseline accuracy for sign off across all the data points.

Trust Development of positional report with regards to the findings for discussion with Strategic groups, for example, Local Authority, Public Health, Clinical Commissioning Group.

31.12.2019

3. Cardio-Metabolic assessment and treatment for people with psychosis –

inpatients – Annual Metric Target 90% Actual 46.24% These are the results from the National Audit of Schizophrenia reports from Oct 2017. The audit sample has been collected and the audit has commenced. Submission deadline is 15 March 2019 and the results are expected to be ratified in June 2019. 4. Cardio-Metabolic assessment and treatment for people with psychosis – Early

Intervention in Psychosis – Annual Metric Target 90% Actual 15% These are the results from the Royal College of Psychiatrists’ Centre for Quality Improvement reports from the audit completed in November 2017 and published in June 2018. Early Intervention in Psychosis services are now on the National Audit for Schizophrenia (NCAP) programme and data collection has been submitted and the results are expected to be ratified in June 2019. An internal analysis has been completed based on the NCAP audit and this is showing 95% for Liverpool and 84% for Sefton. There could be a slight adjustment in these figures but the audit team predict no more than 5%. 5. Cardio-Metabolic assessment and treatment for people with psychosis –

Community Mental Health Team – Annual Metric Target 65% Actual 19.80% These are the results from the National Audit of Schizophrenia reports from Oct 2017. The audit sample has been collected and has been circulated to all relevant Community Mental Health Team to ensure all have got a physical health check completed or refusals documented. The audit will commence end of February 2019. Submission deadline is 15 March 2019 and the audit results will be ratified and available at the end of Q4 2018-19. In relation to points 3, 4, 5, the Trust has undertaken various actions in response to the audit results from 2017 and the key actions are outlined below: • A deep dive occurred on the 5 November 2018 to gain understanding on how the

data is captured on the systems to ensure the auditors are able to access all data as this has been an issue in past audits.

Agenda Item No: B2

• An inpatient dashboard has been developed and shared/available with the LocalDivision which shows the performance for the physical health screenings andinterventions to allow daily monitoring. This allows for identification of the areaswhich gives the division an opportunity to focus and support to improveperformance. The improvement in physical health assessment as seen withinthe Physical Health Metric within the Operational Plan should indicate theexpected improvement for the cardio-metabolic metric for inpatients.

• A prototype dashboard has been developed for physical health screenings andinterventions for the Community Mental Health Teams. This has been sharedwith the Community Managers for feedback. The dashboard has beendeveloped and is currently being validated by Park Lodge and Norris GreenCommunity Teams. Due to an issue with embedding caseloads in each CMHT,the data extraction for the dashboard will be inaccurate and will therefore berolled out to each CMHT once the caseloads have been confirmed.

• The dashboard is being developed for the Early Intervention in Psychosis and isplanned to be completed by end of March 2019.

• The developments of the dashboards for Community and Early Intervention inPsychosis will allow the same focus for teams to improve areas of concern whichshould lead to overall compliance with the associated cardio-metabolic metrics.

• The physical health forms are to be reviewed for optimisation. This will beundertaken once the completion of all the annual audits have taken place.

• Health Promotion folders have been supplied to all wards and Clinical Guidelinesare available on Sharepoint. There has also been e-mails circulated to supportcompletion of relevant screenings including screenshots and step by stepguides. The Physical Health Modern Matron attends the Junior DoctorsInduction to orientate them to the inpatient admission pathway including physicalhealth. There is a physical health induction package for all new starters withinthe Trust.

• Quarterly audits will be undertaken in relation to the interventions beingundertaken to ensure correct interventions are being applied.

• 6-monthly audits to be completed for all Cardio-metabolic metrics. The firstaudits will be undertaken in July 2019.

• Training for the revised early warning score (NEWS2) which will include clinicalskills assessment is being rolled out which will see an increase in physical healthassessments across the Trust.

• Dr Michael Flynn, Clinical Director will be providing support for physical healthwithin the Community.

6. IAPT- Proportion of people completing treatment who move to recovery (FromIAPT data set quarterly) Target 50% Actual 47.42%

The monthly target of 50% and the rolling quarter (December 2019 – February 2019) has been achieved as per the expected improvement trajectory. This is in line with the targets agreed with Liverpool Clinical Commissioning Group.

7. Staff Sickness Target 4.51% Actual 6.97%

The Trust’s sickness absence rate for February 2019 is 6.97%, which is a decrease of 0.72% from the previous month. This is against a trajectory target of 6.00%. The

Agenda Item No: B2 performance for February is above this target by 0.97%. All Clinical Divisions saw a decrease in absence for February 2019. Actions Taken to Improve Performance: • Implementation of a Sickness Absence Reduction Plan which is evidence

based on Department of Health 5 High Impact Changes. This is currently being reviewed for effectiveness.

• Participation in national NHSI programme focussed on how health and wellbeing interventions can impact positively on sickness absence. This work is on going and we have met with NHS Improvement again in January 2019.

• A Trust-wide audit of sickness absence audit is being refreshed to identify teams reporting; short term, long-term sickness >6% sickness absence within the last three months. This is being updated whilst continuing with the identified 16 key actions that have been linked to the Trust’s overarching sickness absence reduction plan. Areas of specific focus have included improvements to return to work compliance and work has commenced with Informatics Merseyside to automate this process via Sharepoint.

• Additional short term investment in staff support services has been approved as it has been recognised that there have been delays in staff accessing staff support services.

8. Income and Expenditure Margin: Distance From Plan Plan 1 Actual 2 The Income and Expenditure Margin: distance from plan is currently at 2, this has changed from last month’s rating of 1. This measures the trust surplus as a proportion of turnover. Turnover for the year to the end of February is £3.9m higher than the planned turnover. This is due to the national pay award funding which the trust was notified to exclude from its submitted 2019/20 plan. Single Oversight Framework – Financial Performance The Trust is currently achieving a risk rating of 2 (low risk) for the use of resources framework. The framework is a combination of 5 metrics. The Trust is achieving the highest level (1) in Income and Expenditure Margin and Liquidity Days and a rating of 2 for Capital Service Capacity, Agency Spend and Income and Expenditure Margin (distance from plan). Capital Service Capacity is currently at 2. This represents the number of times the Trust can pay its capital commitments through its operating surplus. At present, the Trust can achieve this 2.4 times. In order to attain a 1 in this metric the Trust would need to be able to cover its capital costs 2.5 times. To achieve a level 1, the Trust would need to increase its planned surplus by £0.742m. Agency Spend is also at a 2. This is 17.2% above the agency ceiling. To achieve a 1 the Trust would need to reduce agency spend by £1.544m. The current level of medical locum spend is the biggest contributor to this metric.

Agenda Item No: B2 C. Operational Plan 2018/19 The Trust Board approved the Operational Plan for 2018/19 and the Trust is achieving 45% of the Operational Plan Metrics (44). This is an improvement when compared with January 2019 reporting. Further detail is provided below. Our Services Accountable Director: Trish Bennett The Trust is currently achieving 48% of the Operational Plan metrics (25) within Our Services. As part of the quarterly performance framework all identified underperforming operational plan metrics will have a full review which will include a deep dive and challenge of the recovery plan, improvement trajectory and assessment of risk. Area of Performance Focus • % of New Admissions who have had a Physical Health Screening

Completed – Local Division Target 95% Actual 91.59%

The Local Division achieved 91.59% of new admissions who have had a physical health screening completed within 7 days of admission for February 2019, this is a significant improvement when compared with the first position reported from the Clinical System RiO in September 2018 which was 29.91%. The internal trajectory of 88% has been achieved for February 2019. The division are continuing to promote the need for this improvement, deliver training to the wards and provide regular breach reports twice a week. A breakdown of the screenings for February 2019 can be seen below.

Total

True Admissions

Rate % Rate % Rate % Completion Rate %

9 100.00% 100.00% 100.00% 100.00%11 100.00% 100.00% 100.00% 100.00%11 100.00% 100.00% 100.00% 90.91%8 100.00% 100.00% 100.00% 75.00%

10 100.00% 100.00% 100.00% 100.00%16 100.00% 100.00% 100.00% 100.00%3 100.00% 100.00% 100.00% 66.67%

12 100.00% 100.00% 100.00% 100.00%8 100.00% 100.00% 100.00% 100.00%4 100.00% 100.00% 100.00% 75.00%8 100.00% 100.00% 100.00% 62.50%3 100.00% 100.00% 100.00% 100.00%4 100.00% 100.00% 100.00% 75.00%

107 100.00% 100.00% 100.00% 91.59%Total 99.07% 98.13%100.00%

99.07%

100.00% 100.00%Oak 100.00%100.00%

94.39% 100.00%100.00%75.00%

Irwell 100.00% 100.00%100.00%

100.00%Boothroyd 100.00% 75.00%

100.00% 75.00%Acorn 100.00%100.00%100.00% 87.50% 100.00%

100.00% 100.00% 100.00%Windsor House 100.00%100.00%100.00% 100.00% 100.00%Park Unit & Rowbotham Assessment Unit 100.00%100.00%100.00% 66.67% 100.00%Newton PICU 100.00%100.00%100.00% 100.00% 100.00%Morris 100.00%100.00%100.00% 100.00% 100.00%Harrington 100.00%100.00%

75.00% 100.00%Dee 87.50%100.00%Brunswick 100.00%90.91%

100.00%

100.00% 100.00%100.00% 100.00%

100.00% 100.00% 100.00%Alt 100.00%

Rate %

Albert 100.00% 100.00%

Rate % Rate %

100.00%100.00% 100.00%

Smoking Addictions Substance Misuse

BMI

Ward Name Rate % Rate %

Glucose HbA1c

Random Lipids

Blood Pressure

Family Medical Feb-19

Agenda Item No: B2 • Number of All Ligature Incidents Target 45 Actual 82 In accordance with the quality account targets, the Trust should have achieved a total of no more than 45 incidents per month by the end of February 2019. This figure was exceeded by some distance, with an actual total of 82. Local and Specialist Learning Disability divisions accounted for the excess with 68 and 14 incidents respectively (against targets of 35 and 8). There were no obvious hot spots in Specialist Learning Disability division, with incidents dispersed across five wards, none of which experienced more than four incidents. There were two hot spots (two different wards) in Local division with 11 and 43 incidents respectively. The same service user referred to in last month’s narrative was again responsible for the vast majority of incidents on one of the wards, although she has now been discharged and so the ward are anticipating a reduction in next month’s figures. On the other ward, the incidents are primarily related to two service users, both with a diagnosis of Emotionally Unstable Personality Disorder and are being assessed for case management by the Personality Disorder Hub. One has since been discharged and re-admitted, whereas the other remains a delayed discharge owing to problems finding her suitable accommodation. It is also worthy of note that of the 68 incidents in Local division 93% (n = 63) were classified as ‘no harm’ and the remaining 7% (n = 5) as ‘low harm’, which is arguably a good indicator of a healthy reporting culture. • Number of Physical Restraints Associated with Self-Harm Target 36

Actual 59 With regard to restraint associated with self-harm, the overall Trust target should not have exceeded 36 incidents by the end of February 2019, whereas the actual number was 59. Specialist Learning Disability division was primarily responsible for the excess with 50 incidents. There are two hot spots (two wards) identified accounting for 68% of incidents. On one ward, the incidents primarily related to two service users, one of whom, despite experiencing five incidents during the month, has seen a dramatic reduction from 28 the previous month. The other service user however has seen a significant increase and the patter of incidents are being analysed in order to identify possible antecedents or triggers and various tests have been undertaken to rule out any underlying physical cause. The design thinking project referred has now moved into the synthesis phase and ideation work, to design bespoke solutions, is due to commence imminently. Incidents on the other identified ward can be attributed to a number of factors involving at least five different service users, which include deterioration in mental health, a new admission, a delayed discharge, and ‘self-sabotage’ of imminent

Agenda Item No: B2 discharge plans. The majority of such restraints are for the prevention of head-banging, on which further guidance from the divisional leadership team is due to be issued imminently. • Accommodation Status (Data Completeness) - MHSDS Reporting. All

patients who are on CPA, aged between 18 and 69 who have had an Accommodation Status reported within the last 12 months as at the end of the reporting period Target 85% Actual 67.29% Trust Position

• Employment Status (Data Completeness) - MHSDS Reporting. All patients who are on CPA, aged between 18 and 69 who have had an Accommodation Status reported within the last 12 months as at the end of the reporting period Target 85% Actual 67.35% Trust Position

These metrics have been re-introduced following the development of the report. Mersey Care has worked with NHS England to adopt their methodology in developing a local report which will be able to provide the performance for the data completeness metrics based on the latest MHSDS Data Submission. The report has been developed, validated and shared with the Local and Secure Division. The Specialist Learning Disability Division are not included within these metrics. The divisional positions can be found within the body of the report. The methodology is based on:

- All patients who are CPA. - All patients aged between 18 and 69. - All patients who have had an accommodation or employment status reported

within the last 12 months as at the end of the reporting period. Within the Local Division, the recovery plan was approved at the Quarterly Performance Review Meeting held at the end of February 2019 and was presented to the Trust Board on the 27 February 2019 and included the following details within the identified work streams:-

IMPROVEMENT TRAJECTORY (MONTHLY INDICATORS) Ref E5 & E7 - Data Collection Accom / Emp Local Division Month Nov Dec Jan Feb Mar Apr Trajectory Accommodation

43.00% 45.00% 47.00% 50.00%

Actual Accommodation

38.5% 41.56% 45.27% Primary 51.35% Refresh

65.36% Primary

Trajectory Employment

47.00% 49.00% 51.00% 55.00%

Actual Employment

42.53% 45.15% 47.97% Primary 52.74% Refresh

65.36% Primary

Agenda Item No: B2 Data collection recovery actions are in progress. The Business Intelligence Today report for data completeness is now in place to identify the data gaps. Weekly reports are to be sent to Managers from February 2019 and progress will be monitored within weekly safety huddle. Within the Secure Division, divisional data has been checked and any missing information relating to accommodation status has been updated and a process to update the information on an annual basis is now in place. Transformation Plan 2018/19 – Our Services The Trust is currently achieving 71% of the Transformation Programme metrics (24). Divisional Analysis can be found detailed within the report. Metrics which have moved from Green to Red in February 2019 are: • % Incidents that result in harm (excluding HMP Liverpool) – Secure

Division Target 5.04% Actual 9.57%

During February 2019 there were 460 incidents recorded of which 44 resulted in harm. In terms of the severity of harm 36 were low harm and eight were moderate harm. Of the eight moderate harm incidents, seven relate to self harm and one relates to a patient on patient assault in low secure. Of the seven self harm incidents that resulted in moderate harm one was at the Beacon in HMP Garth, three were on medium secure wards and three were on high secure wards. The 36 low harm incidents can be broken into the following sub type categories – property damage 1, deterioration in physical health 2, accidental injury 5, self harm 26, substance misuse 2 and threatening behaviour 1. Of the 36 low harm incidents 20 were in high secure, 14 at the Beacon in HMP Garth and two were in medium secure. The Division is continuing to work with corporate colleagues to check the accuracy of the date, a mapping issue has been identified and resolved and historic data is being updated, once completed the information for the year will be re-run. The indicator is expected to reduce but remain over target. Learning from incidents continues with the reducing restrictive practice agenda as well as no force first work. Analysis for individual patients and ward trends continues to be reviewed by the Divisional Risk Lead and the Divisional Operational and Performance Committee to understand clusters and provide additional support. • Community Scores Friends and Family Test % Positive - Liverpool

Community (Internal Reporting) Target 95% Actual 94.18% The Friends and Family Score for Liverpool was 94.18% during February 2019 which was a decrease compared to the previous month and the first time it has been below 95% this year. The services with the most negative responses during February 2019 were Abacus and Walk in centres.

Agenda Item No: B2 The majority of the Walk in Centres responses were related to estate issues and service managers are working with estates to identify solutions to these issues. The responses relating to Abacus were predominantly regarding waiting times. These are being reviewed by the service to understand if any further actions are appropriate. Performance against this indictor will be monitored closely to ensure that any themes continue to be identified and resolved where appropriate and performance increases back to above 95%. Our People Accountable Director: Amanda Oates From September 2018 trajectories have been introduced as agreed by the Trust Board in August 2018. With the introduction of trajectories, the Trust is now achieving 40% of the Operational Plan Metrics (15) within Our People. 1. Personal Achievement Contribution Evaluation Completed within the last 12

months Target 95% Actual 83.00% Performance Appraisal Compliance – Liverpool Community Only Target 85% Actual 73.57%

The in-month position for February 2019 is 83% of staff having completed a PACE within the last 12 months, level on the month. Liverpool Community Health is reporting at 74%. The divisions are being reminded to encourage staff to complete their PACE and appraisals by the Learning and Development Team and Organisational Effectiveness Team and Clinical leads are actively progressing. PACE upgrades have been actioned. Communication regarding schedule and targeted trajectories for Band 6 and above will be issued to all divisions for 2019/ 20 in March 2019. 2. Mandatory Training Target 92% Actual 88.10% The in-month position is 88.10% which is an increase of 0.71% from the reported position of 87.39% in January 2019. Liverpool and Sefton Community continue to performance improve month on month at +2.32% and +1.89% respectively. The Community division remains the top priority for Learning and Development support and focus. From April 2019 performance (May reporting) the method of calculating Mandatory training will be simplified in line with the rest of the NHS (overall percentage of competencies / overall total of competencies). The target of 95% however will not change. Role Specific Mandated training will also be monitored against the simplified method, targets have been set and agreed at Strategic Workforce Group as 1st quarter 65%, 2nd quarter 70%, 3rd quarter 80% and 90% by end March 2020. Further work is in development with clinical leads and the divisions detailing clinical competencies against job roles, which will be reported in the divisional level Operational Management Board Report.

Agenda Item No: B2 Our Resources Accountable Director: Neil Smith The Trust is currently achieving 50% of the Operational Plan Metrics (4) within Our ‘Resources’. The exceptions are reported below. 1. Budget Year To Date v Expenditure Year To Date The Trust is on plan to achieve planned surplus as at Month 11. Within the Trust position, there are overspends in Specialist LD division, medical services, and corporate division being offset by underspending within Local, Community and Secure divisions. The Specialist LD division overspend at Month 11 is £0.696m which relates predominantly to the STAR unit and other LD services transferred from Local Division. The Medical services overspend at Month 11 is £3.067m relating to use of long term medical locums particularly in the local division. The corporate division overspend at Month 11 is £2.160m which mainly relates to the underachievement of CIP schemes in the current year. The financial position is balanced by underspends in Local division £0.364m, Community £0.591m, Secure division £0.464m and reserves and capital charges £4.748m. Planned Cost Improvement Plans v Actual Cost Improvement Plans The 2018/19 Cost Improvement Plan target for the Trust is £7.639m. Performance against this plan is currently £1.802m underachievement. The £5.837m achievement includes local division which has achieved the saving through non-recurrent support of £0.940m from within the divisional financial position, and clinical divisions are also supporting the admin review within their financial position (£0.436m). There is a recurrent underachievement of £4.241m in 2018/19. Plans to deliver corporate Cost Improvement Plan risk this financial year are still required, and plans to achieve the recurrent gap need to be addressed. There will be additional Cost Improvement Plan targets of £5.800m in 2019/20 relating to Corporate Cost Improvement Plan (£4.200m) and Integration Cost Improvement Plan (£1.600m). The total CIP target for 2019/20 is therefore £10.041m taking into account recurrently undelivered CIP in the current financial year. CIP schemes for 2019/20 totalling £2.612m have been received to date, of which £1.302m have been approved by the Quality Assurance Committee in January, and a further £0.990m of schemes were approved by Quality Assurance Committee in March. Schemes totalling £0.455 have been received but not yet quality impact assessed. With a total CIP target of £10.041m, there is currently a CIP gap of £7.285m for 2019/20.

Agenda Item No: B2 CIPs associated with community integration have been managed in 2018/19, however the plans to deliver total savings of £3.540m in 2019/20 are unlikely to be delivered given the need to maintain safe services. 2. Technology that helps us provide better care - total spend on Global

Digital Exemplar The Trust is expecting to achieve a Public Dividend Capital allocation of £2.500m this financial year, which together with £1.337m revenue funding will make planned GDE expenditure of £3.837m in year. There has been expenditure incurred of £3.578m to Month 11, of which £1.217m is revenue and £2.361m is capital. Our Future

Accountable Director: Louise Edwards Over recent months the Trust has reviewed its long-term strategy and this has informed the development of the Operational Plan for 2019/20 which will be brought to the Board for approval this month (March 2019). In summary, our long-term strategy is to continue to improve quality and safely reduce costs within our services and from this strong platform, develop more preventative, integrated community based services. The Trust is designing and delivering new models of integrated care across North Mersey in collaboration with partners and key stakeholders, including patients, staff and non-statutory organisations. Leading Provider Alliances across Liverpool and Sefton, the Trust is supporting partners to come together and work collaboratively to deliver system change and develop place based services. Delivery of integrated care for neighbourhood populations of 30-50,000. These have been piloted in four neighbourhoods across Liverpool and Sefton (Childwall, Aintree, Crosby and Bootle). Provider Alliance Strategies have been agreed for both Liverpool and Sefton for 2019 and delivery groups have been set up to oversee Alliance plans. Integrated Care Teams will be extended beyond the four initial pilot sites to all 16 neighbourhoods across Liverpool and Sefton by October 2019. In addition a further four key priorities have been agreed for 2019; Urgent Care, Outpatients, Digital Technology and Social Prescribing. There is a proposal that this is tested out with two segments of the population – Frailty/dementia and Complex Needs. The Trust is currently in discussion with North Mersey CCGs around resources to support this work. Cheshire and Merseyside mental health providers were selected to become a wave 2 site for the New Care Models programme for low and medium secure mental health services, in partnership with North West Boroughs Healthcare NHS Foundation Trust, Cheshire and Wirral Partnership NHS Foundation Trust and independent sector providers, Elysium Healthcare and Cygnet Healthcare. The Partnership has reached agreements in respect of standardising processes and agreeing a future delivery model which will include an enhanced Community Forensic Service. The Partnership is working closely with local commissioning colleagues across local authorities and CCGs to design a community housing and support offer. We are also awaiting release of the bidding process for national

Agenda Item No: B2 funding to develop an Enhanced Community Forensic Service to support the pathway which is expected in January 2019. The Partnership is expected to go live as a wave 2 site in July 2019. The team has now finalised negotiations with NHSE in respect of the baseline offer and agreed caveats that mitigate a number of identified financial risks. A report was taken to Performance, Investment and Finance Committee in February and the business case is being updated to be presented in April. RECOMMENDATION The Council of Governors is asked to: 1) Note the assessment of performance against Regulatory and Operational

Plan targets. 2) Note that Performance Improvement Plans have been presented at the

quarterly review meetings to provide assurance that improvement plans are in place for areas of underperformance.

Neil Smith Executive Director of Finance April 2019

Ref Monthly Metrics Trust/ National Median Target

Latest Peer Position* Dec-18 Jan-19 Feb-19 Trend Line

C.1 Mental Health Friends and Family Test: (% positive)** 89.70% 92.40% 88.82% 88.25% 88.96%

C.2 Community Friends and Family Test: (% Positive) 96.20% 96.42% 96.34% 98.35% 94.48%

E.3 Care Programme Approach 7 day Follow Up** 95.00%/ 96.78% 96.43% 98.11% 100.00% 98.36%

E.4 % clients in settled accommodation 63.00% 59.00% 33% Due April 2019 Due May 2019

E.6 % clients in employment 7.00% 7.00% 2% Due April 2019 Due May 2019

S.8 Patient Safety Alerts not completed by deadline 0 0 0 0

S.9 Occurrence of any Never Event (Rolling 6 Month) 0 0 0 0

S.10 Admissions to adult facilities of patients who are under 16 years old 0 0 0 0

W.11 Sickness (In-month)** 4.51% 5.83% 7.63% 7.69% 6.97%

W.12 Turnover (In-month)** 0.90% 0.89% 0.71% 0.70% 0.40%

W.13 Proportion of Temporary Staff** 4.26% 3.52% 3.96% 4.00% 4.05%

R.14 First episode of psychosis begin treatment with a NICE-recommended package of care within 2 weeks of referral (Part A - Unify2 Dataset) (three-month rolling)** 53.00% 81.00% 63.75% 68.29% 67.90%

R.15 First episode of psychosis begin treatment with a NICE-recommended package of care within 2 weeks of referral (Part B - MHSDS Dataset) 53.00% 74.00% 62% 65%

Provisional Due April 2019

R.16 Accident and Emergency Maximum waiting time of four hours from arrival to admission/ transfer/ discharge 95.00% 100.00% 100.00% 100.00%

E.17 IAPT - Proportion of people completing treatment who move to recovery (Internal Reporting) - Monthly 50.00% 52.00% 45.98% 50.27% 51.08%

R.18 IAPT - Waiting time to begin treatment (from IAPT minimum dataset) within 6 weeks** 75.00% 87.00% 98.42% 98.03% 97.60%

R.19 IAPT - Waiting time to begin treatment (from IAPT minimum dataset) within 18 weeks** 95.00% 99.00% 100.00% 100.00% 100.00%

S.20 Inappropriate Out of Area Placement (In-Month) Q4 - 169 0 4 14

S.21 Potential under-reporting of patient safety incidents 55.43 32.77 Not Available Not Available

W.22 Capital Services Capacity Plan - 2 2 2 2

W.23 Liquidity Days Plan - 1 1 1 1

W.24 Income and Expenditure Margin Plan - 1 1 1 1

W.25 Income and Expenditure Margin Variance (based on original plan) Plan - 1 1 1 2

W.26 Agency Spend Plan - 2 2 2 2

S.27 Proportion of Strategic Executive Information System (StEIS) Incidents reported within 2 days - Community Division 100.00% 100.00% 83.33% 100.00%

S.27.1 Proportion of Strategic Executive Information System (StEIS) Incidents reported within 2 days - Liverpool Community 100.00% 100.00% 75.00% 100.00%

S.27.2 Proportion of Strategic Executive Information System (StEIS) Incidents reported within 2 days - Sefton Community 100.00% Not Applicable 100.00% Not Applicable

S.28 % of Harm Free Care (Safety Thermometer) - Liverpool Community Not Applicable 96.20% 93.75% 94.39%

S.29 % of Harm Free Care (Safety Thermometer) - Sefton Community Not Applicable 95.43% 93.79% 96.09%

R.30 Provider Cancellation Rates - Liverpool Community 3.50% 1.96% 2.45% 2.45%

R.31 Provider Cancellation Rates - Sefton Community 3.50% 2.85% 2.95% 2.95%

E.32 Walk In Centre Unplanned Re-attendance within 7 days - Liverpool Community 5.00% 0.70% 0.98% 0.64%

E.33 Walk In Centre Left Without Being Seen - Liverpool Community 5.00% 2.18% 2.16% 2.03%

Mersey Care NHS Foundation Trust - Single Oversight Framework

The five finance metrics above are scored on a scale of 1(best) to 4 by NHS Improvement using their RAG System of 1 = Green, 2 = Yellow, 3 = Amber and 4 = Red.

The data provided on the above metric has a two-month timelag due to national publishing timescales for the Mental Health Services Data Set



The data provided on the above metric is extracted from the NHS Improvement Model Hospital and relates to May 2018.

Ref Quarterly Metrics Trust/ National Median Target

Latest Peer Position* Q1 18-19 Q2 18-19 Q3 18-19 Trend Line

E.34 IAPT - Proportion of people completing treatment who move to recovery (from IAPT minimum dataset) - Quarterly** 50.00% 52.00% 50.28% 50.47% 47.42%

C.35 Staff friends and family test % recommended - care 74.11% 73.78% Staff Survey

C.36 Written complaints per 1,000 staff – rate 18.01 20.69 11.40 10.32 Not Available

E.37 Data Quality Maturity Index (DQMI) - MHSDS Dataset Score - Original 6 Data Items 95% / 98.40% 98.10% 97.30% 97.80% Due May 2019

E.37a Data Quality Maturity Index (DQMI) - Experimental MHSDS Dataset Score - Original 6 data items plus 11 new data items (For Information Only) 95.00% 78.90% 77.00% Due May 2019

Ref Annual Metrics Trust/ National Median Target

Latest Peer Position* 2016/17 2017/18 2018/19 Trend Line

W.38 Staff Survey - Staff recommendation of the organisation as a place to work or receive treatment (Key Findings 1) 3.74 Not Available 3.63 3.67 3.77

C.39 Care Quality Commission - Community Mental Health Survey Lower Limit Range - 6.37

Upper Limit Range - 7.30 7.37 7.47 7.05

R.40 Cardio-metabolic assessment and treatment for people with psychosis - inpatients 90.00% 66.00% 46.24% Not due until Q4 2018/19

R.41 Cardio-metabolic assessment and treatment for people with psychosis - Early Intervention in Psychosis 90.00% Not Available 15.00% Not due until

Q4 2018/19

R.42 Cardio-metabolic assessment and treatment for people with psychosis Community Mental Health Team (CPA) 65.00% 8.00% 19.80% Not due until

Q4 2018/19

KeyMetrics for which a judgement of performance is not appropriateMetrics which are being achieved or where performance is better than the national median.Metrics which are not being achieved at the target or where performance is worse than the national median.

Domain Reference KeyS = Safe, E=Effective, C=Caring, R=Responsive, W=Well-Led

The alignment of the metrics to the Care Quality Commission Domains is subjective and has been developed in conjunction with the Deputy Director of Nursing and Quality and alignment with NHSI Model Hospital (where possible).

** The metrics highlighted use national data where available, however, if this is unavailable for the latter months of reporting internal data is used until such time that the national data becomes available. The change in data could result in a different Red, Amber, Green rating being reported. The national median is the latest data available within NHS Improvement, Model Hospital.

* The peer position represents the latest peer position available from NHS Improvement, Model Hospital and does not necessarily represent the latest data position reported. The peers included are: Cheshire and Wirral Partnership NHS Foundation Trust, Cumbria Partnerships, North West Boroughs Healthcare NHS Foundation Trust, Greater Manchester Mental Health NHS Foundation Trust, Lancashire Care NHS Foundation Trust, Pennine Care NHS Foundation Trust, Bridgewater Community Healthcare NHS Foundation Trust and Wirral Community NHS Foundation Trust.

Mersey Care NHS Foundation Trust - Single Oversight Framework (continued)

The position reported above for 2018/19 is from the National NHS Staff Survey Dataset for Key Findings 1 and is benchmarked against Combined Mental Health / Learning Disability and Community Trusts. This is subject to change once the NHS Improvement Model Hospital has been updated.

The Staff Survey 2018 Results are now presented in 10 key themes and a different scale for reporting, 0 to 10 points where 10 is the best score attainable. 31 organisations are in this group and the average response rate was 45% with Mersey Care achieving 51%. The Trust is average and above average for 6 of the 10 themes and 4 below average. The

Staff survey report goes to Trust Board in March 2019 to inform the high level results and provide 2018/19 action plan for final review. In 2019/2020 the people plan will be the delivery method for improvement against identified hot spots.

The data provided on the above metric is extracted from the NHS Improvement Model Hospital and is the latest available.

The overall experience score has been used for the metric in relation to the Community Mental Health Survey. The data is available from the National Published Benchmark Dataset. The trust is seeking confirmation from NHS Improvement that this is the measure that is used to monitor for this metric.

Ref Trust Target Dec-18 Jan-19 Feb-19 Trend Line

S.43 100.00%

S.44 50.00%

R.45 90.00% 76.20% 82.81% 80.82%

R.46 95.00% 94.72% 93.77% 94.21%

R.124 0 0 0 0

E.47 95.00% 97.75% 100.00% 98.78%

R.48 95.00% 78.50% 86.61% 91.96%

R.48a 95%In-Month Plan 88% 77.00% 86.11% 91.59%

R.48b 95.00% 100.00% 100.00% 100.00%

R.48c 95.00% 100.00% 100.00% Not Applicable

S.49 In-Month Target - 3 5 2 0



E.52 85.00%

E.5 85.00% 44.44% 54.15% 67.29%

E.7 85.00% 47.83% 55.47% 67.35%

Ref Trust Target Q1 18-19 Q2 18-19 Q3 18-19 Trend Line

C.53 90.00% 78.15% 81.82% 82.44%

C.54 90.00% 100.00% 100.00% 100.00%


W.55 100% by 31.03.19 - In-Month Target - 87.50% 83.98% 86.60% 89.03%

S.56 No Target 4 6 2

S.56.1 No Target 4 4 2

S.56.2 No Target 0 2 0

C.57 No Target 1 4 2

C.57.1 No Target 1 3 1

C.57.2 No Target 0 1 1

R.58 8 weeks Commissioner Target 9 9







R.59.1 18 weeks Commissioner Target 7 10





KeyMetrics for which a judgement of performance is not appropriateMetrics which are performing at agreed targetMetrics which are underperforming

Number of Strategic Executive Information System (StEIS) Incidents - Liverpool Community

Number of Complaints - South Sefton Community

Dietetics Waiting Times - Sefton Community

Overall Adult Allied Health Professionals Waiting Times - Liverpool Community

Occupational Therapy Waiting Times - Liverpool Community

Dietetics Waiting Times - Liverpool Community

Physiotherapy Waiting Times - Sefton Community

Podiatry Waiting Times - Liverpool Community

Podiatry Waiting Times - Sefton Community

Speech and Language Therapy Waiting Times - Liverpool Community

Fall Services Waiting Times - Liverpool Community

Physiotherapy Waiting Times - Liverpool Community

Number of Strategic Executive Information System (StEIS) Incidents - South Sefton Community

Number of Complaints - Community Division

Number of Complaints - Liverpool Community

Speech and Language Therapy Waiting Times - Sefton Community

Accommodation Status (Data Completeness) - MHSDS Reporting. All patients who are on CPA, aged between 18 and 69 who have had an Accommodation Status reported within the last 12 months as at the end of the reporting period.Employment Status (Data Completeness) - MHSDS Reporting. All patients who are on CPA, aged between 18 and 69 who have had an Accommodation Status reported within the last 12 months as at the end of the reporting period.

Mersey Care NHS Foundation Trust - Operational Plan 2018/19 Our Services

Monthly Metrics

Within the local division, all inpatients to be offered the opportunity of completing a safety plan.

Within the local division, 50% of discharged patients will be discharged with a safety plan in place by March 2019.

Liaison Response Times (all contacts) of 1 hour in Accident and Emergency.

Training for the safety plan champions on wards continues. The difficulties experienced in the extract from RiO has now been escalated to the supplier, thus reporting on discharge numbers is unable to be actioned at present. RiO reports currently indicate 148 completed safety plans, however we carried out a manual search of RiO and found a number that

have a safety plan in place but the reporting tool had not been completed. This information is being cascaded down to Ward Managers to action.

Not Available

Not Available

% of New Admissions who have had physical health screening completed (National Audit of Schizophrenia Standard)

Liaison Response Times (all contacts) of 24 hours on acute wards.

95% of Service Users receiving best practice gate keeping assessment

Number of incidents where a service user has waited 12 hours or more from the decision to admit within an A&E department to be admitted to their agreed bed.

Not Available

Occupational Therapy Waiting Times - Sefton Community

Quarterly Metrics

Reported Month in Arrears

% of New Admissions who have had physical health screening completed (National Audit of Schizophrenia Standard) - Local Division% of New Admissions who have had physical health screening completed (National Audit of Schizophrenia Standard) - Secure Division

Our Services Metrics - Community

Number of Strategic Executive Information System (StEIS) Incidents - Community Division

Liverpool Community Staff Completing Level 1 Suicide Training by March 2019

Number of Prone Restraints associated with Intramuscular Injection - 50% reduction by March 2019

Number of All Ligature Incidents - 20% Reduction by March 2019

Number of physical restraints associated with self-harm. 20% reduction by March 2019.

