Nottinghamshire Healthcare
NHS
NHS Trust
Positive about integrated healthcare
Integrated Business Plan 2011/12 to 2015/16
Introduction from the Chief Executive I am delighted to introduce this summary of our Integrated Business Plan (IBP).
• National Recovery Demonstration Site awarded – one of only 4 in the country.
The last financial year has seen some notable achievements for the Trust. In short:
Looking forward to the coming year we must build on this success:
• Foundation Trust Standard – Board to Board on 2 August 2010. Authorised for Autonomy on 1 November 2010. A full assessment from Monitor. • New service contracts to be delivered - Transforming Community Services - £86m from 1 April 2011. Offender Healthcare - £13m. Improving Access to Psychological Therapies Bassetlaw and Nottingham City £9.6m. Over £100m of new business during the year. • Patient satisfaction increasing from direct questionnaires received - some 4900 in total. • Staff satisfaction levels rising. Staff Survey 2010 shows an increase in staff engagement and one of our top scores was on people recommending to friends and relatives that Nottinghamshire Healthcare is a good place to work.
We are now a self regulating organisation with a Unitary Board and partnerships to make strategic decisions and a Members’ Council to hold us to account locally. Through service contracts won we are now an integrated health provider. We can provide integrated physical and mental health care pathways to the benefit of our communities. We understand our environment and will proactively respond to market and collaborative opportunities. I look forward to working with all of our staff including 2,383 new community staff who joined us on 1 April from NHS Nottinghamshire County. We will work with all our staff and partners to deliver continual improvement of services for all of our patients, service users and carers. Times are challenging but working together and maintaining our high standards we have the potential to achieve even more than we have already done so far.
Consolidating The last financial year was a year of great achievement for Nottinghamshire Healthcare. We have looked at where we have consolidated standards in our journey towards excellence. We believe it is really important to understand how we achieve success and how we promote it during this time of ambiguity and uncertainty in the public sector as we face the tougher economic situation moving into the new financial year. A number of our key achievements are set out below: External Validation as a Self Regulating organisation. Continued unqualified Care Quality Commission (CQC) registration. CQC Patient Satisfaction Ratings- 80% of service users rated the care they received as excellent, very good or good. This means that overall we are in the top 20% of Trusts in the country. Patient Environment Action Teams (PEAT) – top marks for levels of Privacy and Dignity for inpatients at five of our sites. NHS Litigation Authority (NHSLA) 2 – 50/50 - one of only three Trusts to do so. HMP Inspectorate Prison Audit result at Rampton Hospital – 97%. Placed 12th in the Stonewall Workplace Equality Index for 2010 out of 378 employers and the best employer in the healthcare sector.
Professor Mike Cooke CBE Chief Executive
Nursing Times/HSJ – 12th best employer in the country and best employer with over 3000 staff. Winner in the first Patient Experience National Network Awards in the category ‘Setting the Stage/Strengthening the Foundations. This was for the programme aimed at strengthening the organisation’s commitment to delivering excellent patient experience.
The full document can be found on our website www.nottinghamshirehealthcare.nhs.uk
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Electro Convulsive Therapy service at QMC rated ‘excellent’ by the national ECT Accreditation Service.
good progress A43 Acute Inpatient Mental Health Services (AIMS) Accreditation – measuring increasing levels of patient and staff satisfaction. We anticipate ending the year meeting all our statutory financial obligations. Care Programme Approach for patients: • receiving follow-up contact within 7 days of discharge – at the end of Feb at 100% (target 95%)
• having formal review within 12 months at 95.2% Feb (target 95%) The Trust achieved the target of no learning disability Campus beds within the Trust by December 2010. Sickness continues to improve with an achievement for February of 5.5% for the Forensic Division and 4.6% for the Local Division, the lowest figure for the year.
