Annual Plan 2014 - 2019

1. Lisa Quinn Executive Director Performance and Assurance Annual Plan 2014 - 2019

2. Major change from last year Integrated strategic and operational planning process for 2014 i.e. CCGs, Foundation Trusts, non Foundation Trusts and Local Government (via Health and Wellbeing Boards) Initial guidance issued and a 2 year and 5 year plan is required-but precise requirements still not clear Guidance on precise requirements and content due out week commencing 16th December The Trust’s Plans will continue to reflect IBP (October 2012) and Transformation of Services Annual Plan requirements

3. 10th December 2013-Joint Council of Governors/Board of Directors w/c 16th December 2013-Monitor Guidance, Templates and Tools issued 13th January 2014-Initial high level plan submitted to Monitor 20th March 2014-Council of Governors Full Meeting (review of draft 2 year plan) 26th March 2014-Board of Directors approval of 2 year plan 4th April 2014-Submission of final 2 year plan to Monitor 15th May 2014-Council of Governors Full Meeting (to sign off 5 year plan) 28th May 2014-Board of Directors approval of 5 year plan 20th June 2014-Submission of 5 year plan 15th July 2014-Council of Governors Full Meeting (review of Summary Annual Plan) Annual Members Meeting-Circulation of Summary Annual Plan Provisional Timetable-Key Dates

4. Thank you to all of those that volunteered to be members. Council of Governors Representatives/constituency: Austen O’Malley-Public Marion Moore-Service User Grahame Ellis-Staff Ann Clark-Carer Meetings-monthly January 2014-June 2014 Chair - Steve Brooks, Head of Commercial Support Annual Plan Working Group

5. Questions

6. Council of GovernorsTransforming Services 10 December 2013

7. Strategic Direction • We have to improve quality for the patient • We have to reduce our overall cost of doing so by 20% • We aim to improve clinical effectiveness thus reducing reliance on inpatient beds • We have to create sustainable services, delivered by sustainable organisations, operating in a sustainable system Quality Sustainability -20% Cost The environment in which we work:

8. What we are told nationally: ‘The NHS… needs to develop and implement bold and transformative long term strategies and plans for their services, otherwise they will become financially unsustainable and the safety and quality of patient care will decline’ Joint letter to the NHS and Local Authorities, 4th November 2013 • ‘Call to Action’ and ‘Closing the Gap’ reports highlight that the NHS needs to radically transform to meet the current quality, safety and financial challenges

9. We have to get much better at what we do and how we do it • We have to get better at listening and acting on what people are telling us • We have to be consistently good across all our services • We need to get the patient quickly into the right services and then deliver the best outcome possible Commissioners What our partners have told us: GPs Local Authorities 3rd Sector Other providers

10. They want high-quality, safe care close to home • They want inpatient services to be of a high standard • They want services designed and operated around the needs of patients • They want the patient to be truly ‘at the centre’ • They want to gain and re-gain independence, as far as possible What patients and carers have told us: Patient

11. The Service Model

12. SMR Principles • You should reach us, quickly and simply • The earlier the better • To get the right help and care, safely and easily • From our flexible and skilled workforce • In collaboration with you and your carers and partnership organisations • So that you can gain / re-gain independence, as far as possible • By making smooth and sustainable steps forward • Reaching us again, simply and quickly

13. At any time, 3% of patients are consuming 52% of resources • We spend in inpatient areas to the detriment of community services • A few patients consume much of the resource • Many in-patients perhaps don’t need to be, but we lack the necessary community services to support them out of hospital • We need to balance resources to maximise quality over cost Inpatient Services Community Services £92.2M NTW Whole costs £84.8M NTW Whole costs The need to realign and balance resources:

14. Principal Community Pathways

15. A programme to design and implement new, evidence-based community pathways for adults and older people. • Our ambition is high and is matched by the expectations of service users and carers. The new pathways will: • Significantly improve quality for the patient • Double current productive time of community services by redesigning current systems • Enhance the skills of our workforce • Improve ways of working and interfaces with partners • Reduce reliance on inpatient beds and enable cost savings • This is not achievable in isolation and to be successful we need it to be part of integrated work with partners Principal Community Pathways

16. Principal Community Pathways – Timeline Design Test Implement Pre-engagement Design Test Implement Tranche 1 – Sunderland & South Tyneside Pre-engagement Design Test Implement Tranche 2 – Northumberland & North Tyneside Tranche 3 – Newcastle & Gateshead 1 Apr 14 1 July 14 1 Dec 14 1 Apr 15 1 Dec 13 1 Sep 14

17. Principal Community Pathways – How people have been involved So far 362 people have attended the 27 clinical and supporting systems workshops, these have included: GPs, Local Authority staff, Acute Trust staff, Community and voluntary sector staff, CCG staff, NTW staff and most importantly our service users and carers. • Our Trust-wide Service User and Carer Reference Group has been involved throughout • We have presented our plans to various groups including HealthNet and South Tyneside GP Education Forum • We’ve been ‘walking the wall’ with all of our stakeholders and have so far run sessions for over 800 people – with more to follow

