Business Plan FY18 Q1 Report

Business Plan FY18 Q1 Report

Trust Priorities To make care a joint endeavour with patients, families and 1carers 2 To improve the quality of care by transforming services To support teams to improve the safety and quality of care they 3provide 4 To support leaders to maintain a positive culture for teams To ensure Oxford Health NHS FT is high performing and 5financially viable To lead research and adopt evidence that improves the quality 6of care 7 To embed and enhance the electronic health record

Priority Workstreams 1. To make care a joint endeavour with 1. Deliver patient involvement and experience strategy (trust-wide) patients, families & 2. Deliver the carers strategy carers 1. Deliver Oxfordshire Community Pathway : Locality & Bed Based services (OPD) 2. Deliver new Learning Disability service (Adults) 2. To improve the 3. Deliver improved Adult MH pathway (reduce OATS) (Adults) quality of care by 4. Deliver CAMHS Transformation (CYP) transforming services 5. New Care Models 6. Estates Redevelopment 3. To support teams to 1. Deliver Quality Account priorities improve the safety and 2. Deliver Oxford Centre for Quality Improvement quality of care they 3. Implement the recommendations from the Mazars review provide 1. Deliver recruitment & flexible workforce management solutions 4. To support leaders 2. Deliver workforce strategy to attract and retain staff to maintain a positive 3. Deliver Leadership and Management Development pathways (includes culture for teams mentoring, conferences, clinical leadership) 4. Deliver Equality, Diversity & Inclusion Strategy 5. To ensure Oxford 1. Deliver the Cost Improvement Programme Health NHS FT is high 2. Embed New Performance Team and Performance Management Framework performing and 3. Embed Patient-level costing and Service Line Reporting financially viable 1. Biomedical Research Centre (BRC), Collaboration for Leadership in Applied 6. To lead research and Health Research & Care CLAHRC, Clinical Research Facility (CRF), Clinical adopt evidence that Research Network (CRN), Diagnostic Evidence Co-operative (DEC), Medtech & improves the quality of Invitro diagnostic Co-operative (MIC) care 2. Deliver Case Records Interactive Search 3. Deliver effective Research Management Group 1. Refine and enhance existing EHR functionality 7. To embed and 2. Deliver New Data Warehouse enhance the electronic 3. Reporting Presentation Layer health record 4. Enhance core IT infrastructure

Seven Priorities- Progress Updates (Priorities 1-2) Priority 1. To make care a joint endeavour with patients, families &carers RAG Project Title Progress Update Deliver patient involvement and experience (PEI) strategy Objectives from PEI strategy have not been fully achieved from 2016/17 due to challenges in identifying funds to support the implementation of the work plan behind the strategy and due to staff turnover/recruitment into key leadership roles. The objectives that have been focused on are around improving the PEI pages on the internet, rolling out the use of IWGC across the trust, and developing guidelines for staff and patients on involvement in staff interviews. Deliver the carers strategy Carer Involvement and Engagement Phase 1 During Q1 3 conferences took place during Carers Week in Oxford, Aylesbury and Devizes to engage staff and carers. The Family, Friends and Carers Strategy has been finalised and is being rolled out in different versions; easy read, summaries, paper, web-based. Self-assessment of all services in the Community has been completed. Establish and implement carer feedback mechanism in progress, aiming for completion in October 2017. Phase 2 (to implement the findings and actions from the newly developed Carers' strategy) to commence in Q2. District Nursing Service Efficiencies Project scoping completed and KPIs agreed. Key workstreams already complete, apart from starting from home (as requires GP agreement and IT software) Deliver Oxfordshire Community Pathway : Locality & Bed Based services (OPD) Developing neighbourhood working (ILT Phase 2) Project scoping underway, duty desk will be reviewed as part of urgent care pathway Development of District Nursing Workforce Project scoped, first project meeting 17/07/17 Community Hospitals – Consultation Public consultation plans progressed, but consultation had to be put on hold due to elections (purdah) and further work required by CCG, so new timetable proposed for consultation to start May 2018 2. To improve the quality of