Leadership
We have a strong leadership model to support our vision and will use our self-regulating status to build upon the significant progress already made. We will build on our approach to distributed leadership. We will promote our approach in the following five areas: • Leadership values • Wellbeing for ourselves and our teams • Working relationships • Engagement of staff and effective appraisal • Real team working and team inter-working We place a high value on investing in our current and emerging leaders to ensure that we have the right people with the right skills. Through our various leadership programmes we have now helped 1000 of our staff to help us develop insights, skills and the networks
necessary to deliver better patient care and to build future capability so that we remain aligned, able and agile. We are already seeing the benefits of this investment and the positive impact it is having on service user experience and recovery.
Approximately 188,000 Occupied Bed Days (OBD) (excluding Medium & High Secure). Approximately 25,000 Outpatient Appointments. Approximately 378,000 Community Contacts. Capital spend in 2010/11 of £32m - on budget (£36m in 2009/10). Freedom of Information Requests – Publication Scheme Development and timely response to 250 requests inyear.
Research leadership In addition, we are proud of our wider role in leadership and research. We now formally host: • The Collaboration for Leadership in Applied Health Research and Care (CLAHRC) which is going into its next phase, • The Institute of Mental Health – the second largest group of mental health researchers in the UK and the most interdisciplinary, and • The East Midlands Leadership Academy which supports a range of leadership programmes across the region.
Maximising the Impact of the CLAHRC and our University Links The CLAHRC is one of nine such collaborations between the NHS and Universities in the country. CLAHRC Nottingham, Derby and Lincoln (NDL) brings together work in four clinical themes: Mental Health, Primary Care Stroke Rehabilitation and Children and Young People.
>>> Integrated Business Plan 2011
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an >>> Building Academic Centre and Network for the Future
With our key partner, the University of Nottingham, we will continue to be ambitious in developing research and learning. Our close affiliation with the Institutes of Mental Health and Personality Disorder supports academic research that is relevant to practice and developing our understanding of outcomes.
Our Strategy Our Vision
Our Values
Nottinghamshire Healthcare is committed to being recognised as the leading integrated healthcare provider –
We will deliver our vision through our POSITIVE values for the organisation, and we will be recognised for our POSITIVE brand. Our Vision and Values are focused on improving the lives of people with Mental Health & Learning Disability, or those in the community, by offering the very best services we can.
People: are central to everything we
The Trust’s Wider Leadership Role: The East Midlands Leadership Academy We host the East Midlands Leadership Academy, a membership organisation developed to serve the leadership and development needs across the East Midlands. It aims to develop leadership capacity and capability in all of its membership organisations by designing, commissioning and delivering high quality leadership development interventions and activity. During 2010/11 over twenty programmes ran aimed at particular groups of leaders from Aspiring Directors to Executive Coaching, from safeguarding children to staff undergoing and dealing with major organisational change. For 2011/12 our priorities are: Support for transition to the new NHS & Social Care architecture, GP Commissioning Development, further programmes for Emerging leaders and Top Leaders in support of the National Programme.
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do: we work with people, for people, in partnership;
Openness: we listen to what people tell us, whether we like what we hear, or not, and act on that information;
Safe: sound, supportive, sensitive nationally important, locally relevant, personally valued. We will continually improve our services and our patient, service user and carer experience and, at the same time, reduce the stigma associated with mental illness and learning disabilities. We will be a great place to work for all our staff and a valued partner with clear service standards set by, and with, our commissioners, service users and staff.
practices show how we respect and value our staff, service users and other stakeholders;
Integrity: we behave honestly in a way that demonstrates our values, we celebrate the good things we do, and learn from our setbacks;
Trust: we are trustworthy, we do what we say, and say what we cannot do;
Innovation: we try new things to be the very best in our field;
Value: we value and respect the diversity of our staff, service users and other stakeholders; Excellence: is our standard and we enjoy achieving it together!