18. So what is so different?

19. Access Future State Current State Multiple points + times of access. Referral Source + methods vary area to area. Bouncing. No standardisation of allocation meetings. Access to clinical advice variable quality + recording variable Service users are often sent an appointment letter after the allocation meeting, with no choice of day, time or venue Community services operate 9 to 5 in most areas Most contact with service users is by letter, limited use of phone calls and text messaging reminders. Many teams have waiting lists for assessment and for treatment Multiple routes for re-engagement into services by historical service users, no clear route back in Single point of access for service users, carers and referrers, open 24/7 Service Users and carers are able to self-refer to services within the scope of Principal Community Pathways Referrals are accepted by telephone, letter, email and fax Clear single point for obtaining advice and information, including clinical advice Wider hours of operation for community services Service User is contacted within 24hrs of referral being received and offered choice of venue and time for appointment. Service User is asked how they would prefer to be contacted in the future e.g. letter/phone/email/text/Skype. There are no waiting lists for patients Opportunity for easier and more streamlined route back into services should this be required following discharge

20. Assessment & Formulation Current State Future State First appointment date is within 7 days of referral being received (agreed) Service User offered a choice of appointment days/times/venues Service Users given information and invited to tell us a little about their life using a “introduction to me” before assessment to feel more prepared Service User can choose to receive a text message or phone call to remind them of the appointment Where clinic appointment is required, Service User is greeted by front of house staff where demographic information is checked and an explanation of their visit is provided Where required, Service Users will also receive a full baseline physical health check. Where appropriate, carers involved throughout the assessment and formulation process Service user and carers will leave with a plan and a clear understanding of what will happen next First appointment date may be several weeks after referral being received Limited choice of appointment days/times/venues Service Users often unprepared for the assessment, giving rise to anxiety and is a cause of DNAs Very limited use of reminders of appointments, often just one appointment letter sent out with no follow up Mixed availability of reception services at clinical venues, and mixed customer service skills Limited access to physical health check facilities, many service users not offered this option

21. Treatment Future State Current State Service Users continue to have the choice of text message or phone call reminders for appointments Service Users receive treatment in the form of clinical interventions and /or medication as agreed in their treatment plan and in line with NICE guidance with clear review points to monitor/change care where appropriate Service Users will have access to Peer Support Workers as well as community workers to help them with benefits, housing, social issues Service Users will receive treatment and care in the most suitable environment Service Users, Carers and other professionals will be able to call a review Care plans will be developed collaboratively with the patient/carers where appropriate Service Users often only receive a single letter about an appointment, without options to receive reminders Service Users receive mixed levels of treatment in the form of clinical interventions and/or medication, as agreed in their treatment plan Service Users have mixed access to community support to help them with benefits, housing, social issues Service Users receive treatment and care in a range of environments which are not always the most suitable Care planning is not always developed collaboratively with the Service User/carers

22. Discharge Future State Current State The term ‘discharge’ will only be used when the service user is leaving NTW services in their entirety – otherwise, the terms ‘transfer’ and ‘transition’ will be used Discharge process is part of treatment and the Service User will feel prepared for the discharge. Any disputed issues will be resolved prior to last meeting. Service User will agree a discharge plan including how to ‘stay well’ and what steps they should take in the event of a relapse Carers will be involved throughout discharge planning Service Users are often ‘discharged’ by one part of NTW while care continues to be provided by another part, which is confusing to them, carers and referrers Discharge planning is not a standardised approach Often service users return to NTW because of unresolved issues in the wider world (social issues, housing, benefits, welfare), for which they receive varied levels of support across services Service Users do not always have a clear plan of how to ‘stay well’ and what steps they should take in the event of a relapse Carers are not always involved in discharge planning, and their needs are not always directly considered

23. Mark’s Story

24. Mark Mark is 38yrs old and has struggled with low mood and paranoid thoughts all of his life. He had a difficult upbringing, his Dad beat him from a young age and would always pick fights and criticise him. Mark left home at 16 years old. He spent many years on the street, took a lot of drugs and was in and out of prison for a few years. He was staying in B&Bs but has recently got a place in a supported living block. He finds it difficult as he feels paranoid most of the time and thinks people are talking about him. He hears the voice of his Dad continuously – criticising him and telling him how useless he is. He used to take ODs or get as smashed as he could to stop the voice, he was always in A+E or being brought in by the police but nowadays he tends to just withdraw to his room. He smokes a lot of weed which sometimes relaxes him. He has seen a psychiatrist in the past and they put him on a tablet. It made him feel blank and tired and it put weight on him which he hated, so he stopped taking it. He sees his GP quite regularly for this and that. He’s been referred back to the mental health team a few times but only seen a CPN once for 20 mins and finds it difficult to get in touch with him. He admits he’s missed a few appointments. He really wants to stop the voice and improve his mood but he thinks nobody’s bothered about him because he doesn’t cause trouble anymore. His doctor asks him to rate his mood on a scale of 1 to 10. It’s 1.