Service Users will have full protected characteristics demographic data recorded to enable effective analysis.

Triangle of Care Completion Compliance

The methodology for this metric has been agreed and the report is being developed and validated.

Triangle of Care - % Self-Assessed as "Green" (of applicable criteria)

% of New Admissions who have had physical health screening completed (National Audit of Schizophrenia Standard) - Specialist Learning Disability Division

Ref Target Dec-18 Jan-19 Feb-19 Trend Line

E.80 345

E.81 100.00%

S.82 13.60%

E.83 49.22 46.62 44.32 39.23

R.84 389 458 386 349

R.85 12.98% 7.62% 11.76% 11.61%

S.86a 12.52% 11.48% 7.21% 7.01%

C.1.1 95.00% 92.08% 90.56% 92.49%


R.87 7.50% 1.65% 2.30% 2.36%

S.88 In-Month 15908 days 16736 17626 17960

E.89 1.69 Years 1.36 1.39 1.63

E.90 1.8 Years 1.64 1.52 1.59

S.86b 5.04% 7.98% 3.90% 9.57%

C.1.1 95.00% 80.85% 80.41% 76.04%


S.91 90.00% 99.64% 100.00% 100.00%

S.92 100.00% 100.00% 100.00% 100.00%

S.93 100.00% 100.00% 99.00% 100.00%

S.86c 14.51% 15.02% 14.68% 16.91%

Ref Target Q1 18-19 Q2 18-19 Q3 18-19 Trend Line

C.1.1 95.00% 66.67% 61.19% Staff Survey


S.94 2 1 4 2

S.95 2 2 2 2

S.96 0 0 1 0

S.94.1 2 1 2 2

S.95.1 1 2 1 2

S.96.1 0 0 1 0

S.94.2 0 0 2 0

S.95.2 1 0 1 0

S.96.2 0 0 0 0

S.97 8.47% 8.96% 7.98% 7.84%

S.97.1 8.47% 10.31% 9.21% 8.11%

S.97.2 8.47% 7.45% 6.67% 7.57%

S.98 95.00% 94.05% 96.06% 97.68%

S.99 39.02% 27.18% 27.68% 25.38%

S.99.1 39.92% 26.55% 26.28% 23.22%

S.99.2 35.35% 29.30% 31.56% 31.90%

C.2.1 95.00% 95.81% 98.24% 94.18%

C.2.2 95.00% 99.20% 100.00% 100.00%

% Incidents that result in harm (All incidents) - Liverpool Community

% Incidents that result in harm (All incidents) - Sefton Community

Community Scores Friends and Family Test % Positive - Liverpool Community (Internal Reporting)

Community Scores Friends and Family Test % Positive - Sefton Community (Internal Reporting)

Completion of FALLS Risk Assessment - Sefton Community

% Incidents that result in harm (All incidents) - Community Division

Quarterly Metrics

Patient Experience Friends and Family (Quarterly Position) Test: (% positive)

Community Division - Transformation Programme

Community Acquired and Avoidable Grade 3 Pressure Ulcers - Liverpool Community


Community Acquired and Avoidable Grade 2 Pressure Ulcers - Sefton Community

Community Acquired and Avoidable Grade 3 Pressure Ulcers - Community Division




"Did Not Attend" Rates - Community Division

Metrics



"Did Not Attend" Rates - Liverpool Community

"Did Not Attend" Rates - Sefton Community

Cumulative Average Length of Stay in Low Secure Unit - Discharged Patients (years)

Cumulative Average Length of Stay in Medium Secure Unit - Discharged Patients (years)

% Incidents that result in harm (excludes HMP Liverpool)

Mental Health Friends and Family Test: (% positive) - Internal Reporting - Secure Division

% Incidents that result in harm (Target: Mean Average 2017-18) - SpLD

Specialist Learning Disability Division - Transformation ProgrammeMetrics

% of Admissions to Hospital Prevented from the Specialist Support Team Caseload

All Service Users have received a HbA1c Test in the last 12 months (rolling 12 months)

All Service Users have received a Cholesterol Test in the last 12 months (rolling 12 months)

% Incidents that result in harm - Local Division

Mental Health Friends and Family Test: (% positive) - Internal Reporting - Local Division

Delayed Discharges (Low and Medium Secure Services)From April 2018 data excludes Reed Lodge.

Reduction in time spent in long term segregation (days). 2018-19 Target based on March 2018 Outturn Position - 20% Reduction by March 2019.

Secure Division - Transformation ProgrammeMetrics

Readmissions 28 days - Adult Mental Health Services (Target - Mean average 2017/18)

Mersey Care NHS Foundation Trust - Transformation Programme 2018/19 Our Services

Metrics

Count of Service Users in Clusters 1-3 on the caseload

100% of demographic data shared (Consent given) with the Life Rooms on discharge from Community Mental Health Teams

Average Length Of Stay for discharged patients reduced by 5% (mean average) - Adult Mental Health Services

Local Division - Transformation Programme

The methodology of the above metric is to be confirmed and once this is confirmed, a report will be built to capture the neccesary data.

Outpatients Did Not Attend - Total Did Not Attends (%) for both New and Ongoing appointments

Delayed Transfers of Care (Occupied Bed Days) - Adult Mental Health Services (In-Month)

Not Available

Not Available

Not Available


W.65 6.00% - Internal In-Month target 7.63% 7.69% 6.97%

W.66 11.00% 10.95% 11.22% 10.50%

W.67 No Target 9.71% 9.70% 9.72%

W.68 45 Days 46.6 43.5 39.7

W.69 94% - Internal In-Month target 86.78% 87.39% 88.10%

W.70 5.00% 14.58% 14.18% 13.59%

W.71 5.00% 8.63% 8.31% 7.73%

W.72 7.00% 6.29% 6.42% 6.45%

W.73 7.00% 7.11% 6.52% 6.84%

W.74 95.00% 86.89% 89.59% 93.25%

W.152 95.00% 87.12% 88.72% 94.13%

W.75 95% by 31.07.18 Window Closed

Window Closed

Window Closed

Window Closed

W.76 95.00% 84.99% 83.94% 83.00%

W.77 85.00% 77.40% 76.70% 73.57%

W.78 90.00% 85.35% 90.33% 92.02%

W.79 90.00% 85.09% 89.92% 91.99%


W.116 M11 Plan £3,517,250 £3,191,872 £3,323,103 £3,578,436

W.117 M11 Plan £26,363 £40,101 £36,392 £32,408

W.118 M11 Plan £329,587 £269,433 £300,593 £329,342.000

W.119 7.639m 5.837m 5.837m 5.837m

KeyMetrics for which a judgement of performance is not appropriateMetrics which are performing at agreed targetMetrics which are underperforming

Mersey Care NHS Foundation Trust - Operational Plan 2018/19 Our People

Personal Achievement and Contribution Evaluation (PACE) Compliance 2018/19 (Attainment within Window) (Excludes Liverpool Community)

Our People Metrics

Staff Sickness (In-Month) - Internal Reporting

% Turnover (Rolling 12 Months)

Bank and Agency Usage as a Proportion of Paybill

Recruitment Time to Hire (days) (inclusive of Bank Staff)

Completion of Core Mandatory Training (Previously known as Statutory Training)

Turnover Rates for Medical Staff (excluding retirements) (Rolling 12 Months)

Turnover Rates for Qualified Nursing (excluding retirements) (Rolling 12 Months)

Vacancy Rate for Qualified Nursing %

Overall Vacancy Rate %

Information Governance Training Compliance (Attainment within 2018/19)

Information Governance Training Compliance Completed within last 12 months (Excludes Liverpool Community)

The National Target for Information Governance Compliance of 95% has to be achieved by 31 March 2019 but internally we have set a target to achieve 95% by 31 December 2018.

Personal Achievement and Contribution Evaluation (PACE) Compliance 2018/19 Completed within last 12 months (Excludes Liverpool Community )

Performance Appraisal Compliance - Liverpool Community Only

Clinical Supervision completed in line with Trust Policy (every 8 weeks) - All Clinical Staff (Local, Secure and Specialist Learning Divisions Only)Clinical Supervision completed in line with Trust Policy (every 8 weeks - Professional Staff Only (Local and Secure Division Only)

Planned Cost Improvement Plan v Actual Cost Improvement Plans £m

Mersey Care NHS Foundation Trust - Operational Plan 2018/19 Our Resources

Our Resources Metrics

Technology that helps us provide better care - total spend on Global Digital Exemplar

Planned Cashflow vs Actual Cashflow £000's

Budget Year To Date vs Expenditure Year To Date £000's

Domain / Ref Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19

W.65 6.50% 6.50% 6.50% 6.25% 6.25% 6.00% 5.83%W.66 11.50% 11.50% 11.50% 11.25% 11.00% 11.00% 11.00%

W.69 90.00% 90.00% 91.00% 92.00% 93.00% 94.00% 95.00%

W.74 62.00% 73.00% 84.00% 95.00% 95.00% 95.00% 95.00%

W.152 63.00% 73.00% 84.00% 95.00% 95.00% 95.00% 95.00%

W.76 87.50% 87.50% 87.50% 90.00% 90.00% 95.00% 95.00%

W.78 75.00% 75.00% 80.00% 85.00% 85.00% 90.00% 90.00%

W.79 75.00% 75.00% 80.00% 85.00% 85.00% 90.00% 90.00%

Personal Achievement and Contribution Evaluation (PACE) Compliance 2018/19 Completed within last 12 months (Excludes Liverpool Community )Clinical Supervision completed in line with Trust Policy (every 8 weeks) - All Clinical Staff (Local, Secure and Specialist Learning Divisions Only)Clinical Supervision completed in line with Trust Policy (every 8 weeks - Professional Staff Only (Local and Secure Division Only)

Staff Sickness (In-Month) - Internal Reporting

Internal Trajectories - Our People Metrics

% Turnover (Rolling 12 Months)Completion of Core Mandatory Training (Previously known as Statutory Training)Information Governance Training Compliance (Attainment within 2018/19)

Information Governance Training Compliance Completed within last 12 months (Excludes Liverpool Community)

Agenda Item No: B3

Page 1 of 6

COUNCIL OF GOVERNORS

Report provided (check necessary boxes): Report to: Council of Governors

To Note: ☒ For Assurance: ☐

For Decision: ☐ For Consent: ☐ Meeting Date: 25 April 2019

Specialist Learning Disabilities Division Retraction Update

Accountable Director(s): Trish Bennett, Executive Director of Nursing and Operations Report Author(s): Susan Wrathall, Chief Operating Officer

Lisa Rens, Strategic Operations Manager

Purpose of Report To allow members of the Council of Governors to: • be updated on the transformation programme progress for the

Specialist Learning Disability Division


• On the 31st March 2019 there were 102 (24F, 78M) resident service users on the Whalley site.

• A key focus for the service is to close 16 ESS & Stepdown beds and to reduce the LSU beds from 52 to 40.

Recommendation:

The Council of Governors is asked to: 1) To note progress to date 2) To note the content of the report



Council of Governors

Jan 2019 SLD Retraction Update Noted

PURPOSE

1. To allow members of the Council of Governors to be updated on developments within the Specialist Learning Disability Division.

EXECUTIVE SUMMARY

2. On the 31st March 2019 there were 102 (24F, 78M) resident service users on the Whalley site.

3. A key focus for the service is to close 16 ESS (Enhanced Support Service) & Stepdown beds and to reduce the LSU beds from 52 to 40.

Agenda Item No: B3

Page 2 of 6

4. The 4 planned discharges for February and March 2019 have been delayed to April or May due to legal issues or the need to secure a community RC.

5. Demand for services is ongoing with 17 service users awaiting admission, 5 are internal for Service Users requiring to transfer from medium to low secure services and 12 are external to the Trust.

6. A key focus for accelerated discharges remains on the 16 service users within the ESS and Stepdown services. Collaborative working continues with CCG Commissioners for Lancashire, Greater Manchester and Cheshire & Merseyside planning the discharges that are likely to take place during the next year.

7. As of 31st March 2019 there were 33 male Low Secure Unit (LSU) service users currently in the transfer/discharge process.

8. There are currently three Service Users with Individual Packages of Care (IPC) on the Whalley site and Lancashire CCG Commissioners are leading on the options and agreement of the final plan for the services.

9. A multi-disciplinary group from NHS England have been meeting to agree the clinical criteria, model and pathway and the first potential service users for transfer are being assessed

10. The Specialist Support Teams now have 429 service users on the caseload and have supported service users with out of hours support and attendance at urgent meetings which have resulted in no service users from the caseload being admitted to hospital in January or February 2019.

11. NHS England have provided the draft Quality of Life Report which was commissioned by Pathway Associates. The draft has 7 recommendations, once the final report is agreed the Division will provide a response to each recommendation.

12. The Division as a whole had 94.89 wte vacancies at the end of February 2019 of which 80.54 relate to the Whalley site and 10.2 wte are registered nurse vacancies, which is positive following recent nurse recruitment and seconded staff returning from nurse training. The largest vacancy area is for Nursing Assistants with 50.83 vacancies for the Whalley site. Adverts are out in the local area and via NHS Jobs for Nursing Assistant posts.

13. Funding for the new LSU has recently been confirmed by NHS England, a communication to staff explains it will be approximately 3 years before the new low secure unit will be open in Maghull.

14. Work on the Rowan View MSU build is progressing well and without delay.

Agenda Item No: B3

Page 3 of 6

BACKGROUND/ CONTEXT

15. The national transformation plan ‘Building the Right Support’ (NHSE 2015), outlines the requirement to move people with learning disabilities (LD) into ‘more appropriate community settings’ with less reliance on in-patient beds. The report also signalled a 50% reduction in low secure learning disability beds and 25% reduction in Medium Secure Unit (MSU) beds. In addition, NHS England advised following the consultation (28th March 2017) that all hospital beds on the Whalley site will close and be re-provided over the next three years on a case by case basis for each service user, in the community or in new state of the art units elsewhere in the North West.

ISSUES FOR CONSIDERATION

OUR SERVICES

16. On the 31st March 2019 there were 103 (24F, 78M) resident service users on the Whalley site in the following services:

• IPC 3 • ESS & Stepdown 16 (incl. 2 NHSE funded service users) • LSU 51 (incl. 1 CCG funded service user) • MSU 32

Transfer/Discharge Planning

17. A key focus for the service is to close 16 ESS & Stepdown beds and to reduce the LSU beds from 52 to 40.

18. During February and March 2019 there have been no discharges (4 were planned) from inpatients, service users that were expected to be discharged experienced further delays and are not anticipated to be discharged until April or May 2019. Delays were due to legal issues relating to the court of protection and the need to secure a community RC.

Admissions, Waiting Lists and Referrals

19. The MSU bed numbers have reduced to the planned commission number of 40. Normal business continues and during March 2019 there have been two Male admissions and there are four open male referrals.

20. Waiting lists remain in place, as at the 31st March 2019 there were 17 service

users awaiting admission to the following services:

• Male LSU- 6 (1 external, 5 internal)

• Female LSU – 5 (4 external – 2 Arbury Court, 2 Cygnet Derbyshire, 1 internal)

Agenda Item No: B3

Page 4 of 6

• Female MSU – 6 (6 external - 3 Calverton Hill (1 having an LSU gatekeeping

• assessment), 1 Scott Clinic, 1 Edenfield Centre & 1 Arbury Court)

ESS & Stepdown

21. A key focus for accelerated discharges remains on the 16 service users within the ESS and Stepdown services. Collaborative working continues with CCG Commissioners for Lancashire, Greater Manchester and Cheshire & Merseyside planning the discharges that are likely to take place during the next year.

Male LSU

22. As of 31st March 2019 there were 33 male LSU service users currently in the transfer/discharge process. Although male LSU beds are to reduce to 20, NHS England Commissioners are reviewing new admissions on a case by case basis to meet patient need. Weekly tracking of service users in the transfer/discharge process continues, enabling potential issues that may prevent a successful discharge to be minimised and escalated appropriately.

IPC

23. There are currently three IPC’s on the Whalley site. There have been several meetings held regarding the future of the services provided in the periphery housing and Lancashire CCG Commissioners are leading on the options and agreement of the final plan, they continue to work closely with the Trust and NHS England Commissioners and importantly the Service Users and their families.

Autism Spectrum Disorder Group

24. A multi-disciplinary group from NHS England have been meeting to agree the clinical criteria, model and pathway and the first potential service users for transfer are being assessed.

Specialist Support Services – Lancashire and Greater Manchester

25. The Specialist Support Teams (SST) are operating in line with the service specification and the Standard Operating Procedure. In February the Greater Manchester team accepted 17 new referrals and currently have 182 people who are active cases, 66 of these are to coordinate discharge from hospital and 121 are to prevent a hospital admission. The Lancashire and South Cumbria team accepted 22 new referrals and currently have 189 people who are active cases, 70 of these are to coordinate discharge from hospital and 119 are to prevent a hospital admission. There was one instance where the Out of Hours service was used and support was provided by the Lancashire and South Cumbria SST in February.

26. Key Performance Indicators have been developed for the Lancashire and South Cumbria teams. The KPIs are now focussed to reflect normal business and outcomes of service users, rather than the setting up and establishment of service user caseloads. One of the new key indicators relates to the prevention of hospital admissions for service users from the SST caseload, since it was introduced 3 months

Agenda Item No: B3

Page 5 of 6

ago the SSTs have been working with 240 people who are considered to be at risk of admission. In December there was one admission and in January and February there were no admissions to hospital, although the team attended 2 urgent meetings in February. In all cases the outcome was to recommend continued care in the community.

27. The SSTs have also been supporting the more complex discharges from low secure,

ESS and stepdown services. Attending meetings with carers and potential future providers to explain what support and expertise they will provide to ensure a safe discharge. Supporting discharges is a key priority for the service.

Quality of Life Report

28. NHS England have shared a draft copy of the Quality of Life Report with the Trust, this is part of the evaluation of the transforming care programme in the North West. Pathway Associates have been commissioned by NHS England to evaluate the quality of life of people with learning disabilities in the North West. The evaluation covers two groups of Service Users, those currently at Whalley and those discharged through the transforming care agenda from hospital into the community for between 6 and 18 months.

29. The aim of the project is to make recommendations to contribute to the evaluation of the Transforming Care programme and to propose sustainable improvement on the ways in which quality of life should be conceptualised, evaluated and quality of life improved. The draft reports details 7 recommendations; once the final report is received a response will be collated.

OUR PEOPLE

Staffing

30. The Division is currently budgeted for 708 WTE staff. At the end of February there were a total of 94.89 vacancies (13.4%) excluding transition. A summary by service/location is provided below:

Budget Actual Vacancies

Whalley Services 553.22 472.68 -80.54

Liverpool & Sefton LD Services 85.47 86.83 1.36

Lancs & Greater Manchester SST 69.38 53.67 -15.71

Total 708.07 613.18 -94.89

31. A further breakdown by staffing group as at the end of February 2019 is provided below, which details 26.97 (9.54%) registered nurse vacancies and 54.96 nursing assistant vacancies (14.9%).

Agenda Item No: B3

Page 6 of 6

Vacancies Medical Registered

Nurses Nursing

Assistants Scientific & Therapeutic

Non Clinical Total

Whalley Services 0 -10.51 -50.83 -9 -10.2 -80.54 Liverpool & Sefton LD Services 0 -1.26 0.67 0.95 1 1.36 Lancs & Greater Manchester SST -1 -5.2 -4.8 -3.71 -1 -15.71 Total -1 -16.97 -54.96 -11.76 -10.2 -94.89

32. Recruitment is ongoing, along with the development of recruitment and retention initiative including an annual offer for qualified nurses to undertake a Masters programme. The first 18 qualified nurses from secure and the Specialist Learning Disability Division have just commenced the programme.

33. There is also a specific focus on recruiting nursing assistants. Adverts are out in the local area and via NHS Jobs for NA posts to support individual packages of care that will not be included in Rowan View plans. Two new Nurse Associates will take up post from April and three registered nurses commenced their preceptorship during March 2019, after completing their apprenticeship secondments.

OUR RESOURCES

Low Secure New Build

34. Funding for the new LSU has recently been confirmed by NHS England, a communication to staff explains it will be approximately 3 years before the new low secure unit will be open in Maghull.

Rowan View MSU

35. Construction remains on target and is progressing well. The recruitment plan was due to start during March 2019 but has been put on hold whilst organisational change for the staff currently working in the SLS Service within the Local Division takes place as some staff may be re-deployed into vacancies for the new MSU.

36. NEXT STEPS

23. The Division will continue to progress the retraction of services in collaboration with commissioners.

RECOMMENDATIONS

37. The Council of Governors is asked to:

a) Note progress and the content of the report.

TRISH BENNETT EXECUTIVE DIRECTOR OF NURSING AND OPERATIONS

April 2019

Agenda Item No: B4

1


Report provided (check necessary boxes):

To Note: ☒ For Assurance: ☐ Report to: Council of Governors


Community Services Improvement Programme Update

Accountable Director(s): Trish Bennett, Executive Director of Nursing and Operations Report Author(s): Chris Lyons, Director of Transformation and Service Delivery

Purpose of Report To provide members of the Council with: • an overview of progress against the 44 issues within the

Community Services Improvement Programme. Summary of Key Issues for Consideration of Governors :

• It is important that the Council of Governors are provided with assurance that a structured and comprehensive approach to the improvement of community services is in place.

Recommendation:

The Council of Governors is asked to: 1) note the continued progress within the programme based on

this high level overview report. Next Steps: (Subject to recommendation being accepted)

None identified.



LCS Sub Committee

18 March 19 Community Services Improvement Programme Update

Noted.

Agenda Item No: B4

2

EXECUTIVE SUMMARY/ BACKGROUND

1. This report follows on from the Transition Sub Committee meeting of 18 March 2019. No issues were identified as requiring escalation.

2. The improvement programme for Community Services continues to be implemented across 44 identified issues. Attached to this report as Appendix 1 is a table providing a progress update in relation to each issue as of the end of February 2019

3. A request was made by the Sub Committee Chair to provide a handover document

which would confirm outstanding issues to be addressed and the management/governance arrangements for each issue going forward. This is attached as Appendix 2 to this report.

4. A decision has since been made to continue with the Transition Sub Committee until the end of the year, with the Committee meeting on a bi-monthly basis, in order to continue to monitor performance against the programme’s original objectives.

PROGRESS REPORT

5. Appendix 1 is an 11-monthly status report outlining progress in relation to each issue against the agreed milestones and timelines. In the main, progress has been made across all issues. Currently 25 of the 44 issues have been completed within the terms of the programme’s original objectives.

6. Appendix 2 is a handover document which outlines timescales and management/governance arrangements for each of the remaining issues.

RECOMMENDATIONS

7. The Council of Governors is asked to: a) note the continued progress within the programme based on this high level

overview report.

TRISH BENNETT EXECUTIVE DIRECTOR OF NURSING & OPERATIONS

April 2019

Agenda Item No: B4

3

Liverpool and Sefton Physical Community Services Improvement Programme

Status report on progress to date – Month 11 As of 28 February 2019

Prepared by Chris Lyons, Director of Transformation and Service Delivery and Emma Welsby, Strategy and Delivery Facilitator

This paper presented to the Board Development Session on Wednesday 9 January 2019 provides a detailed update in relation to all of the 44 issues identified in the original Community Services improvement plan. The Board is asked to note that all issues have been effectively addressed from a safety perspective. However, there is still outstanding work to be done, which will be completed by the end of March 2019, which will then influence the development of a future improvement plan.

Key:

Complete - Issue has been fully addressed. 25

On track – Significant and measurable progress has been made. The project timelines may have had to change due to complexity. However immediate safety and risk issues have been addressed.

19

Limited progress has been made – Little or no progress has been made or a significant risk still exists which has not yet been addressed despite best efforts.

0

Agenda Item No: B4

4

Quality Assurance – Executive Lead, David Fearnley, Medical Director

Problem / Issue to be addressed

Required outcome / solution

Senior Responsible Officer

Original timeline for completion/ Milestones

Progress Rating

11 Month position commentary

QA1 Serious Untoward Incident Review - Complete a review of the handling of previous serious incidents to ensure they have been properly investigated and lessons learned

Report to be presented to Mersey Care Board of Directors and findings implemented across the organisation based on an agreed action plan.

Arun Chidambaram

Report to be submitted on the analysis of SUIs/infrastructure safety and quality by June 2018 Agree actions to resolve SUIs and create a 'learning health system' by September 2018 Measures of safe and effective care in place by December 2018 Enhanced learning programmes by March 2019

SI review panels are progressing according to plan. Five expert panels are scheduled to meet and review the various categories of serious incidents during the month of February. Lancashire Care Foundation Trust have been represented in the SI panel for prison deaths relating to the period when LCFT provided services in HMP Liverpool. Work has progressed in reviewing the data that was not available during the earlier phase of serious incident review. The final expert panel is scheduled for 1st March 2019 and will be chaired by Dr Fearnley, Medical Director.

QA2 Quality Improvement – There will be a need to implement fully the findings of the SUI review.

Full implementation plan agree and implemented.

Jennifer Kilcoyne and Jenny Hurst

See milestones for QA1

The full development of the quality improvement programme will be completed once the findings of the SI review are available (end of March 2019).

QA3 Safety – There is a Alignment of the two safety Steve See milestones for The risk and safety framework has

Agenda Item No: B4

5

requirement to align the two safety systems.

systems.

Morgan

QA1 been reviewed across the organisation, which has included the development of safety huddles in each division where risk related data is considered with the aim of identifying areas where further support are needed to enhance safety and quality. The Executive Safety Huddle provides a vehicle to analyse risks across the organisation and provide guidance and challenge on management arrangements. A new process has been developed to oversee the completion of Serious and Untoward incident reports which include a divisional process led by a senior manager with corporate support and final oversight by the Medical Director. Progress has been made in improving the quality of reports and identifying where further work is required. Key areas for improvement have been identified and the Centre for Perfect Care engage in supporting the improvement process, examples include the reduction of pressure ulcer programme.

QA4 Datix Migration – There is a need to ensure that all LCH staff begin to use Mersey Cares Datix

A single, unified Datix system used by all staff

Dave Hurley

All community staff are using Mersey Care’s Datix system. 31st October 2018.

The changeover to the MCT Datix system will take place week commencing 11 March 2019, and from that point all new incidents will be reported on that system. There

Agenda Item No: B4

6

system and cease to use the old LCH Datix system.

will be a three-week period during which other systems will be closed down, and an interim reporting solution will be in place until the BI team have fully migrated.

QA5 Pharmacy Patient Group Directives – Review of all 63 PGD’s.

Completion of PGD reviews and alignment to policies.

Lee Knowles

A full report confirming that all PGD’s have been reviewed and update to be present to Sub Committee after the end of August 2018.

No expired PGDs sit on the intranet so there is no risk to the organisation, staff or patients of a PGD being referenced from the intranet that is out of date. 17 National PGDs have been adopted by the organisation. When the expired ones need to be replaced the additional work is being absorbed into the programme schedule for the PGD Group. As of February 2019, 45/57 of the locally owned PGDs have been reviewed and rebranded. This equates to the work being 79% complete. A work schedule has been submitted and it is estimated that the review and rebranding will be complete by the end of June 2019. In addition, the following work has also been completed: • A programme of audit has started

which has triggered learning and development opportunities;

• The PGD Policy has been moved

Agenda Item No: B4

7

to the Mersey Care template, reviewed and forwarded for approval to Mersey Care Policy Group;

• The Terms of Reference (TOR) for the PGD Group has been rebranded and revised to reflect the changes in reporting to the Divisional Governance Group.

QA6 Medicines Management Policies – Medicines Managements policies need to be reviewed and brought together into a single Medicines Management Framework.

A single Medicines Management Framework policy to be agreed and implemented.

Lee Knowles

Report to be provided by end of October 2018 outlining the establishment of a single medicines management framework and the work that has been done to achieve this.

This piece of work is being done as part of the overall review of PGD’s.

Agenda Item No: B4

8

Operational Performance and Delivery (including CQC oversight) – Executive Lead, Trish Bennett, Executive Director of Nursing




Original Timeline for completion/Milestones

Progress Rating


OP1 HMP Liverpool Review

Mersey Care with the other members of HMP Liverpool’s Health Board is required to: • To develop a joint

clinical audit program for the prison’s healthcare services.

• To ensure that the key metrics in respect of the services provided by Mersey Care to HMP Liverpool are reported regularly through the Mersey Care’s performance report.

• To provide an update to

Mersey Care Board of Directors that services are safe and effective.

• To develop and

implement an action plan against CQC and prison standards.

Steve Newton

An initial status report outlining the issues to be addressed, the action plan and the organisation-al arrangements to be put in place to be provided to the Sub Committee in June. Update report on implementation of action plan to be provided to committee in September, December and March.

We continue to progress service transformation and the development of robust effective care pathways to ensure continuation of care for individuals received into the establishment and through the gate back into community services. The CQC have now confirmed the outcome of the current review with a positive report. A full report will be provided to the Sub Committee in March 2019.

Agenda Item No: B4

9

OP2 Review of NHS England’s Commissioning Arrangements –Contribute to NHS England’s review of commissioning arrangements to ensure that prison healthcare services at HMP Liverpool are safe and effective

Mersey Care is required in partnership with Spectrum Healthcare CIC and other members of HMP Liverpool’s Health Board to develop a model of care which will provide safe and effective services to the prison. There is a requirement to provide a report to the Mersey Care Board of Directors on the development of HMP Liverpool’s model of care.

Steve Newton

An initial status report outlining the approach to the development of HMP Liverpool’s model of care to be provided to the Sub Committee in June. Update report on implementation of model of care to be provided to committee in September, December and March.

We are working closely with NHSE as commissioners of the service to ensure we are delivering against the national MH service offender health specification. We have reviewed the appropriateness and feasibility of the specification and prepared a document in collaboration with colleagues at Greater Manchester Mental Health NHS Foundation Trust at the request of NHSE, this was discussed and agreed at the North Offender Health Provider Forum in January. We will meet NHSE in April, representing colleagues working across Offender Mental Health services, to discuss and agree appropriate amendments to the service specification.

OP3 Management of Pressure Ulcers - The Kirkup Review noted poor performance in respect of the management of pressure ulcers. There is a need to improve pressure ulcer management and evidence by key information regarding incidence and prevalence.

There is a need to commission a review of past and present pressure ulcer management to identify systemic failures in practice. This report will be presented to the Board and its recommendations (if accepted) developed into an action plan.

Nicky Ore and Jenny Hurst

Action plan to improve Pressure Ulcer management based on Sefton experience to be completed by 15th June. (Nicky Ore) Action plan with agreed timelines and responsibilities to be brought to workstream meeting by 15th August. Report to be

The comprehensive Pressure Ulcer Reduction Programme continues to be developed and the Trust continues to participate in the national Stop the Pressure collaborative the final NHSI event was undertaken in November 2018 – both projects are now being scaled up for implementation across the division. Learning from the Cat 4 PU increase gaps were identified and a QPA was developed and implemented across the division and wider organisation; for example, there will be no

Agenda Item No: B4

10

completed and the implementation of the action plan commenced based on the findings of the SUI review carried out on Locktons by 31st August 2018 (Jenny Hurst)

presentation of cases at Being Open without full written chronology report from all services involved. Safety huddles are to be undertaken every day in every team across Liverpool and Sefton Community Division using agreed safety huddle template, audit completed in each locality Q3 2018/ 19 analysis now underway. TVN report is now completed by the skin service for all Cat 3 and Cat 4 serious incidents going to RCA investigation within 10 working days. Key progress against PU reduction programme work streams: • A bespoke pressure ulcer

dashboard has been developed to further enhance intelligence and identify key areas for improvement. This enables locality level detail monthly – this is now under further development to include deterioration of Cat 2/ Cat 3 pressure ulcers.

• Work has commenced to develop and implement a pressure ulcer programme across the other Mersey Care Divisions. First meeting has taken place and plan in place to support.

• As part of the NHSI Stop the

Agenda Item No: B4

11

Pressure Collaborative Approach, LSSCD has completed the 120 day improvement project this work is now being scaled up across the division.

• A SEM (sub-epidermal moisture) scanner pilot has been undertaken over the past 3 months in conjunction with Perfect Care Team. Pilot closed on 15.02.19 currently working with the company on analysis of results – expected April 2019.

• Machine Learning – this project is the development of an ‘app’ in conjunction with Liverpool John Moore’s University and Perfect Care. The app will support the grading of pressure ulcers alongside defining the tissue type.

• Latest NHSI competency frameworks have been developed. Dedicated work stream implemented as part of pressure ulcer reduction programme. Target date for implementation is April 2019, in line with national implementation timeframes.

This issue is now considered to be business as usual, managed through

Agenda Item No: B4

12

the divisional Operational Management Board and the Quality Assurance Committee.

OP4 Liverpool and South Sefton Corporate Governance Arrangements – There is a need to put in place robust governance arrangements for the new Liverpool and South Sefton Community Division

The establishment of Liverpool Community Services Transition Committee and confirmation of Terms of Reference.

Andy Meadows (supported by Lee Taylor)

Governance arrangements in place by 30th April 2018

Governance arrangements have been fully established.

OP5 Medical Devices – There is an urgent need to agree and implement management and governance arrangements for the management of Medical Devices across both Liverpool and South Sefton (Currently there is interim arrangements in place which reduces/negates immediate risks)

A review is to be carried out and the recommendations to be formally agreed and approved by Medical Director. Note: It is important that Informatics are aware of contracts / suppliers as they need to ensure the device operating systems meet security requirements (these were the items generally affected by the Cyber attack last year).

Jenny Hurst Review of services and option appraisal with clear recommendations regarding future configuration of services to be completed and submitted to sub committee and PIC by September 2018

The service review has commenced. A paper will be submitted to the Sub Committee in March 2019 with a proposal for the requirements for medical devices.

OP6 On-call & Emergency

Single system identified and implemented.

Nicky Ore Functional combined On-call

This issue has now been fully addressed.

Agenda Item No: B4

13

Management System (EMS) – There is a need to combine Liverpool and South Sefton On-call and EMS and to ensure that these On-call are integrated to the overall Trust On-call arrangements and EPRR policy.

to be in place by 30th June 2018 and effective from 1st July 2018. (update the date for go live has been extended to 27th July).

OP7 Lone Working Devices – There is a need to agree and implement a managed unified process across Liverpool and South Sefton for managing Lone Working Devices including who Reliance contacts out of hours in the event of incident occurring.

An agreed policy and action plan which is implemented after sign off by Operational Management Board (OMB). In the interim period the asset list with be completed by 30th June and Liverpool Community security management specialist will have been appointed

Nicky Ore A finalised policy and action plan to be presented to Community Services Sub Committee 30th September 2018

Divisional project plan continues to be developed. This has been delayed due to project management support gap – this has now been addressed and support in place. The project approach will enable a true baseline to be established informing the contract requirements going forward / options appraisal and a systematic approach to low / medium and high risk users. Divisional performance reports to enable robust data / performance/ utilisation reporting developed – report for February 2019 is now available to review. • Divisional / locality level usage

reports – this will now be included within monthly performance reporting

• Reports are available at locality level

Agenda Item No: B4

14

An operational policy on the management of LWD’s has been drafted and escalated for consultation. The policy will now be presented to the health and safety committee in March for agreement and placed on the intranet. In support of this policy a LWD information page has been set up on the intranet to provide guidance and support and to encourage self-help. Due to increase in demand an additional 100 devices were ordered and received however distribution to staff has been a challenge due to capacity – at the time of writing this up date 40 of the 48 staff have been trained. A request has been submitted by H&S via the lone working budget to employ two temporary admin support who will visit teams across the community division and update LWD escalation forms (new process being implemented by H&S). This will enable the Trust to de-conflict numbers and names against information held by Reliance and create a more accurate list of holders and device numbers. This information will also support

Agenda Item No: B4

15

redesigning usage reports aimed at line manager level to encourage device monitoring at team level. The work is planned between Mar – Jun 2019 provided the application of temp staffing is approved.