‘Quality at the heart of everything we do’ Our seven stage Quality Strategy signals an increased focus on continuing to improve the quality of services we provide. In our quality strategy 2011/16 we set out our five year strategy which includes quality improvement priorities for 2011/12, the content of the 2010/11 Quality Account and our CQUIN measures for 2011. Within an increasingly challenging financial climate that both Health and Social Care face over the coming few years, it becomes increasingly important that the Trust maintains its focus of improving quality and maintaining safe services. Our goal is that we should systematically measure, analyse and improve quality. We have already begun to improve the quality of services. We will continue to seek improvements in safety, service user experience and effectiveness of our treatments. In line with “High Quality Care for All” our strategy includes the dimensions of: Patient safety – the first dimension of quality must be that we do no harm to patients. This means ensuring the environment is safe and clean, that patients shouldn’t fear violence, and that avoidable errors such as drug errors are minimised. Patient experience – the quality of care is the quality of caring. This means how personal care is – the compassion, dignity and respect with which patients are treated. Effectiveness of care – this means understanding the outcomes of different interventions, providing real challenges for mental health, learning disability and community services. Outcomes need to be real for patients and for their
families, getting back to work, freedom from disabling symptoms or the ability of people to live independent lives. Our 2010/11 Quality Account established priorities for quality improvement. These are:
Our Plans Local Services Division:
The Division is proud to be a recognised Development Site for the provision of Recovery focused care; all services are determined to promote recovery as an opportunity for personal growth and hope.
Profile Safety • Reducing the frequency and severity of violent Incidents • Improving the physical healthcare of patients Patient Experience • Improving the information people receive • Experience of our acute inpatient environment • Carer satisfaction Clinical Effectiveness • Introducing Measures of Recovery to Support the Recovery Strategy • Length of stay on acute admission wards/reducing delays in transfer We will use The National Patient Experience Survey to measure patient experience. This focuses on community patients’ experiences in addition to local intelligence and information gathered via our involvement activities. We also undertake a routine postcard survey of service users. We will continue to systematically measure and publish information about the quality of care from the frontline up. Measures will include patients’ own views on the success of their treatment and the quality of their experiences. We will publish our third Quality Account in June 2011, where we will be held publicly accountable for the quality of the services we provide.
The Local Services Division employs 2,965 staff with expenditure of £137m. There are five Directorates: Adult Mental Health Services (County) Adult Mental Health Services (City) Mental Health Services for Older People (MHSOP) Specialist Services Directorate incorporating Learning Disability Services, Substance Misuse Services Specialist Services, Child & Adolescent Mental health Services (CAMHS) and Psychological Therapies and Improving Access to Psychological Therapies (IAPT)
Major Service Ambitions 2011/12 – 2015/16 There are 3 key messages that will set the direction for all of the services within the Division over this strategic period. Protect and enhance the services we provide across Nottinghamshire (Recovery Pathway) Use our reputation and credentials to move into new markets (Market Opportunities) Ensure that the quality of experience is high and uses resources effectively (Productivity) Our prioritised developments for the next three years are outlined below:
Planned Developments 2011/12 We have secured Board approval and capital funding for a major development of our inpatient services. This programme will commence during 2011/12 and will result in significantly improved facilities for patients across our campuses in the county, focussed particularly on the Millbrook hub in Mansfield. We are also developing exciting plans for an innovative Dementia intensive care unit.
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Our Plans continued... We will continue to develop proposals with our partners, Barchester, to deliver inpatient services for working age dementia and Huntington’s disease services along with a base for the community Teams. This is proposed for the Forest site in Mansfield. We will continue the roll out of our current pilot programme for an electronic patient record.
Forensic Division: The core of the Forensic Services Division’s High, Medium and Low Secure Services will remain focussed on inpatient provision along with outpatient from Low Secure services. We have been awarded contracts through Transforming Community Services (TCS) to deliver an integrated package of healthcare into HMPs Nottingham and Whatton. Over the next year, we will develop these services by consolidating them, integrating them into the governance structures of the Trust and achieving high quality of care through the delivery of the Key Performance Indicators (KPIs) for each service. We will actively develop our role as a global source of knowledge on Forensic Mental Health Care and will be seen as the UK development organisation for Forensic Healthcare standards.
Proposed Developments 2012/13 (subject to business case approval) Redevelopment of 11 beds at Highbury Hospital to a refurbished 16 bedded unit. Commissioners’ approval with 16 beds. Further development of the Highbury Hospital Site.