25. Process step Mark will receive treatment in line with NICE guidance. Treatment package tailored to his needs. Mark will have access to Peer Support Workers and Recovery College to help him with important issues. Mark can request a Review at any point. Mark’s GP will have access to an advice line where they can speak directly to an NTW psychiatrist or pharmacy about any issues in relation to Mark’s care. Mark is provided with information about what to expect from his visit to NTW Mark will be sent a ‘introduction to me’ pack where he can prepare for his first assessment If deemed necessary Mark will also receive a full baseline physical health check. Mark’s care plan will be developed collaboratively with him Mark’s discharge planning commences at this point Mark is able to ring one number. The single point of access service is available 24/7 Mark is contacted within 24hrs of referral being received and offered choice of venue and time for appointment. Mark’s GP is able to contact the same number for support or advice about Mark’s care NTW will work in collaboration with social care, and 3rd sector partners to support Mark Upon discharge Mark will agree a discharge plan including how to ‘stay well’ Mark’s discharge plan will also include what steps he should take in the event of a relapse Mark’s GP will also receive a copy of this plan along with any early warning signs and initial management plan Mark

26. Augmenting Services

27. Total beds per 100,000 of population within the Mental Health Care Packages & Pathways consortium

28. What does this mean for inpatient services? Our aim for in-patient services is to ensure that when service users need to be in hospital, they are looked after in • an appropriate environment, • which is properly staffed, and • delivers effective interventions which are focussed on recovery • supporting people to step down out of hospital, as soon as their needs allow

29. Bed Model Current State (42 Wards April 2013) Northgate URGENT Male Acute Stepped Care PLANNED Female Acute OP Organic PICU St Georges LD The Grange OPS (func.) St Nicholas Rose Lodge S Tyneside DH CAV Monkwearmouth QE Cherry Knowle Elm House Brooke House

30. What does this mean for inpatient services? • Overall, across the Trust we are looking to reduce in-patient provision for adults and older people’s services from the current level of 723 beds to around 425.

31. A group of senior clinicians suggested that the following suite of wards, with the appropriate enablers in place, could be a starting point for a discussion about the future of NTW inpatient services Key Male Assessment Female Assessment PICU LD Functional Frail Male HDU Female HDU Moving On Organic Complex Care

32. Senior NTW clinical staff agree the co-location of certain “ward types” makes clinical sense Key Functional / Complex Services Male Assessment Female Assessment PICU LD Functional Frail Male HDU Female HDU Moving On Functional Frail / Organic Organic Complex Care

33. Option W (26 Wards) Male Assessment Male HDU Female Assessment Female HDU St Georges PICU Moving On LD Organic Functional Frail Complex Care Rose Lodge St Nicholas Monkwearmouth Hopewood Park

34. Option X (26 Wards) Male Assessment Male HDU Female Assessment Female HDU St Georges PICU Moving On LD Organic Functional Frail Complex Care Rose Lodge St Nicholas Monkwearmouth Hopewood Park

35. Option Y (26 Wards) Male Assessment Male HDU Female Assessment Female HDU St Georges PICU Moving On LD Organic Functional Frail Complex Care Rose Lodge St Nicholas Monkwearmouth Hopewood Park

36. Option Z (26 Wards) Male Assessment Male HDU Female Assessment Female HDU St Georges PICU Moving On LD Organic Functional Frail Complex Care Rose Lodge Monkwearmouth Hopewood Park

37. The travel issue… Across NTW it is not unusual for people to travel to the right inpatient services. Every patient is asked about travel for them and their carers/family on admission Wards have a number of resources available to help families and patients, including ward cars, access to information on grants for families etc. We are working on ways to ensure local staff can keep in touch without too much travel

38. The staff perspective • NTW does not anticipate making any compulsory redundancies as a result of this change • There will be separate staff consultations in due course • Affected staff will have access to TED – the Transitional Employment and Development Approach

39. Proposal for public involvement and consultation 2014 Phase 1 – FDP delivery schemes for 2014/15 • Newberry closure • Hebron closure • Newcastle dementia (castleside) • Greentrees - Interim • Rehabilitation South of Tyne (Brooke House and Elm House) • Rehabilitation North of Tyne (The Grange and Church View) Potentially interim

40. Proposal for public involvement and consultation 2014 Phase – Inpatient Beds Consultation • Options W, X, Y, Z • 6 local authority areas (NB South Tyneside TBC) • i.e. all adult and older peoples assessment and treatment beds, dementia and LD • Exclude rehabilitation beds

41. Proposal for public involvement and consultation 2014 Timing Preparation: December 2013 Phase 1: January – March 2014 Phase 2: Mid May – August 2014 Implement phase 1 from April 2014 Implement phase 2 from April 2015

42. Questions?