OP8 Policy Alignment – There are circa 120 policies that need to be reviewed and aligned to Sefton in relation to the Trust format of SOP’s, Guidance, Local and Trust policy.

Plan developed which clearly indicates when all policies will be merged and implementation plan with oversight to manage this process. Implementation of this plan.

Ian Christensen

Scoping exercise to identify all relevant policies and implementation timeline to be completed by end of May 2018 Progress review report to Community Services Sub Committee end July 2018 Policy alignment process completed by 31st March 2019

A work plan of policies together with their review dates has been developed to support a systematic approach to the management / timely review of all divisional clinical policies. Some policies that were extended to end February 19 have been further extended to May / June 19 whilst their review takes place, however the expectation is that for the majority of policies they will have been reviewed and updated by end March 2019. Traction is required to ensure all policies are reviewed in a timely manner as part of the plan, which will continue post March 2019 as policies are reviewed and updated when they become due, and this will report through to the Executive Committee via the Divisional Clinical Policies and Procedures Group and Operational Management Group.

Agenda Item No: B4

16

OP9

Rebranding –There is a need to rebrand LCH documentation to Mersey Care. This will require scoping out and identification of documentation that needs to be rebranded.

All rebranding completed Elaine Darbyshire (supported by Rachel Robinson)

Scoping exercise to identify extent of rebranding needed. This scoping exercise should also include an implementation timeline with costings if appropriate by 30th June 2018 Interim report to Community Services Sub Committee.

The rebranding exercise has been fully completed across Liverpool and South Sefton. We are awaiting feedback on a small number of leaflets and will make any necessary changes in line with the needs of services. Any other changes to resources will form part of business as usual operations.

OP10 Information provided in other languages - The provider should ensure that a range of information leaflets in clinical areas such as tests and screening is available in languages other than English.

Comprehensive range of information leaflets in other languages.

Elaine Darbyshire (supported by Rachel Robinson)

Review to be commissioned and carried out internally and findings reported back to the July Sub Committee. 30th June. Implementation plan to be developed and implementation commenced 31st July.

All Liverpool and South Sefton patient information leaflets include a standard section informing patients how to access the leaflet information/content in another format or language. All of the trust sites display posters advising the same messaging. A small number of patient leaflets, standard patient letters have been translated into other languages and easy read (Social Inclusion Team and Phlebotomy, Health Visiting etc). Trust website has been updated to reflect the Equality and Diversity

Agenda Item No: B4

17

Team and access to information (interpreting, translation, BSL etc).

OP11 Engaging with patients about quality of services – There is a need to improve engagement with patients in order to obtain feedback on service provision.

Demonstrable evidence of feedback received from patients in relation to quality of services.

Elaine Darbyshire (supported by Michael Crilly and Berenice Gibson)

Implementation plan to be submitted to Sub Committee in June 2018.

Following the submission to Sub Committee in February 2019 relating to the following questions, an item is to be tabled for a) Local & Community Services OMB & b) PIFC to seek funding approval to enable on going engagement with patients and families and the provision of spiritual care and bereavement services.

1) How is the intelligence

gathered during the engagement with patients, service users, families and carers being shared with services?

2) What does good community services engagement look like and what might that cost to deliver in Mersey Care?

3) What would the necessary spiritual care and bereavement provision for end of life/palliative care patients and families look like for community services and what might that cost to deliver?

In the absence of funding it is currently not possible to initiate anything further and the trust is in the process of winding down the

Agenda Item No: B4

18

project team, however the balance of the Participation Support Workers funding will help to support an increase in volunteering across physical health services until the end of September 2019.

OP12 Review of Community Structures – There is a need to agree and implement revised management structures below Director level within Liverpool and South Sefton community services which facilitate internal integration but also allow future place-based services to be delivered.

Revised community structures agreed and process of implementation commenced as part of the Integration Programme.

Trish Bennett (supported by Lee Taylor)

Initial report to be submitted to committee by 30TH August 2018. To be submitted to September sub committee.

An initial report was submitted to Sub Committee in September confirming that a revised senior leadership structure has been established within the division. A review will now be undertaken of remaining management tiers. A report on this further review will be provided to the Sub Committee in March 2019.

OP13 Service Reviews – There is a need to carry out a service review on every individual clinical service in Liverpool and where appropriate align them with Sefton service provision.

Completion of all Service Reviews on a prioritised basis. Note: Whilst all services will be reviewed particular attention will be paid to those services which have been identified as a cause for concern by Kirkup, Capsticks, CQC reports, Due Diligence and Quality Handover reports. These services are referred

Lee Taylor Prioritised reviews to be completed by 31st August 2018 and a full report provided to the subcommittee in September. Remaining services to be reviewed by 31st December 2018

Following discussions with Trish Bennett in January 2019, it has been agreed that there are no further service reviews required at this time, other than the six prioritised reviews.

Agenda Item No: B4

19

to below and these service reviews will be completed by the end of August.

and a full update report to subcommittee in January.

OP14.a

Special Schools – There is a need to agree our policy position in relation to Special School provision. Once this is agreed there is a need to implement the agreed approach. (Note: There will be a need to assess the risk to both individual patients and to the organisation in relation to the decision made)

Agreed policy statement Trish Mattinson

A two year action plan to be developed in advance of the policy review. This two year action plan is to address immediate issues to stabilise and improve current service provision and has been done in partnership with Alder Hey. Update report to sub committee in May. Report outlining findings of service review with recommendations for future actions and update on progress against Action Plan to be submitted to Community Services Subcommittee by 31st August 2018. To go to

There has been continuous progress against the 2 year improvement plan which serves to provide assurance that all issues relating to safety and quality have been addressed, mitigated or resolved. Further work is required with CCG colleagues to determine service specification in addition to the current Healthy Child Specification from Liverpool City Council. There is also further work required with IMersey and Alder Hey Children’s Hospital to support implementation of systems and processes to assure robust information sharing in the most timely and effective manner. An update paper will be provided to the Transition Sub Committee on 18th March 2019 with the recommendation that the work to date and future planned actions within the Special School Service is managed within the Community Services Division as ‘Business as Usual’ reporting via the Senior Leadership Team and Operational Management Group. Expected resolution of remaining issues in relation to this item is September

Agenda Item No: B4

20

September Sub Committee.

2019. There are 3 key elements to this 1) Information sharing processes with Alder Hey Children’s Hospital (AHCH) anticipated delivery June 2019. 2) Service Specification delivery June 2019 3) Capture of ‘voice of the child’ in special school processes anticipated delivery September 2019.

OP14.b

Dental –

Outcomes to be agreed following the completion of the initial service review

Lynda Taylor

Report outlining findings of service review with recommendations for future actions to be submitted to Community Services Subcommittee by 31st August 2018.

The service is currently meeting commissioned Key Performance Indicators and is in a significantly improved position compared with March 2018. It was agreed at the Transition Sub Committee on 19 November 2018 that management of this service would revert to ‘business as usual’, with no immediate requirement for an additional service review.

OP14.c

Safeguarding –

In relation to the Kirkup finding in the next column- it is the case that this issue will be addressed as part of the SUI review (QA1). Once this review is carried out these incidents and others will be reviewed by Sandra O’Hear to determine if they should have been referred to as Safeguarding incidents to the Local Authority at the time. In addition the question would

Sandra O’Hear

Following completion of the SUI review (QA1) Sandra O’Hear will review the identified incidents to determine if any of the incidents should have been reported at the time to the Local Authority and if any of the incidents still need to be

This issue cannot be taken forward until the SI Review has been completed.

Agenda Item No: B4

21

have to be asked if any of these incidents need to be referred.

reported. 31ST August. A report will be provided to Sub Committee in September.

OP14.d

Walk-In Centres


Dave Jones

Report outlining findings of service review with recommendations for future actions to be submitted to Community Services Subcommittee by 30th September 2018

A number of senior Mersey Care staff from both Community and Local Division Divisions joined other NHS and Social Care colleagues from across the region to attended Liverpool and South Sefton Clinical Commissioning Group’s (CCG) Urgent Care Workshop on 6 March 2019. The majority of this session involved presentations of co-produced urgent care data and insight from Liverpool CCG’s Urgent Care engagement (November 18 - January 2019), so that all attendees had a shared understanding in order to start developing the future North Mersey Urgent Care service. The case for change outlined by commissioners explained the need for all people residing within the North Mersey footprint to have good access to Urgent Care, for it to be easier to access the right Urgent Care service, for any future model to reduce pressure on Accident and Emergency services, to make best use of staff and financial resources

Agenda Item No: B4

22

and take new NHS guidance on the development Urgent Treatment Centres into account. The session ended with attendees taking part in group work to reflect on what had been presented, identify benefits and challenges and what other information was needed. There was an acknowledgement that mental health data was missing from much of what had been presented and a promise from Liverpool CCG that this would be included in the future. The plan for the next Workshop, taking place on 20 March 2019, is for attendees to consider messages form public and staff engagement in more depth and to start to co-develop ideal model(s) of Urgent Care and suitable assessment criteria. Two workshops are then planned on 3 April 2019 and 15 May 2019 with an aspiration to shape the development of a pre-public consultation business case after local elections in May this year.

OP14.e

CHIS (Child Health Information Systems) –


Lynda Taylor Report outlining findings of service review with recommendations

In addition to the progress reported at the previous Sub-Committee, the SOP’s are now in place to ensure processes are robust, e.g. School

Agenda Item No: B4

23

for future actions to be submitted to Community Services Subcommittee by 31st August 2018. In advance of this service review being carried out, and Action Plan addressing immediate issues and concerns is to be developed. A report outlining this action plan is to be submitted to July Sub Committee.

Immunisation SOP, Desktop Outbreak Exercise SOP and Data Quality Audit SOP. These are monitored at the CHIS Programme Board via the finalised version of the CHIS Assurance Dashboard. As part of our work with NHSE and NHS Digital, the initial validation work to align our cohort with General Practices is complete and work is underway to develop a process for monthly validation. IMerseyside are leading on a project to ensure consistent use of PDS across Community Services, including Children’s Services, V&I team and CHIS. Appropriate use of PDS will be subject to audit. The key challenge in completing the action plan is in fully digitising receipt of all information from our partner organisations and the currency of caseloads within all school years for School Nurse services. A timescale for completion is not certain but anticipated to be September.

OP14.f

District Nursing –


Karina Woodyer-Smith

Report outlining findings of service review with recommendations for future actions to

The plan has now been agreed following a Confirm and Challenge with the Executive Director of Operations and Nursing and submission to the Sub Committee in

Agenda Item No: B4

24

be submitted to Community Services Subcommittee by 30th September 2018. (to go to October Sub committee).

December 2018. Implementation will be overseen by a team chaired by Karina Woodyer-Smith, which will report directly to the divisional Operational Management Board.

OP15 There is a need to develop a Mersey Care ICRAS service.

There is a need to implement a single ICRAS Service which pulls together all of the staff under one single team, one manager; working to the same assessment and care protocols. The manager should have overall control of the budget and resources and be able to allocate the resources on a daily basis as the demand on services increases/ decreases across the Division.

Michelle Fanning

Report outlining findings of service review with recommendations for the future model and actions to be submitted to Community Services Subcommittee by 30th September.

The plan has now been agreed following a Confirm and Challenge with the Executive Director of Operations and Nursing and submission to the Sub Committee in December 2018. Implementation will be overseen by a team chaired by Michelle Fanning, which will report directly to the divisional Operational Management Board.

OP16 CQC Preparation – There is a need to prepare for a full CQC inspection.

There will be a full programme of Quality Review Visits (QRV) ensuring that all new services have been reviewed within a 6 month period. At the same time we need to ensure that the current schedule of QRV’s, safe staffing reviews and profiling excellence is maintained.

Sandra O’ Hear

Full schedule of QRV visits planned to be submitted to QAC and Sub Committee – May 2018 CQC Steering Group set up with representation from all areas across Trust – June 2018

The CQC Inspection has now taken place and an update paper was provided to the Sub Committee meeting on 17 December 2018.

Agenda Item No: B4

25

Initial teleconference with CQC lead inspector – May 2018 Three way meeting with lead inspector and lead for acute services CQC – End of May 2018.

OP17 Children’s Services – Development and implementation of a pre birth – 19 pathway and the establishment of a single integrated team based on this agreed pathway.

Development of a pre birth – 19 pathway which is described in a single document which brings together information regarding the principles of the pathway, the organisational and management arrangements, and the clinical models/protocols to be adopted (Phase 1). The establishment of a single integrated team to implement the pathway (Phase 2). It will also be necessary to ensure agreement and sign up to the new pathway by all relevant commissioning agencies.

Trish Mattinson

Project arrangement and support agreed by the end of May. Phase 1- Development of a pre birth – 19 pathway which is described in a single document which brings together information regarding the principles of the pathway, the organisational and management arrangements, and the clinical models/protocols to be adopted. To be completed by 30st August 2018.

An exercise to assess what is required to stabilise each service / team within the children’s services structure is continuing which will result in an action plan and supporting project documentation being produced to manage on-going change and improvement programmes. An additional piece of work has been undertaken to understand the primary drivers and initial phase of a programme of work to realise the aim of Children and Young People’s Services, specifically; To deliver services for Children and Young People which uses strength-based approaches, building non-dependent relationships to enable efficient working with the identified population (Children, Young People and Families) to support behaviour change, promote health protection

Agenda Item No: B4

26

Report submitted to September sub committee. Phase 2 – September onwards following consultation with staff The establishment of a single integrated team to implement the pathway (Phase 2). Progress report to sub committee in January and April.

and keep children safe. All of this work will lend itself to providing integrated services across our population bases in line with Adult Services. This is a programme of stabilisation which is likely to continue for 2 years and will inevitably involve service redesign(s) and staff consultation(s).

OP18 Reliance on hybrid records – There are a number of recommendations in the CQC 2016 reports. There is a need to address these in advance of a further CQC inspection

Development of a clear, strategic and operational plan

Sylvia Carney and Steve Appleton

Situational report to be developed which identifies the issues to be addressed and make precise recommendations to address these issues – End of June 2018 (23rd July meeting) Implementation plan to be developed and agreed – End of June 2018 and outlined in report

Significant progress has been made across community services to move towards a paper-lite solution with EMIS bring the primary record. A programme of work is now well established, and to date a number of services have gone live with new system functionality and agile working devices. A review was carried out across District Nursing which is the largest service, to address delays experienced during Q3. A firm plan is in now in place to get the service back on track, this work is now integrated with the wider transformation programme across

Agenda Item No: B4

27

going to July sub committee. Update report to be provided to November sub committee.

community nursing services. The DN service is due to go live Q4 2018/19, with Q1 2019/20 for processes to be embedded and optimised, and any remaining agile devices deployed. The Benefits Management workstream has received a wide range of metrics on a service basis which will help to understand in detail the positive impact this programme has had across the division. A details benefits report will be produced during Q1, highlighting outcomes achieved to date, and areas for further support to ensure services are fully maximising the potential benefits of these new technologies and processes.

OP19 Cleanliness Audit Data – There is a need to ensure that cleanliness audit data is available across all facilities

Improve comprehensive cleanliness audit data

Jenny Hurst Assurance report to go to the Infection, Prevention and Control Committee and Sub Committee/ QAC. End of August 2018

A report to describe the audit process and escalation to ensure failed audits are actioned was completed and presented to the Sub Committee on 17 September 2018. No further update is required to the Sub Committee as the cleaning audits will be managed as described by the divisions and through the IPP Committee.

OP20 Do Not Resuscitate Process - The trust should ensure staff record the Do Not

Update report regarding situation and any outstanding issues by end of June 2018

Jenny Hurst Update report regarding situation and any outstanding issues

The DNR policy has been agreed by both the clinical standards group and the policies group and from the end of August 2018 has been

Agenda Item No: B4

28

Attempt Cardiopulmonary Resuscitation (DNACPR) status of patients.

by end of June 2018

implemented.

Workforce and Cultural Alignment – Executive Lead, Amanda Oates, Executive Director of Workforce





Progress Rating

6 month position commentary

W1 Disciplinary Cases Review – There is a need to review the handling of disciplinary cases to ensure they have been properly and appropriately resolved as referred to in the Kirkup report. (This review will be carried out but will go beyond the timeline suggested by Kirkup and instead will look at disciplinary cases right up to October 2017.)

Independent practitioner review to be completed, and a report to be given by Amanda Oates to Mersey Care’s Board of Directors with findings implemented across the organisation based on an agreed action plan.

Amanda Oates

W.1.1 - Initial report July 2018 W.1.2 - Final report September 2018 W.1.3 - Action plan to be developed as issues materialise but to be completed no later than end of October.

There remain significant gaps in data available for us to provide full assurance against the initial ask in the Kirkup Report and the subsequent questions posed by NHSI. Further investigations continue this month to close any further gaps, although we do not expect the overall position to change substantially.

Agenda Item No: B4

29

W2 Review of Whistleblowing Cases – There is a need to review the handling of whistleblowing cases to ensure they have been properly and appropriately resolved.

Independent Practitioners Review to be completed and a report by Amanda Oates to be given to Mersey Care’s Board of Directors in March 2019.

Steve Morgan

W.2.1 - Appoint independent person to carry out review June 2018 W.2.2 -Identify and find cases September 2018 W.2.3 – Final report to sub committee end September 2018 W.2.4 – Action plan to be developed and completed mid October 2018

The investigation has identified fourteen whistleblowing cases during the period October 2010 – December 2014. Eight of these fourteen cases were reported directly to the CQC and not passed to LCH for investigation or response; we understand they were the prompt for the unannounced CQC visit which uncovered significant failings. Of the remaining 6 cases • 2 of them were fully investigated

by external consultants who were commissioned to undertake this work and liaise with the whistleblowers, both of whom were known to LCH.

• 2 of them came into the CQC anonymously and were passed to LCH to investigate and the Trust’s findings and response were sent to the CQC. Whilst not a formal whistleblowing investigation report, they are an appropriate response to the issues raised.

• 2 of them appear to have not been investigated in line with LCH’s whistleblowing policy, although one was investigated under Bullying and Harassment due to the nature of concerns raised. The other case doesn’t appear to have been investigated

Agenda Item No: B4

30

at all. W3 Fit and Proper

Persons Process – There is a need to ensure all staff who may influence Mersey Care’s Board of Directors decision making processes are subject to the fit and proper persons process

Review Mersey Care’s fit and proper persons process (FPP) to ensure it reflects recent changes to the CQC’s FPP’s guidance. Ensure that all direct reports to members of the Executive Team are subject to a fit and proper persons test for those persons who may influence the Board of Directors (currently only clinical divisions’ Associate Medical Directors and Chief Operating Officers).

Andy Meadows

W.3.1- Paper to Board to give assurance that this review has been completed 31ST July 2018

A full report was submitted to the board in September which confirmed that the ‘fit and proper persons’ process had been completed for all Board members, in keeping with the national requirements. The Board has decided to extend this process to the 31 direct reports to directors.

W4 Well Led Governance – There is a need to ensure that the external review of Mersey Care’s well led governance process considers the implications and themes of the Kirkup Review, particularly in respect of the

As part of its response to the Kirkup Review, Mersey Care has commissioned Mersey Internal Audit Agency (MIAA), supporting by the Advancing Quality Network North West (AQuA), to undertake a well-

Andy Meadows

W.4.1 - Stage 1 will focus on the Board’s self-assessment and will report to June 2018’s Board Development Session, prior to a

Following the announcement by the CQC of its Well-led Inspection, the specification of this task was changed so that Mersey Internal Audit Agency was tasked with supporting the Trust’s preparations for the inspection. Although it was then intended that MIAA would undertake the well-led review post the inspection, guidance from NHS Improvement indicates that such reviews should not be undertaken by

Agenda Item No: B4

31

trust’s governance and assurance processes

led and board skills review over the coming year.

management response to July’s Public Board. W.4.2 - Stage 2 will undertake targeted reviews focussed on divisional governance, to report to October 2018’s Board Development Session prior to a management response to November’s Public Board W.4.3 - Stage 3 will involve a full well-led developmental review, to report to February 2019’s Board Development Session prior to a

a firm who provide audit services to a trust. As such a specification is being prepared for consideration by the Audit Committee to appoint another firm to undertake this well led review to start in 2019/20.

Agenda Item No: B4

32

management response to March’s Public Board

W5 On-going Kirkup Staff Briefings – There is a need to ensure staff are fully briefed on Mersey Care’s response to the Kirkup Review.

Ensure communication bulletins reference this Action Plan and provide regular updates on progress. Working with Staff Side on the delivery of this Action Plan and support provided to staff. Once Action Plan formally approved, make this accessible to all staff and provide regular updates on delivery.

Elaine Darbyshire

W.5.1 - Present to staff side the Kirkup action plan at meeting scheduled 5th June 2018 W.5.2 - Following this to develop a briefing to staff and timelines for regular communications for end of June 2018

Following the recent visit to the trust from the Rt. Hon. Stephen Hammond MP, Chair of NHSI Dido Harding and NHSI’s Chief Executive Ian Dalton, we are now working with NHSI on the next steps in the assurance process as directed by Bill Kirkup in his 2018 report on the trust. A reactive communications plan is in place for Mersey Care as events stand at present and we have also contacted NHSI communications about the development of a joined-up approach to the on-going management of communications as we move forward with the investigation process. This will be reported back to the Sub Committee as appropriate.

W6 Kirkup Review Briefings - Gain further insight into the Kirkup Review

Invite Dr Bill Kirkup to speak to a workshop hosted by Mersey Care for representatives of those providers providing former LCH services, together with local stakeholders and

Elaine Darbyshire

W.6.1 - Invite Bill Kirkup to speak January 2019

Kirkup and CQC briefings for community staff have commenced. Dr Kirkup visited the organisation on Wednesday 7th November to meet with the Executive Team and members of the Board. This was a very constructive and informative meeting. At present there is no intention to

Agenda Item No: B4

33

regulator invite Dr Kirkup to speak at a workshop hosted by Mersey Care .

W7 HR Development Programme – To complete a diagnostic review of HR competencies of community services in Liverpool as defined by the CIPD professional competencies map in response to findings and recommendations set out in the Kirkup report.

To produce a report and to implement its findings

Clare Almond

W.7.1 - Appoint independent consultant by end of April 2018 W.7.2 - Diagnostic work with stakeholders completed by 4th May 2018 W.7.3 - Development day to take place 2nd May 2018 W.7.4 - Report to Amanda Oates by 2nd June 2018 W.7.5 -Action plan developed end July 2018 W.7.6 - Initiate and complete the

All elements of the HR Development Programme have now concluded. The HR team have received their individual feedback and initial coaching and where agreed this is on-going for individuals.

Agenda Item No: B4

34

same process for HR across the ensure Mersey Care organisation.

W8 Organisational Effectiveness and Learning

1. Training 2. Supervision 3. Appraisal

The aim is to develop and implement a comprehensive programme to address training, supervision and appraisal deficits

Joanne Davidson W.8.1 - MIAA audit complete March 2018 W.8.2 - Report received by Amanda and presented to sub committee end of May 2018 W.8.3 - Action plan developed end of June 2018 W.8.4- Update report regarding implementation of action plan to go to October Sub Committee

The Organisational Effectiveness team at Mersey Care completed a competency assessment process in 2017 aligned with the leadership academies newly developed “OD business competencies” for health. OE resources have been extended in Community Division (an additional Band 8a post and Band 6 post) and the team is now deployed to work in line with Community Division priorities. The Learning & Development Team is currently part way through an Organisational Change process as part of wider Org Change in the Workforce Service. As of January 2019 the three process of training, supervision and appraisal have now largely been subsumed within the Mersey Care processes. There is one minor proviso, which is that the supervision records have not been made electronic. This is expected to be completed by April 2019, and hence the decision to assume that this is business as usual.

Agenda Item No: B4

35

meeting. W.8.5-Update report regarding implementation of action plan to go to February Sub Committee meeting.

W9 Organisational Effectiveness (Lack of Leadership skills) Kirkup highlights lack of leadership skills at senior and management levels. Para 3.1 Kirkup poor organisation culture. Para 3.22 poor leadership.

Implementation of a comprehensive leadership skills programme (THRIVE, STRIVE and DRIVE)

Joanne Davidson W.9.1 - Identify with Trish Bennett priority teams requiring OD intervention end April 2018 W.9.2 - Leadership programme for 100 leaders in 100 days to commence by end of June 2018 W.9.3 - Update report to sub committee on progress end

Leadership Development – 83 Community Division leaders at Band 6,7,& 8a have now completed Strive & Thrive. A further 11 Community middle leaders have just commenced on the current cohort of Thrive (February 2019). Development for the Senior Leadership Team around “Values Led Leadership”, Resilient Leadership and Leading Change is scheduled to take place in Q1 2019/20 in line with the organisational re-design. Senior Leadership Team Development. Team Based Working - work continues with those teams identified as a priority for 2018 (Riverside, Garston, Allerton & Aigburth, Childwall District Nurse Teams. Health Visitors ( South Teams ),

Agenda Item No: B4

36

of June 2018 W.9.4 - Full programme to be developed and implemented in relation to inclusion of community services staff in Leadership Forums (e.g. Birthday Breakfasts etc.)

Single Point of Contact Teams, Vacs & Imms, Central Admin & Phlebotomy). The focus for Team Based Working in 2019 will be upon District Nursing teams in line with the DN Transformation Programme. A full programme of team based working will be rolled out across the whole DN workforce. An impact assessment will be carried out in March 2019. One to one coaching – 40 colleagues from Community Division are currently accessing support from the Mersey Care coaching pool. Staff Engagement – 2018 Staff survey results indicate that Community Division staff engagement has improved against 8 of the 9 questions relating to overall staff engagement. Results will be communicated via Spring staff Roadshows during March & April. Management of this issue is now considered to be business as usual.

W10 Expanding Just Culture – There is a need to introduce and implement Mersey Care’s Just Culture into

Expansion of Just Culture into Liverpool and Sefton community services

Stuart Eales W.10.1 - Identify lead for Just and Learning work April 2018

Appointment has been made to the staff side lead Just & Learning post. This will allow Just & Learning Culture to be further rolled out within the division.

Agenda Item No: B4

37

community services

W.10.2 - Commence engagement May 2018 W.10.3 - Update report to sub committee on progress end of May 2018 W.10.4 - Identify staff side lead by end of May 2018

W11 Alignment of sickness management arrangements/practice – There is a need to ensure that Mersey Care’s sickness management arrangements are fully implemented across Liverpool community services staff

Full implementation of sickness management practice across Liverpool community services.

Lynn Lowe

W.11.1 - Review of policy completed and ratified by end of September 2018 W.11.2 - Training schedule completed and implementation

There are no longer any sickness cases being managed under the former LCH sickness policy or with an outstanding sanction. All staff are now managed via the MCFT Supporting Attendance Policy. As of January 2019, it has been confirmed by Lynn Lowe that management of this issue has now reverted into business as usual.

Agenda Item No: B4

38

commenced September 2018 W.11.3 - Implementation completed end of March 2019

W12 Alignment of disciplinary/grievance arrangements – There is a need to ensure that Mersey Care’s disciplinary/grievance arrangements are fully implemented across Liverpool community services staff

Full implementation of disciplinary/grievance practice across Liverpool community services

Lynn Lowe W.12.1 - Review of policy completed and ratified by end of September 2018 W.12.2 - Training schedule completed and implementation commenced September 2018 W.12.3 - Implementation completed end of March 2019

A sub group of HR Policy group has now met week commencing 5th November 2018 to commence work on harmonisation of HR policies including Disciplinary and Grievance procedures. As of January 2019, it has been confirmed by Lynn Lowe that management of this issue has now reverted into business as usual.

Agenda Item No: B4

39

Corporate Alignment – Executive Lead, Amanda Oates, Executive Director of Workforce



Allocated work

stream / owner


Progress Rating


CA1 Corporate Team Integration – There is a need to integrate corporate services teams across the enlarged organisation.

Completion of options paper and adoption of agreed option by Trust Board and implementation as soon after as possible.

Amanda Oates (supported by Chris Lyons and Gayle Wells)

Initial proposal to reorganise corporate staff completed and shared with executive team. 31st May 2018. Consultation with affected staff to take place. 31st August 2018. Implementation Occurs.

All moves that can take place from LIP to V7 have taken place. Movement of staff from V7 cannot take place due to car parking restrictions. This integration process is complete to the extent that it can be at the present time.

Agenda Item No: B4

40

Report to: Liverpool Community Services Transition Sub Committee Meeting Date: 18 March 2019

This Report is provided: ☐ for a decision ☒ to note / for information ☐ as a consent item

Report on Oversight of 44 Issues Following March 2019

Accountable Director(s): Trish Bennett, Executive Director of Nursing and Operations David Fearnley, Medical Director Amanda Oates, Executive Director of Workforce

Report Author(s): Chris Lyons, Director of Corporate Transformation Andy Meadows, Trust Secretary Lee Taylor, Chief Operating Officer (Community Division)

Alignment to Strategic Objectives:

Our Services ☒ Save time and money ☒ Improve quality (STEEEP)

Our People ☒ Great managers and teams ☒ A productive and skilled

workforce ☒ Side by side with service users and carers

Our Resources ☒ Technology that provides

better care ☒ Buildings that work for us

Our Future ☒ Effective partnerships ☒ Research & innovation ☒ Grow our services

Alignment to the Quality Domains:

STEEEP ☒ Safe ☒ Timely ☒ Effective ☒ Efficient ☒ Equitable ☒ Person-centred

CQC ☒ Safe ☒ Responsive ☒ Effective ☒ Caring ☒ Well-led

Purpose of Report: To allow members of the Sub Committee to: 1) Note the oversight and reporting arrangements of the 44 issues in

the Community Services Improvement Programme from April 2019;

2) Note the expected timescales for completion of each remaining issue.

Recommendation: The Sub Committee is asked to: 1) Be aware of new oversight arrangements for each of the 44

issues.

Previously Presented to: Committee Name Date (Ref) Title of Report Outcome / Action

Do the action(s) outlined in this paper impact on any of the following issues? Area Yes If ‘Yes’, outline the consequence(s) (providing further detail in the report)

Operational Performance ☒ Implementation of this improvement programme covers all aspects of service delivery and will impact adversely on all four areas across the Trust if the improvement programme is not effectively implemented. Provider Licence Compliance ☒

Legal Requirements ☒ Resource Implications ☒

Equality & Human Rights Analysis Yes No N/A Do the issue(s) identified in this report affect one of the protected group(s) less or more favourably than any other? ☐ ☒ ☐

Are there any valid legal / regulatory reasons for discriminatory practice? ☐ ☒ ☐ If answered ‘YES’ to either question, please include a section in this report explaining why

Agenda Item No: B4

41

EXECUTIVE SUMMARY

1. Following the acquisition of Liverpool Community services in April 2018, 44 issues were identified which needed to be addressed within the first year. Oversight of these 44 issues during this year has been provided by the Transition Sub Committee.

2. As of March 2019, the planned actions against 25 of these issues have now been completed, albeit further actions are being undertaken on some of these issues.

3. From April 2019, it is intended that the remaining issues will be managed individually by appropriate groups and committees at divisional or corporate level within the trust. It is expected that oversight of the majority of issues will become part of ‘business as usual’.

4. Appendix A provides a table outlining expected timescales for outstanding issues and actions, the immediate reporting arrangements for each issue, as well as the groups which will provide assurance.

BACKGROUND

5. The Community Services Improvement Programme was set up following the acquisition of Liverpool Community Health services in April 2018. 44 issues were identified which needed to be addressed within the first year. These issues were divided into four workstreams:

a) quality assurance;

b) operational performance and delivery;

c) workforce and cultural alignment;

d) corporate alignment.

6. The Transition Sub Committee was set up to monitor the progress of the improvement programme.

7. Over the past 10 months, the planned actions against 25 issues have now been completed, albeit further actions are being undertaken on some of these issues as part of ‘business as usual’.

8. Following agreement that the Transition Sub Committee would be dissolved after March 2019, a paper was submitted to the Sub Committee in February 2019 outlining proposed new oversight arrangements for each issue. It was agreed that an updated version of this report would be provided to the March Sub Committee meeting providing planned timescales for each issue.

OVERSIGHT AND REPORTING ARRANGEMENTS

9. From April 2019, the 44 issues within the Community Services Improvement Programme will be managed individually by appropriate groups and committees at divisional or corporate level within the trust. It is expected that management of the majority of issues will become part of ‘business as usual’.

Agenda Item No: B4

42

10. Appendix A provides a table outlining expected timescales for outstanding issues and actions, the immediate reporting arrangements for each issue, as well as the groups which will provide assurance.

11. Appendix A also outlines key priorities (if applicable) for each issue for 2019/20.

COMPLIANCE AGAINST THE CQC’s DOMAINS 12. The 44 issues which are being addressed cover all of the CQC domains and their

elements.

GAPS IN ASSURANCE / NEXT STEPS

13. It is not considered that there are any gaps in assurance in this report.

RISKS

14. The successful implementation of this programme and the associated risks are included in the Board Assurance Framework.

TRISH BENNETT EXECUTIVE DIRECTOR OF NURSING & OPERATIONS

March 2019

Agenda Item No: C1

Page 1 of 6


Report provided (check necessary boxes): Report to:

Council of Governors To Note: ☒ For Assurance: ☒


PROSPECT New Care Model

Accountable Director(s): Louise Edwards, Director of Strategy 0151 471 2399

Report Author(s): Teresa Clarke, Head of Commissioning 0151 471 2399

Purpose of Report 1) To update the Council of Governors on the PROSPECT New Care Model for low and medium secure services across Cheshire and Merseyside, including progress to date and next steps.


1) PROSPECT is a New Care Model (NCM) pilot that allows providers to collaborate in order to influence commissioning decisions in respect of adult mental health low and medium secure services for the people of Cheshire and Merseyside, with Mersey Care as the ‘Lead Provider’.

2) Since its acceptance to the NCM pilot programme the Partnership has been progressing with a programme of work and undertaking extensive due diligence in preparation for becoming a live NCM site.

3) The Partnership is now at the stage of finalising its business case.

Recommendation:

The Council of Governors is asked to: 1) Note the content of this report.

Next Steps: (Subject to recommendation being accepted)

An updated business case will be presented to the April Performance, Investment and Finance Committee before final submission to the Board of Directors in May 2019. Simultaneously each Partner will also take the business case through their appropriate governance arrangements.



Board of Directors Jan 2019 PROSPECT New Care Model Update

Noted

Performance, Investment and Finance Committee

Feb 2019 PROSPECT New Care Model Update

Noted

Agenda Item No: C1

Page 2 of 6

PURPOSE

1. The purpose of this report is to update the Council of Governors on the PROSPECT NCM for low and medium secure services across Cheshire and Merseyside, including progress to date and next steps.

BACKGROUND/ CONTEXT

2. The New Care Model (NCM) programme was introduced in the NHS Five Year Forward View (2014). It acknowledged that the traditional divides between primary care, community services and hospitals are a barrier to the personalised and coordinated health services that people need. The NCM programme provides opportunities to address these barriers at a local level, thereby improving patient experience and delivering best value for money.

3. PROSPECT is an NCM pilot that allows providers to collaborate in order to influence commissioning decisions relating to adult mental health low and medium secure services for the people of Cheshire and Merseyside.

4. The PROSPECT Partnership consists of three NHS providers, Mersey Care, North West Boroughs and Cheshire and Wirral Partnership; plus two independent sector providers, Elysium Health Care Ltd and Cygnet Health Care Ltd. Mersey Care are the ‘Lead Provider’ within the Partnership.