Profile The Forensic Services Directorates represent the largest NHS forensic portfolio in the Country with expenditure totalling £129m in 2009/10. The portfolio includes: Offender Healthcare services into 13 prisons across South Yorkshire, West Yorkshire, Nottinghamshire and Leicestershire and Rutland. Low Secure provision from The Wells Road Centre (Nottingham), with a community forensic service. Medium Secure services at Wathwood Hospital (Rotherham) and Arnold Lodge Medium Secure Unit (Leicestershire); Rampton High Secure Hospital providing the national service for Women, Deaf patients and Learning Disability, as well as services for Mental Health, Personality Disorder and Dangerous and Severe Personality Disorder.
Major Service Objectives 2011/12 – 2015/16 The Division has five major service ambitions:
Proposed Developments 2013/14 (subject to business case approval): Development of Child & Adolescent Mental Health Services, including Thorneywood.
Agreed Planned Developments 2011/12 Low Secure & Community Forensic Services: Creation of additional bed capacity in the Wells Road hub Continuation of the Divisional Moving Forward benefits realisation programme Development of 16 step-down beds in the Lodges at Wathwood Medium Secure Unit Development of new admission wards at Arnold Lodge Medium Secure Unit.
Planned Developments 2012/13 Low Secure & Community Forensic Services: negotiation of enhanced secondary care across four Nottinghamshire prisons; step down services at Wells Road brought on line (subject to commissioner support); provision of a 10 bed low secure male personality disorder service (subject to commissioner support). Refurbishment of the older inpatient estate at Arnold Lodge Medium Secure Unit (commissioner support secured).
Planned Developments 2013/14 Continuation of 2012/13 programmes.
Service
Planned Development
Implementation from
High Secure
Restricted Patient Egress at Night (on wards with en suite facilities)
Pilot 2011/12, Full Roll Out 2012/13
High Secure
Reconfiguration of Wards (Personality Disorder Service)
2011/12
Medium Secure
Development of 16 bed step down facility at Wathwood Hospital
2011/12
New Admission Ward (Rutland Ward) at Arnold Lodge
2011/12
Development of the Wells Road site as a forensic hub over two financial years in three phases increasing bed capacity from 47 to 88 beds
2011/12 to 2012/13
Medium Secure Low Secure
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Development of Attention Deficit Hyperactivity Disorder services at Thorneywood.
acute hospital services, as commissioners seek to save money to meet increased activity in acute trusts
County Health Partnerships The successful bid for the majority of the community services from NHS Nottinghamshire County in 2010/11 was a major strategic achievement for the Trust. On 1 April we welcomed 2,383 staff into the Trust. This new £86 million contract represents a substantial addition to our range of services, making us a truly integrated provider of healthcare. We will now begin a process of transforming those services and ensuring that they achieve the high quality outcomes that our patients deserve. Our immediate ambition is to help reduce the number of acute hospital admissions and to support earlier discharge through developing responsive community services, aligned to the needs of the distinct local populations of
Nottinghamshire and the individual requirements of each clinical consortium. This approach will have four benefits: • it will enable individual patients and their carers to receive the best care in the best place which often is not in an acute hospital setting • it will support modernisation programmes by helping to reduce acute hospital expenditure on patients who do not need to be seen in hospital • it will help to prevent budget reductions in community services through reducing the amount spent on
• by reducing budgetary pressure on commissioners, it will remove competing demands on mental health, learning disability and substance misuse budgets, thus preserving services for other key client groups. The introduction of Any Willing Provider and personal budgeting will require the development of flexible, decentralised service leadership. The new market will also provide opportunities around the borders of Nottinghamshire and we will seek to exploit those, We will work with our acute and social care colleagues to deliver added value for them. The development of community services will be in two broad phases: 2011/12 will see the post-transfer development of new locality based structures and the alignment of the Division with the corporate services of the Trust. This will be done with our partners in primary care and will include the appointment of clinical directors in the new locality directorates. 2012/13 and beyond will see the transformation of community services to meet the aspirations of local commissioners and our primary care partners. More detailed service plans and priorities will be developed as an early priority. The Division will adopt the corporate processes of the wider Trust and anticipates early preparation of IBPs for the new directorates.