care by transforming services Deliver new Learning Disability service (Adults) During Q1, all contracts fully negotiated and agreed. LD specialist services transitioned to OHFT on the 1st July 2017. Risk register continues to be maintained. The internal project board convened and completed. Now first 100 days reported via Execs weekly. Services working to and setting timescales through the Transforming Care Partnership Board Deliver improved Adult MH pathway (reduce OATS) (Adults) EDPS using telepsychiatry as part of business as usual. Project closed and now scoping other areas of the organisation to spread good practice. Carers handbook complete and printed, this has been distributed to all Adult Mental Health Team (AMHT's) and inpatient wards. Appointment cards delivered and distributed to AMHT's. All feedback to be locally collated and processed via I want great care system. Decision made for 10 bedded supported housing facility to be dedicated to Forensic service users due to higher demand. Other alternatives to admissions continue to be explored. Good progress has been made with the EPCSS team and Patient Safety at a Glance (PSAG) boards will be directly linked to Carenotes. Specification has been drafted, some amendments will be made and final version signed off 31/08/2017. Proposal agreed by Partnership Management Group for Single Point of Access go live for OMHP due in October. Swindon, Wiltshire, Bath & NE Somerset Transformation project board meets monthly, key focus on online referrals and new eating disorder pathway Deliver CAMHS Transformation (CYP) Buckinghamshire Transformation project board meets monthly, key focus on resources and skills in universal services, access for young people in crisis, compliance with national guidelines, and improved access Oxfordshire New model and transformation project board re-launched in July 2017, to focus on single point of access, neuro-development, getting help / getting more help, risk support, and social work. New Care Models Estates Redevelopment Thames Valley & Wessex Forensic Network (Adults) In Q1, 2 repatriations and 3 patients placed out of area. M12 data validation ongoing to enable approval of initial NHSE budget offer in July. Network governance structures are in place, with regular meetings. Project group identifying initial community accommodation. Ongoing issues to resolve between OHFT and NHS England regarding Case Managers and support from hubs. Eating Disorders New Care Model (CYP) During Q1, the final application was completed and submitted to NHSE, panel interview has taken place and the bid to lead a wave 2 new care model was successful. Milestones for Q2 on track with engagement event with provider partners planned for September. If business plan is approved expected ‘go-live’ is April 2018. Warneford redevelopment master plan approved. Initial Consultation events held with stake holders; initial meetings held with OCC.

Seven Priorities- Progress Updates (Priorities 3-4) Priority 3. To support teams to improve the safety and quality of care they provide RA G Project Title Progress Update Deliver Quality Account priorities No concerns/risks identified for under delivery of priorities at year end. Full report to be provided for Q2. Deliver Oxford Centre for Quality Improvement Organisational change process underway. Recruitment campaign to commence following internal process at the beginning of July. Budget now agreed and in place. Engagement with OMT, Adult and Childrens and Young People Directorate commenced. Meeting with Older Adults to follow. Appropriate financial arrangements with the University of Oxford being made to enable recruitment to research arm. JD for Medical Lead prepared and awaiting approval. Working with Estates Department to prepare POWIC building for occupancy in Sept / Oct. Meeting with Marjorie Wallace for introductions arranged. Academic interest starting. Development of the Measurement and Monitoring framework underway in collaboration with Matryn Ward’s team. First visualisation of database interaction through ‘layering’ prepared. Agreements made to work collaboratively with the new centralised project management team to ensure that each project is supported by sufficient project time and quality improvement lead time. Invitation to join national Engagement and Observations QI Collaborative accepted. QI team agreed with Adult Directorate. Data collection underway. Project management resource agreed in Adult Directorate. Study days agreed for team. Heath