5. The NCM will give providers greater authority, allowing clinical experts from across PROSPECT to influence the secure pathway and model of care, and as such influence NHS England’s (NHSE) financial and contracting flows.

6. The overall aim of the NCM is to deliver high quality care that reduces lengths of stay, improves services in the community and prevents unnecessary out of area placements.

7. PROSPECT will manage low and medium secure services as a whole system, based on a shared commitment to becoming more recovery and outcome-oriented, gradually shifting resources away from inpatient services towards more prospectively planned inpatient and community services that are rooted in communities and place.

8. This will mean working with wider partners and stakeholders to ensure service users’ needs are addressed holistically across the range of services they access. The diagram below shows the PROSPECT partnership, and the wider system relationship with Mersey Care’s role as system integrator.

Agenda Item No: C1

Page 3 of 6

9. It is anticipated that in doing this PROSPECT will deliver a number of benefits for both service users and staff, of which the top five are:

10. Initially it was intended that PROSPECT would take responsibility for commissioning low and medium secure services on behalf of NHSE, with Mersey Care managing the

Agenda Item No: C1

Page 4 of 6

budget as the ‘Lead Provider’. This is now no longer the case; PROSPECT’s role is to advise NHSE on its commissioning decisions and NHSE will retain the budget.

11. The responsibilities of PROSPECT will be delivered through a formal partnership board (currently the Shadow PROSPECT Partnership Board), underpinned with appropriate governance arrangements within each partner organisation.

12. In addition to the Shadow Partnership Board, a number of dedicated programme working groups have been established and continue to meet, including an Operational Delivery Group which reports to the Shadow Partnership Board and which oversees development and delivery of the pilot.

13. A management structure has also been agreedwhich supports delivery of the NCM.

COMMISSIONING RESPONSIBILITIES

14. The Partnership will have responsibility for informing commissioning decisions only; to be clear NHSE retain responsibility for commissioning and contracting with providers separately.

CLINICAL MODEL 15. A Clinical Network has been in place for over 12 months developing a standardised

model of care which has been informed by comprehensive engagement with over 100 service users. This has been agreed by the Clinical Network and will be presented to Shadow Partnership Board for ratification before being taken through each individual organisation’s governance processes.

16. The Clinical Network has reviewed and considered the challenges and opportunities in implementing the optimum approach to service delivery across the secure care pathway, agreeing a set of standard operating principles.

17. These principles are based on what is now known by the Partnership as the 4D test; minimising Delay, reducing Duplication, avoiding Drift, preventing Disempowerment. The model does this in a number of ways:

Agenda Item No: C1

Page 5 of 6

COMMUNITY FORENSIC SERVICES 18. Integral to the PROSPECT offer is an Enhanced Community Forensic Service that will

support people post-discharge. This will have 12 key components:

i. Care pathway management

ii. Long term specialist case management iii. Specialist forensic assessment iv. Specialist therapeutic interventions v. 24/7 Crisis response vi. Substance misuse vii. System relationships viii. Education and employment support ix. Skills and competencies x. Carers xi. Psychosocial interventions xii. Peer mentorship

19. There will be an opportunity to bid for national funding to develop the Enhanced Community Forensic Service. This was expected to be advertised by the end of February 2019 but was unfortunately delayed. We are however anticipating that it will be published imminently and significant work has already taken place to develop our offer in preparation for this.

20. Extensive engagement has taken place with local Cheshire and Merseyside commissioners, from both CCG and Local Authorities, to design the housing and support service offer for people being discharged from forensic services. As a result of this, Liverpool City Council has undertaken some soft market testing on behalf of the group and discussions are currently on-going as to how this service could be commissioned in future.

Agenda Item No: C1

Page 6 of 6

FINANCE AND GOVERNANCE 21. Currently there is no legal framework in place to allow the NCM budget to be

delegated to the PROSPECT Partnership and therefore this, alongside the contracting elements, will remain with the NHSE specialised commissioning regional hub.

22. The Partnership will also be responsible for any overspend on that budget for commissioning services for Cheshire and Merseyside residents and this will be addressed via a robust risk/gain share and investment agreement.

23. The baseline budget for the NCM is circa £40.4 million, and following extensive due diligence there were three financial risks identified which have been mitigated by subsequent negotiations with NHSE.

24. Prior to going live as a NCM site Mersey Care, as Lead Provider, will enter into a Management Agreement with NHSE that sets out the roles and responsibilities of each party, which will be varied into it’s contract with NHSE, and all partners will enter into a Collaboration Agreement which outlines how the Partnership will operate.


25. The NCM is an exciting opportunity for Mersey Care to lead system change for tertiary mental health services across Cheshire and Merseyside. This is the national direction of travel for the future of commissioning and service delivery, as referenced in the NHS Long Term Plan -

‘To move more care to the community, we will support local systems to take greater control over how budgets are managed. Drawing on learning from the New Care Models in tertiary mental health services, local providers will be able to take control of budgets to reduce avoidable admissions, enable shorter lengths of stay and end out of area placements’.

NEXT STEPS

26. An updated business case will be presented to the April Performance, Investment and Finance Committee before final submission to the Board of Directors in May 2019. Simultaneously each Partner will also take the business case through their appropriate governance arrangements

RECOMMENDATIONS

27. The Council of Governors is asked to: a) Note the content of this report.

LOUISE EDWARDS DIRECTOR OF STRATEGY

April 2019

Agenda Item No: D1

Page 1 of 9


Report provided (check necessary boxes): Paper No: D1

To Note: ☐ For Assurance: ☐ Report to: Council of Governors

For Decision: ☒ For Consent: ☐ Meeting Date: 25 April 2019

Governance Update

Accountable Director(s): Elaine Darbyshire, Executive Director of Corporate Governor and Communications

Report Author(s): Sarah Jennings, Deputy Trust Secretary

Purpose of Report This purpose of this paper is to: • outline the proposed Council of Governors Work Plan for

2019/20; • advise Governors of the resignation of Non Executive Director,

Matt Birch; • advise Governors of the outcomes of the 2019 Council of

Governors elections which will concluded on 22 March 2019 and the associated induction arrangements;

• provide details of those elected Governors whose terms of office will conclude on 30 April 2019;

• advise Governors of plans to further review the membership of the Groups established by the Council of Governors;

• provide an update on membership and plans to recruit additional members.


• It is good governance to ensure a work plan is in place to support the Council of Governors in discharging its duties. As such, a proposed Work Plan has been prepared (Appendix A) for comment and agreement.

• Following a change in employer, Non Executive Director, Matt Birch, has resigned from the trust. The composition of the Board will be reviewed in the next few months;

• The 2019 Council of Governor elections have now concluded and 8 of 9 seats have been filled. New Governors will be required to undertaken a series of eligibility checks and induction and will attend the Council of Governors meeting on 3 August subject to completion of these;

• There are a number of Governors whose terms of office will end on 30 April 2019 and their feedback will be sought to ensure we learn from their experience on the Council of Governors;

• The composition of the Council of Governors changes in October 2018 and will change again following recent elections. As such, it is necessary to review the membership of the groups established by the Council of Governors and we will do this over the next two months;

Agenda Item No: D1

Page 2 of 9

• The Trust has a duty to ensure it has a representative membership. In order to recruit new members, specifically in the areas of under-representation, we have arranges a membership recruitment drive through the Liverpool Echo and Social Media. The Membership and Engagement Group will monitor the impact of this on our membership numbers and breakdown.

Recommendation:

The Council of Governors is asked to: 1) Comment upon and agree the 2019/20 Council of Governors

Work Plan (Appendix A) 2) Note the resignation of Non Executive Director, Matt Birch; 3) Note the outcomes of the 2019 Council of Governors elections

(Appendix B) and induction and training plan (Appendix C) 4) Note the Governors whose terms of office will conclude on 30

April 2019; 5) Note the plans to further review the membership of the Groups

established by the Council of Governors; 6) Note the update on membership and plans to recruit additional

members.



COUNCIL OF GOVERNORS WORK PLAN 2019/20

1. It is good governance to ensure a Work Plan is in place to support the Council of Governors in discharging its duties in line with its Terms of reference. Appendix A sets out the proposed Work Plan for 2019/20.

2. The Work Plan is intended to show subjects that the Council of Governors is required to consider, such as the Trust’s Operational Plan, Performance Report and Annual Accounts and builds on the previous work plan approved by the Council of Governors in April 2018. In addition the Work Plan includes reports and surveys which it is anticipated are likely to be of interest to governors such as the annual Staff Survey and Patient Survey but that will be provided for information purposes only.

3. The Work Plan is attached for comment and agreement but is not intended to provide

an exhaustive list of all issues to be considered by the Council of Governors over the next 12 months. Additional subjects for consideration are likely to arise throughout the year and the work plan will be regularly updated to reflect this. In light of this and to enable the Council of Governors to monitor delivery of the Work Plan, an updated document will be provided to each formal meeting.

4. Give that the attached Work Plan cover the forthcoming 12 months, it does not reflect

those items scheduled to be reported to the Council of Governors in 2020/21 or 2021/22 as follows:

Agenda Item No: D1

Page 3 of 9

a) Appointment of the Trusts External Auditor – the Council of Governors appointed Grant Thornton as the Trusts External Auditor from 1 April 2017 for a period of three years (extendable up to a maximum of 5-years on an annual basis);

b) Review of the Constitution.

NON EXECUTIVE DIRECTOR RESIGNATION

5. Matt Birch resigned from his role as Non Executive Director at the end of March 2019 following 7 years with Mersey Care NHS Foundation Trust and its predecessor.

6. The composition of the Board will be reviewed later in 2019 and if required, a new Non Executive Director will be appointed by the Council of Governors.

COUNCIL OF GOVERNORS ELECTIONS 2019

7. The 2019 Council of Governor elections to fill the nine seats to become vacant on 30 April 2019 have now concluded and, subject to completion of all required eligibility checks, the following 8 Governors will be appointed for a three year period: a) Public Constituency [2 seats]:

• Jayne Moore [Liverpool, Sefton and Knowsley]

b) Service User and Carer Constituency [4 seats]: • Mark McCarthy • Andrew Naylor • Hilary Tetlow • Tashi Thornley

c) Staff Constituency [3 seats]:

• Gillian Davies [Nursing] • Karen Elliott [non-clinical staff] • Dean Hegarty [Other clinical, scientific, technical and therapeutic staff]

8. The seat in the Ribble Valley Public Constituency remains vacant. The formal Reports

of Voting, provided by our election provider Mi-Voice, are included in Appendix B.

9. Induction sessions have been arranged for new Governors on Friday 12 and Tuesday 16 April 2019 outlining the governance of an NHS Foundation Trust, the role of the Board or Directors and Council of Governors and the Trust’s journey and plans.

10. In addition, a series of other training modules have been arranged for May – June 2019 in respect of the following topics:

a) The Trust’s Strategy and Operational Plan;

b) Striving for Perfect Care;

c) Quality of Services;

d) Performance and Finance ;

e) Specialist Learning Disability Services Division and Secure Division overviews;

Agenda Item No: D1

Page 4 of 9

f) Local Services Division and Liverpool and South Sefton Community Division overviews.

11. The arrangements for these modules are outlined in Appendix C and all new and existing Governors are invited to attend.

12. Arrangements are also been made for NHS Providers to repeat their Govern-Well training programme in summer 2019 which will provide Governors with essential skills in the role of Governors, effective questioning and challenge, holding Non Executive Directors to account and membership and public engagement.

GOVERNORS END OF TERMS OF OFFICE

13. The following Governors terms of office will conclude on 30 April 2019:

a) Maria Tyson [staff constituency];

b) Sara Finlayson [staff constituency];

c) Mike Jones [staff constituency];

d) Martin Murphy [service user and carer constituency];

e) Debra Doherty [service user and carer constituency];

f) Johanna Birrell [service user and carer constituency]

14. Both Jayne Moore (public constituency) and Mark McCarthy (service user and carer constituency) nominated themselves for re-election and were successful.

15. Feedback questionnaire will be circulated to those Governors listed above to ensure we learn from their experience on the Council of Governors.

COUNCIL OF GOVERNORS COMMITTEE MEMBERSHIP

16. As a result of the recent and forthcoming changes in the membership of the Council of Governors it is appropriate to further review the terms of reference and membership of the Council’s:

a) Nominations and Remuneration Group;

b) Membership and Engagement Group.

17. Once new Governors have been issued formal letters of appointment we will contact all Governors to seek members for the above Groups.

MEMBERSHIP

18. As a Foundation Trust we are locally accountable to our membership though the Council of Governors and being a member of Mersey Care provides the general public, services users/carers and staff with the opportunity to participate and get involved with the trust.

19. We currently have over 13,000 members and the breakdown of our membership is monitored via the Membership and Engagement Group regularly to ensure we understand and actively recruit members in our under-represented areas.

20. In order to increase our membership and ensure this is reflective of the new services we provided following the acquisition of Liverpool Community Health NHS Trust, we taking the following steps:

Agenda Item No: D1

Page 5 of 9

a) Commencing in mid April 2019 an item will appear in the Liverpool echo (health

section) to seek new members each week for one month; b) We will shortly be launching a social media campaign which allows us to recruit

new members through a targeted approach.

21. We will monitor the effectiveness of the above methods and will report on the impact of this on membership via the Membership and Engagement Group.

RECOMMENDATIONS

22. The Council of Governors is asked to: a) Comment upon and agree the 2019/20 Council of Governors Work Plan

(Appendix A) b) Note the resignation of Non Executive Director, Matt Birch; c) Note the outcomes of the 2019 Council of Governors elections (Appendix B) and

induction and training plan (Appendix C) d) Note the Governors whose terms of office will conclude on 30 April 2019; e) Note the plans to further review the membership of the Groups established by

the Council of Governors; f) Note the update on membership and plans to recruit additional members.

SARAH JENNINGS

DEPUTY TRUST SECRETARY

March 2019

Agenda Item No: D1

Page 6 of 9

Appendix A Council of Governors Work Plan

25 April 2019

2 Aug 2019

17 Oct 2019

Jan 2020

OPENING BUSINESS Welcome & Apologies

Declarations of Interest

Minutes of previous meeting

Action Log Review

Matters Arising

Chairman’s Update

STANDING ITEMS Chief Executives Report

Performance Report

Whalley Retraction Plan Update

Community Services Improvement Plan

ADDITIONAL REPORTS FOR DISCUSSION CQC Inspection Update

Strategy & Operational Plan (Update & Draft)

Quality Account – Indicator Selection

Quality Account (Draft)

Mersey Care NHS FT Annual Report

Annual Accounts

External Audit Report

Staff Survey Findings

Patient Survey Findings

ADDITIONAL REPORTS FOR INFORMATION Strategy & Operational Plan (Final)

Quality Account

Agenda Item No: D1

Page 7 of 9

(Final) PROSPECT Partnership Update

Winter Plan 2018/19 Review

Winter Plan 2019/20

Board Assurance Framework

COUNCIL OF GOVERNORS - GOVERNANCE Council of Governors Annual Work Plan*

Council of Governors Annual Report*

Council of Governors Development Plan*

Membership Strategy

Governor Involvement Strategy

Membership Update (Including M&E Cttee)*

Lead Governor Election Process*

Lead Governor Election & Declaration of Result*

Chairman / Ned Appraisal Process

Chairman / NED Appraisal Outcomes

Non Executive Directors Re-Appointments

Chairman / NED Remuneration (plan & outcomes)

Review of Governor Handbook*

Governor Elections Update*

Governor Committee’s – Terms of Reference Review

CLOSING BUSINESS Feedback on Events/ Visits

Review of Annual Work Plan

Any Other Business

Note: items relating to governance marked with * will be combined in one report namely, Council of Governors Governance Update.

Agenda Item No: D1

Page 8 of 9

Appendix B 2019 Council of Governor Election Outcomes

Agenda Item No: D1

Page 9 of 9

Appendix C Governors Induction and Training Plan

!

Democracy Technology Ltd, Epsilon House, Enterprise Road, Southampton Science Park, Southampton, Hampshire, SO16 7NS, United Kingdom

Tel: +44 (0) 845 241 4145 Fax: +44 (0) 845 241 4146 Email: [email protected] Web: www.mi-voice.com

Mersey Care NHS Foundation Trust – Governor Elections 2019 The result of voting in the elections which closed at 5.00pm on Thursday 21 March 2019, are as follows: SERVICE USERS AND CARERS CONSTITUENCY

Number of electronic and postal ballots issued 2,153

Total number of valid votes cast 441

Turnout 20.48% Result (four to be elected)

Hilary Tetlow Elected 189

Andrew Naylor Elected 172

Mark McCarthy Elected 135

Tashi Thornley Elected 126

David Marsh 111

Sonia Cropper 96

Hikmah Ibrahim 84

Stephanie Kenwright 75

Mark Vanner 63

John Parsons 51

Keith Morgan 48 PUBLIC – LIVERPOOL, SEFTON AND KNOWSLEY CONSTITUENCY



Turnout 18.24% Result (one to be elected)

Jayne Moore Elected 273

Frank Hont 114

Saad Al Shukri 81

Amanda Ellwood-Roberts 78

Stuart Ingham 75

Continued/…

!

Democracy Technology Ltd, Epsilon House, Enterprise Road, Southampton Science Park, Southampton, Hampshire, SO16 7NS, United Kingdom

Tel: +44 (0) 845 241 4145 Fax: +44 (0) 845 241 4146 Email: [email protected] Web: www.mi-voice.com

CLASSES OF THE STAFF CONSTITUENCY Non Clinical Staff




Karen Elliott Elected 186

Tina Walmsley 127

William Coughlin 78

Bridget Irene Evans 44

Donald Moss 15 Nursing Staff




Gillian Davies Elected 193

David Whalley 94

Philippe Mion 56 Other Clinical and Clinical Support Staff




Dean Hegarty Elected 191

Karl Smith 72

Christina Thompson 48

Joshua Takwa 25

COUNCIL OF GOVERNORS INDUCTION, TRAINING & DEVELOPMENT PLAN

COMPULSARY INDUCTION SESSION FOR NEW GOVERNORS:

Training / Development Details Participants Date / Venue INDUCTION MODULES Induction Module Lead: A Meadows / S Jennings

An overview of Foundation Trusts, the role of the Board of Directors and Council of Governors and a summary of the work undertaken by the Council of Governors to date

New Governors [Existing Governors may attend]

Friday 12 April 2019 2pm – 4pm Room 1, V7 Building Kings Business Park Prescot Liverpool L34 1PJ Tuesday 16 April 2019 2pm – 4pm Quaker Meeting House

External Training on: • Holding to Account • Effective Questioning and

challenge • Member and Public

Engagement Lead: NHS Providers

Bespoke one-day training course provided by NHS Providers (Governor Well Programme).

New and Existing Governors

To be arranged for Sept 2019


OTHER TRAINING MODULES [OPTIONAL]

DEVELOPMENT MODULES

Striving for Perfect Care Lead: D Fearnley

This session will focus on what we mean by perfect care, how this translates across our strategy and how we are working with others – particularly colleagues at Stanford University – through our Centre for Perfect Care & Wellbeing to embed perfect care in the way we deliver services.


3 May 2019, 9am – 11am Room 1, V7 Building Kings Business Park Prescot Liverpool L34 1PJ

Overview of Local Services Division & Community Services Division Leads: D Robinson / L Taylor

This session will allow for an overview of the Local Division and Liverpool and South Sefton Community Services Division with an update on the transformation to be delivered.


8 May 2019 2pm – 4pm Room 1, V7 Building Kings Business Park Prescot Liverpool L34 1PJ

The Trusts Strategy and Operational Plan Lead: H Bennett

The Trust’s Strategy and Annual Operational Plan sets out our direction and objectives in improving quality whilst safely reducing costs. Governors will be provided with an overview of the Trusts key objectives and how these are being delivered.


Tuesday 14 May 2019, 2pm – 4pm Room 1, V7 Building Kings Business Park Prescot Liverpool L34 1PJ

Training / Development Details Participants Date / Venue


Quality of Services Lead: T Bennett

The session will focus on how the trust undertakes quality surveillance and provides assurance to the Board of Directors, the Council of Governors, its commissioners and regulators on the quality and safety of the services the trust provides;


20 May 2019 9am – 11am Boardroom, V7 Building Kings Business Park Prescot Liverpool L34 1PJ

Performance and Finance Lead: I Lythgoe

The trust measures its performance against a range of indicators and targets, some of these are set nationally by regulators, some locally by our commissioners and some by the trust itself to ensure the successful delivery and implementation of the trust’s strategy. The session will provide governors with an understanding of the key performance issues and financial pressures facing the trust.


29 May 2019 9am – 11am Room 3, V7 Building Kings Business Park Prescot Liverpool L34 1PJ

Overview of Specialist Learning Disabilities Division & Secure Division Leads: S Wrathall / Des Johnson

This session will allow for an overview of the SLD Division and Secure Division with an update on the transformation to be delivered.


6 June 2019 1pm – 3pm Room 1, V7 Building Kings Business Park Prescot Liverpool L34 1PJ

Agenda Item No: D2

Page 1 of 6

Report provided (check necessary boxes): Meeting: Council of Governors

To Note: ☐ For Decision ☒ Meeting Date: 25 April 2019

Proposed Process for the Appraisal of the Chairman and Non Executive Directors

Report Author(s): Sarah Jennings, Deputy Trust Secretary

Summary of Key Issues: • The NHS Foundation Trust Code of Governance states that the Board of Directors should undertake a formal, rigorous annual evaluation of its own performance and of its committees and of its individual Directors.

• In line with Your statutory Duties: a Reference Guidance forNHS Foundation Trust Governors’, conducting performance appraisals and then reviewing the results will significantly assist the Council of Governors in performing its statutory duties, specifically when considering the potential re-appointment or removal of the Chairman and re-appointment of Non-Executive Directors.

• The Council of Governors, which is responsible for theappointment and re-appointment of Non-Executive Directors, should take the lead on agreeing a process for the evaluation and appraisal of the Chairman and the Non-Executives.

• The Nominations and Remuneration Group (established by theCouncil of Governors) met on 21 March 2019 to review the proposed appraisal process and recommended this to the Council of Governors for formal approval.

Recommendation: The Council of Governors is asked to: 1. Consider approve the proposed process for the appraisal of

the Chairman including the proposed timescales for 2019/20 appraisals;

2. Consider and approve the proposed process for the appraisalof the Non Executive Directors including the proposed timescales for 2019/20 appraisals;

3. Note the arrangements for the appraisal of Executive Directors;

PURPOSE & INTRODUCTION

1. The purpose of this report is to:a) Outline and seek agreement of the proposed process for the appraisal of the

Chairman;b) Outline and seek agreement of the proposed process for the appraisal of the Non

Executive Directors;c) To confirm the arrangements in place for the appraisal of Executive Directors;

2. The objective of an appraisal is to enable the Chairman or Non-Executive Director toevaluate their performance, to build upon strengths and address any areas fordevelopment.

Agenda Item No: D2

Page 2 of 6

3. In line with Your statutory Duties: a Reference Guidance for NHS Foundation TrustGovernors’, conducting performance appraisals and then reviewing the results willsignificantly assist the Council of Governors in performing its statutory duties,specifically when considering the potential re-appointment or removal of the Chairmanand re-appointment of Non-Executive Directors.

4. The Council of Governors, which is responsible for the appointment and re-appointment of Non-Executive Directors, should take the lead on agreeing a processfor the evaluation and appraisal of the Chairman and the Non-Executives. Theoutcomes of the evaluation of the Chairman and the Non-Executive Directors shouldbe agreed by the Governors. The Governors should bear in mind the desirability ofusing the Senior Independent Director to lead the Non-Executive Directors in theevaluation of the Chairman.

5. The appraisal process for Chairman’s and Non-Executive Directors should achieve thefollowing:a) Hold the Chairman and Non-Executive Directors to account for their performanceb) Set appropriate objectives, consistent with the rolec) Identify learning and development needs.d) Clarify expectations and capacity to meet the time requirements to effectively

deliver the role of the Chairman/Non Executive Director.

6. The Chairman and Non-Executive Director appraisal process was developed andapproved by the Council of Governors in 2016 and was approved for use in 2017 and2018. Following the appraisals undertaken in 2018, it was agreed that that a full reviewof the process would be undertaken.

7. As such, a revised appraisal processes for the Chairman and Non Executive Directorsare set out below for consideration and approval. This was considered by theNominations and Remuneration Group on 21 March 2019 who recommended theprocess for approval by the Council of Governors.

PROCESS FOR APPRAISAL OF THE TRUST CHAIRMAN

A) PROCESS

8. In line with the NHS Foundation Trust Code of Governance, the focus of theChairman’s appraisal should be their performance as leader of the Board of Directorsand the Council of Governors.

9. The Senior Independent Director will undertake the appraisal of the Chairman with theinvolvement of the Lead Governor, taking soundings from the Chief Executive,Executive Directors, external stakeholder and members of the Council of Governorscollated by way of 360 degree review.

10. It is proposed that the appraisal of the Chairman will consist of the following key steps:

Agenda Item No: D2

Page 3 of 6

Step 1 Part 1 of the Chairman’s appraisal form to be completed by the Chairman (Form A)

Step 2 The Senior Independent Director (SID) will request that all members of the Board of Directors complete, on an anonymous basis, a peer assessment form (Form B) to be returned to the Deputy Trust Secretary.

Step 3 The Lead Governor will request that Governors complete, on an anonymous basis, a peer assessment form (Form C) to be returned to the Deputy Trust Secretary. Note – since some of our Governors are very new to their role, completion of the form is not mandatory.

Step 4 The Deputy Trust Secretary will request feedback from a series of external stakeholders on the performance of the Chairman.

Step 5 The results will be aggregated and a summary prepared for the SID and Lead Governor

Step 6 A joint discussion will take place between the SID, Lead Governor and Chairman regarding performance, professional and personal development based on the summary provided by the Deputy Trust Secretary, to include:

• A joint review of the achievements / objectives of the previous year

• Discussion on the outcomes of the self-assessment / peer assessments

• Agreement of objectives and a personal development plan for the forthcoming year

• Completion of part 2 of the Chairmans appraisal pro-forma (Form A)

Step 7 The SID will summarise the performance of the Chairman and share this with the Council of Governors.

B) PROPOSED TIMESCALES

Activity Due Date Chairman appraisal process to be considered/ agreed by Nomination and Remuneration Committee

March 2019

Chairman appraisal process to be formally approved by Council of Governors

25 April 2019

Peer assessment questionnaires to be issued to Board of Directors and Governors

26 April 2019

Feedback to be sought by the Trust Secretary from external stakeholders on the Chairman’s performance

26 April 2019

Chairman to undertake self-assessment

May 2019

Peer assessment questionnaires to be returned to Trust Secretary [note: for Governors, this will be via the Lead Governor]

31 May 2019

Agenda Item No: D2

Page 4 of 6

Summary of peer assessment produced by Deputy Trust Secretary and discussed by SID, Lead Governor and Chairman

June 2019

Summary report to Council of Governors

2 August 2019

Summary report to Board of Directors.

25 September 2019

PROCESS AND CRITERIA FOR APPRAISAL OF NON-EXECUTIVE DIRECTORS

A) PROCESS

11. The Chairman, with the support of the Deputy Trust Secretary, will undertake the appraisal of the Non-Executive Directors, taking soundings from the Chief Executive and appropriate members of the Board of Directors.

12. It is proposed that the appraisal of Non Executive Directors will consist of the following

key steps:

Step 1 Each Non Executive Director will prepare a self-assessment of their performance and contribution using the NED appraisal form.

Step 2 A joint discussion will take place between each Non Executive Director and the Chairman regarding performance, professional and personal development based on completion of the self assessment, to include:

• A joint review of the achievements / objectives of the previous year;

• Discussion on the outcomes of the self-assessment; • Agreement of objectives and a personal development plan for

the forthcoming year; • Completion of the NED appraisal form

Step 3 A summary of the appraisal will be shared with the Council of Governors by the Chairman.

13. It is proposed that the Senior Independent Director (SID), in addition to the criteria for appraisal as a Non-Executive Director, will be assessed against their role as SID, specifically demonstrating that they: a) have a good understanding of the Trust’s constitution b) are able to commit the time necessary to carry out the role c) are fully committed to best practice set out in the NHS Foundation Trust code of

Governance to “comply” or “explain” d) are able to intervene to resolve issues of concern to work with the Chairman other

directors and/or governors, to resolve significant issues.

Following discussions at the Nomination and Remunerations Group meeting on 21 March 2019, it was proposed that whilst Governors would not be asked to complete an full assessment of NEDs performance, there will be opportunity to provide feedback.

Agenda Item No: D2

Page 5 of 6

B) PROPOSED TIMESCALES

Activity Due Date Non-Executive Directors appraisal process to be considered/ agreed by Nomination and Remuneration Committee

March 2019

Non-Executive Director appraisal process to be formally approved by Council of Governors

25 April 2019

Non-Executive Directors to undertake self-assessment May 2019 Non-Executive Directors to meet with the Chairman to review performance and set objectives

June/ July 2019

Summary report to Council of Governors 2 August 2019 Summary report to Board of Directors. 25 September 2019

FIT AND PROPER PERSONS TEST 14. Mersey Care has a duty to comply with Regulation 5 of The Health and Social Care

Act 2008, to ensure all members of the Board of Directors, or officers the Trust believes are in a position to influence the Board, are subject to the Trust’s Fit and Proper Persons Test (FPPT) process. Mersey Care has had a process in place since January 2015. This ensures that these officers:

a) have the necessary qualifications, skills and experience;

b) able to perform the work that they are employed for after reasonable adjustments are made;

c) able to supply information as set out in Schedule 3 of the 2014 Regulations when requested by the Care Quality Committee

15. As reported to the Council of Governors in late October 2018/ January 2019, the FPPT

have been undertaken for members of the Board of Directors, and all declarations were satisfactory and compliant with the FPPT process.

16. The annual request for FPPT declarations and checks have commenced for 2019/20 and as part of the revised appraisal process for the Chairman and the Non-Executive Directors, assurance of completion of the FPPT will be requested.

EXECUTIVE DIRECTOR APPRAISALS

17. In line with the requirements of the Foundation Trust Code of Governance the Chief Executive takes lead responsibility on the evaluation of the Executive Directors. Executive Directors are appraised through the Trust’s robust Personal Achievement and Contribution Evaluation which is applicable to all employees of Mersey Care NHS Foundation Trust.

REVIEW & SUBSEQUENT APRAISALS

18. This framework for appraisals will be reviewed annually, to ensure its effectiveness and to take account of any emerging guidance or legislation.

RECOMMENDATION


Agenda Item No: D2

Page 6 of 6

a) Consider and recommend to the Council of Governors the proposed process for the appraisal of the Chairman including the proposed timescales for 20119/20 appraisals;

b) Consider and recommend to the Council of Governors the proposed process for the appraisal of the Non Executive Directors including the proposed timescales for 2019/20 appraisals;

c) Note the arrangements for the appraisal of Executive Directors;

SARAH JENNINGS

DEPUTY TRUST SECRETARY

March 2019

Form A

Chairman Appraisal Form

MERSEY CARE NHS FOUNDATION TRUST

APPRAISAL OF THE CHAIRMAN Name: Appraisal Year: ______________________________________________________________ PART 1 (to be completed by Chairman prior to appraisal) A) ASSESSMENT OF YOUR ROLE AS A BOARD MEMBER Please provide an assessment of your role as a Board member in response to the following statements. Please ring the number that represents your skill level, 1 being least skilled, 5 being exceptionally skilled. Skill Capability Level Comments Have a defined area of expertise and routinely use this expertise when in Board and Committee meetings for the benefit of the Trust

1 2 3 4 5

Use my insight into the organisation’s capability, capacity and culture to help inform and shape Board debate and decision making

1 2 3 4 5

Align my contributions with the Board’s vision and strategy for the organisations

1 2 3 4 5

Help to ensure that the organisation is progressing towards achieving the Board’s vision and meeting all its national and local targets

1 2 3 4 5

Understand the performance information presented at Board meetings

1 2 3 4 5

Understand the regulatory and legal environment the organisation operates within

1 2 3 4 5

I work effectively with Governors

1 2 3 4 5

I am known internally and externally as a Chairman that 1 2 3 4 5

operates with integrity Always deliver on my commitments to the Board

1 2 3 4 5

Invite and accept feedback on my own strengths and areas for development

1 2 3 4 5

Routinely demonstrate the values of the organisation (continuous improvement, Accountability, respect, enthusiasm, support)

1 2 3 4 5

B) REVIEW OF THE PREVIOUS YEARS ACHEVEMENTS / OBECTIVES What were your objectives for 2018/19 To what extend did you meet these?

*Comment on your progress and to what extent you have behaved in accordance with the Trust Values (

PART 2 (to be completed with SID and Lead Governor at appraisal) C) SUMMARY OF PEER ASSESSMENTS Chairing of the Meetings of the Board of Directors and Council of Governors Leadership Style and Commitment Personal Style Impact D) PROPOSED OBJECTIVES FOR 2019/20 Objectives linked to Strategic Aims [Our Services, Our People, Our Resources, Our Future]

Development/ Support Required

E) COMMENTS

Fit and Proper Persons Test I can confirm that I have received assurance that the Chairman has completed the Fit and Proper Persons Test Declaration and has provided HR with the relevant evidence required.

Overall Assessment Outstanding Exceeds Expectations Meets Expectations Needs Improvement/ Developing Performer

Signed………………………… Date……………………………… Chairman Signed………………………… Date……………………………… Senior Independent Director Signed………………………… Date……………………………… Lead Governor

Agenda Item No: D2

Form B

Chairman’s Appraisal Peer-Assessment Form – Board Members


APPRAISAL OF THE TRUST CHAIRMAN Peer-Assessment Form (For Completion by voting and non-voting members of the

Board of Directors) Name: When completed, please return, marked ‘confidential – addressee only’, or by e-mail, to Sarah Jennings, Deputy Trust Secretary, by 31 May 2019. All peer-assessments will be summarised by the Deputy Trust Secretary and provided to the Chairman and the Senior Independent Director for consideration as part of the appraisal process. ______________________________________________________________ Instructions On the following pages, please rate the Chairman against the attributes/skills/behaviours listed. Circle or shade if completing electronically, one rating for each statement. Circle/Shade the appropriate number as follows: 1 strongly disagree; 2 disagree; 3 agree; 4 strongly agree; 5 cannot say 1. CHAIRING MEETINGS OF THE BOARD Agrees an annual cycle of Board business with the Board and sets the Board agenda in accordance with the cycle and other priorities identified by Board members

1 2 3 4 5

Ensures that the Board’s agenda prioritises items on quality, strategy, corporate risks and feedback from stakeholders

1 2 3 4 5

Manages the agenda within the time allocated

1 2 3 4 5

Encourages open debate and contributions from all

1 2 3 4 5

Advocates constructive challenge

Agenda Item No: D2

1 2 3 4 5 Handles conflict and sensitivities between Board members well

1 2 3 4 5

Summarises Board discussions well, captures the main points that have been made and clarifies how the Board will progress the item under discussion

1 2 3 4 5

2. LEADERSHIP STYLE Is visible within the Trust and is regarded as approachable

1 2 3 4 5

Works well with the Chief Executive

1 2 3 4 5

Promotes effective teamwork between Board members

1 2 3 4 5

Behaviour is consistent with the values of the Trust

1 2 3 4 5

Is well respected by our local health and social care partners and commissioners

1 2 3 4 5

Promotes positive relationships between the Board and the Council of Governors

1 2 3 4 5

4. PERSONAL STYLE Listens dispassionately, attentively and carefully to what is being said

1 2 3 4 5

Is concise, avoids jargon and tailors content to the audience’s needs

Agenda Item No: D2

1 2 3 4 5

Is courteous to and supportive of other Board members

1 2 3 4 5

Has authority and credibility

1 2 3 4 5

Is attentive to the needs and experiences of service users

1 2 3 4 5

Operates with the best interests of the Board and ultimately the Trust in mind

1 2 3 4 5

Does not dominate meetings of the Board

1 2 3 4 5

5. IMPACT

Has a significant, positive impact on the performance of the Board and ultimately the performance of the Trust

1 2 3 4 5

Adds value to the work of the Board

1 2 3 4 5

COMMENTS:

Agenda Item No: D2

Form C

Chairman’s Appraisal Peer-Assessment Form - Governors


APPRAISAL OF THE TRUST CHAIRMAN

Peer-Assessment Form (For Completion by Governors) When completed, please return, marked ‘confidential – addressee only’, or by e-mail, to Sarah Jennings, Deputy Trust Secretary, by 31 May 2019 All peer-assessments will be summarised by the Trust Secretary and provided to the Chairman and the Senior Independent Director for consideration as part of the appraisal process. __________________________________________________________ Instructions Contribution of Governors in this appraisal is not mandatory. Circle/Shade the appropriate number as follows: 1 strongly disagree; 2 disagree; 3 agree; 4 strongly agree; 5 cannot say 1. CHAIRING MEETINGS OF THE COUNCIL OF GOVERNORS Ensures that the Council of Governors prioritises items on strategy, corporate risks and feedback from stakeholders

1 2 3 4 5

Ensures that items on the Council of Governors’ agenda that are simply for information/ noting, are kept to a minimum

1 2 3 4 5

Manages the agenda within the time allocated

1 2 3 4 5

Encourages open debate and contributions from all

1 2 3 4 5

Agenda Item No: D2 Advocates constructive challenge

1 2 3 4 5

Handles conflict and sensitivities between Governors well

1 2 3 4 5

Summarises Council of Governor’ discussion well, captures the main points that have been made and clarified how the Council will progress the items under discussion.