Our Financial Plans The Trust is financially robust with a sound history of strong financial performance meeting all its statutory financial duties in every year since its inception. These include meeting the breakeven duty, staying within the notified Capital Resource Limit and External Finance Limit and achieving a 3.5% return on assets.
Historic summary of balance sheet
Total Non current Assets Total Current Assets Total Current Liabilities Net Current Assets/ (Liabilities)
Strong financial performance is fundamental to the Trust’s service aspirations and plans which need to be grounded within a strong business and financial management model.
Actual £M 2007/08
Actual £M 2008/09
Actual £M 2009/10
Forecast £M 2010/11
295.8
281.3
301.6
313.6
29.7
27.7
28.1
24.9
-26.8
-25.5
-23.5
-27.7
2.9
2.2
4.6
-2.8
Total Non Current Liabilities
-14.9
-14.9
-15.8
-21.5
Total Assets Employed
283.8
268.6
290.4
289.3
Integrated Business Plan 2011
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Five Year financial strategy
Service Line Reporting and Management
Our five year plan includes the Community Services contract recently awarded and assumes this contract is retained going forward. The primary financial strategic aim is to enable and support the Trust in achieving its strategic service vision and in the delivery of its objectives in accordance with the Trust values. It is not an end in itself but one element of a set of coherent enabling strategies in support of the overall Trust service strategy. The five year financial strategy is to continue to build a strong financial base and within the regime allowed, to maximise the opportunities and flexibilities given. The key strategic financial targets and our forecast achievement against them is shown in the table below.
Target
Achieved in Forecast
Maintain a risk rating of at least 3
The Trust has introduced Service Line Reporting to improve and enable the front line service-line management integration of clinical, operational and financial objectives and outcomes. This will enable the Trust to fulfil its overall objectives. Over the last two years the Trust has ensured that its organisational structures are tailored to the characteristics of the markets it operates in and that this is aligned to a culture of devolution and responsibility to the three operational Divisions. The Trust has implemented Service Line Reporting without the advantage of a nationally
Achieve EBIDTA* margin of at least 5% Achieve surplus by year 3 under a downside scenario Achieve at least 3% return on assets Achieve a liquidity ratio in line with the High Secure compliance framework *Earnings before Interest, Tax, Depreciation and Amortisation.
The table below shows the forecast Income and Expenditure for 2010/11 to the last year in the 5 year plan.
The table below summarises the main changes in costs for the forecast period. Pay costs reduce from 2011/12 driven by the savings generated by our cost improvement plans, though this is partially offset by incremental drift.
Summary Income & Expenditure Account (I&E)
Forecast Income & Expenditure Summary
Income & Expenditure Account
Forecast £m
Forecast Forecast Forecast Forecast Forecast £m £m £m £m £m
2010/11
2011/12
2012/13
2013/14
2014/15
2015/16
303.8
393.9
385.0
376.6
370.8
365.1
(278.6)
(370.2)
(361.0)
(352.6)
(345.9)
(339.5)
25.2
23.7
24.0
24.0
24.9
25.6
8%
6%
6%
6%
7%
7%
(22.2)
(3.6)
3.9
3.9
4.2
4.4
2010/11 £m
2011/12 £m
303.8
393.9
-222.0
-293.6
-56.6
-76.6
-278.6
-370.2
EBITDA*
25.2
23.7
Depreciation & amortisation
-8.4
-8.7
Impairments
-28.2
-7.6
Net Interest
-1.2
-1.6
PDC Dividend
-9.6
-9.5
-22.2
-3.7
6.0
3.9
Total Income Pay Costs
Total Income Total Operating Costs EBITDA* EBITDA* Margin Net Surplus/(Deficit) Net Surplus before Impairment
6.0
3.9
3.9
3.9
4.2
4.4
Other Non Pay Costs Subtotal Operating Costs
Net Surplus Net Margin % shown after impairments
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2.0%
1.0%
1.0%
1.0%
1.1%
1.2%
Net Surplus before impairments
agreed way of costing or charging (through a tariff) for Mental Health Services being available. Until this situation changes it will continue to use the reference cost index information as a national comparator. The table below shows our reference costs for the past 3 years. The movement between 2007/08 and 2008/09 is a combination of increased costs and reduced activity across a range of services. The reference cost index in 2009/10 improved as activity volumes overall increased, combined with lower costs. The Trust also ceased to manage out of area independent sector placements.