Services Investigation Branch work with Serious Incident Team to conduct investigation through parallel process agreed. Arrangements made for first collaboration with OXINAHR on nursing research agenda working with Johns Hopkins. New screening tool including categorisation tool finalised and in process of being embedded across services. At end of Q1 varied implementation of tool. Implement the recommendations Directorates have started to test and shadow directorate level MRG in Q1 and this will be further developed in Q2. from the Mazars review ToR for Trust-wide MRG reviewed and amended. Programme of thematic reviews developed. Having carefully considered the Workforce Management System (WFMS) deployment plan the decision has been taken to adhere to the current plan. Whilst Deliver recruitment & flexible speeding up deployment would bring some advantages it would also stretch the deployment team considerably and result in increased risks around subworkforce management solutions optimal or inconsistent deployment. We are involved in the Carter 90 day programme, a focused NHSI intervention designed to share best practice around e-rostering systems and deployment. Since the June Board meeting at which concerns were expressed about levels of staffing in certain wards, the CEO has chaired two Extraordinary Executive Meetings on 6 and 14 July. These have included the Executive Team, operational leaders from all Directorates, HR, Estates, Quality and Heads of Nursing. There has also been one Operational Management Team held on 17 July dedicated to the people issues facing the Trust. Issues discussed have included Deliver workforce strategy to Reward (recruitment and retention premia and other ideas from Tim Boylin’s HR Strategy presentation), building up our Bank staff, reducing reliance on attract and retain staff Agency staff with a particular focus on the HCA population, standardisation of terms and conditions, fair distribution of shifts and the possibility of speeding up the deployment of the new Workforce Management System. Retention is key and work is ongoing with HR, leadership teams and staff representatives to examine underlying causes of staff turnover, causes of stress, best practice from other Trusts and other elements to enable us to slow down attrition. Apprentices: Achieved employer provider status and are now recruiting apprentices. Deliver Leadership and Associate Nurses: 25 Nurse Associate Trainees recruited who are now 3 months into their course. Management Development Graduate status: Scoped the position in relation to our Band 7s and above and are now trying to develop appropriate programmes. pathways Leadership pathways: Developed the required material and are advertising this to Band 6 and above w/c 17/07/2017 Workforce Race Equality Standard (WRES) Analysis of 2016 WRES results with accompanying report produced. Work underway collating the required information for the 2017 submission due during Q2. Race equality action plan devised, presented to exec and suggested amendments made. 4. To support leaders to maintain a positive culture for teams Accessible Information Standard (AIS) Standard 1 (of 5) achieved with guidance notes for staff being developed. New ‘Alert System’ on Carenotes approved by OCCG Equality Manager. Work has commenced on achieving Standard 2. Deliver Equality, Diversity & Inclusion Workplan Stonewall Workplace Equality Index (WEI) Feedback from Stonewall on 2017 submission delivered and best practice areas identified. Stonewall conference held in May to promote OHFT as diversity champions, with CEO of Stonewall delivering key note speech. Work underway to gather evidence for submission during Q2 with the aim to improve the trusts ranking in the index. OHFT representation at Oxford Pride, sharing a stall with Unison colleagues. Staff Equality Networks Ongoing promotion of staff equality networks. Meetings taking place bi-monthly with good attendance. Working in collaboration with network members on WRES, AIS, WEI & leaders conferences in September focussing on ‘fairness’ (OMT to review/provide input). Newsletter produced to promote ‘National Day for Staff Networks’ in May. Draft ‘Workforce Gender Identity Policy and Procedure’ for staff produced for staff who are proposing to undergo, undergoing or have undergone a process of gender reassignment. Equality & Diversity Steering Group and Delivery Group being reviewed and refreshed for establishment in Q2 to focus on overseeing, monitoring and measuring progress.