1 2 3 4 5

2. LEADERSHIP STYLE Is Visible within the Trust and is regarded as approachable

1 2 3 4 5

Promotes effective teamwork between Governors

1 2 3 4 5

Behaviour is consistent with the values of the Trust

1 2 3 4 5

Works continuously to improve the performance of the Council of Governors

1 2 3 4 5

Promotes positive relationships between the Board and the Council of Governors

1 2 3 4 5

4. PERSONAL STYLE Listens dispassionately, attentively and carefully to what is being said

1 2 3 4 5

Agenda Item No: D2 Is concise, avoids jargon and tailors content to the audience’s needs

1 2 3 4 5

Is courteous to and supportive of Governors

1 2 3 4 5

Make a strong, positive impression on first meeting and establishes rapport quickly.

1 2 3 4 5

Has authority and credibility

1 2 3 4 5

Shows an understanding of the feelings and needs of others and a willingness to provide personal supported when needed.

1 2 3 4 5

Operates with the best interests of the Council of Governors and ultimately the Trust in mind

1 2 3 4 5

Does not dominate meetings of the Council of Governors

1 2 3 4 5

5. IMPACT

Has a significant, positive impact on the performance of the Council of Governors and ultimately the performance of the Trust

1 2 3 4 5

Agenda Item No: D2 Adds value to the work of the Council of Governors

1 2 3 4 5

COMMENTS:

Form D

Non- Executive Director Appraisal Form


APPRAISAL OF THE NON EXECUTIVE DIRECTOR

Self-Assessment Form Name: Appraisal Year: Specific Roles/ Lead Areas of Responsibility: ______________________________________________________________ PART 1 A) REVIEW OF THE PREVIOUS YEARS ACHEVEMENTS / OBECTIVES What were your objectives for 2018/19 To what extend did you meet these?

*Comment on your progress and to what extent you have behaved in accordance with the Trust Values

PART 2 B) ASSESSMENT OF YOUR ROLE AS A BOARD MEMBER Please provide an assessment of your role as a Board member in response to the following statements. Please ring the number that represents your level of agreement as follows: 1 strongly disagree; 2 disagree; 3 agree; 4 strongly agree; 5 cannot answer

Skill Level of Agreement Have a defined area of expertise and routinely use this expertise when in Board and Committee meetings for the benefit of the Trust

1 2 3 4 5

Use my insight into the organisation’s capability, capacity and culture to help inform and shape Board debate and decision making

1 2 3 4 5

Align my contributions with the Board’s vision and strategy for the organisations 1 2 3 4 5

Help to ensure that the organisation is progressing towards achieving the Board’s vision and meeting all its national and local targets

1 2 3 4 5

Understand the performance information presented at Board meetings 1 2 3 4 5

Understand the regulatory and legal environment the organisation operates within 1 2 3 4 5

I work effectively with Governors 1 2 3 4 5

I am known internally and externally as a Director that operates with integrity 1 2 3 4 5

Always deliver on my commitments to the Board

1 2 3 4 5

Invite and accept feedback on my own strengths and areas for development 1 2 3 4 5

Routinely demonstrate the values of the organisation (continuous improvement, Accountability, respect, enthusiasm, support)

1 2 3 4 5

PART 3 – Senior Independent Director Appraisal Only C) FULFILLMENT OF THE ROLE OF SENIOR INDEPENDENT DIRECTOR Skill Capability Level Comments I have a good understanding of the Trust’s constitution

1 2 3 4 5

I am able to commit the time necessary to carry out the 1 2 3 4 5

role I am fully committed to best practice set out in the NHS Foundation Trust code of Governance to ‘comply’ or ‘explain’

1 2 3 4 5

I am able to intervene to resolve issues of concern to work with the chair other directors and/or governors, to resolve significant issues.

1 2 3 4 5

D) PROPOSED OBJECTIVES FOR 2019/20 Objective (linked to Strategic Aims) Development/ Support Required Our Services:

Our People:

Our Resources:

Our Future:

PART 4 – To be completed with Chairman E) CHAIRMANS ASSESSMENTS AND COMMENTS

Fit and Proper Persons Test I can confirm that I have received assurance that …………………………………… has completed the Fit and Proper Persons Test Declaration and has provided HR with the relevant evidence required.

Overall Assessment Outstanding Exceeds Expectations Meets Expectations Needs Improvement/ Developing Performer

Signed………………………… Date……………………………… Non Executive Director

Signed………………………… Date……………………………… Chairman

Agenda Item No: E1

Page 1 of 7

Report to: Council of Governors Meeting Date: 25 April 2019 This Report is provided: ☐ for a decision ☒ to note / for information ☐ as a consent item

Operational Plan 2019/20

Accountable Director(s): Louise Edwards, Director of Strategy Report Author(s): Helen Bennett, Deputy Director Strategic Planning and Intelligence

Alignment to Strategic Objectives:

Our Services ☒ Save time and money ☒ Improve quality (STEEEP)

Our People ☒ Great managers and teams ☒ A productive and skilled

workforce ☒ Side by side with service users and carers

Our Resources ☒ Technology that provides

better care ☒ Buildings that work for us

Our Future ☒ Effective partnerships ☒ Research & innovation ☒ Grow our services

Alignment to the Quality Domains:

STEEEP ☒ Safe ☒ Timely ☒ Effective ☒ Efficient ☒ Equitable ☒ Person-centred

CQC ☒ Safe ☒ Responsive ☒ Effective ☒ Caring ☒ Well-led

Purpose of Report: To present the Trust Strategy and Operational Plan 2019/20 to the Council of Governors for information.

Recommendation: The Council of Governors is asked to: 1) note the Trust strategy and operational plan for 2019/20, included

in appendix one of this report.

Previously Presented to: Committee Name Date (Ref) Title of Report Outcome / Action

Board of Directors 29 March Operational Plan 19/20 Approved

Do the action(s) outlined in this paper impact on any of the following issues? Area Yes If ‘Yes’, outline the consequence(s) (providing further detail in the report)

Operational Performance ☒ The Strategy and Annual Operational Plan set out the Trust’s delivery and resourcing priorities. Provider Licence Compliance ☐

Legal Requirements ☐ Resource Implications ☒

Equality & Human Rights Analysis Yes No N/A Do the issue(s) identified in this report affect one of the protected group(s) less or more favourably than any other? ☐ ☒ ☐

Are there any valid legal / regulatory reasons for discriminatory practice? ☐ ☐ ☒ If answered ‘YES’ to either question, please include a section in this report explaining why

Agenda Item No: E1

Page 2 of 7

EXECUTIVE SUMMARY

1. This report updates the Council of Governors in relation to the review of the Trust strategy and development of the operational plan for 2019/20. The operational plan is included in appendix one and was approved by the Board of Directors at its meeting in March 2019.

2. The Trust strategy was developed five years ago and in light of organisational changes since that time and the uncertainties in the current and future environment in which we operate, we have reviewed Mersey Care’s five year strategy, engaging key stakeholders in the process. Following this analysis of our environment, emerging trends, challenges, solutions and key themes, we have identified our strategic aims for the next five years 2019-24.

3. Our operational plan for 2019/20 is year one of delivering this strategy and sets out how our strategy will be delivered in our services with corporate support. We will continue our focus on perfect care, and continuous quality improvement along with the cost improvements we have made. We will also begin to develop new clinical models to integrate services to improve total quality and safely reduce cost across the wider health and care systems in which we operate.

4. Alongside these quality and safety improvements, the plan sets out how we will make cost improvements safely by addressing the top three financial risks for the Trust of medical staffing, community services and corporate services.

OUR OPERATIONAL PLAN FOR 2019/20

5. This year, we will continue to improve quality and cost in our services, and from this strong platform, develop more preventative, integrated services working with partners across the wider health care systems in which we operate.

6. Within our operational plan we describe how we will do this through a focus on continuous quality improvement and Perfect Care within our services. Initiatives to improve quality and safety include implementing our community services action plan, implementing a new crisis resolution and home treatment service and further embedding Trust quality and safety framework. We will make progress in integration of community services through our work to implement integrated care teams at neighbourhood level and through beginning to integrate the mental and physical health care we provide for people with frailty/ dementia and for people and families with complex needs.

7. We will make progress towards becoming an employer of choice by supporting staff health and wellbeing, reducing sickness absence, delivering our equality and diversity action plan and further development of a Just and Learning Culture. Recognising that service users are experts by experience, we will embed a new side by side active participation process and focus on supporting family carers. We will also seek to expand the reach of the Life Rooms.

8. Our strategy for guaranteeing the longer term financial sustainability of our services is to develop a more preventative (and thus cost-effective) clinical model and focus on

Agenda Item No: E1

Page 3 of 7

our three key financial risks – medical recruitment, community services and corporate services. In the year ahead, we will transform our corporate services to enable us to deliver our strategy now and in the future and achieve significant cost efficiencies.

9. Strategic investment is also important to the financial sustainability of our services, and we plan to invest in estate and digital infrastructure so that we have a solid platform for improvement and integration in the future.

10. Our long term strategy also reflects the need for Mersey Care to work as part of a wider system at neighbourhood, place and system levels because the challenges we face require a collaborative effort to overcome them.

11. We have updated our strategic wheel to reflect our strategic aims for the period 2019-24, as we continue to improve quality and cost in our services, and from this strong platform, develop more preventative, integrated community based services.

12. Mersey Care’s key long-term challenges and solutions are set out in figure one,

alongside the initiatives set out in this plan to address those challenges and the associated resourcing/ investment.

Agenda Item No: E1

Page 4 of 7

Figure one: Our term challenges, solutions and initiatives

Agenda Item No: E1

Page 5 of 7

RESOURCING OUR STRATEGIC PRIORITIES

13. Delivering our strategy will enable Mersey Care to remain in financial balance, through service redesign that develops more preventative and integrated services, but also through focusing on our main financial risks of medical recruitment, corporate services and community services.

14. We have reviewed our cost improvement scheme in light of the changing demand and acuity facing our clinical services. We have also taken account of the recommendations of the Carter Review regarding corporate / back office functions. As a result the efficiency savings planned for 2019/20 are set out below:

Cost efficiency savings required 2019/20 (£m)

Local Division (carried forward from 2017/18) 0.940 Corporate Division 6.501 Community Service 2.600 Total 10.041 15. This translates into a cost improvement plan (CIP) of £10.441m. The Trust will deliver

the service and workforce changes necessary to release this efficiency saving whilst maintaining a high quality and safe clinical service.

16. The initiatives that we will pursue in 2019/20 are accounted for within our financial planning for the year ahead. In the main, these initiatives will be resourced through maintained investment, realignment of existing resource and new commissioner resources, subject to contract settlement.

17. In addition, our initiatives for 2019/20 will also allow opportunity for productivity gain (e.g. reduced duplication through introducing integration within our services for frailty/ dementia, core technology upgrades such as paper-light), cost savings (e.g. corporate transformation) and value generation (e.g. research and development and commercialising our knowledge).

ENGAGING STAKEHOLDERS IN DEVELOPING OUR PLAN

18. We have engaged a number of key stakeholders in the review of our strategy and development of this Operational Plan for 2019/20.

a. Board development sessions from January to March 2019. b. A Clinical Reference Group has been established with representation from

medical, nursing, psychology and allied health professionals across each of the clinical divisions. In addition, a wider group of staff has been engaged through the existing schedule of management forums and regular leadership collaborative.

c. Commissioners have been engaged in the development of our strategy through regular engagement within our commissioning and contracting discussions and have been given the opportunity to comment on a draft of the operational plan.

d. The Trust Strategic Planning Group, with senior representatives from the clinical divisions and corporate functions has supported the coordination of the

Agenda Item No: E1

Page 6 of 7

operational plan development and also supported wider engagement across the Trust.

19. Two Governor engagement sessions have been held to allow comment and discussion regarding priorities as the operational plan has been developed (12 December 2018 and 28 February 2019). Priorities from the Governors who participated in these sessions focussed on the provision of seamless, whole-person care and this is reflected through our plans for integrated care at neighbourhood level (30-50,000 population) set out in our operational plan.

20. Following discussion at the Council of Governors meeting in January 2019, greater attention has been paid within the operational plan to supporting family carers. In 2019/20, we will test carer passports across the Trust to improve the experience of carers and test ‘always events’ for carers within Specialist Learning Disability services to consistently improve carer experience. In the year ahead, Community Services division will routinely offer carers assessments as part of care planning and Local Division will adopt appropriate aspects of the well-regarded Secure Division carer toolkit.

MONITORING AND MEASURING DELIVERY OF THE PLAN

21. We have worked with each of our divisions in the production of the Operational Plan and the Plan contains detailed summaries of where each division will focus in the year ahead.

22. In April 2019, we will work with the clinical divisions to agreed targets and trajectories for the measures set out in the operational plan. This approach will ensure full engagement and learning from the approach taken in 2018/19 to ensure the measures are fully agreed and embedded.

23. Delivery against our operational plan priorities will be reported via the Executive Performance Report, which will be updated to reflect the structure and priorities set out in our plans along with the measures and targets set for 2019/20.

24. Quarterly performance reviews with each division, established in 2018/19, will continue, identifying areas of under performance and agreeing performance improvement plans where required. This will ensure regular oversight of delivery of our operational plan in 2019/20.

25. We will undertake quarterly performance reviews with our corporate strategic programmes, to ensure delivery by corporate services of our strategy and plan. Throughout the year ahead we will continually review our priorities to ensure that we use our resources appropriately to deliver our operational plan.

COMPLIANCE AGAINST THE CQC’s DOMAINS 26. The ‘Vision and Strategy’ component of the well led domain requires the Trust to have

a clear vision and credible strategy to deliver high-quality sustainable care to people,

Agenda Item No: E1

Page 7 of 7

and robust plans to deliver this. The strategy review and operational plan development process described will ensure compliance with this domain.

NEXT STEPS

27. Implementation of our Operational plan for 2019/20 and monitoring of delivery.

CONSEQUENCES OF NOT TAKING ACTION

28. Without an effective 5 year strategy and associated annual operational plan, the Trust will not be in a position to build successfully on our progress to date and deliver improvements to quality whilst safely reducing cost.

RECOMMENDATIONS

29. The Council of Governors is asked to note the Trust strategy and operational plan for 2019/20, included in appendix one of this report.

LOUISE EDWARDS DIRECTOR OF STRATEGY

April 2019

Our Operational Plan 2019/20

2

Contents

1. Summary

2. Our five year strategy 2.1 An overview of our long term strategy 2.2 How this operational plan delivers our long term strategy 2.3 Our commissioning landscape and wider system working

3. Our services: Strive for Perfect Care 3.1 Our current position 3.2 Improving quality: Perfect Care 3.3 Improving quality (STEEP): Continuous improvement 3.4 Population health 3.5 Integration

4. Our people: Become the employer of choice in our sector 4.1 Becoming an employer of choice in our sector 4.2 Just and Learning Culture 4.3 Working side by side with service users and carers

5. Our resources: Develop a solid financial, estate and digital platform for future integration 5.1 Maintaining financial balance 5.2 Improving our estate 5.3 Invest in digital technology

6. Our future: Work with and learn from others to have greater impact 6.1 Developing Provider Alliances 6.2 Research and development 6.3 Commercialising our knowledge assets

7. Monitoring and measuring delivery of this plan 7.1 What this plan means for our divisions 7.2 Executive Performance Review

8. Financial impact of this plan 8.1 Resourcing our strategic priorities

9. Risks to delivery of this plan

3

66911

121213141516

18182020

22222426

28283030

323232

3737

39

3

Mersey Care’s vision is to provide Perfect Care that enables people with physical health and mental health conditions, learning disabilities and addictions to live longer, healthier lives.

2019 is the first year of a new five year strategy. We will continue our focus on Perfect Care, improving quality and safely reducing cost. But we also need to change our focus for the future. We need to develop more preventatitve and integrated services for children, young people and adults that enable them to to take a more active role in their own health and we must think differently about our workforce models and realise the potential benefits of digital technology.

Our long term strategy is to develop new clinical models to prevent crisis in community settings, enable people to take more control of their own health and integrate services. These exciting new service models, developed using co-production with service users and carers, along with the continued development of a Just and Learning Culture and a focus on quality and inclusion, will make us the employer of choice in our sector.

Delivering our strategy will enable Mersey Care to remain in financial balance, through service redesign that develops more preventative and integrated services, but also through focusing on our main financial risks of medical recruitment, corporate services and community services. We will also invest in improving our digital and physical estate so that Mersey Care has a solid platform to enable our new service models for the future.

Mersey Care cannot rise to the quality, workforce and financial challenges we face by working on our own. The development of partnerships with other providers at neighbourhood, place and Cheshire and Merseyside levels is essential to the future sustainability of our services.

We will measure delivery of this strategy and plan ensuring quality improvements in our current service portfolio but also in our key workforce, estate and financial indicators. We will also measure delivery of this strategy by using key measures of integration including patient experience, effectiveness of team working, hospital readmissions and delayed transfers of care.

1OPERATIONAL PLAN: SUMMARY

Programmes

Ove

rsig

ht b

y Q

ualit

y A

ssur

ance

Com

mit

tee

Ove

rsig

ht b

y Pe

rfor

man

ce, I

nves

tmen

t an

d Fi

nanc

e Co

mm

itte

e

Programmes

Initiatives

Initiatives

Measures

Measures

• Centre for Perfect Care• Community services

improvement plan• Patient safety

programme• Provider Alliances• Mental and physical

health integration.

• Corporate services review

• Long term financial model

• Global Digital Exemplar

• Strategic estates programme.

• Perfect Care areas• Equality and inclusion action

plan• Small team review• Therapies review• Trust wide quality and safety

framework• Crisis Resolution Home

Treatment (CRHT) implementation

• Integrated Community Reablement and Assessment Service (ICRAS) rollout North Mersey

• Integrated Care Team implementation

• Integrate divisions• Primary care mental health

model• Introduce integration for

frailty/ dementia• Introduce integration for

complex lives/families• Introduce integration for

children

• Focus on three main financial risks – corporate services, medical staffing and community services

• Corporate transformation programme

• Core technology infrastructure upgrades

• Electronic personal health records

• Share2Care clinical platform• Plan for Liverpool 2 and

specialist learning disability low secure unit

• Future plan for Whalley and Maghull sites

• Improve community estate in partnership

• Open Hartley Hospital (Autumn 2019) and Rowan View (Autumn 2020).

• Progress on top three financial risks• Achieve financial control total• Cost Improvement Plan (CIP) delivery• Digital maturity and capability• Increase in category B estate• Increase in single sex, single room

accommodation.

• CQC good across all services• Incidents resulting in harm• Ligature incidents• Progress towards CRHT fidelity• Length of stay and delayed transfers of care

in mental health• Hospital readmissions• Improved patient satisfaction with

involvement in care planning• End of life care access/response times• Dying in place of choice• Therapies waiting times• CIP quality impact

Oversight by Perform

ance, Investm

ent and

Finance C

om

mittee

Oversight by Q

uality Assuran

ce Co

mm

ittee

Programmes

Programmes

Initiatives

Initiatives

Measures

Measures

• Provider Alliances• PROSPECT secure new

care model• R&D strategy• Commercial and

business development team

• Centre for Perfect Care (research).

• Equality and inclusion• Just and Learning

Culture• Organisational

effectiveness and learning

• Leadership development

• Life Rooms.

• Mobilise Provider Alliances in Liverpool and Sefton

• PROSPECT partnership go live

• Consolidate prison health progress

• Review and relaunch research and development strategy

• Increase commercial income from our knowledge.

• Equality and inclusion action plan

• Support health and wellbeing, reducing sickness absence

• Improve basic workforce systems

• Just and Learning Culture priorities

• Culture of care barometer implementation

• Develop Life Rooms model• New side by side active

participation process• Always events and passports

for carers.

• Effective integrated team working• Delayed discharges• Hospital readmissions• Length of stay in secure care• Commercial income.

• Patient and staff experience for those with protected characteristics

• Staff sickness• Time to recruit• Agency use• Culture of care• Triangle of Care• Patient experience• CQC well-led organisation.

6

2.1 An overview of our long term strategy

Mersey Care’s strategy for Perfect Care was developed in 2012 and since then the Trust has changed considerably, not least acquiring specialist learning disability services in 2016 and then becoming a provider of community physical health care in 2017. In light of these changes, and the uncertainties in the environment in which we operate, we have reviewed Mersey Care’s five year strategy, identifying key trends that will impact us about how we will need to change in response to these future trends and bridge the gap between where we are today and achieving future success.

We face a range of challenges and uncertainties in the next five years (2019-24) which will require fundamental redesign of our organisation and the way in which we operate. Doing more ‘business as usual’ faster and more efficiently is not going to be a sufficient response to these challenges.

The key long term challenges and solutions for the next five years are summarised in figure 1.

Key future themesFrom these challenges and opportunities, we have identified a number of key themes which will direct our strategic approach over the next five years.

Continuous improvement in our clinical and operational platform – Mersey Care has been striving for Perfect Care in our services for several years. Our staff are passionate about delivering the best possible services for the people we serve, but achieving this in our current and future environment is not going to be easy. Even in a tough financial environment in which demand for our services is often greater than the service capacity that is available, we believe that our staff can always find new opportunities to improve our services and save money at the same time. Over the next five years we will continue to setting our own stretching goals for improvements in care rather than aiming to meet minimum standards, and we will increasingly get the basics of care right every time. We will accelerate the learning cycle, so that we are testing out improvements, learning from our mistakes and applying successful improvements and innovation faster. Over the next five years we will aim for an ‘Outstanding’ CQC rating, and we will seek out partnerships with other Trusts so that we can share our knowledge but also learn from others.

2OUR FIVE YEAR STRATEGY

7

Prevention and population health focus - We must take action with partners to break the cycle of acute care dependency, which leaves less focus and resources available for preventative services. To do this, we will need to understand the specific needs of the local population, the impact of wider determinants and to explore gaps in care and unwarranted variation. In five years time, through the use of data, we will predict and prevent the increasing acuity of people’s needs; identifying those people most at risk from deteriorating health wellbeing and targeting earlier interventions and proactive care. Mersey Care will also enhance its preventative interventions alongside its core treatment services through our Life Rooms and through working in partnership with the voluntary sector and general practice.

Integration of physical and mental health, taking into consideration the social context, is going to be important in meeting future demand – There is a quality and cost improvement opportunity if we coordinate services to meet people’s needs. For example, there are over 7,000 patients currently accessing both mental health and physical

health services from Mersey Care and there appears to be little planned coordination of these interventions between our mental and physical health services. To meet growing demand for services and meet people’s needs holistically, we will integrate physical and mental health services. In five years time, we will be delivering fully integrated care at neighbourhood level. For example, care will be integrated for people with complex lives which draws together mental and physical health care, social care and the third sector to improve outcomes.

Effective community services will be vital if we are to break the current cycle of acute dependency – Community services play an invaluable, but often overlooked, role in people’s lives. We need a more ambitious and proactive approach to community services because they are important to people’s long term health needs more effectively and to support people’s long term physical and mental health more holistically. To make our community services more effective, we will standardise care pathways, ensuing consistent, high quality care, make best use of digital technology to improve productivity

Figure 1: Long term challenges and solutions

8

and integrate physical and mental health services. In five years time, our community services will be paperlight and our staff will be expert in using digital technology, including patient held records and shared clinical information systems, to delivery proactive integrated care which limits the use of acute services.

Becoming an employer of choice in our sector – We must work to develop a high performing, happy workforce, getting the basics right for our staff and continuing to work towards a Just and Learning Culture. Whilst this will support our aim to become an employer of choice, we will need to work flexibly with other trusts to overcome workforce challenges across bigger footprints. In five years time, we will have mitigated our main workforce risks and secured sustainable recruitment and retention within our workforce. We will have equipped our staff with the knowledge and skills to work in new roles in neighbourhood integrated care; in particular skills to make full use of the digital tools which support integrated care.

Use of digital technologies is going to be essential to meeting demand, addressing our workforce challenges and to making services affordable – In the short term, we must make the most of opportunities to improve productivity within

our services through mobile working and tele-health services and to improve patient care through the integrated patient held record and shared clinical records. In five years time, digital advances, such as virtual reality and wearable devices will have started to reduce the volume of physical premises that are required and by complementing skilled, experienced staff will help to mitigate some of the workforce challenges facing us. In five years time, Mersey Care services will be offered routinely through digital channels, so that people do not have to wait so long to receive treatment and do not always have to see a clinician in person to get the support they need.

Working with other providers is going to be essential to our long term strategy –Public services face significant challenges to continuously improve care within a constrained finances, whilst facing increasingly acute and complex demand. Collaboration between organisations will be vital way for public services to support each other and to raise standards in such an environment, and will also reflect the fact that people’s care needs are becoming more complex. For Mersey Care over the next five years, this means that we will increasingly operate as a platform of integrated care across the health economies that we operate in, and we will develop formal alliances and contracts to reflect this

9

integration over time. Rather than providing services through separate organisational units that concentrate on narrow sets of interventions, we believe that in the next five years outcomes can be maximised through systems that are accountable for the end-to-end patient journey.

2.2 How this operational plan delivers our long term strategy

2019/20 is year one of our new five year strategy.This year, we will continue to improve quality and cost in our services, and from this strong platform, develop more preventative, integrated community-based services. Within this plan we describe how we will do this through a focus on continuous quality improvement and Perfect Care within our services. Initiatives to improve quality and safety include implementing our community services action plan, implementing a new crisis resolution and home treatment service, improving access to therapies, reviewing our specialist small teams and implementing team and ward accreditation as part of our Trust quality and safety framework. We will make progress in integration of community services through our work to implement integrated care teams at neighbourhood level and through redesign of the care we provide for people with frailty/ dementia and for people and families with complex needs.

We will make progress towards becoming an employer of choice by supporting staff health and wellbeing, reducing sickness absence, delivering our equality and diversity action plan and further development of a Just and Learning Culture. Recognising that service users are experts by experience, we will embed a new side by side active participation process and focus on supporting family carers. We will also seek to expand the reach of the Life Rooms.

Our strategy for guaranteeing the longer term financial sustainability of our services is to develop a more preventative (and thus cost-effective) clinical model and focus on our three key financial risks – medical recruitment, community services and corporate services. In the year ahead, we will transform our corporate services to enable us to deliver our strategy now and in the future and achieve significant cost efficiencies. Strategic investment is also important to the financial sustainability of our services, and we plan to invest in estate and digital infrastructure so that we have a solid platform for improvement and integration in the future. Specifically, our initiatives include a programme of

core technology infrastructure upgrades along with digital support to integrated service through patient held records and the Share2Care clinical record sharing platform. We will review our community estate with partners to make this fit to support integrated care and continue our Rowan View (medium secure unit) and Hartley Hospital developments. We will continue planning for new developments, subject to capital funding, and develop future plans for the Whalley and Maghull sites.

Our long term strategy also reflects the need for Mersey Care to work as part of a wider system at neighbourhood, place and system levels because the challenges we face require a collaborative effort to overcome them. In the year ahead, we will develop our system collaboration through Provider Alliances in Liverpool and Sefton, and our PROSPECT low and medium secure partnership. We will increase our research and development capability in support of our strategic direction and commercialise our knowledge capital to invest back into our services.

Mersey Care’s key long-term challenges and solutions are set out in the table overleaf, alongside the initiatives set out in this plan to address those challenges and the associated resourcing/ investment.

10

Lon

g term challen

ges

Lon

g term so

lution

sO

ur op

erational p

lan respo

nse in 2019/20 - our

initiativesFinan

cial Imp

act

Realignment of existing resource

New resources subject to contact settlement

Maintained investment

Business case required

Cost efficiency savings

Planned investment

Income generation

Dem

and for services is increasing putting pressure on the current m

odels of service

Develop preventative, com

munity based services

that reflects co-m

orbidity and biopsychosocial solutions

Integrated Care Team

implem

entation at 30,000 to 50,000 population level

Develop Life Room

s model

Implem

ent new prim

ary care mental health m

odel

Side by side active participation process

Alw

ays events and passports for carers

There is unwanted variation in clinical quality in our

servicesSupport continuous im

provement in our clinical and

operational platform

CQ

C ‘G

ood’ in all areas

Trust wide sm

all team review

Trust wide therapies review

Trust wide team

accreditation

Crisis resolution and hom

e treatment team

implem

entation

ICR

AS rollout N

orth Mersey

Perfect Care areas

Consolidate prison health progress

Services are fragmented, causing quality issues and

waste

Integrate physical and mental health interventions.

Collaborate w

ith system partners to im

prove the w

hole care pathway

Integrate clinical divisions

Introduce integration for people/families w

ith complex lives

Introduce integration for frailty/dementia

Introduce integration for children

Significant shortages of clinical staff and NH

S Trusts are com

peting for a limited pool of people

Become an em

ployer of choice and work w

ith other Trusts to reduce com

petition. Transform corporate

services.

Support staff health and wellbeing, reduce sickness absence

Equality and inclusion action plan

Improve basic w

orkforce systems

Just and Learning Culture priorities

Implem

ent culture of care barometer

The resources available to the NH

S are not sufficient to support transform

ation

Save money through a preventative clinical

model: use of digital technology, focus on three

main financial risks

Transformation of corporate services

Sustainable medical staffing m

odel

Improve com

munity estate in partnership

Open H

artley Hospital (2019) and Row

an View

(2020)

Future plans for Whalley and M

aghull sites

Core technology infrastructure upgrades

Personal health records

Share2Care clinical platform

Com

mercialise know

ledge

Review and relaunch R&

D strategy

The challenges the Trust faces require partnership w

ith other providersEstablish alliances to encourage collaboration in our core geographies and sectors

Mobilise Provider A

lliances in Liverpool and Sefton

PROSPEC

T new care m

odel

11

2.3 Our commissioning landscape and wider system working

Mersey Care is commissioned to provide services by Clinical Commissioning Groups responsible for Liverpool, Sefton, Knowsley, the wider North West and also by NHS England. We work as part of the Cheshire and Merseyside Health and Care Partnership in relation to region wide opportunities for joint working, for example where there are opportunities to develop or improve services across larger footprints.

In mental health services, local commissioners have indicated that they wish to prioritise the delivery of access standards within services and also the development of crisis care and primary care mental health liaison services across North Mersey. CCGs are committed to meeting the Mental Health Investment Standard, but point out that Mersey Care is not the only provider of mental health services to their populations.

We will seek to work with commissioners to develop an open and transparent view of the funding flows to support the Mental Health Investment Standard, with the aim of ensuring that funding is invested into core services to enable delivery of the five year Forward View Mental Health standards. Commissioners have indicated that their performance priorities in the year ahead are:• Falls • Communication• Psychotherapy • Crisis care • Core 24 mental health liaison • Dementia - care navigators• Physical health • Follow up of service users on CPA• Eating disorder treatment within 18 weeks• Learning disabilities

In community physical health services, commissioners have recognised activity growth within services and wish to standardise services across North Mersey in line with the recommendations from a series of service reviews. They also wish to see services increasingly aligned to neighbourhoods of 30,000 to 50,000 people, where appropriate.

NHS England commissions specialist mental health and learning disability services from Mersey Care. In 2019/20, its priorities are high quality specialised mental health services that are integrated with local health systems and are delivered as close to home as possible, driving further reductions in inappropriate out-of-area placements.

In addition, NHS England will continue with its commissioning intention to reduce the number of people with learning disability and autism who are treated in inpatient settings and supporting local health systems to manage the learning disability and autism care of their whole population.

In the year ahead, Mersey Care will continue to work with the Cheshire and Merseyside Health and Care Partnership (STP – Sustainability and Transformation Programme) to deliver system-wide efficiencies. In particular, we are a partner within their mental health programme, leading the secure workstream with delivery of the PROSPECT new care model for secure services.

Cheshire and Merseyside Health and Care Partnership mental health ‘at-scale’ priorities for the year ahead are planned to be crisis care, personality disorder and the new care model programmes for secure care and specialist child and adolescent mental health.

12

3. OUR SERVICES: Strive for Perfect Care

3.1 Our current position

Feedback from patients and their carers Whilst the Trust receives positive feedback via the national patient surveys, we have identified through our engagement with patients, carers and through complaints analysis, that there is room for improvement, particularly in relation to communication and joined up care which meets the psychological, the social and the physical needs of patients.

We will test carer passports across the Trust to improve the experience of carers and test ‘always events’ for carers within Specialist Learning Disability services to consistently improve carer experience. We will also pilot a new ‘side by side’ process for active participation (co-production) when considering service improvements and redesign in 2019/20.

In the year ahead, we will prioritise the development of integrated physical and mental health care through the development of integrated care teams at neighbourhood level. This will improve the care coordination of people with complex needs, helping them to feel more informed about their care plan and improving communication with them.

Evidence tells us that in general terms, the more positive the experiences of staff within an NHS Trust, the better the outcomes and patient satisfaction. We will work with our staff by prioritising actions within our People Plan to ensure they feel valued and supported, along with further developments in embedding a Just and Learning Culture. Through our equality and inclusion action plan, we will focus on improving access, experience and outcomes within our services for those who share protected characteristics.

Care Quality Commission Mersey Care has an overall ‘Good’ rating from the CQC. We are currently waiting for the results of an inspection which took place in November and December 2018.

3.1. Current position

OUR SERVICES: Strive for Perfect Care 3

13

3.2 Improving quality: Perfect Care

Our quality improvement strategy is simple: to deliver Perfect Care as defined by our service users and staff.

This year we will remain focused on our long term quality improvement goals, building on our success to date in each area. Our Centre for Perfect Care will support the following key priorities in 2019/20:

Zero suicide • Zero inpatient suicides in 2019/20• Develop world leading practice guidance on reducing self harm in people with

personality disorders by October 2019.Reducing restraint • Full compliance with Reducing Restrictive Practice Guide by March 2020

• Reduce restraints in specialist learning disability services from 2018/19 baseline by 20% in 2019/20.

Physical health for mental health service users

• Identify innovation in the physical health offer to mental health service users by July 2019 with implementation proposals to follow.