Reference Cost Index 2007/08 2008/09 2009/10 97.6 101 99.3
Our Health Economy Under the Any Willing Provider (AWP) model, any provider who is able to provide services and meets the required minimum standards, can be listed as a possible provider. No provider has any guarantee of any volume of business. Instead, patients are able to choose which provider on the AWP list they wish to see. The NHS White Paper makes it clear that there will be a significant increase in the use of the AWP model, across most sectors of care. In order to be part of the new health economy and position ourselves as a willing provider of choice we will ensure that we are part of and support the development of the Local Health and Wellbeing Board. We will consider contract bidding opportunities which either align with our existing service portfolio or are consistent with our experience and expertise in
2013/14 £m
2014/15 £m
2015/16 £m
385.0
376.6
370.8
365.1
-284.1
-276.4
-269.3
-262.4
-76.9
-76.2
-76.6
-77.1
-361.0
-352.6
-345.9
-339.5
24.0
24.0
24.9
25.6
-9.0
-9.0
-9.3
-9.5
0.0
0.0
0.0
0.0
-1.6
-1.6
-1.6
-1.7
-9.5
-9.5
-9.8
-10.0
3.9
3.9
4.2
4.4
3.9
3.9
4.2
4.4
The need to be influential in the wider health and social care system is stronger than ever, as we face together the challenge of delivering better services to more patients with fewer resources. Within Nottinghamshire, NHS organisations have joined to form “Productive Notts” as a collaborative approach to meeting the Quality, Innovation, Prevention and Productivity (QIPP) requirements. Over the next five years the health economy needs to save 509 million pounds recurrently. The most significant savings are required during 2011/12. As a Trust we have been influential in promoting system-wide approaches across Nottinghamshire through the Productive Notts programme. We will continue to be leaders in promoting this
Services provided
Commissioner
High Secure Services
National High Secure Commissioning Team supported by National Oversight Group (NOG)
85.8
Dangerous and Severe Personality Disorder (DSPD)
National High Secure commissioning team
16.3
Medium secure services, Wathwood and Arnold Lodge
Regional Specialised Services Commissioners
25.2
Prison & Offender Health
Local PCT commissioners
4.5
Low Secure Services – Wells Road
East Midlands Strategic Commissioning Group (EMSCG) for Inpatients and local commissioners for community services
6.7
Nottinghamshire Mental Health & Learning Disabilities Substance Misuse Services 2012/13 £m
to undertake. We are pleased that these have all been agreed in advance of the start of the new financial year.
County Health Partnerships
Trust contract value (£Million) 2010/11
NHS Nottingham City NHS Nottingham City on behalf of the Drug and Alcohol Action Team
124.2
NHS Nottinghamshire County
85
delivering services for local populations for people with long term conditions and/or under-served groups. These contracts will enable us to deliver integrated care and deliver added value for Commissioners. Any contract opportunity will be assessed through a due diligence process to ensure the new contract positively impacts upon the delivery of existing services. The Trust has an extremely complex set of commissioning arrangements (see above) owing to the wide range of services it provides. During 2010/11 we were successful in bidding for new patient contracts, expanding further into the offender healthcare and community services markets. This means that the Trust has a substantial number of contract negotiations
9.6
collaboration. We will develop pathways, both internally and linked with other organisations, to support the objectives of the Productive Notts approach and also to pursue growth opportunities. We remain well positioned in the current and future markets. We will retain this through an ongoing focus on quality and innovation, partnership with others, use of our research links and the development of care pathways which offer increased quality and efficiency. The immediate future will be a period of consolidation, as we embed the new services into the Trust’s portfolio. We will retain an absolute focus on delivery of high quality services across the full range of our services, those we have traditionally delivered, as well as the new ones.