Seven Priorities- Progress Updates (Priorities 5-6) Priority RAG Project Title Progress Update Adults Directorate In Q1 delivered 177,338 Vs target of 235,884 (-25%), in FY18 forecast to deliver 1,072,000 Vs Target of 2,100,000. The reason for YTD slippage is in relation to Forensics New Care models. There are issues around extracting patient activity and finance data from the NHSE Specialist Mental Health database, a full financial breakdown for Q1 is expected in August, this will then be reviewed on an ongoing basis. Adults are forecasting to deliver below target due to limited opportunities and lack of plans. Cost Improvement Programme 5. To ensure Oxford Health NHS FT is high performing and financially viable Children & Young People Directorate In Q1 delivered 157,251 Vs target of 157,251 (100%), in FY18 forecast to deliver 632,000 (of which 378,000 is non recurrent) Vs Target of 1,700,000. There has been no slippage YTD. Children and Young People are forecasting to deliver below target due to limited opportunities and lack of plans. Older Adults Directorates In Q1 delivered 161,775 Vs target of 272,613 (-41%), in FY18 forecast to deliver 751,765 (of which 150,000 is non recurrent) Vs Target of 2,100,000. The reasons for YTD slippage include cost pressures in relation to Community Hospital agency staffing. Integrated Locality Teams have identified skill mixing opportunities and posts to be removed but they are currently occupied or covered by pay protection. Older Adults are forecasting to deliver below target due to the slippage outlined above, limited opportunities and lack of plans. Support Services In Q1 delivered 108,666 Vs plan of 108,666 (100%), in FY18 forecast to deliver 504,451 (of which 100,991 is non recurrent) Vs Target of 1,500,000. There has been no slippage YTD. Support Services are forecasting to deliver below target due to limited opportunities and lack of plans. Embed New Performance Team and Performance Management Framework Consultation complete and all queries responded to, appropriate adjustments made to the proposal. Head of Service Change & Delivery and Performance & information recruited. Offer has now been made to Head of Business Services. Successfully appointed Senior Programme Managers, Performance & Information manager and Commercial & Contracts Managers There are still some ongoing discussions with a small number of staff about posts. This position should be resolved early to mid August Embed Patient-level costing and Service Line Reporting A new hierarchy in the GL chart of accounts has been set up to reflect SLR. Budgets were presented by service line and from month 2 the Finance Board Report and Directorate finance reports included financial performance by service line. Biomedical Research Centre (BRC) Contracting process with NIHR complete and funding started. Patient & Public Involvement strategy manager in post and work has commenced. Collaboration for Leadership in Applied Health Research & Care Annual CLAHRC Symposium took place on 06/06/2017. Ongoing work to continue to deliver the objectives of themes 1-6. CLAHRC 6. To lead research and adopt evidence that improves the quality of care Clinical Research Facility (CRF) Contracting process with NIHR commenced and funding started. Ongoing discussions with partners regarding the integration of Acute Vascular Imagining Centre (AVIC) into the existing Warneford CRF and increasing the number of beds at AVIC to support neuroscience research. Work has started to increase the number of experimental medicine research studies in line with NIHR CRF remit with BRC studies being directed to CRF. CRF at capacity and work has started to limited phase III studies and find alternative Trust accommodation for studies Clinical Research Network (CRN) New Associate Director of R&D appointed and leading on the integration of True Colours - a remote mood monitoring app, into clinical practice. Diagnostic Evidence Co-operative Ongoing work in the following areas: Horizon Scan programme, unmet clinical needs assessment, point-of-care testing and attitudes to implementing IVDs (DEC) in primary care:. Medtech & Invitro diagnostic Co-operative (MIC) Submission of the funding application and NIHR Review and interview process completed. Decision on funding delayed due to purdah. Deliver Case Records Interactive Search Use of D CRIS ceased, UK CRIS is now live & D CRIS Users utilising UK CRIS. The process of UK CRIS roll out across the trust has started with research and has been used to support one audit. Awaiting UK CRIS training material in order to deliver training in groups rather than one to one. POMH audit supported by UK CRIS. Approx 85% of audit done by CRIS reducing resource from 37 hours to 5 hours Deliver effective Research Management Group Engagement is growing, although slow uptake with CRN and CLAHRC. Quarterly highlight reports of the various elements of research within the Trust are being produced for many areas, with some refinements required. Demonstrating to be a good forum for collaborative discussions