Pressure ulcers • Zero deterioration of pressure ulcers within our care in 2019/20.

Just and Learning Culture

• Our priorities for 2019/20 can be found in the ‘our people’ part of this plan

Learning from deaths • Produce high impact plan to reduce mortality in our services, incorporating learning and best practice, by October 2019.

Enablers • Enable all divisions to improve their use of data for improvement, including use of statistical process control, by March 2020

• 100% increase in number of improvement projects across the Trust from 2018/19 baseline and development of quality improvement database by March 2020.

Figure 2: Our Perfect Care priorities for 2019/20

14

3.3 Improving quality (STEEP): Continuous improvement

Having reviewed benchmarking and performance information and through engagement with our clinical divisions, we have identified quality improvement requirements aligned to the STEEP framework (safe, timely, effective, equitable and person-centred). Our clinical divisions will retain a focus on improvement in these areas through our Operational Management Boards and our Board of Directors will retain focus through our Quality Assurance Committee.

The headlines STEEP priorities for the year ahead are shown in the table below. Divisional summaries (see page 32 to 35) provide more detail.

We will work to achieve a Care Quality Commission rating of ‘Good’ across all community physical and mental health services and maintain ‘Good’ in other service areas.

Safe • Implementation of community services improvement plan and post-Kirkup quality and safety improvement plan

• Implement a standardised Trust Quality and Safety Framework, including dashboards and ward/ team accreditation by September 2019.

• Audit and monitoring of the deteriorating patient pathway (including NEWS2 and sepsis pathway)

• Focussed awareness-raising and increased reporting of safeguarding risks within community physical health division

• Address risks to children in care by fully implementing the Children in Care Quality Improvement Plan

• Roll out standardised falls assessment and management across older peoples services and other high risk areas

• Safety planning in secure mental health and prison services• Improved risk assessment processes and training for section 17 leave• Address high levels of ligature incidents in specialist learning disability services.

Timely • Reduction in waiting times for therapy services (including psychological therapies in the community) across the Trust, with a Trust-wide review of therapy services.

• Achievement of national mental health waiting times and performance targets• Reduced length of stay and delayed discharges in mental health services. • Implementation of Red2Green across all appropriate services.• Timeliness of access and assessment in end of life care services and work with

partners to increase the number of people able to die in their place of choice.

Effective • Single Integrated Community Reablement and Assessment Service (ICRAS) model across North Mersey

• Implement crisis resolution and home treatment service• Integration of our children’s services within neighbourhoods as part of integrated

care team development.• Build on progress in unplanned care, working with partners in urgent care treatment

centre developments.• Clearly articulate our prevention offer, working jointly with partners to deliver

preventative health services.• Trust wide accreditation for wards and teams.

Equitable • Improvement to patient experience for those with protected characteristics, including monitoring harm by protected characteristics.

• Fully implement equality analysis with quality impact assessment process for service change, transformation and Cost Improvement Plans (CIPs)

Person centred • Pilot carers passport across the Trust• Increased reporting of satisfaction with involvement in care planning• Implement framework to embed thematic learning from data and information on

the experience of people who use our services by December 2019

15

3.4. Population health

The NHS is currently out of kilter with the needs of the population it serves, health needs data tells us that the people of Liverpool and Sefton are living with multiple enduring long term conditions but NHS services are commissioned to provide acute episodes of care to particular groups. Population health has been steadily deteriorating despite money spent on the NHS and this in turn is driving increased demand for services.

A focus on population health means aiming to improve the health of an entire population. It is about improving the physical and mental health outcomes and the wellbeing of children, young people and adults, whilst reducing health inequalities within and across a defined population. It includes action to reduce the occurrence of ill-health, including addressing the wider determinants of health, and requires working with communities and partner agencies.

Population health management improves population health by data-driven planning and delivery of care to

achieve maximum impact. It includes segmentation, stratification and impact modelling to identify local “at risk” groups and in turn, designing and targeting interventions to prevent ill health and to improve care and support for people with on-going health conditions, reducing unwarranted variation in outcomes.

Through this approach, we will better understand access, exprience and outcomes for people who share protected characteristics and take action to reduce inequalities, making every contact count across the breadth of Mersey Care services.

Population health management is a theme of our long term strategy, as through this approach we will be able to understand people’s needs more effectively, and understanding the population’s health needs will enable the NHS to develop services that predict, prevent and intervene more effectively. This is illustrated in figure 3.

Milestones for 2019/20• Develop shared approach to population health segmentation with local authorities and CCGs by April 2019• Confirm population segmentation categories, data flows and produce initial report of ‘raw data’ for

Liverpool and Sefton by April 2019• Construct segmentation tool by August 2019• Go live with activity data in September 2019 and costing data by March 2020.

Figure 3: Taking a population health approach to develop more preventative care

16

3.5 Integration

The term ‘Integration’ means to address fragmentation in services, and enable better coordinated and more continuous care for people of all ages.

Mersey Care is focusing on integration in community physical and mental health services because patients receiving care in community settings often have multiple, complex health needs and depend on many health and social care services to meet these needs. Rather than continue to run separate mental health, social care or physical community services, Mersey Care will help local providers to operate within an all-age ‘One Team’ ethos for out of hospital care, uniting primary care, social care, community physical and mental health services and the voluntary sector.

The Liverpool and Sefton Provider Alliance plans set out how we will begin to use our collective resources to have greater impact by pulling in the same direction, working in similar ways and collaborating to provide more holistic support to people in our communities.

In practice, integration will mean that patients have to be assessed and referred between separate organisations less often because those organisations are working together to produce one care plan.

Patients will receive care that factors in their physical, mental health and social needs and their social needs will be met more effectively through non-medical services such as the Life Rooms, services provided by local voluntary organisations and Information and advice hubs/children’s centres.

People will be enabled to take more control of their own health through the development of a personal health record, and through psychological support that takes into consideration someone’s motivations and life circumstances. This is illustrated below in figure 4.

Our plans for integration will be supported by a social care strategic plan which we will develop this year in partnership with social workers and the local authority.

Figure 4: What integration will mean in practice

An integrated care team that understands that Mary has:• anxiety• loneliness• insecurity• confusion• dependency

Enablers:• Person Held Record• Telehealth• Proactive care plan

ROOMSLIFEThe

WALTON

Network of voluntary services

Information and advice hubs/

citizen’s centres

Community connections

Create a single care plan

17

For Mersey Care in 2019-20, our integration initiatives focus on the integration of Mersey Care’s own mental health and physical health services. This integration will be carefully managed and phased slowly, in recognition of the scale of organisational change for our people and to acknowledge that previous Liverpool Community Health services require support to reduce variation in quality.

This balance of beginning to integrate Mersey Care’s mental health and physical health services, with the continued quality improvement support to physical community services is reflected in our milestones for the year.

Milestones for 2019/20• Through the Provider Alliances, implement

integrated care teams, including our children’s services, at 30,000 to 50,000 population across Liverpool and Sefton by October 2019.

• Implement new primary care mental health model, subject to commissioner investment

• Integrate Mersey Care clinical divisions – one division for secure and specialist LD services by December 2019, and one division for local mental health and community services by April 2020.

• Introduce integration in Mersey Care’s services for frailty/dementia

• Introduce integration in Mersey Care’s services for people/families with complex lives

• Introduce integration for children

Key measures• Effectiveness of team working using ITMA tool

(Integrated Team Monitoring and Assessment)• Patient experience and activation using validated

measurement framework• Hospital readmissions within 30 days of discharge• Delayed transfers of care.

18

4.1 Becoming an employer of choice in our sector

Our People Plan 2018 to 2021 sets out our commitment to focussing on our people; those who deliver services and support our communities. We recognise that there has never been a more important time for Mersey Care to have a workforce that has the right values, skills, support and development to deliver Perfect Care. The vision for our People Plan is simple, “to create a compelling place to work where we attract, retain and develop the best people to deliver the best care and be the best they can be”.

The People Plan describes five strategic key priorities that are aligned to deliver the overall Trust aims, all of which we know to be fundamental to creating a high performing, happy workforce, and to the delivery of Perfect Care in accordance with our values and a Just and Learning Culture.

In our workforce planning, we have identified three trustwide workforce planning risks – nursing supply, medical supply and age profile (both the workforce coming up to retirement resulting in a loss of experience and experience levels of the remaining staff in post). We will prioritise actions in our People

Plan which help us to recruit, retain and develop the future workforce.

Milestones for 2019/20: • Continue to review workforce plans, alongside the

divisional transformation programmes, to ensure we continue to have actions in play to mitigate our workforce risks and to ensure that our workforce becomes more reflective of the communities we serve

• Support our workforce through complex organisational change, transition and integration

• Implement culture of care barometer across all clinical divisions to provide a regular temperature check of teams, and use data to identify required actions by September 2019

• Ensure leaders demonstrate Mersey Care values and behaviours and have the courage to challenge and address issues where colleagues are not acting in accordance with our values

• Implement the action plan resulting from the review of how people raise concerns across Mersey Care from May 2019

• Cleanse and review electronic staff records to ensure they reflect new structures and therefore record and report accurate data by March 2020

• Continue to review and streamline recruitment process and delivery of the Trust’s time to hire targets throughout the year.

4OUR PEOPLE: Become of the employer of choice in our sector

19

Our approach to staff sickness in the year ahead will include:• Targeted focus on well being to assess impact

from April 2019• Develop easy to read electronic booklet to

explain managing attendance policy for staff and managers by June 2019

• Review and redesign management development training sessions with HR and staff side by June 2019 and roll out from September 2019.

• Pilot HR/operational management coaching and support sessions within hot spot areas from June to September 2019

• Review available electronic solutions to support line managers in managing absence by June 2019.

• Review and report the timeliness of employee relations cases and embed any learning in line with our Just and Learning Culture approach (including a focus on those with protected characteristics) by end of June 2019.

Key measures:• Maintain staff sickness at 6.5% or below.• Ensure a maximum time to hire of 45 days• Achieve 95% core mandatory training compliance,

with 90% role specific training by March 2020.• Achieve clinical supervision levels of 90% by June

2019.• Achieve 95% PACE compliance within rolling 12

month period.• Maintain a vacancy rate at 11% or below for

qualified nurses (mental health and community)• Maintain a vacancy rate at 14% or below for

consultant doctors (mental health and community)

Our Equality and Inclusion Strategy sets out our equality objectives for 2019 to 2021, which are:• To improve year on year the reported employee

experience for protected groups• To embed high quality analysis through the use of

data into the design and delivery of our services including our decision making processes

• To reduce health inequalities for protected groups by improving access to all services

• To improve year on year the reported patient/service user experience for protected groups

Mersey Care is committed to taking equality, diversity, inclusion and human rights into account in everything we do, whether that’s through our aspiration to deliver Perfect Care for our patients and services users to employing a diverse workforce in a Just and Learning Culture.

Milestones for 2019/20: • Deliver our Equality and Inclusion Action Plan to

improve experience for staff and service users by March 2020.

• Maintain a continual focus on the recording of protected characteristics within our clinical services, with a particular focus on community division where there is a lower baseline position.

• Commission health needs analysis, reporting by October 2019, focussing on access, experience and outcomes for people who share protected characteristics within our services to allow the development of a focussed improvement plan

Key measures:• Improve equality, diversity and inclusion staff

experience to above average levels for 2019/20, as measured by the national staff survey.

• Improve the five workforce race equality scheme key questions, as measured by the national staff survey by March 2020.

• Achieve 95% recording of protected characteristics data of staff within our services. We will agree an improvement trajectory for community division by April 2019.

20

4.2 Just and Learning Culture

Mersey Care is a national pioneer in developing a Just and Learning Culture in the NHS. In the two years since we began work on Just and Learning Culture, we have achieved significant impact for our staff with a 54% reduction in disciplinary investigations.

In the year ahead, we will consolidate our progress and ‘hard wire’ cultural change by embedding Just and Learning Culture within every day working practices. Our priorities in 2019/20 are set out below:

Milestones for 2019/20:• Developing and implementing a tool / framework

to support restorative conversations in practice. • Developing a tool/framework, aligned to our

organisational values, that fosters and supports civility in practice.

• Every team to have Just and Learning conversations, highlighting learning from routine with processes working well, alongside learning from processes when something doesn’t go to plan.

• Refreshing Datix (incident reporting) pro-formas, process, training offered and guidance on completion.

We will also focus within our Just and Learning Culture on the experience of black, asian and minority ethnic staff and of those who share protected characteristics.

4.3. Working side by side with service users and carers

Seeing things from our service users’ perspectives, and working side by side with them to design and improve services gives us powerful opportunities to continually improve experience and outcomes for the people we serve and to stop doing things which don’t add value.

Over recent years, the way in which Mersey Care engages and works with service users and carers has evolved from simply talking to people; to getting people more involved; to asking people to actively participate in our work. The acquisition of community health services, as well as the need for a Foundation Trust to engage more actively with a wider membership and the communities we serve, requires us to think differently about and strengthen our approach to engagement.

In 2019/20, Mersey Care will implement a new process for active participation (co-production) when

21

considering service improvement and redesign. This approach was developed taking account of feedback from various service user and carer groups as well as the discussions with members of the Service User and Carer Assembly.

Life RoomsOur Life Rooms in Walton and Southport have had over 80,000 visits since their openings in May 2016 and 2017 respectively. Life Rooms at Hugh Baird College in Sefton opened in February 2019, with a focus on meeting the needs of young people. Currently over 60 GPs are referring to the Life Rooms and over 3,500 social prescriptions are managed.

In the year ahead, the Life Rooms will continue to be strengthened in order to provide support to people outside the traditional models of service delivery and enable people to take more control over their health and recovery. This will build upon the established Life Rooms pathways for patients discharged from community mental health team caseloads. In partnership with Liverpool and Sefton Provider Alliances, the Life Rooms will form part of a single ‘social prescribing’ pathway for Liverpool and Sefton which makes the most of the community and voluntary sector non medical support and services with neighbourhoods.

Milestones for 2019/20• Pilot a new side by side process for active

participation (co-production) when considering service improvement / redesign by March 2020

• Pilot service user and carer participation in our leadership programmes by March 2020

• Pilot ‘Always events’ for carers within Specialist Learning Disability services from June 2019, and review with a view to further roll out

• Pilot carer passports across the Trust from June 2019

• Pilot Life Rooms Ashworth by March 2020• Continued development our student mental health

offer• Contribute to the design and delivery of a social

innovation model for Liverpool and Sefton in support of integrated care teams throughout 2019/20.

Key measures:• 90% compliance with Triangle of Care in mental

health services. We will develop measures applicable for the breadth of our services in 2019/20.

22

5.1. Maintaining financial balance

NHS Operational, Planning and Contracting Guidance published in January 2019, sets out how the five year funding settlement for the NHS announced in June 2018 will be implemented. This, amongst other national finance changes has resulted in a change in the Trust’s control total for 2019/20 of breakeven.Over recent years the Trust has acquired several organisations which has increased our turnover from £213m (April 2016) to £370m (April 2019). Over the same period the Trust’s surplus has reduced to £1.842m which reflects the additional level of investment across front line services.

In 2018/19 the Trust will achieve its financial control total. However, in achieving the financial position the Trust has experienced financial risks associated with:• Medical staffing cost pressures• Non achievement of corporate efficiency savings• Non delivery of savings anticipated from the

integration of physical and mental health.

In 2019/20 the Trust has a financial plan of breakeven which will attract a Provider Sustainability Fund allocation of £3.721m. This creates an overall use of resources risk rating of 2 which is expected to improve

to 1 by the end of the financial year as a result of the Trust achieving its agency spend target.

Additional investment identified as part of the NHS Long Term Plan recognises mental health and community services as areas of priority. As such, financial resources have been identified through the national NHS five year funding settlement to support the delivery of the service transformation. This will enable the achievement of mental health investment standard alongside support for current and future cost pressures associated with a growth in demand.

We have reviewed our cost improvement scheme in light of the changing demand and acuity facing our clinical services. We have also taken account of the recommendations of the Carter Review regarding corporate/back office functions.

As a result the efficiency savings planned for 2019/20 are set out in figure 5.

OUR RESOURCES: Develop a solid financial, estate and digital platform for future integration 5

23

This translates into a cost improvement plan (CIP) of £10.041m. The Trust will deliver the service and workforce changes necessary to release this efficiency saving whilst maintaining a high quality and safe clinical services.

The financial plan recognises a number of risks which will need to be addressed in 2019/20. They are medical staffing cost pressures, corporate services transformation programme and mental health and community service integration savings.

We will take the following actions in order to management those risks effectively:

• Medical staffing – In the year ahead, we will improve medical recruitment and retention, reducing relliance on medical locums, and embed a Just and Learning Culture. We will develop new roles (physician associates) as part of a wider restructure of medical leadership roles and a new approach to job planning.

• Community services – Implementation of the community services improvement programme post-Kirkup will continue in the year ahead, taking account of the emerging findings from the post-acquisition review work. Our ability to deliver the required transformational change safely at the intended pace is challenged by the level of clinical and quality risk that transferred with the services. The introduction of additional funding has enabled the Trust to defer any efficiency requirements until the service has been stabilised.

• Corporate services – Effective corporate services are essential in supporting our clinical divisions to provide high quality care. In the year ahead, we will develop our corporate services so they consistently provide high quality customer service and enable us to deliver our strategy now and in the future. Following the acquisitions of Calderstones Partnership NHS Foundation Trust and Liverpool Community Health NHS

Trust, our corporate services have grown and in 2019/20 we will agree a new target operating model for high quality corporate services within Mersey Care by December 2019, which will also generate efficiencies and cost savings to support delivery of our cost improvement plans. The cost improvement plan for corporate services in 2019/20 is £6.501m. Some of these corporate savings will be delivered by the opportunities highlighted within the Carter recommendations. In addition, the trust has begun to implement more collaborative working across the local delivery system and wider health economy with regards to corporate functions.

Milestones for 2019/20:• Agree principles of corporate target operating

model and identify high level opportunities from stakeholder engagement by June 2019

• Develop target operating model by September 2019

• Commence implementation of target operating model, including consultation where required, by December 2019

• Target operating model implemented by April 2020

• Throughout this process, implementation of functional CIPs identified through diagnostic exercise.

Key measures• Deliver total Cost Improvement Plan (CIPs) of

£10.041, of which £6.501m relates to corporate services, in 2019/20.

Cost efficiency savings required*

2019/20 (£m)

Local division (carried forward from 2017/18)

0.940

Corporate division 6.501Community services 2.600Total 10.041

Figure 5: Cost efficiency savings required

24

Capital developments 2019/20 *subject to business case approval 2019/20 (£m)Medium secure unit (Rowan View) 27.9Low secure unit* 1.5Southport Redevelopment (Hartley Hospital) 5.4Community Hub Investment* 1.0Global Digital Exemplar 1.9Secure ward refurbishments 4.2Liverpool Inpatient Facility (Liverpool 2) – Scoping /Enabling* 1.0Step Down Unit* 2.0Training Facility* 1.0High Secure HDU Redevelopment* 0.5 Saturn House* 0.5Total 46.9

Figure 6: Our estates framework 2019 to 2024

Figure 7: Capital developments 2019/20

5.2. Improving our estate

Our vision is for our buildings to not only meet 21st century standards but to reshape services themselves, allowing us to deliver integrated care which is more preventative and less crisis-focussed, whilst delivering clinical excellence in our services. Specifically, in developing our estate, we will ensure that the right environment is provided to deliver integrated care for neighbourhoods of 30,000 to 50,000 people and stratify our beds according to acuity of need. Our estates framework (2019 to 2024) is summarised below in figure 6:

Since 2012 we have invested £97m in our estate to provide high quality care. This includes the opening of Clock View, the Sid Watkins Brain Injury Unit, the Hope Centre (addictions), investment in community mental health bases, high secure ward refurbishments and a brand new pharmacy.

We are also investing a further £72m in building a new 123 bed medium secure unit (Rowan View) and a 40 bed inpatient facility in Southport (Hartley Hospital).

The Trust plans to invest £46.9m in its estate in 2019/20.

In addition to these investments set out in figure 7, we are also planning a new inpatient facility in Liverpool, a new low secure unit for people with learning disabilities and a new high dependency unit in high secure. These projects are subject to capital funding being available.

It is important that the we continue to deliver a surplus and manage our resources effectively, as this allows us to continually invest in improving our estate.

25

Our estates developments will be tested against a number of key principles, which reflect our service transformation and quality improvement priorities: • Our buildings will support the Trust’s ambition

to deliver Perfect Care (safe, timely, effective, equitable, patient centred)

• Our buildings will reflect the clinical and emotional needs of service users

• Our buildings will provide an environment in which colleagues want to work

• Our buildings will support agreed partnership pathways across the health economy and wider community.

Milestones for 2019/20:• System wide review of community estate in

partnership with other organisations within each ‘Place’ (for example, Liverpool and Sefton) to enable integrated care.

• Identification of pilot neighbourhoods for shared estate by May 2019 and mobilisation thereafter.

• Continued development of Southport’s Hartley Hospital – due to open from Autumn 2019

• Continued development of Rowan View Medium Secure Unit – due to open Autumn 2020

• Continued planning for Liverpool 2 and Learning Disabilities Low Secure Unit

• Planning and business case for high secure high dependency improvement works

• Forward plan for future use of Whalley and Maghull sites

• Work with Cheshire and Merseyside Health and Care Partnership (STP) to enable consolidation of estate across Cheshire and Merseyside and ensure that Mersey Care developments are reflected in their capital planning.

Key measuresOver the five years of our strategic estates plan (2019 to 2024), we will see:• 5% savings on estates running costs• Reduction from 8% (2018/19 baseline) unoccupied

floor space to 2.5%• Increase from 59% (2018/19 baseline) of facilities

in acceptable condition/satisfactory performance to 100%

• Increase from 42% (2018/19 baseline) of estates in category B condition or above to 100%.

26

5.3. Invest in digital technology

Digital technology will transform the way we deliver person-centred, productive, and integrated care. Digital tools and systems have already changed how we operate, but we know there is so much more that technology can do to help us work effectively, safely, and efficiently. We also know that digitisation is as much about people as it is about technology.

Digital solutions must be designed around insight, co-production and digital skills development with our workforce and with our service users.

Our vision is to transform the digital experience for our workforce and the populations we serve so that technology is both the visible alternative to traditional ways of working and the invisible enabler, working effectively in the foreground and background supporting what we do.

Figure 8 shows the way in which digital technology can support us to meet growing demand for services and our workforce and financial challenges.

Figure 8: Using technology as a solution to our long term challenges

Picture here

27

In 2019/20 we will invest strategic capital to strengthen our digital foundations.

Our aspiration to fundamentally redefine the way services use digital technology will only be realised if we have a strong, dependable and cyber secure infrastructure. The following themes are therefore key in a rolling programme of infrastructure and core technology upgrades:

• The right tools for the job – End user device rolling replacement programme, including upgrading all of the PC/Laptop estate to Windows 10 by January 2020.

• Wi-Fi – Upgrading the Wi-Fi infrastructure to improve connectivity by July 2019.

• Agile working – Roll out Express Access as part of the rolling replacement programme; and Skype for business by May 2019.

• Servers and data centres – Upgrading and consolidating servers for improved performance and efficiency, including Windows Server 2016 updates by January 2020.

We’ll also continue building on our plans as a Global Digital Exemplar by embedding digital tools in services and innovating to develop digital solutions that help align the right resources to the right people and enable the right care.

Digital technology is a critical enabler of our plans to provide proactive integrated care at neighbourhood level. As such we launched a personal health record system in December 2018 and are working with other providers in Cheshire and Merseyside to share clinical records to improve continuity of care by having access to discharge letters; clinical correspondence; pathology and labs; and GP records. Mersey Care will share care plans; crisis plans and discharge letters with other providers.

By rolling out paperlight solutions, we will allow our clinicians working in the community to capture data at the point of care and have access to key information from anywhere at any time.

Milestones for 2019/20• Mobilise personal health record pilot sites at

neighbourhood level with three community integration teams testing the functionality of: shared care plans, crisis plans and appointments from the RiO and EMIS Community Systems; goal setting; trackers for mood, sleep and activity; and diary in April 2019.

• Launch phase two of personal health record pilot sites with at least 5 integration teams to include: link to social prescribing platform; messaging; social care data; and patient surveys and questionnaires from September 2019.

• Join the regional clinical record sharing platform Share2Care in August 2019.

• Link the Personal Health Record to the Share2Care platform to give service users and patients access to parts of their clinical records from all providers across Cheshire and Merseyside region by March 2020.

• Modernise patient administration system in Community Equipment Store (go live March 2019), Child Health Information Service (digital enhancements throughout 2019/20) and Sexual Health (go live March 2020).

• We aim for all adult community services to have completed paperlight by March 2020

• Work with our digital system provider Informatics Merseyside to gain security assurance accreditations for the systems they provide by March 2020.

Key measures:• An increase from current levels to a minimum

of 70% digital maturity, with 85% maturity achieved in relation to clinical records, by 2020/21. We aim to achieve 90% digital maturity by 2024/25.

28

6.1. Developing Provider Alliances

Mersey Care must work with other organisations if we are to deliver our aspiration for continuous improvement, reflecting population health and integration set out in this operational plan. Mersey Care is leading the development of place-based care in Liverpool and Sefton, and the development of a more effective secure services pathway with providers across Cheshire and Merseyside.

Place-based provider alliancesWe have established Provider Alliances in both Liverpool and Sefton which bring together health, social care, third sector and housing providers to use our collective resources to deliver new, integrated models of care designed to improve the health and wellbeing of our communities. We will work together to reduce fragmentation of care for people with complex comorbidities, ensuring the person is at the centre of our decision making. Our new community based services will focus on prevention and proactive care, thereby reducing demand on crisis and urgent care, and promoting choice and independence. This new model of care is focussed on delivering highly effective integrated care teams for populations of 30,000 to 50,000.

In the future, we expect that the Provider Alliances will have a greater influence over tactical commissioning

decisions with the role of CCGs being one of a strategic commissioner, setting the outcomes for its populations. As a result, in 2019/20, we will establish formalised programme management arrangements for the Provider Alliances under the leadership of Mersey Care.

In the year ahead, the Provider Alliances will deliberately move away from multitude of condition specific projects/schemes driven by a single condition policy or targets and identify high impact collective action for population by segmentation and identifying needs, service utilisation and alternative for particular cohorts/segments of the population. Together, we will also work to deliver the children’s transformation plan for Liverpool.

The Provider Alliances will build new operating system (people, processes and technology) for integrated care, specifically:• Integrated care teams based on neighbourhoods

for 30,000 to 50,000 population• Social prescribing to support integrated care teams

at 30,000 to 50,000• Outpatient services and alternatives• Digital technology to support integrated care

teams and outpatient review• Urgent care review

OUR FUTURE: Work with and learn from others to have greater impact 6

29

The operating system will be tested for two population segments in 2019 - frailty/dementia, and complex needs. Achieving measurable change for these cohorts will be high impact for the health system and will generate ‘headroom’ for further change in the system over the longer term.

For Mersey Care, this will mean more integrated working for Mersey Care’s community physical and mental health, learning disability and addiction services. Staff in our local and community divisions will be expected to work increasingly on a neighbourhood basis and as part of an all-age ‘one team’ ethos for that neighbourhood. This will mean closer working with colleagues from social care, housing, the voluntary sector and other agencies working in that neighbourhood.

We are conscious of the need to ensure that the pace of integration of existing Mersey Care services is carefully managed and does not distract colleagues from delivering other aspects of our operational plan. To this end, we will carefully plan the phases of integration with operational colleagues.

Milestones for 2019-20 • Establish integrated care teams in each of the 16

neighbourhoods across Liverpool and Sefton by October 2019.

Key measures:• Effectiveness of team working using ITMA tool

(Integrated Team Monitoring and Assessment)• Patient experience and activation using validated

measurement framework• Hospital readmissions within 30 days of discharge• Delayed transfers of care.

PROSPECT new care model in secure servicesMersey Care will also continue to develop provider alliances for our secure mental health services.

Our PROSPECT partnership was established to manage the local low and medium secure bed base in an efficient and consistent way, and that any changes to practice and provision are subject to the PROSPECT 4D test, and therefore must impact in one of the following ways; minimise delay, reduce duplication, avoid drift, prevent disempowerment.

Single point of referralTrusted assessment

Appropriate level of securityCare bundles

Bed stratificationEstimated discharge dates

Clinical oversight groupMulti service planning

Transition planningHousing

Community forensic services

Duplication

DelayDisempowerment

Drift

Figure 9: PROSPECT 4D test: Our new care model

30

Milestones for 2019/20:• ‘Go live’ as a New Care Model site, following sign-

off of a full business case by July 2019.• Ongoing implementation of a new clinical

model of care which has been developed by the PROSPECT Clinical Network, specifically a single point of assessment and clinical oversight group.

• Bidding for national money to develop enhanced community forensic services to deliver a much more robust community offer and pathway by May 2019.

• Continuing to work with local commissioning colleagues to design and deliver a housing and community support for people discharged from a forensic pathway.

Key measures• Reduce average length of stay for service users

within the PROSPECT low and medium secure services by 5% once the single point of assessment and clinical oversight group are fully implemented.

6.2 Research and development

While there is good knowledge about causes and treatment of mental disorders there are still many gaps which need further understanding and research if we are to improve outcomes. Mersey Care’s aim is to increase research into mental health conditions across the life span, support treatment discovery in biological, psychological social and digital sciences and bring these benefits to help mental and physical health services to provide better health outcomes. As our services grow and there is greater integration with physical health and focus on population health we will work with other stakeholders and partners to support, develop and conduct research in these disciplines too.

Milestones for 2019/20:• Increase our capability in conducting and delivering

research by developing a programme of training and support to increase the number of clinicians involved in active research as Chief Investigators and Principle investigators and continue to achieve

our targets for National Institute for Health Research (NIHR) adopted studies.

• Form a strategic alliance with Liverpool Health Partners to influence collective effort towards mental health research in the city of Liverpool. Through this collaboration and with Clinical Trials Units in acute provider Trusts, we will seek to conduct our first commercial clinical trial.

• Support ongoing digital research (Swim app, AVERT – artificial intelligence applications) to completion and scope further research in evolving technologies.

• Continue to support internally generated research towards Perfect Care priorities of suicide prevention, reducing restraint, improving physical health and Just and Learning Culture.

• Work with academic partners to apply for external research grants.

Key measures:• Five additional Chief Investigators and Principle

Investigators in place by March 2020.• Achievement of our external research grant target

of one external grant in 2019/20.

6.3 Commercialising our knowledge assets

The overarching aim of Mersey Care’s commercial strategy is to deliver a financial return which contributes to the Trust’s efficiencies and additional income targets, helping to reinvest back into the Trust, safeguarding and developing the front line services that the we provide.

Mersey Care possesses a unique combination of clinical expertise and academic expertise, in a broad range of specialist areas. Our improvement and innovation cycle has the potential to generate more value to be reinvested back into the NHS, through developing consultancy to other organisations and through developing services and products that are valuable to the wider health system (for example, the Zero Suicide Alliance).

31

Milestones for 2019/20• Finalise Commercial Opportunity Assessment Tool

kit by April 2020• Create a process and develop expertise for the

management, protection, development and commercialisation of our intellectual property (IP) assets, which runs alongside our innovation process by October 2019

• Develop a ‘commercial and innovation’ process for internal and external opportunities, and be able to manage these through a process including Commercial Assessment, intellectual property and trademarking process, marketing and management and support and development of a commercial pipeline by October 2020

• Develop a governance and quality assurance process to identify our assets, develop our assets and then commercialise our products. The majority of our products will be developed from a research and evidence base (Centre for Perfect Care) through our innovation process.

• Progress areas identified as truly distinctive and market leading in recent commercialisation review from April 2019.

Key measures:• Successful progress of three commercial

opportunities by October 2019 and six by March 2020

Strategicinnovation

Prototype Incubate

Tomorrow’sbusiness

AdaptExistinginnovations

Accelerate

Figure 10: Commercialising our knowledge capital to reinvest back into the NHS

New ventures and innovation

32

7.1 What this plan means for our divisions

We have worked with each of our divisions in the production of this plan and in the following pages we set out their specific areas of focus in supporting the delivery if this operation al plan in 2019/20.

7.2 Executive Performance Review

Delivery against both our strategic aims and operational plan priorities will be reported via the Executive Performance Report, which will be updated to reflect the structure and priorities set out in our plans along with the measures and targets set for 2019/20.

Quarterly performance reviews with each division, established in 2018/19, will continue, identifying areas of under performance and agreeing performance improvement plans where required. This will ensure regular oversight of delivery of our operational plan in 2019/20.

We will also undertake quarterly performance reviews with our corporate strategic programmes, to ensure delivery by corporate services of our strategy and plan, continually prioritising our resources in year.

MONITORING AND MEASURING DELIVERY OF THIS PLAN 7

Ou

r Se

rvic

esLo

ng

ter

m q

ual

ity

imp

rove

men

t -

Perf

ect

Car

e ar

eas:

Zero

su

icid

e•

Dev

elop

men

t, t

rain

ing

and

roll

out

of t

ailo

red

divi

sion

al s

afet

y pl

ans,

incl

udin

g to

pris

on s

ervi

ces

from

Jun

e 20

19•

Targ

eted

rol

e ou

t of

leve

l 2 s

uici

de t

rain

ing

to c

harg

e nu

rses

fro

m A

pril

2019

.

Red

uci

ng

res

trai

nt

• Em

bed

the

six

key

war

d ba

sed

redu

cing

res

tric

tive

prac

tice

inte

rven

tions

in a

ll w

ards

by

Apr

il 20

20.

• Ba

rrie

rs t

o ch

ange

and

HO

PE p

rogr

amm

e ro

lled

out

to r

educ

e lo

ng t

erm

seg

rega

tion

from

Jun

e 20

19•

Act

ive

mon

itorin

g of

long

ter

m s

egre

gatio

n an

d re

stric

tive

prac

tice

by p

rote

cted

cha

ract

eris

tics.

Phys

ical

hea

lth

• Pr

omot

ing

incr

ease

d ta

ke u

p of

phy

sica

l act

ivity

off

er•

Off

er a

ll se

rvic

e us

ers

a fu

ll pr

ogra

mm

e of

imm

unis

atio

ns a

nd v

acci

natio

ns.

Pres

sure

ulc

ers

• Ta

rget

ed t

rain

ing

and

awar

enes

s to

men

tal h

ealth

sta

ff o

n pr

essu

re u

lcer

s/ s

kin

care

by

Mar

ch 2

020.

Lear

nin

g f

rom

dea

ths

• Re

view

and

lear

n fr

om d

eath

s of

tho

se in

sec

ure

and

spec

ialis

t le

arni

ng

disa

bilit

y se

rvic

es, i

mpl

emen

ting

divi

sion

al a

ctio

n as

req

uire

d.

Co

nti

nu

ou

s q

ual

ity

imp

rove

men

t –

STEE

P:

Safe

•

Con

tinue

d us

e of

qua

lity

impr

ovem

ent

met

hodo

logy

to

addr

ess

high

le

vels

of

ligat

ure

inci

dent

s in

spe

cial

ist

lear

ning

dis

abili

ty s

ervi

ces

(SLD

) in

201

9/20

• U

nder

stan

d an

d ad

dres

s se

lf ha

rm a

t th

e Be

acon

ser

vice

Mar

ch 2

020.

Tim

ely

• Im

prov

ed a

cces

s to

reh

abili

tatio

n vi

a pi

lot

of L

ife R

oom

s A

shw

orth

by

Mar

ch 2

020

• Fo

cus

of s

peci

alis

t su

ppor

t te

ams

on d

isch

arge

pla

nnin

g/ s

uppo

rt.

Effe

ctiv

e•

Plan

ning

for

red

evel

opm

ent

of a

dmis

sion

and

hig

h de

pend

ency

uni

t by

Mar

ch 2

024.