Integrated Business Plan 2011
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Our Estate The Trust has a large asset base and for its Forensic Services in particular this will continue. Forensic Services are by their very nature capital intensive. The Trust also recognises that it needs to invest in its estate to ensure the patient environment is fit for purpose, meets patient and commissioner expectations as well as regulatory requirements. For 2011/12 the NHS capital regime remains as now where the primary decision on the level of capital investment is whether the Trust can afford it. However it is likely that public sector investment in capital projects will be constrained in future years. The Trust capital investment plan is both affordable and realistic. There will have to be capital investment in the NHS to maintain services and the NHS infrastructure. The Trust priorities have been modelled only and this leaves the Trust flexibility to respond and invest further, subject to business case and affordability and the wider capital context without weakening the Trust’s balance sheet. The key financial assumptions underpinning the approach to capital investment are based on the current NHS Trust capital regime and the anticipated financial terms and freedoms of the Trust being Foundation Trust Standard. Internally generated cash will be the primary source of capital funding. Around £8.5m of cash from depreciation is available each year. The Trust will also use generated cash surpluses to support schemes which improve the quality of its service provision. Additional funding 10
should be realised through asset disposal although this is recognised as high risk in terms of current market conditions and is small in relation to the overall funding requirement. Loans will be taken out for those schemes which generate net additional income to the Trust where the service generate a Return on Assets (ROA) of greater than 5%. Each scheme will require a business case which demonstrates affordability, value for money and ensures that the loan is within the Trust’s notified Prudential Borrowing Limit. Again at this point in time, the plan does not assume any loans. The potential for additional funding and alternative solutions through routes such as
Private Finance Initiative (PFI), Local Improvement Finance Trust (LIFT) and joint ventures will be considered. However, other than continuing with the existing 2 Private Finance Initiative schemes, no further such initiatives have been assumed. The following table presents a summary of the planned expenditure and planned funding source for 2011/12. At this stage best case scenario schemes are not included, and will be the subject of Business Case approval by the Board allowing us to respond to changing service requirements. This will require wider agreement to change our Capital Resource Limit commensurate with any alterations in this plan.
Approved capital programme 2011/12 Project Total Planned expenditure £m £m 2011/12 Major Capital Rutland Ward, Arnold Lodge, pre-commitment Maun, Meden and Kingsley refurbishment Wathwood Lodges extension and refurbishment Wells Road Centre Phase 1 refurbishment Rampton Boiler Replacement – business case only Sub Total Major Capital Sub Total Local Minor Block Sub Total Forensic Minor Block Sub Total IM&T Total: Major Capital, Minor Capital, IMT Unallocated Proposed Overall Capital Resource Limit (CRL) 2011/12
7.5 3.3 2.0 2.0 6.0 8.8 3.4 2.7 1.1 16.0 1.0 17.0
1.2 3.0 2.0 2.0 0.6
Governance
We welcome the opportunities presented to us as an FT Standard organisation to be self regulating. We have established robust assurance processes and strong self governance mechanisms. We will be supported in our approaches through our Members’ Council, which grows from strength to strength, and our accountability arrangements through the Trust Board.