Seven Priorities- Progress Updates (Priority 7) Priority RAG Project Title Progress Update Q1 has focused on upgrading Adastra and both Mental Health and Community Health instances of Carenotes. These upgrades have been deployed successfully and a significant improvement in the deployment process was experienced. The Carenotes upgrades are providing end users with approx. 25 minor functional additions and approx. 37 issue fixes. The Adastra upgrade provides end users with a couple of issue fixes and enabling functionality such as the MIG viewer. Refine and enhance existing EHR functionality Deliver New Data Warehouse 7. To embed and enhance the electronic health record Reporting Presentation Layer Q1 has also focused on phase 1 of interoperability: E-Correspondence is now in place for Mental Health Interim Discharge Summaries which are being sent directly from Carenotes to GPs within Oxon, this will be rolled out to include Bucks GPs shortly. View only access to GP Primary Care Data directly from within Adastra and Carenotes via the MIG is in test, with a planned deployment of July 2017. The Carenotes App together with the deployment method has been upgraded, all staff have now reregistered and work is on going to support all Mental Health Community Teams to use the App alongside accessing Carenotes via Web@Work; this is being hampered by App and Web@Work issues. The roll out to Community Health will follow on from this. Work is underway to decommission a third party tool which has been used in BI for the past three years. Besides providing a 45K saving, this will also give the Trust better control and easier maintenance of the legacy BI solution. At the same time work is advancing on introducing a new data warehouse. This is being built 'from scratch' with new and streamlined extraction, transformation and loading routines, including fully documented rules for all data to ensure consistency going forward. In Q1 the main projects the BI Team has been focusing on are: Safer Care / incidents reporting: more than 70% of the incident data has been merged with Carenotes activity data and a interactive dashboard has been developed which enables the Trust to explore correlations between incidents and activity. This replaces a current manual process of gathering the data from various sources/people within the organisation to produce monthly/quarterly reports. Further work is required in order to completely replace the manual process of reporting and the scope of a new project is currently being defined. Bucks CCG have highlighted several issues with the cluster reporting in the past. Working together with the head of performance and information and the head of costing, the BI team has developed a new cluster reporting solution with clearly defined rules. This has been presented to the Bucks CCG and positive feedback has been received. The solution improved transparency within the Trust and the CCG, but also highlighted some data quality issues which are already being addressed. The main focus of work during Q1 has been on Office 365. The pilot deployment of Office 365 has now largely concluded. Amongst several technical findings, the pilot showed that the Microsoft security overlay known as Enterprise Mobility Security (EM S) was not a good fit for the needs of the Trust it's too 'bleeding edge' at this time (i.e., risky). Activity therefore continues to find a third-party security overlay that more closely suits the Trust’s requirements. Enhance core IT infrastructure RAG Key Milestone Status Red Milestones delayed Amber Milestones at risk of delay Green Milestones complete and/or on track During Q1 spend on replacement PC devices is low although departmental spend still appears to be continuing at a reasonably aggressive rate. The approach of not pro-actively replacing devices continues, with the trend of longer life being obtained from legacy hardware continuing to hold true. Further investment has been made in replacing legacy Wi-Fi Access Points. Plans to re-procure the Trust's network have stalled due to the delayed deployment of the national HSCN (Health and Social Care Network) project - i.e., the wider network that the Trust's infrastructure will need to link with.

KPI Dashboard Reference Indicator Reference QUALITY Indicator OPERATIONAL EXCELLENCE Q01 No. of Incidents Reported OE01 % CPA Caseload Contacted in 12 Months Q02 Unexpected Deaths OE02 DNA Rates Q03 No. of physical violence OE03 Number of patients delayed discharge Q04 No. of Falls Resulting in Harm OE04 Percentage of bed days lost Q05 No. of Grade 3&4 Pressure Ulcers OE05 Median Length of Stay Q06 No. of Self Harm (including attempted suicide) OE06 % Bed Occupancy Q07 No. of Reported Medication Incidents OE07 Delivery of Cost Improvement Q08 No. of Incidents involving controlled drugs OE08 Bank and Agency Spend Q09 No. of Patients Absent without Permission Q10 No. of PALS Enquiries LPC01 % of Sickness and Absence Q11 No. of Complaints LPC02 % of Vacancies Q12 No. of Compliments LPC03 % Staff Turnover Q13 % Complaints Closed within 25 Days LPC04 Overall Extent of Staff Engagement Q14 Friends & Family Test LEADERSHIP, PEOPLE, CULTURE Trend (consecutive points up or down negatively impacting performance) Shift (consecutive points above mean) Astronomical data point ( /- 3 standard deviations)