• Pl

anni

ng f

or S

LD lo

w s

ecur

e un

it, s

ubje

ct t

o fu

ndin

g.

Equ

itab

le:

• M

onito

ring

of lo

ng t

erm

seg

rega

tion

and

rest

rictiv

e pr

actic

e by

pro

tect

ed c

hara

cter

istic

s.

Pers

on

-cen

tred

• ‘A

lway

s ev

ent’

pilo

ts f

or c

arer

s w

ithin

SLD

fro

m J

une

2019

• C

arer

pas

spor

t pi

lot

with

in id

entifi

ed s

ervi

ces

from

Jun

e 20

19.

Ou

r R

eso

urc

es•

Secu

re w

ard

refu

rbis

hmen

t pr

ogra

mm

e•

Secu

re H

DU

red

evel

opm

ent

prog

ram

me

• O

pen

Row

an v

iew

med

ium

sec

ure

unit

in A

utum

n 20

20.

• Sp

ecia

list

LD lo

w s

ecur

e un

it pr

ogra

mm

e (s

ubje

ct t

o fu

ndin

g)•

Cor

e te

chno

logy

upg

rade

pro

gram

me.

Ou

r Fu

ture

• G

o liv

e as

a n

ew c

are

mod

el f

or s

ecur

e se

rvic

es (P

ROSP

ECT)

fro

m

June

201

9.•

Impl

emen

t ne

w c

linic

al m

odel

of

care

dev

elop

ed b

y PR

OSP

ECT

clin

ical

net

wor

k, s

peci

fical

ly s

ingl

e po

int

of a

cces

s an

d cl

inic

al

over

sigh

t gr

oup

• Bi

d fo

r na

tiona

l mon

ies

to e

nhan

ce c

omm

unity

for

ensi

c se

rvic

es.

We

will

mea

sure

ou

r d

eliv

ery

of

ou

r d

ivis

ion

al p

rio

riti

es w

ith

in t

he

op

erat

ion

al p

lan

usi

ng

th

ese

key

ind

icat

ors

:•

Mai

ntai

n an

d im

prov

e ex

istin

g C

QC

goo

d ra

tings

• Re

duce

d le

ngth

of

stay

in s

egre

gatio

n•

Redu

ced

use

of fl

oor

rest

rain

t (s

upin

e) in

Spe

cial

ist

LD•

Incr

ease

d ta

ke u

p of

mod

erat

e ex

erci

se•

Redu

ced

leve

ls o

f ha

rm•

Redu

ced

leng

th o

f st

ay a

nd d

elay

ed d

isch

arge

s•

Patie

nt e

xper

ienc

e of

tho

se w

ith p

rote

cted

cha

ract

eris

tics

• St

aff

sick

ness

leve

ls•

Equa

lity,

div

ersi

ty a

nd in

clus

ion

staf

f ex

perie

nce.

Wh

at t

his

op

erat

ion

al p

lan

mea

ns

for

us

in 2

019/

20 –

Se

cure

an

d S

pec

ialis

t Le

arn

ing

Dis

abili

ty D

ivis

ion

s

Ou

r Pe

op

le•

Inte

grat

e se

cure

and

spe

cial

ist

lear

ning

dis

abili

ty d

ivis

ions

by

Dec

embe

r 20

19•

Impl

emen

t cu

lture

of

care

bar

omet

er•

Team

acc

redi

tatio

n pr

ogra

mm

e•

Impl

emen

t di

visi

onal

Jus

t an

d Le

arni

ng C

ultu

re a

ctio

n pl

an•

Use

new

sid

e by

sid

e pr

oces

s fo

r ac

tive

part

icip

atio

n in

ser

vice

im

prov

emen

t/ r

edes

ign

by M

arch

202

0•

Pilo

t Li

fe R

oom

s A

shw

orth

fro

m M

arch

202

0.

Ou

r Se

rvic

esLo

ng

ter

m q

ual

ity

imp

rove

men

t -

Perf

ect

Car

e ar

eas:

Zero

su

icid

e:•

Ensu

re c

ompl

ianc

e w

ith le

vel 1

sui

cide

tra

inin

g.

Red

uci

ng

res

trai

nt

• A

cces

s to

de-

esca

latio

n/ b

reak

away

tra

inin

g fo

r pr

iorit

ised

sta

ff b

y M

arch

202

0.

Phys

ical

hea

lth

• Sh

are

lear

ning

fro

m W

ard

35 r

egar

ding

fal

ls a

sses

smen

t an

d m

anag

emen

t ac

ross

clin

ical

div

isio

ns.

Pres

sure

ulc

ers

• Ze

ro d

eter

iora

tion

of p

ress

ure

ulce

rs w

ithin

our

car

e.•

Del

iver

pro

gram

me

of t

arge

ted

trai

ning

to

men

tal h

ealth

sta

ff o

n pr

essu

re u

lcer

s/ s

kin

care

by

Mar

ch

2020

.

Lear

nin

g f

rom

dea

ths

• Im

plem

ent

actio

n pl

an p

rodu

ced

follo

win

g re

view

of

harm

in L

iver

pool

Com

mun

ity

Hea

lth s

ervi

ces.

Co

nti

nu

ou

s q

ual

ity

imp

rove

men

t –

STEE

P:

Safe

: •

Focu

ssed

aw

aren

ess-

rais

ing

and

incr

ease

d re

port

ing

of s

afeg

uard

ing

risks

.•

Impl

emen

t th

e C

hild

ren

in C

are

Qua

lity

Impr

ovem

ent

Plan

.•

Full

impl

emen

tatio

n of

pos

t-K

irkup

qua

lity

and

safe

ty im

prov

emen

t pl

an.

• Im

plem

ent

stan

dard

ised

saf

ety

hudd

les

from

Apr

il 20

19, a

udite

d qu

arte

rly

Tim

ely

• Re

duce

wai

ting

times

for

the

rapi

es s

ervi

ces

alig

ned

to T

rust

-wid

e re

view

of

ther

apie

s.•

Impl

emen

t Re

d2G

reen

acr

oss

ever

y ap

plic

able

com

mun

ity s

ervi

ce b

y O

ctob

er 2

019.

• 10

0% C

HC

ass

essm

ents

with

in 2

8 da

ys o

f id

entifi

catio

n by

Mar

ch 2

020.

Effe

ctiv

e•

Dev

elop

and

impl

emen

t ac

cess

and

ass

essm

ent

targ

ets

for

end

of li

fe c

are

by

Sept

embe

r 20

19.

• W

ithin

spe

cial

ist

serv

ices

, max

imis

e pr

even

tion

offe

r in

201

9/20

.•

Sing

le p

oint

of

cont

act

for

dist

rict

nurs

ing

and

com

mun

ity m

atro

ns b

y Se

ptem

ber

2019

.•

Revi

ew o

f sm

all t

eam

s w

ithin

com

mun

ity s

ervi

ces

by J

uly

2019

.

Equ

itab

le:

• Fu

ll pr

otec

ted

char

acte

ristic

s re

cord

ed a

cros

s al

l ser

vice

s an

d re

view

ed a

long

side

har

m d

ata.

• Re

view

ref

erra

l doc

umen

tatio

n to

ens

ure

early

iden

tifica

tion

of le

arni

ng d

isab

ility

by

Mar

ch 2

020.

Pers

on

-cen

tred

• C

arer

s as

sess

men

t ro

utin

ely

offe

red

by D

ecem

ber

2019

• Im

plem

ent

patie

nt in

form

atio

n le

aflet

s at

poi

nt o

f tr

ansi

tion

by S

epte

mbe

r 20

19

Ou

r Pe

op

le•

Inte

grat

e lo

cal a

nd c

omm

unity

div

isio

ns b

y A

pril

2020

.•

Mob

ilise

inte

grat

ed c

are

team

s, in

clud

ing

Chi

ldre

n’s

serv

ices

, acr

oss

all 1

6 ne

ighb

ourh

oods

by

Oct

ober

201

9.•

Org

anis

atio

nal c

hang

e w

ith s

ervi

ce li

ne d

eliv

ery

alig

ned

to

neig

hbou

rhoo

d de

liver

y by

May

201

9.•

Impl

emen

t cu

lture

of

care

bar

omet

er•

Team

acc

redi

tatio

n pr

ogra

mm

e em

bedd

ed b

y O

ctob

er 2

019.

• Im

plem

ent

divi

sion

al J

ust

and

Lear

ning

Cul

ture

act

ion

plan

• En

hanc

ed p

sych

olog

ical

sta

ff s

uppo

rt o

ffer

for

com

mun

ity s

taff

by

June

201

9, o

pera

tiona

l acr

oss

all s

ervi

ces

by M

arch

202

0.•

Use

new

sid

e by

sid

e pr

oces

s fo

r ac

tive

part

icip

atio

n in

ser

vice

im

prov

emen

t/ r

edes

ign

by M

arch

202

0.•

Embe

d cl

inic

al c

ompe

tenc

ies

in O

LM a

nd r

epor

ting

by S

epte

mbe

r 20

19

Ou

r R

eso

urc

es•

Revi

ew o

ur c

omm

unity

est

ate

in p

artn

ersh

ip w

ith o

ther

or

gani

satio

ns•

Iden

tifica

tion

of p

ilot

neig

hbou

rhoo

ds f

or s

hare

d es

tate

by

May

20

19.

• C

ore

tech

nolo

gy u

pgra

de p

rogr

amm

e•

Pape

rlite

acr

oss

all a

dult

com

mun

ity s

ervi

ces

by M

arch

202

0.•

Mob

ilise

use

of

Shar

e2C

are

clin

ical

rec

ords

pla

tfor

m f

rom

Aug

ust

2019

.•

Mod

erni

se p

atie

nt a

dmin

istr

atio

n sy

stem

s in

CES

, CH

IS a

nd s

exua

l he

alth

.

Ou

r Fu

ture

• D

eliv

er in

tegr

ated

car

e as

par

t of

Pro

vide

r A

llian

ce p

riorit

ies

in

Live

rpoo

l and

Sef

ton,

wor

king

with

Prim

ary

Car

e N

etw

orks

.

We

will

mea

sure

ou

r d

eliv

ery

of

ou

r d

ivis

ion

al p

rio

riti

es w

ith

in t

he

op

erat

ion

al p

lan

usi

ng

th

ese

key

ind

icat

ors

:•

CQ

C g

ood

acro

ss a

ll se

rvic

es•

End

of li

fe a

cces

s an

d re

spon

se t

imes

• W

aitin

g tim

es f

or t

hera

pies

• U

rgen

t ca

re r

espo

nsiv

enes

s•

Patie

nt s

atis

fact

ion

and

goal

att

ainm

ent

(inte

grat

ion

scor

ecar

d)•

Redu

ced

leve

ls o

f ha

rm•

Patie

nt e

xper

ienc

e of

tho

se w

ith p

rote

cted

cha

ract

eris

tics

• St

aff

sick

ness

leve

ls•

Equa

lity,

div

ersi

ty a

nd in

clus

ion

staf

f ex

perie

nce

Wh

at t

his

op

erat

ion

al p

lan

mea

ns

for

us

in 2

019/

20 –

C

om

mu

nit

y D

ivis

ion

Ou

r Se

rvic

esLo

ng

ter

m q

ual

ity

imp

rove

men

t -

Perf

ect

Car

e ar

eas:

Zero

su

icid

e:•

Sing

le r

isk

man

agem

ent

fram

ewor

k th

at in

corp

orat

es s

afet

y pl

anni

ng, r

isk

asse

ssm

ent

and

form

ulat

ion

deve

lope

d an

d ro

lled

out

to 1

00%

pat

ient

s by

Mar

ch 2

020

• D

ecis

ion-

supp

ort

fram

ewor

k

Red

uci

ng

res

trai

nt

• A

gree

(by

Oct

ober

201

9) a

nd im

plem

ent

an a

cuity

mea

sure

acr

oss

all w

ards

by

Mar

ch 2

020.

• Im

plem

ent

the

appr

opria

te c

ore

redu

cing

res

tric

tive

prac

tice

inte

rven

tions

in a

ll w

ards

by

Apr

il 20

20.

Phys

ical

hea

lth

• C

ontin

ue t

o im

prov

e ph

ysic

al h

ealth

scr

eeni

ng p

erfo

rman

ce a

cros

s th

e di

visi

on w

ith a

foc

us o

n co

mm

unity

ser

vice

s.

Pres

sure

ulc

ers

• Re

ceiv

e pr

ogra

mm

e of

in-r

each

and

tra

inin

g fr

om c

omm

unity

phy

sica

l hea

lth

serv

ices

, prio

ritis

ing

com

plex

car

e w

ards

Lear

nin

g f

rom

dea

ths

• U

nder

take

tw

o th

emat

ic r

evie

ws

base

d on

mor

talit

y da

te b

y M

arch

202

0.•

Ensu

re o

utco

mes

fro

m a

ll re

view

s ar

e di

scus

sed

mon

thly

in g

over

nanc

e m

eetin

gs.

Co

nti

nu

ou

s q

ual

ity

imp

rove

men

t –

STEE

P:

Safe

: •

Impr

ove

risk

asse

ssm

ent

proc

ess

for

leav

e (c

oron

ers

lett

er d

ate)

with

le

ave

plan

s in

pla

ce f

or a

ll se

rvic

e us

ers

by A

pril

2019

.•

Stan

dard

ised

ele

ctro

nic

solu

tion

obse

rvat

ions

and

ass

essm

ents

, ena

bled

by

digi

tal b

oard

by

Mar

ch 2

020.

Tim

ely

• Im

plem

ent

actio

n pl

an t

o re

duce

wai

ting

times

for

psy

chol

ogic

al t

hera

pies

, w

ith t

raje

ctor

ies

set

by A

pril

2019

.•

Impl

emen

t Re

d2G

reen

in e

very

inpa

tient

war

ds b

y O

ctob

er 2

019.

• D

eliv

er n

atio

nal I

APT

rec

over

y an

d w

aitin

g tim

es t

arge

ts, s

ubje

ct t

o co

mm

issi

oner

fu

ndin

g.

Effe

ctiv

e•

Impl

emen

t C

risis

Res

olut

ion

and

Hom

e Tr

eatm

ent

(CRH

T) w

ith f

ull r

ecru

itmen

t in

pla

ce b

y M

ay 2

019.

• Im

plem

ent

unit

co-o

rdin

ator

res

ourc

e ac

ross

inpa

tient

ser

vice

s by

Apr

il 20

19.

Equ

itab

le:

Embe

d pr

otec

ted

char

acte

ristic

s in

all

gove

rnan

ce m

onito

ring

from

Apr

il 20

19.

Pers

on

-cen

tred

• Re

view

and

ado

pt s

ecur

e se

rvic

e ca

rer

invo

lvem

ent

tool

kit

with

div

isio

nal a

ctio

n pl

an b

y Ju

ne 2

019.

Ou

r Pe

op

le•

Inte

grat

e lo

cal a

nd c

omm

unity

div

isio

ns b

y A

pril

2020

.•

Impl

emen

t cu

lture

of

care

bar

omet

er•

Team

acc

redi

tatio

n pr

ogra

mm

e•

Impl

emen

t di

visi

onal

Jus

t an

d Le

arni

ng C

ultu

re a

ctio

n pl

an•

Use

new

sid

e by

sid

e pr

oces

s fo

r ac

tive

part

icip

atio

n in

ser

vice

im

prov

emen

t/ r

edes

ign

by M

arch

202

0.

Ou

r R

eso

urc

es•

Revi

ew o

ur c

omm

unity

est

ate

in p

artn

ersh

ip w

ith o

ther

or

gani

satio

ns•

Ope

n H

artle

y H

ospi

tal i

n A

utum

n 20

19.

• C

ontin

ued

plan

ning

for

Liv

erpo

ol 2

inpa

tient

uni

t.•

Cor

e te

chno

logy

upg

rade

pro

gram

me

• M

obili

se u

se o

f Sh

are2

Car

e cl

inic

al r

ecor

ds p

latf

orm

fro

m A

ugus

t 20

19.

Ou

r Fu

ture

• D

evel

op p

rimar

y ca

re m

enta

l hea

lth r

ole

to s

uppo

rt in

tegr

ated

car

e at

nei

ghbo

urho

od le

vel,

subj

ect

to c

omm

issi

oner

fun

ding

.•

Lead

Per

sona

lity

Dis

orde

r re

desi

gn a

s pa

rt o

f C

hesh

ire a

nd

Mer

seys

ide

Hea

lth a

nd C

are

Part

ners

hip

prio

ritie

s.

We

will

mea

sure

ou

r d

eliv

ery

of

ou

r d

ivis

ion

al p

rio

riti

es w

ith

in t

he

op

erat

ion

al p

lan

usi

ng

th

ese

key

ind

icat

ors

:•

CQ

C g

ood

acro

ss a

ll se

rvic

es•

Redu

ced

leng

th o

f st

ay a

nd d

elay

ed d

isch

arge

s•

Impr

oved

pat

ient

sat

isfa

ctio

n w

ith in

volv

emen

t in

car

e pl

anni

ng•

Wai

ting

times

for

psy

chol

ogic

al t

hera

pies

• Pr

ogre

ss t

owar

ds C

RHT

fidel

ity m

odel

• Re

duce

d le

vels

of

harm

• Pa

tient

exp

erie

nce

of t

hose

with

pro

tect

ed c

hara

cter

istic

s•

Staf

f si

ckne

ss le

vels

• Eq

ualit

y, d

iver

sity

and

incl

usio

n st

aff

expe

rienc

e.

Wh

at t

his

op

erat

ion

al p

lan

mea

ns

for

us

in 2

019/

20 –

Loca

l Div

isio

n

Ou

r Se

rvic

esC

orp

ora

te s

ervi

ces

will

co

nti

nu

e to

su

pp

ort

ou

r cl

inic

al

div

isio

ns

to p

rovi

de

con

sist

ent,

hig

h q

ual

ity

care

.

Co

rpo

rate

div

isio

n w

ill s

up

po

rt t

he

del

iver

y o

f o

ur

lon

g

term

qu

alit

y im

pro

vem

ent

Perf

ect

Car

e ar

eas

as w

ell a

s o

ur

con

tin

uo

us

qu

alit

y im

pro

vem

ent

(STE

EP)

pri

ori

ties

in

2019

/20

thro

ug

h k

ey p

rog

ram

mes

, in

clu

din

g:

• C

entr

e fo

r Pe

rfec

t C

are

• C

omm

unity

ser

vice

s im

prov

emen

t pl

an•

Patie

nt s

afet

y pr

ogra

mm

e•

Dev

elop

men

t of

Pro

vide

r A

llian

ces

We

will

dev

elop

our

cor

pora

te s

ervi

ces

to p

rovi

de h

igh

qual

ity

cust

omer

ser

vice

now

and

in t

he f

utur

e, im

plem

entin

g a

new

ta

rget

ope

ratin

g m

odel

for

cor

pora

te s

ervi

ces

by A

pril

2020

.

Ou

r Pe

op

le•

Impl

emen

t ou

r Eq

ualit

y an

d In

clus

ion

actio

n pl

an•

Supp

ort

our

wor

kfor

ce t

hrou

gh c

ompl

ex o

pera

tiona

l cha

nge

• W

orkf

orce

pla

nnin

g to

miti

gate

wor

kfor

ce r

isks

• C

ontin

ued

focu

s on

act

ions

to

redu

ce s

taff

sic

knes

s•

Embe

d Ju

st a

nd L

earn

ing

Cul

ture

into

eve

ryda

y pr

actic

e.•

Lead

a n

ew s

ide-

by-s

ide

proc

ess

for

activ

e pa

rtic

ipat

ion

• Fu

rthe

r de

velo

p th

e Li

fe R

oom

s in

sec

ure

serv

ices

and

dev

elop

a

stud

ent

men

tal h

ealth

off

er.

Ou

r R

eso

urc

es•

Focu

s on

man

agin

g ou

r to

p th

ree

finan

cial

ris

ks –

med

ical

sta

ffing

, co

mm

unity

ser

vice

s an

d co

rpor

ate

serv

ices

.•

Impl

emen

t a

new

tar

get

oper

atin

g m

odel

for

cor

pora

te s

ervi

ces

by

Apr

il 20

20.

• D

eliv

er s

trat

egic

est

ates

pla

n w

ith f

ocus

on

syst

em w

ide

revi

ew

of c

omm

unity

est

ates

, con

tinue

dev

elop

men

t of

Har

tley

Hos

pita

l an

d Ro

wan

Vie

w ,

plan

ning

for

Liv

erpo

ol 2

and

LD

low

sec

ure

unit

andf

orw

ard

plan

ning

for

Mag

hull

and

Wha

lley

site

s.•

Del

iver

pro

gram

me

of in

fras

truc

ture

and

cor

e te

chno

logy

upg

rade

s.•

Impl

emen

t pe

rson

al h

ealth

rec

ords

and

Sha

re2

Car

e cl

inic

al r

ecor

d sh

arin

g in

sup

port

of

inte

grat

ed c

are.

Ou

r Fu

ture

• Su

ppor

t M

erse

y C

are’

s le

ader

ship

of

Prov

ider

Alli

ance

s •

Del

iver

res

earc

h an

d de

velo

pmen

t st

rate

gy a

nd m

axim

ise

allia

nce

with

Liv

erpo

ol H

ealth

Par

tner

s •

Impl

emen

t co

mm

erci

al s

trat

egy,

rei

nves

ting

with

the

tru

st.

We

will

mea

sure

ou

r d

eliv

ery

of

ou

r d

ivis

ion

al p

rio

riti

es w

ith

in t

he

op

erat

ion

al p

lan

usi

ng

th

ese

key

ind

icat

ors

:•

Mai

ntai

n an

d im

prov

e ex

istin

g C

QC

goo

d ra

tings

• A

chie

ve fi

nanc

ial c

ontr

ol t

otal

• D

eliv

ery

of £

6.50

1m c

orpo

rate

CIP

s•

Staf

f si

ckne

ss le

vels

• Eq

ualit

y, d

iver

sity

and

incl

usio

n st

aff

expe

rienc

e•

Esta

tes

impr

ovem

ent

• D

igita

l mat

urity

Wh

at t

his

op

erat

ion

al p

lan

mea

ns

for

us

in 2

019/

20 –

C

orp

ora

te D

ivis

ion

37

FINANCIAL IMPACT OF THIS PLAN8

8.1 Resourcing our strategic priorities

Delivering our strategy will enable Mersey Care to remain in financial balance, through service redesign that develops more preventative and integrated services, but also through focusing on our main financial risks of medical recruitment, corporate services and community services.

The initiatives that we will pursue in 2019/20 are accounted for within our financial planning for the year ahead. In the main, these initiatives will be resourced through maintained investment, realignment of existing resource and new commissioner resources, subject to contract settlement, as summarised below:

Realignment of existing resource

New resources subject to contract settlement

Maintained investment

Business case required

Planned investment

• Integrated care team implementation

• Side by side active participation process

• Always events for carers• Trust wide therapies

review• ICRAS North Mersey• Integrate clinical

divisions• Introduce integration

for frailty/ dementia, complex lives and children

• Improve community estate in partnership

• Future plans for Whalley and Maghull sites

• Mobilise provider alliances

• Implement new primary care mental health model

• Crisis resolution and home treatment implementation

• PROSPECT new care model

• Perfect Care areas• Consolidate prison

progress• Reduce sickness

absence• Equality and

inclusion• Just and Learning

Culture priorities• Open Hartley

Hospital and Rowan View

• Review and relaunch R&D strategy

• Quality and safety framework

• Develop Life Rooms model

• Core technology upgrade

• Personal health records

• Share2Care clinical record sharing

38

Productivity gainA number of our initiatives in 2019/20 will support greater productivity, helping us to maintain financial balance, whilst improving quality with our services. Examples include introducing integration with our services for people with frailty/dementia, where we have identified duplication with our services, reviewing therapies provision across the trust in order to standardise services and improve access. Implementing core technology upgrades, including paperlight, will allow our staff to make better use of their time for face to face care.

Furthermore, we know that integrated, proactive care can bring benefits for the wider system by reducing reliance on hospital care. Evidence from the Kings Fund suggests that those who receive proactive care have a 20% less chance of admission to hospital in the subsequent 12 months.

Cost savingsIn 2019/20, we have identified a £6.501m cost improvement plan (CIP) for our corporate services. Following recent acquisitions, our corporate services have grown. By pursuing opportunities for internal efficiency and greater collaborative working across with wider system partners, we will develop and agree a new target operating model for high quality corporate services by September 2019. This will support our clinical divisions to delivery high quality care and enable us to deliver our strategy now and in the future.

Implementation of the community services improvement programme post-Kirkup will continue in the year ahead, taking account of the emerging findings from the post acquisition review work. Our ability to deliver the required transformational change safely at the intended pace is challenged by the level of clinical and quality risk that transferred with the services.

Through improvements to medical recruitment and retention and embedding our Just and Learning Culture, we will reduce our reliance on costly medical locums in 2019/20. This will accompany the development of new roles as part of a wider restructure of medical leadership and a new approach to job planning within Mersey Care.

Value generationIn the year ahead, we will generate income and value to be reinvested back into our services through commercialising our knowledge assets and progressing our research and development activities with a focus on improving health outcomes.

39

79RISKS TO DELIVERYOF THIS PLAN

Risk area (and related BAF risks where relevant)

Risk/impact to plan How the operational plan addresses the risk

Maintaining quality and safety whilst delivering organisational change and efficiency

SRR 2018/19 – 04; 11; 02

If cost reduction becomes a stronger driver than quality, then the quality of our services may be adversely impacted, resulting in quality of care not meeting required standards.

Continuous improvement in STEEP priorities (page 14)Community services improvement plan (page 34) and divisional plans (page 33)Perfect Care priorities (page 13)Regular board monitoring and measurement of delivery of this plan (page 32)Corporate services transformation (page 23)

Delivering the required savings

SRR 2018/19 – 01

If the required savings are not delivered, then we may not achieve best value from our financial resources, resulting in failure to meet financial duties.

Strong management of the CIP delivery programme and focus on top three financial risks (page 23)Monitoring of savings delivery through the PIFC.Long term financial planning.

Our people

SRR 2018/19 – 061305LOC. 140

Without appropriate staffing, and leadership skills to lead change, quality of care may not meet required and our clinical transformation and integration plans will not be realised.

People plan (page 18)Workforce modelling and actions to support recruitment and retention, including ‘growing our own’, succession planning, leadership development (page 18) Development of Just and Learning Culture (page 20)Programme of staff engagement.

40

Risk area (and related BAF risks where relevant)

Risk/impact to plan How the operational plan addresses the risk

Availability of capital

SRR 2018/19 – 03SPLD CM 04

If national restrictions on capital prevent the planned investment, then quality of care will be affected.If capital resources are not made available for NHS England to replace the Specialist LD low secure unit, staff uncertainty will grow and may impact on the ability to maintain safe services.

Estates strategic framework (page 24)Prioritise and sequence capital investment (page 24)Seek alternative funding sources.Relationship with Cheshire and Merseyside Health and Care Partnership (STP) planning and prioritisation (page 25)Plan for Whalley site and learning disability (LD) low secure unit (page 25)

Managing demand for our services

If demand for our services increases above the level for which we are funded, then both delivery of our services and our financial resources may be impaired, resulting in adverse impacts upon quality of care and financial performance.

Adopt neighbourhood level preventative, integrated approach to care to manage demand. (page 28)Manage demand more effectively in partnership with primary care (page 28)Standardise pathways of careInnovate to meet needs at earliest stage in their condition/pathway (page 7)Seek opportunities through provision of physical community services to support self care (page 28)

System leadership If we do not develop our senior leaders to work in partnership across the health and care system, there is a risk to ongoing sustainability in North Mersey/ Cheshire and Merseyside.

Adopt system leadership role in Sefton and Liverpool through Provider Alliances. (page 28)PROSPECT new secure care model leadership across Cheshire and Merseyside (page 29)Explore other opportunities for greater impact through partnerships (page 28)

Contact detailsContact us at the following address:Mersey Care NHS Foundation TrustV7 Building, Kings Business Park, Merseyside, L34 1PJ

@Mersey_Care

MerseyCareNHSFoundationTrust

MerseyCareNHSFT


Report provided (check necessary boxes): Report to:

Council of Governors To Note: ☒ For Assurance: ☐


High Level Results of the annual NHS Staff Survey (2018)

Accountable Director(s): Amanda Oates, Executive Director or Workforce Report Author(s): Jayne Toole, Senior Organisational Effectiveness Practitioner

Purpose of Report 1) This report provides a high level overview of the key themes of the annual NHS Staff Survey (2018) highlighting the changes to the format of the presentation of the data by the national Survey Co-ordination Centre.


1) This report contains comparisons to 2017 where possible for guidance. 2018 will become ‘Year Zero’ and set the organisational benchmark for future results.

2) The report also provides a final update on the 2018/19 action plan for review and aligns the Staff Survey Themes to the Trust’s People Plan as the delivery method for improvement in response to the enclosed findings.

Recommendation:

The Council of Governors is asked to: 1) Note the findings of the NHS Staff Survey 2018. 2) Note update on actions carried out in response to 2017 results

and any measurable impact. 3) Agree that the delivery of the Trust’s People Plan will be the

vehicle for improvement in response to the enclosed findings. Next Steps: (Subject to recommendation being accepted)

1) Continue the implementation of the People Plan objectives 2) Continue to implement the Culture of Care Barometer 3) Agree divisional action plans and report to Operational

Management Boards



Board of Directors 27 March High Level Results of Staff Survey (2018)

Noted.

BACKGROUND/ CONTEXT

1. The NHS Staff Survey represents the largest body of employee engagement data in the world. This data is used in empirical research that demonstrates that staff experience directly impacts their wellbeing and the delivery of high quality, safe care.

2. It provides an opportunity for organisations to survey staff in a consistent and systematic manner, making it possible to build up a picture of staff experience. Obtaining feedback from staff and taking into account staff views and priorities is vital for driving real improvement.

3. There is a national requirement for all NHS organisations to conduct the Survey

annually and the CQC use the results to monitor on-going compliance with essential standards of quality and safety as part of the Well Led domain.

4. The Trust historically has a good response rate when compared to other similar Trusts,

and takes seriously the findings which are used to develop, inform and review the Trust’s People Plan and Divisional Engagement Plans.

5. The NHS Staff Survey was conducted between 5 October and 30 December 2018, the Trust achieved a response rate of 51% which is above national average.


2018 response rate

6. The response rate for 2018 was 51% which is an 8% decrease from the previous year. However this remains above the national average for the comparator group which was 45%.

7. The response rates by division were:

Directorate 2018 2017 Variance

Corporate Services Division 59% 65% -6% IM Revenue 70% 77% -7% Liverpool Community Services Division 49% 40% 9% Local Services Division 49% 60% -11% Secure Services Division 46% 55% -9% South Sefton Community Services Division 53% 55% -2% Specialist Learning Disabilities Division 53% 57% -4%

8. It is noted that the timeframe for completing the survey coincided with the recent CQC

inspection and a time of competing priorities for services.

New reporting for NHS staff survey 2018

9. Historically Staff Survey results have been presented as 32 key findings (KF) made up of a number of questions using either percentage scores or scale summary scores. Percentage scores were calculated as the percentage of respondents who gave a specific answer to a question. Scale scores were worked out for questions answered on a scale e.g. strongly agree, agree, neither agree nor disagree, disagree, strongly disagree and appear as a score between 1 and 5.

10. Following a review and consultation the Staff Survey Co-Ordination Centre have changed the way that the results are reported, aiming to provide more accessible question level data and benchmarking.

11. Key changes include;

• 10 Key Themes replace the 32 Key Findings. Themes are; o Equality, diversity and inclusion o Health and wellbeing o Immediate managers o Morale o Quality of appraisals o Quality of Care o Safe Environment – Bullying and Harassment o Safe Environment – Violence o Safety culture o Staff engagement

• All themes are scored on a 0-10 point scale, and are reported as mean

scores, a higher score indicates a more favourable result for all themes.

• A set of questions feed into each theme totalling 52 questions over all, these will be referred to as ‘Core Questions’. An overview of the questions that make up these themes are listed in Appendix 1.

• There are also an additional set of questions of 38 questions that do not

contribute to a theme.

• Benchmarking is available providing comparison to ‘best’ and ‘worst’ scores in our comparator group, as well as national average.

12. Given the changes to our organisational structure following the acquisition of Liverpool Community Health (LCH), there is no comparable data provided by the Survey Co-Ordination Centre. This analysis has been conducted internally where possible for guidance to indicate trends from previous years. To this effect 2018 will become ‘Year Zero’ of the new integrated organisation and the new reporting format to provide the benchmark for future results.

13. This report will primarily focus on the 52 core questions that contribute to the 10 themes but also provide some analysis on the remaining questions to identify areas of success and opportunities for improvement.

Statistical significance

14. After moving to a 0-10 point mean score scale the Survey Co-Ordination Centre have applied no parameters to determine statistical significance as they did in previous years with percentage and 0-5 scale scores.

15. When conducting internal analysis of the raw data to identify trends in comparison to 2017 results, parameters of +/-5% or +/- 0.05 were used to determine statistically significant deterioration or improvement. These tolerances had been provided by Business Intelligence (BI).

Overall Trust results

16. The Trust’s results for this year are encouraging in terms of comparison against national average and against 2017’s results. The Trust is either meeting or above average in 6 out of the 10 key themes.

17. When compared to the national average for Combined Mental Health/LD and Community Trusts, the 2018 results show:

Theme Variance Above national average Quality of care +0.1

Safety culture +0.1 Meeting national average Health and wellbeing -

Morale - Staff engagement - Safe environment – bullying and harassment -

Below national average Equality, diversity and inclusion -0.1 Immediate managers -0.1 Quality of appraisals -0.1 Safe environment - violence -0.2

18. An overview of the Trust’s performance against the 10 themes in comparison to national average, best score and worst score can be found in Appendix 2

19. When reviewing the 90 individual questions in the survey in comparison to 2017 Trust

performance it was found that; Number of questions where we have improved 59 Number of questions where we have seen a slight deterioration 11 Number of questions where the results are the same as the previous year 12 Number of questions which are new so have no direct comparator 8

2018 Areas that are going well

20. Top 5 scoring questions

Question MC 2018 National Avg. 2018 MC 2017

18a. If you were concerned about unsafe clinical practice, would you know how to report it?

98% 96% 99%

16c. Last time you saw an error, incident or near miss you reported it?

97% 96% 98%

22a. Patient/Service User feedback is collected 92% 94% 90%

Nb. Although the questions above are the highest scoring questions for 2018, the Trust has seen deterioration in 3 of these areas.

21. Top 5 biggest improvement in comparison to 2017

22. It is noted that the trust wide reduction in physical violence against staff could be, in part due to the inclusion of physical health services where the rate for this is typically much lower. However Local, Secure and Specialist Learning Disability have all seen a positive reduction in this area in comparison to 2017.

2018 Areas for improvement

23. Lowest 5 scoring questions

within my service 3b. I am trusted to do my job 91% 91% 91% My organisation encourages us to report, errors, incidents or near misses

89% 89% 87%


12a. In the last 12 months, how many times have you personally experienced physical violence from patients, service users or the public? *Lower score is better

19% 14% 29%

17a. My organisation treats staff who are involved in an error, near miss or incident fairly

55% 58% 46%

16a. In the last month have you seen any errors, near misses or incidents that could’ve hurt staff? *Lower score is better

16% 15% 23%

17c. When errors, near misses or incidents are reported my organisation takes action to ensure that they do not happen again

74% 71% 67%

5g. Satisfaction with level of pay 40% 38% 34%


11g. When you felt unwell, have you put yourself under pressure to come to work? *Lower score is better

91% 93% 90%

6a. I have unrealistic time pressures 25% 25% N/A 4g. There are enough staff in this organisation for me to do my job properly

34% 33% 28%

9c. Senior managers here try to involve staff in important decisions

35% 36% 35%

9d. Senior managers act on staff feedback 36% 35% 35%

24. Biggest deteriorations in comparison to 2017

Nb. Staff in Liverpool Community Services are currently not undertaking values based performance conversations as part of the existing PDR process. These services will align to the Trust’s PACE process from April 2019.