We have become a £100 million larger organisation this year and will continue to keep under review our risk profile and risk appetite. We work continuously to ensure that our clinical, financial and quality risks are understood and mitigated. We are clear as an organisation that risk management is an integral and positive part of our self-regulating culture. Our Members’ Council was recruited during Summer 2010 and comprises 41 Governor Members, in the following three constituencies: Constituency
No. of Governors
Public/service user and carer
21
Staff
7
Partner
8
Responsibility and Accountability Arrangements The Trust Board ensures that effective risk management processes are in place. It has a duty to assure itself that the organisation has properly identified the risks it faces and that it has processes and controls in place to mitigate those risks and the impact they have on the organisation and its stakeholders. The Trust Board is committed to the comprehensive management of risk and the maintenance of a sound system of internal controls to support the achievement of the Trust’s policy aims and objectives. The Trust Board is responsible for the overall performance of the Trust and recognises its responsibilities for self regulation and compliance. The performance management reporting framework is designed to help discharge this responsibility effectively. Each month, the Trust Board receives a performance report highlighting performance against key national and local indicators and each key performance indicator is attributed to an Executive Director.
We have developed a Governor Development Plan and a Governor Divisional Ambassador role which has been very well received and allows opportunities for Governors to engage with particular services. We continue to build a 16,000 public/service user/patient/carer membership of the organisation and currently have 7845 public members and 5953 staff members (March 2011). A Membership Strategy has been approved and a Membership Office Manager has been appointed.
We want our membership to focus on areas where their impact will be most effective. One of the most productive ways of doing this is when people work together in groups around a common interest. We are calling these groups ‘Communities of Interest’. We have three types of Communities of Interest: Communities of Place, Communities of Identity and Communities of Issue The following Communities of Interest have already been established: • Support and treatment for people with recurrent depression and their carers • Our response to domestic violence and abuse • Wellbeing of local deaf communities • Welfare rights for adults with Asperger’s syndrome and their families • Health and wellbeing of patients at Arnold Lodge • Inter-professional on-line ethics debate • Women, medication and mental health.
Integrated Business Plan 2011
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Closing remarks We remain true to our vision, values and strategic purpose. These have served us well and we will build on them as a Foundation Trust Standard organisation. We are a self regulating provider with strong strategic sustainable governance including a new Members’ Council. Our governor and member engagement approaches will add to our strength as an organisation.
From April 2011, we became an integrated provider with our core business as Mental Health Learning Disability, Substance Misuse, Forensic Services and integrated services through our Transforming Community Services as hosts of County Health Partnerships. Our scale and influence as an integrated provider will be key in future. The immediate future will be a period of consolidation, as we embed new services into the Trust’s portfolio. We will retain
an absolute focus on delivery of high quality services across the full range of our services, those we have traditionally delivered, as well as the new ones. As a self-regulating organisation, we can now operate with greater freedoms. In discharging these freedoms we will continue to build on our sound history of strong financial performance meeting all of our statutory financial duties. This will be particularly important as the health economy faces unprecedented challenges to deliver efficiencies. The current climate is difficult and turbulent. The local health economy must reduce in size by £509 million recurrent over the strategic period. This will only be achieved if we can truly demonstrate that we are Aligned, Able and Agile. The need to be influential in the wider system is stronger than ever, as we face together the challenge of delivering better services to more patients with fewer resources. National public sector policy changes require us to be innovative and to work in ever closer collaboration with our partners and other public sector colleagues. The QIPP challenge will gain momentum with the most significant savings required during 2011/12. As a Trust we have been influential in promoting system-wide approaches across Nottinghamshire through the Productive Notts programme. We will continue to be leaders in promoting this collaboration and will seek, with our partners, to promote resilience, rehabilitation, re-ablement and recovery. We will use our IBP to move beyond the immediate period of disruption to create momentum for success. In future we will be increasingly more connected and commercially motivated. We will challenge ourselves to work outside and beyond our normal behaviours. We will keep the momentum whilst holding true to our POSITIVE values and exerting discipline over high quality service delivery. We remain well positioned in the current and future markets and will build on our distinguishing features of: • Breadth in scope of services
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Nottinghamshire Healthcare NHS Trust Duncan Macmillan House, Porchester Road, Nottingham NG3 6AA Telephone: 0115 969 1300 www.nottinghamshirehealthcare.nhs.uk
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• Depth in level of expertise • Integration opportunities following recent additions to services delivered • Scale as a large provider of integrated healthcare.
12 Printed on Revive · 100% recycled paper
May 2011