Overall staff engagement

25. Overall Staff Engagement is calculated using a combination of the following;

a) Staff recommendation of the trust as a place to work or receive treatment b) Staff motivation at work c) Staff ability to contribute towards improvement at work

26. As one of the ten Themes, Overall Engagement is now scored on a scale of 0-10 on

the Trust and divisional results provided by the Survey Co-ordination Centre. Where further analysis has been conducted internally, an average percentage of positive scores have been used.

27. In general terms, the Trust has improved in each of the areas that are used to calculate overall staff engagement, resulting in an overall score of 7.0.

28. The average staff engagement score for comparable trusts is also 7.0. This sees Mersey Care meeting the national average for staff engagement.

Overall Staff Engagement by Division

29. Overall staff engagement score by division;

2018 Score Mersey

Care Score National Average

Score Community Services 7.1

7.0 7.0 Corporate 6.9 Local 6.9 Secure 7.0 Specialist LD 7.1


13d. The last time you experienced bullying or harassment at work, did you report it?

65% 58% 71%

20. Have you had any training, learning or development in the last 12 months?

69% 72% 72%

11b. In the last 12 months, have you experience musculoskeletal problems as a result of work activities? *Lower score is better

24% 23% 27%

19e. The values of my organisation were discussed as part of my appraisal process

38% 39% 40%

30. While divisional Theme scores show only slight differentiation from the Trust score,

when comparing the 9 questions that make up this theme against 2017 performance it shows clear improvements in all of the clinical divisions and by contrast a deterioration in Corporate Services which reflects a pattern against previous years results. This may reflect the impact of organisation change and action taken against the Carter Review over the same period. See Appendix 3 for the full comparison. Overall Staff Engagement by Staff Group

31. Overall Staff Engagement is highest amongst Allied Health Professional and Medical and Dental staff (see below).

Overall Staff Engagement 2018 Results

2017 Results Variance

Allied Health Professionals 77.2% 66.1% +11.1% Medical and Dental 74.5% 66.0% +8.5% Add Prof Scientific and Technical 73.9% 66.6% +7.3% Nursing and Midwifery 73.5% 68.2% +5.3% Admin and Clerical 70.8% 69.9% +0.9% Additional Clinical Services 68.5% 61.8% +6.7% Estates and Ancillary 55.6% 55.3% +0.3%

32. Allied Health Professionals have seen an 11.1% increase in overall engagement, this reflects the work undertaken with this group, cumulating in the first annual AHP conference.

33. There has also been a marked increase in Medical Staff engagement (8.5%) who where identified as a priority in 2017’s survey results and have since received a targeted approach to engagement activity by the Medical Executive and the Organisational Effectiveness team through the Clinical Senate.

34. It is noted that the changes to the Trust’s workforce over the past 12 months may have contributed to the shift in scores amongst certain groups.

35. In 2017 overall engagement for staff in Bands 1-4 was identified as an area for

improvement. Throughout 2018, work has been undertaken to identify underlying causes of disengagement and implement solutions. This years survey data did not included a breakdown of results by Band, this has been requested and once received will be presented to Strategic Workforce Group for review. Overall Staff Engagement by Age Group

36. A key area of focus for the Trust in previous years has been engagement of staff who are age 51 and over, who historically have the lowest levels of engagement of all age groups within the Trust. While this remains the lowest of the age groups in terms of engagement, it has seen the largest increase of 5.9%

37.

Overall Staff Engagement 2018 Results

2017 Results Variance

Age 31 - 40 72.8% 69.6% +3.2% Age 21 – 30 70.4% 67.9% +2.5% Age 41 – 50 69.5% 65.8% +3.7% Age 51 and over 66.9% 61.0% +5.9%

WRES (Workforce Race Equality Standard)

38. Analysis of the 5 staff survey questions that contribute to our WRES results for 2018/19 can be found in Appendix 4. Comparison to previous years is difficult because of the changes in the organisation. 2017/18 data provided did not include former LCH staff.

39. The 5 WRES questions relate to career progression, discrimination and bullying and harassment from staff, managers and members of the public. The results show that the Trust is consistent with the national average for 2 of these questions and below national average for 3 out of the 5. In all questions BME staff have a worse experience than white colleagues.

40. The Equality and Diversity theme also includes a question about reasonable

adjustments in preparation for the introduction of the Workforce Disability Equality Standard (WDES) later this year. The results demonstrate that 71.9% of respondents felt that they had adequate reasonable adjustments in place to enable them to carry out their work. This is worse than the national average of 77.3% for this question.

41. These staff survey results will be shared with the Equality and Inclusion Lead and

improvement actions included in the Trust wide Equality and Inclusion Action Plan which is monitored by the Equality & Inclusion Group.

42. Strategic oversight of this agenda is included within the trusts Operational Plan and

Equality and Inclusion Strategy which will be presented at Board in May 2019 following stakeholder consultation held in January 2019.

Safety Culture

43. Since the launch of our Just and Learning Culture, a key area of focus has been on

staff feedback relating to learning from incidents and safety culture. These questions are now combined in the new theme of Safety Culture, indicating the focus on this area nationally.

44. The Trust has seen improvement in all of the 6 questions Safety Culture questions, see Appendix 5. This is a significant achievement and shows the positive impact of the Just and Learning culture work being undertaken.

45. Results are particularly encouraging in Community Services Division who undertook

the Staff Survey 6 months after the acquisition and have seen some of the biggest increases in this theme. Reflecting the intense work underway in the Division to

support staff and teams. Appendix 6 shows notable increases in relation to each question for this division.

Divisional results

46. For the clinical divisions, divisional results have been summarised and analysis provided where possible which has been shared with the Senior Leadership Teams.

47. Divisional Senior Leadership Teams are being supported by the Organisational Effectiveness (OE) Team to develop divisional action plans in response to the findings. These will be approved by the Strategic Workforce Group (SWG) and monitored on a regular basis.

48. The Culture of Care Barometer (CCB) provides regular temperature checks of staff

engagement and team climate and has been implemented throughout 2018/19 in the clinical divisions, with the exception of Community Division who will use the tool for the first time in August 2019. To ensure consistency divisional staff survey action plans will align to the results of the Barometer.

49. Appendix 7 provides an overview of the divisional results in comparison to the Trust

average.

50. Appendix 8 provides a summary of the highlights and improvement areas for each of the divisions.

51. For Corporate Division, the findings have been summarised and analysis sent to the

relevant Executive Leads and the Director of Corporate Transformation. As Corporate Division show some deterioration for the second consecutive year a separate summary of the service line results has been provided in Appendix 7.

NEXT STEPS

Trust-wide

52. In previous years the Trust has identified the most appropriate actions in response to the Survey findings. The final update for the 2018/19 action plan can be found in Appendix 9 for review

53. For 2019/20 the Trust’s People Plan will be the vehicle for delivery against all of the 10 Staff Survey Themes. The delivery of the People Plan objectives, approved by the Board in September 2018, will ensure that Mersey Care is an employer of choice and positively impacts on staff’s experience at work. Appendix 10 provides an overview of the Staff Survey Themes and how these directly link with objective agreed in the People Plan.

54. The Board of Directors will be cited on regular progress against the delivery of the

People Plan.

55. A communications plan will be developed to ensure regular updates are cascaded to staff throughout the year as actions progress, reinforcing action based on their feedback.

Divisional

56. Divisions will be supported by the Organisational Effectiveness team to develop action

plans to sustain improvements and target areas of low performance.

57. Divisional action plans will be presented at Strategic Workforce Group in April for approval with regular monitoring throughout the year. Team level

58. The Culture of Care Barometer provides regular temperature checks of staff

engagement and team climate. The use of the Barometer and resources to support managers and teams will be aligned to the new Themes of the Staff Survey, ensuring that managers can utilise the Barometer to sustain or increase staff engagement throughout the year.

RECOMMENDATIONS


a) Note the findings of the NHS Staff Survey 2018. b) Note update on actions carried out in response to 2017 results and any measurable

impact. c) Agree that the delivery of the Trust’s People Plan will be the vehicle for improvement

in response to the enclosed findings.

AMANDA OATES EXECUTIVE DIRECTOR OF WORKFORCE

March 2019

Summary of Appendices

1. 2018 NHS Staff Survey Themes and associated questions 2. Overview of Trust results by theme 3. Overall Staff Engagement by division 4. WRES 2018 question responses 5. Safety Culture question responses (Trust-wide) 6. Safety Culture question responses (Community services) 7. Divisional comparisons against Trust average, including directorate analysis of

Corporate Services 8. Divisional summaries 9. Staff Survey 2018/19 Action Plan 10. 2019/20 People Plan Objectives mapped to Staff Survey Themes

Appendix 1

NHS Staff Survey 2018 – Themes and Questions

Equality, Diversity and Inclusion

• Equality of opportunity • Experience of discrimination

Health and Wellbeing

• Flexible working • Positive action on health and wellbeing

• Experience of work relates stress or injury

•Coming to work despite feeling unwell

Immediate Managers

• Supported and valued by manager

• Receives clear feedback

• Involvement in decision making

• Supported to receive learning and development

Staff Engagement

• Motivation at work • Ability to contribute to improvement • Recommend the trust as a place to work or receive treatment

Safe Environment – Violence

• Experience of violence from patients, public etc. • Experience of violence from manager

• Experience of violence from colleagues

Morale

• Involved in changes that affect me

• Time pressures • Relationships at work • Planning to leave the trust

Quality of Appraisal

• Help me to improve how I do my job

• Agree clear objectives • Left me feeling that my work is valued

• Discussed trust values

Quality of Care

• Satisfied with quality of care I deliver

• My role makes a difference

• Able to deliver the care I aspire to

Safety Culture

• Treating staff involved in errors fairly

• Taking action to ensure errors do not happen again

• Giving feedback after an incident or near miss

• Feel safe raising concerns

• My organisation acts on concerns raised

Safe Environment – Bullying and Harassment

• Experience of bullying and harassment from patients, public etc.

• Experience of bullying and harassment from manager

• Experience of bullying and harassment from colleagues

Appendix 2

Overview of Trust results by Theme

Appendix 3

Overall Staff Engagement – Divisional Comparison

National Average

MCT Local Secure SLD Corporate Community

2018 2017 Trend 2018 2017 Trend 2018 2017 Trend 2018 2017 Trend 2018 2017 Trend 2018 2017 Trend

Staff engagement- Motivation Q2a- I look forward to going to work 59.1% 56.5% 53.6% 56.3% 51.9% 59.5% 54.0% 61.2% 48.3% 49.6% 54.3% 56.6% 54.6%

Q2b- I am enthusiastic about my job 74.5% 76.0% 73.1% 76.5% 72.7% 76.1% 74.1% 79.5% 67.2% 72.3% 72.0% 76.7% 74.3%

Q2c- Time passes quickly when I am working 79.1% 75.1% 73.3% 74.2% 73.3% 72.9% 69.2% 69.2% 61.8% 76.8% 79.8% 77.1% 77.4%

Staff engagement- Ability to contribute to improvements Q4a- There are frequent opportunities for me to show initiative in my role 74.1% 73.7% 70.9% 73.6% 71.8% 72.0% 67.2% 83.1% 69.5% 69.8% 71.2% 72.0% 68.2%

Q4b- I am able to make suggestions to improve the work of my team / department 77.6% 77.1% 75.1% 73.3% 73.2% 76.2% 71.8% 83.8% 74.6% 71.6% 78.6% 78.6% 74.4%

Q4d- I am able to make improvements happen in my area of work 58.3% 59.2% 57.0% 55.4% 52.5% 61.0% 54.3% 62.9% 58.5% 62.5% 65.4% 56.9% 51.6%

Staff engagement- Recommendation of the organisation as a place to work/receive treatment Q21a- Care of patients / service users is my organisation's top priority 73.6% 78.6% 75.9% 73.6% 69.4% 82.6% 82.0% 79.9% 82.1% 76.1% 77.1% 81.6% 78.1%

Q21c- I would recommend my organisation as a place to work 59.0% 58.0% 52.9% 56.4% 47.7% 54.5% 50.4% 56.4% 48.9% 53.8% 57.9% 59.7% 55.4%

Q21d- If a friend or relative needed treatment I would be happy with the standard of care provided by this organisation

66.2% 68.1% 63.0% 62.1% 58.6% 62.9% 62.4% 63.0% 62.4% 60.9% 64.9% 78.2% 76.7%

Appendix 4

WRES 2018 – Question Responses

2018/19 2017/18

Themes: National Average

MCT Overall

MCT MCT Overall

MCT BME White BME White Q14- Does your organisation act fairly with regard to career progression / promotion, regardless of ethnic background, gender, religion, sexual orientation, disability or age? (Higher score is better)

85.8% 84.2% 76.6% 84.9% 84.0% 76.0% 84.0%

Q15b- In the last 12 months have you personally experienced discrimination at work from manager / team leader or other colleagues? (Lower score is better)

6.6% 6.6% 11.6% 6.3% 6.0% 13.0% 6.0%

Q13a- In the last 12 months how many times have you personally experienced harassment, bullying or abuse at work from patients / service users, their relatives or other members of the public? (Lower score is better)

26.3% 27.4% 40.4% 27.2% 33.0% 39.0% 32.0%

Q13b- In the last 12 months how many times have you personally experienced harassment, bullying or abuse at work from managers? (Lower score is better)

10.8% 11.3% 12.4% 11.5% 11.0% 12.0% 10.0%

Q13c- In the last 12 months how many times have you personally experienced harassment, bullying or abuse at work from other colleagues? (Lower score is better)

16.3% 14.0% 20.2% 13.9% 16.0% 19.0% 16.0%

Appendix 5

Safety Culture – Question Responses (Trust-wide)

Question National Average

Comparison with National

Average 2018 Score Trend 2017 Score

Q17a- My organisation treats staff who are involved in an error, near miss or incident fairly 58.00%

Consistent with national average

55.00% 45.90%

Q17c- When errors, near misses or incidents are reported, my organisation takes action to ensure that they do not happen again

70.20% Consistent with

national average

73.50% 66.40%

Q17d- We are given feedback about changes made in response to reported errors, near misses and incidents 61.70%


64.60% 59.70%

Q18b- I would feel secure raising concerns about unsafe clinical practice 73.30%


76.00% 73.90%

Q18c- I am confident that my organisation would address my concern 60.00%

Better than national average

66.30% 64.10%

Q21b- My organisation acts on concerns raised by patients / service users 73.90%


78.00% 76.90%

Appendix 6

Safety Culture – Question Responses (Community Services Division)

Appendix 7

Divisional Comparisons – Compared to Trust average

Appendix 8 Divisional Summaries

Corporate Division

In 2017 Corporate Division saw a statistically significant deterioration in relation to a number of areas including effective team working and support from immediate managers.

In 2018 Corporate Services achieved the highest response rate of all divisions with 59%, however directorate response rates ranged from 46% - 73%.

Results this year have seen a further deterioration in 32 of the 52 core questions. This, we believe, is compounded further by the integration and physical relocation of Corporate Services. This deterioration is likely to continue as more of the corporate departments commence organisational change and this is a serious risk to the Trust, see Appendix 9 for an overview of this year’s survey results for the division.

Areas of greatest deterioration are staff engagement, quality of appraisal and support from immediate managers.

Areas where the division score positively are health and well-being, raising concerns and experience of violence, bullying and harassment from patients, service users or public.

Community Division

Liverpool Community response rate increased from 40% (2017) to 49% (2018). South Sefton Community Response Rate decreased from 55% (2017) to 53% (2018).

Liverpool and South Sefton Community Services are reported as separate divisions; therefore Theme scores for the wider Community Services are unavailable. However, we are able to compare theme scores of the localities with the Trust average:

South Locality exceeded or met the Trust average score in 6 out of the 10 Themes; this includes immediate managers, quality of care and staff engagement. The locality was lower than the Trust average score for the remaining 4 Themes which include quality of appraisals and experience of violence.

Central Locality exceeded or met the Trust average score in 4 out of 10 Themes, this includes equality and diversity and experience of bullying and harassment. The locality was lower than the Trust average score for the remaining 6 Themes which includes health and wellbeing, morale and quality of appraisals.

North and South Sefton Locality exceeded or met the Trust average score in 7 out of the 10 Themes, this includes equality and diversity, morale and staff engagement. The locality was lower than the Trust average score for the remaining 3 Themes which includes health and wellbeing and quality of appraisals.

When considering the 52 core questions for the division as a whole; 13 have seen statistically significant improvement compared to last year’s results and 39 have either shown no significant change or are new questions. There are no questions that have seen a statistically significant deterioration compared to 2017.

There has been a Divisional increase in staff engagement, particularly in the area of “Recommendation of the organisation as a place to work / receive treatment”, in comparison to 2017. The 2018 percentages in this area exceed the trust and comparator group average.

Overall the results for Community Services are encouraging, however there are area’s for improvement, including Quality of Appraisals (lower than Trust Score in all localities). It is noted that the division will move to the Trust’s PACE appraisal system from April 2019 and targeted training will be available to staff in the division to embed the process.

Local Division

Local Division is meeting or exceeding the Trust average in 5 of the 10 Themes. The division exceeds the Trust average in Immediate Managers and Quality of Appraisal Themes.

When considering the 52 core questions, 9 have seen a statistically significant improvement, 39 have either remained the same or are new questions. There is only 1 area of statistically significant deterioration.

This is encouraging during a year of ongoing change and service pressures. Staff are reporting improvements in safety culture, staff engagement, health and wellbeing. The number of staff reporting violence or bullying and harassment has also decreased.

The 1 area of deterioration is in relation to adequate adjustments being made to support staff. Further analysis will be done to understand this, as there may be a connection to the review of informal flexible working arrangements and flexible rostering practices.

Staff continue to report good communication between senior managers and staff. This may reflect the targeted engagement activity, ‘Free up Friday’ and ‘Meet the Managers’ where each new manager to the division is visited by the Chief Operating Officer.

The division has been using the Culture of Care Barometer since May 2018 and receive quarterly updates on staff feedback. The senior leadership team have been supported by OE to identify the most impactful actions for 2019/20 which align both the Barometer and the Staff Survey.

On reviewing teams in the division who have received OE interventions and fully embraced staff feedback there is a direct correlation to positive Quality Review Visit (QRV) outcomes.

Secure Division

Secure Division is meeting or exceeding the Trust average in 6 of the 10 Themes. The Division exceeds the Trust average in Quality of Appraisals, Safety Culture and Immediate Manager Themes.

When considering the 52 core questions, 12 have seen a statistically significant improvement compared to last year’s results and 32 have either remained the same or are new questions. There are no areas of statistically significant deterioration.

Staff are reporting improvements in immediate line manager support, the ability to make improvements in changes at team level and actions and reporting around a safety culture. The number of staff reporting experience of violence has also decreased. This is positive during a year of ongoing change and continuing staffing pressures across the Division.

Staff continue to report good communication between senior managers and staff and also that senior managers act on staff feedback. The past year has seen targeted engagement activity in the Division where the Senior Team have carried out one to one career conversations and consistent investment in growing and developing staff potential. The introduction of Morning Meetings on wards, annual ward away days and the introduction of regular newsletters from the Deputy Chief Operating Officer have contributed to improvement in staff feedback.

Key themes where the Division has scored lower than the Trust are Equality, Diversity & Inclusion, Bullying & Harassment, Violence and Quality of Care. Further analysis will be done to understand these themes in more detail. In 2018/19 work was carried out in the Division to compare actual recorded incidents of violence compared to perception and this will continue into this year.

The Division continues to have high levels of retirement and there is an ongoing programme of recruitment to manage vacancies, mitigating workforce risks and ensuring the continual deployment of adequate and skilled resources in the lead up to opening the new Medium Secure Unit.

Specialist Learning Disability Division

Specialist Learning Disability Division is meeting or exceeding the Trust average in 6 of the 10 themes. The Division exceeds the trust average in Quality of Appraisals, Safety Culture, Immediate Managers and Staff Engagement themes.

When considering the 52 core questions, 15 have seen a statistically significant improvement compared to last year’s results, 29 have no significant change albeit 20 are improving and 9 deteriorating. There are 8 new questions with no comparison and there has been 1 statistically significant deterioration.

Colleagues are reporting improvements in the number feeling unwell as a result of work related stress, flexible working patterns and adjustments to carry out work. They also report increased involvement in decisions that affect their work, delivery of the quality of care and in recommending the organisation as a place to work.

Colleagues continue to report a positive safety culture where action is taken to ensure errors, near misses or incidents do not happen again and are engaged and able to make suggestions to improve the work of their team. This may reflect the engagement action in the Division including increased visibility of senior leaders, ‘you said we did’ boards/screens, active participation of Just and Learning Ambassadors, the roll out of the Culture of Care Barometer Survey and the phased introduction of new models of care. The percentage of staff experiencing physical violence has also decreased.

Key themes where the Division has scored lower than the Trust are Equality, Diversity and Inclusion with the experience of discrimination at work from manager/team leader or other colleague. Also in the Morale Theme with choice in deciding how colleagues can do their work and in intention to leave or look for a new job in the next 12 months.

The Division continues to contract services with plans in place for phased closures and transfer of colleagues over to inpatient wards and/or the Specialist Support Teams. There are regular engagement events to keep colleagues involved in the development of the Medium Secure Unit.

Appendix 9 Staff Survey Action Plan 2018/19 – For final review

Staff Survey

Theme Action Responsibility Deadline/ Timescales Impact Measurable

Outcomes Progress

1. Effective Team

Working

1.1 Implement Culture of Care Barometer (CCB) to provide regular temperature check of teams, and use data to focus priority and action Chief Operating

Officers (COOs) / Organisational

Effectiveness (OE)

Local Division - May 2018

Specialist Learning Disability Division -

Sept 2018

Secure division Jan 2019

Corporate Division

Community Division TBC

Increased understanding of staff engagement at regular intervals at team level

Team level engagement measures

Action Complete Implemented in Local, SpLD and Secure Divisions with a plan in place to launch in Community Division from August 2019. Implementation in Corporate division is currently being scoped to ensure alignment to the delivery of the Corporate Transformation Programme.

1.2 Continue to embed Team Based Working through team development and development of team leaders to utilise this approach Chief Operating

Officers (COOs) / Organisational

Effectiveness (OE)

Agreed at divisional levels

Improve engagement, enable teams to get the basics right, and meet quality indicators

Culture of Care Barometer Staff Survey Sickness and Employment Relations Activity Care Quality Commission Rating Delivery of Ops Plan / Key Performance Indicators

Action complete Embedded within the THRiVE programme and offered as a separate leadership module. In 201/19 91 leaders have attended and a further cohort of 12 people have been developed by Affina OD to become accredited team coaches.

Staff Survey Theme Action Responsibility Deadline/

Timescales Impact Measurable Outcomes Progress

2. Physical Violence

2.1 Include data relating to staff assaults trends in divisional roadshows

Perfect Care Team (Danny Angus) / Divisional Chief

Operating Officers

September 2018

Increased awareness of declining numbers of assaults on staff

Improved Staff Survey results for % staff experiencing physical violence from patients, relatives or the public

Action Complete Included in Autumn 2018 roadshows

2.2 Include staff assaults trends data in PSS training Perfect Care Team

(Danny Angus) August 2018



Action Complete Trends data now included in PSS training

2.3 Introduce monthly update on Reducing Restrictive Practice as part of communications campaign

Perfect Care Team (Danny Angus) /

Internal Communications

Manager

July 2018



Action Complete Launched communications campaign on Reducing Restrictive Practice

3. Involvement

in Improvement

3.1 Review communication channels within the Corporate Division. Consider a refresh and re-introduction of roadshows.

Executive Director of Workforce November 2018

Acknowledge dip in Corporate Division engagement, potentially linked to Corporate Review. Update and involve people in decisions that affect them

Improve Staff Survey score for Corporate Division Engagement

Action Complete Corporate roadshows suspended due to change of Exec portfolio’s and emerging Corporate Transformation programme. Exec’s engaging via service leads to ensure communication cascade for Corporate Division is effective.



3.2 Engagement event for staff based at Whalley site

Executive Director of Workforce / Staff

Side September 2018

Would allow us to understand what would keep staff, retain valued skills and expertise that can be utilised in new Medium Secure Unit

Improve Staff Engagement Score for Specialist Learning Disability Division

Action Complete Joint Secure and SpLD engagement events have been held, staff received updates on the MSU build and to explore ‘How can we make Rowan View the best place to work for you?

3.3 Delivery of Just and Learning Culture four Objectives: 3.31 By the end of March 2019, 100% of leaders band 7 and above or equivalent (with people management responsibilities) will have been assessed and have a development plan to support their teams in a Just and Learning environment 3.32 To support colleagues' psychological safety through the development of bullying awareness for staff based on a preventative approach to recognise bullying behaviour and develop a process to resolve issues

Executive Director of Workforce March 2019

Designed to enable learning and improvement through staff and culture change

Improve Staff Survey score Monitored through Quality Account Reported to Quality Assurance Committee

Action Complete The Respect and Civility Group has been established has launched an internal Anti-Bullying campaign. The campaign will focus on raising awareness of Bullying and Harassment, how to challenge behaviours that constitute bullying and harassment and how we can create a culture where staff feeling empowered and psychologically safe.



4. PACE

4.1 Full evaluation of PACE and creation of action plan to support this. Chief Operating

Officers and Senior Leadership Teams,

supported by Organisational Effectiveness

October 2018

To gain a better understanding of the issues affecting PACE quality i.e. system, implementation or skills

Improve Staff Survey Score for PACE quality

Action Complete 88% completion rate within 2018 window (most successful year to date). As part of the annual PACE cycle an evaluation was completed with a summary report and recommendations to SWG.

5. Flexible Working

5.1 All areas to review current flexible working arrangements

All Managers October 2018

If arrangements are no longer required, this may create more flexibility for other requests to be considered.

Staff survey and Culture of Care Barometer survey

Action Complete All divisional managers have been asked to review their flexible working contracts with staff – the work is on going.

5.2 Policy to be developed for retirement including flexible retirement and retire and return programmes. Human Resources July 2018

Staff will be able to see the options available to them and there will be consistency across the organisation.

Monitor flexible retirement Action Complete. Policy has been developed and is now in place

5.3 Managers to implement pre-retirement career conversations from the retirement policy All Managers July 2018

Staff and managers will get a better understanding of how to best support staff in the lead up to retirement.

Staff survey and Culture of Care Barometer survey

Action Complete Policy has been developed and will be disseminated across all services.



6. Black and

Minority Ethnic (BME) Colleagues

6.1 Review Black and Minority Ethnic (BME) access and outcomes for Apprenticeships

Apprenticeship Centre Manager / Black and Minority

Ethnic Staff Network / Equality and Diversity Lead

November 2018

Improve development opportunities for Black and Minority Ethnic staff

Staff Survey Key Finding 21: % staff believing organisation provides equal opportunities for career progression / promotion

Action Complete Processed for recruitment of apprentices reviewed, positive action cadet scheme to commence June 2019

6.2 Complete Equality and Diversity analysis of access and outcomes of leadership development programmes

Organisational Effectiveness /

Black and Minority Ethnic Staff

Network / Equality and Diversity Lead

July 2018

Understand if targeted access required for Black and Minority Ethnic staff

Reduce disparity between Staff Survey Key Finding 21 Workforce Race Equality Standard WRES) score for Black and Minority Ethnic and White staff groups (2017: 77% BME, 84% White)

Action Completed Review completed and proposed recommendations have been for internal and external programmes

6.3 Review Reverse Mentoring with view to extending to second cohort Equality and

Diversity Lead June 2018

Improve understanding of the barriers to equality for Black and Minority Ethnic staff

Staff Survey Question 17B Staff Survey Key Findings 25, 26, 21

Action Complete Evaluation presented to SWG, second cohort planned launch in March 2019

6.4 Engagement with Black and Minority Ethnic staff to share and drill down into Staff Survey information

Equality and Diversity Lead /


Network

September 2018

To build on the baseline data that staff survey provides


Action Complete BME Staff Network has been re-established from September 2018 and have reviewed the findings and are to monitor regularly.



6.5 Review Unconscious Bias workshop

Equality and Diversity Lead July 2018

Increases awareness and promotes equality

Staff Survey Key Finding 26: % staff experiencing harassment, bullying or abuse from staff in the last 12 months (lower score is better

Action Complete Commissioned external training following a review of provision. 240 places offered from September 2018 – March 2019.

6.6 Review Equality and Diversity content for leadership development programmes Equality and

Diversity Lead October 2018

Improve awareness and promote equality for leaders


Action Complete Review complete, unconscious bias training integrated as a core part of STRiVE and a recommended module for THRiVE, also included in leadership and manager forums.

6.7 Review Black and Minority Ethnic staff networks

Equality and Diversity Lead /


Network

September 2018

Supports Black and Minority Ethnic staff and provides an opportunity to further engage

Staff Survey Question 17B, Staff Survey Key Findings 25, 26, 21

Action Complete BME network established from September 2018 with quarterly meetings, meetings are well attended with structured agendas. Network members also actively contribute to Just and Learning groups.



6.8 Embed unconscious bias into recruitment processes

Human Resources / Equality and

Diversity November 2018

Using values based recruitment techniques improves organisational fit / retention

Staff Survey Key Finding 26

Action Complete Unconscious bias training is offered to all recruiting managers and we have used forums to raise the awareness around the impact of bias on recruitment. Further work to review recruitment is ongoing with community and staff groups.

6.9 Review induction content

Equality and Diversity / Learning and Development

July 2018

Improve the on-boarding process, raising awareness of individual and collective responsibilities in providing a safe place to work

Staff Survey key Finding 26

Action Complete Equality and Inclusion is embedded throughout content. Actions agreed to make the content more explicit. E&D and Staff networks are producing materials to be distributed at induction.

6.10 Promote reporting of harassment and bullying via Datix

Risk / Equality and Diversity August 2018

Incidents can be quickly acted upon and closely monitored

Staff Survey Key Findings 25 and 26

Action Complete Bullying and Harassment working group established developed that reports to J&L Committee. BME Staff Network and E&D Lead actively contribute to this work stream.



6.11 Deep dive into formal cases of bullying and harassment

Associate Director of Workforce – Human Resources

August 2018 Identify themes or learning. How satisfied are staff members with investigations?

Staff Survey Key Finding 26

Action complete Discussed with BME staff Network at two meetings. Recommendations included in our WRES action plan

6.12 Review violence and aggression policy for equality elements

Equality and Diversity Lead / Health and Safety Manager

June 2018 Ensure that the Equality and Diversity element is specific in terms of responsibilities and penalties for bullying and harassment of BME Staff

Staff Survey key Findings 25 and 26

Action Complete Policy reviewed, recommendations will be incorporated into the scheduled review of the policy.

6.13 Communications campaign to all service users and visitors re zero tolerance of abuse

Communications / Equality and Diversity

September 2018 Ensure that trust values are clear in terms of zero tolerance

Staff Survey key Findings 25 and 26

Action Complete Respect & Civility group have commenced a communications campaign to support zero tolerance of abuse.

6.14 Redesign equality pages on the intranet to include advice and signposting information

Equality and Diversity Lead

September 2018 Provide a useful resource for staff, patients and visitors

Staff Survey Question 17B Staff Survey Key Finding 25, 26, 21

Action Complete Pages redesigned and will be reviewed quarterly



6.15 Evaluate the “Drum Out Discrimination” project in Specialist Learning Division for potential roll out to other divisions

Equality and Diversity Lead / Divisional Chief Operating Officer

October 2018 Promotes awareness of trust values and zero tolerance of harassment and bullying of BME staff and patients

Staff Survey Key Findings 25 and 26

Action Complete Evaluation Complete. Elements of the project will be used in the Respect & Civility campaign. Project still ongoing in SPLDD

7. Bands 1 - 4

7.1 Engagement event for Bands 1 - 4 clinical colleagues

Executive Director of Nursing and Operations / Organisational Effectiveness Team

September 2018 Better understanding regarding the factors affecting engagement, so solutions can be identified and implemented

Improvement Staff Survey scores Health Care Assistant Engagement

Action complete 15 engagement sessions held for staff in Bands 1-4 across the geographical footprint supported by senior divisional representatives.

7.2 Engagement event for Bands 1-4 non-clinical colleagues

Executive Director of Workforce / Organisational Effectiveness Team

September 2018 Better understanding regarding factors affecting engagement, so solutions can be identified and implemented

Improvement Staff Survey scores overall engagement

Action Complete Combined with Action 7.2 to deliver joint engagement sessions for Clinical and Non Clinical staff.

7.3 Refine and implement the Mersey Care recruitment campaign - ‘Attract’

Workforce Function March 2019 Address workforce plan risks and improve engagement

Rate of attrition Reduction in use of bank and agency

Action Complete Recruitment events held in October and November 2018 with further events planned for 2019/20



8. Medical Colleagues

8.1 Re-introduce Medical Senate Deputy Medical

Director March 2018

Forum to include, engage and involve medical colleagues

Improve Staff Survey score for Medical Engagement

Action Complete 3 Senates were held in 2018/19 with regular sessions in 2019/20

8.2 Continue Medical Engagement sessions Deputy Medical

Director / Organisational Effectiveness

September 2018

Improve engagement and connectivity of medical colleagues with trust strategy and objectives

Reduction in vacancy rates Reduction in attrition Improvement in Staff Survey findings for staff group

Action Complete The Medical Senate is now the vehicle for engagement with medical staff.

8.3 Offer medics internal leadership development opportunities

Deputy Medical Director /

Organisational Effectiveness

September 2018

Greater alignment and involvement in transformation


Action Complete Exploring opportunities for provision and publicising Trust internal programmes through job planning and appraisal. Deputy MD and HR Business Partner met representatives of SAS doctors who have expressed an interest in taking up leadership and management roles. This has been welcomed by the Trust and information regarding resources will be shared regularly.



8.4 Targeted activity to attract, recruit and retain medics Deputy Medical

Director / Human Resources

July 2018

Improved medical staffing levels

Reduction in medical staff vacancy rates Improvement staff survey engagement score for medical staff group

Action Complete Several work streams are in progress to achieve this. A paper is being submitted to PIFC and regular updates provided to Executive Committee

8.5 Continue to implement Trust talent management project “Maximising Potential” amongst medical colleagues

Deputy Medical Director /

Organisational Effectiveness

Update September 2018

Provide pro-active career development planning with a view to engaging and retaining our medical workforce


Action Complete Maximising Potential conversations have been facilitated for MD, Deputy MD, RO, Divisional AMD roles. Plans to cascade this to Clinical Directors in progress.

Agenda Item No:

Page 35 of 35

Appendix 10

2019/20 People Plan objectives mapped to Staff Survey Themes

Attract,

recruit and retain the best people

Grow, develop and maximise potential

Support health and wellbeing

Include, engage and involve

Excel in leadership and management

Equality & Diversity

X X X X

Health & Wellbeing

X X X X

Immediate Managers

X X X X X

Morale X X X X X

Quality of Care X X X X X

Quality of Appraisal

X X X

Safe Environment – Bullying and Harassment

X X X

Safe Environment – Violence

X X X

Safety Culture X X X

Staff Engagement

X X X X

PART 1 – FORMAL MEETING IN PUBLIC...Jayne Moore Virginia Peneche Deb Riozzie Paul Smith Paul Taylor Maria Tyson Veronica Webster Chairman (Meeting Chair) (Left meeting for Item D1)

Documents