Trust develops various programmes to improve quality and empower staff to deliver clinically excellent and responsive services, reducing staff turnover rate to 8.1 per cent

Synopsis:

The tireless support of staff ensured that we rapidly improved our CQC rating from “Requires Improvement” in 2016 to “Good” during our inspection in 2017; a rating that we maintained for our inspection in January 2019, which highlighted further improvements including:

• Safety on adult wards and PICU improved to “Good”.
• Mental Health Crisis improved to “good” for being safe and well-led.
• A clear vision and strategy of quality and patient safety with staff involved well in supporting and helping to direct developments.
• “Outstanding practice” highlighted in areas of patient engagement, self-harm and suicide prevention, SMASH and redesigning of acute pathways to reduce out of area transfers (S.E.1.1.1.1). Our success in driving sustainable improvements is attributable to our genuine commitment to:
• Putting patients at the centre of everything that we do through real patient and carer engagement that tangibly informs the way in which we provide care.
• Treating our staff with the respect and value that they deserve, empowering them to deliver clinically excellent and responsive services.
• Quality improvement as part of every staff member’s role to maximise patient safety across all of our services.
• A focus on providing the Right Care, in the Right Place, First Time, Every Time

Ambition:

We have seen significant improvements to the quality of our services, achieved at pace, despite challenges in relation to:

• High demand for services (See Supporting Evidence (S.E.1.1.1.2).
• Achieving our Financial Control Total in 2018/2019, improving our cash position from £8.6m to £11.2m and achieving 4.7% recurrent savings (£5.9m) through improved support provided to operational managers (S.E.1.2.).
• Reducing our staff turnover rate from 13.8% in 2017/2018 to just 8.1% in 2018/2019 (S.E.1.3.1.) in a geographical area where recruitment and retention represent a significant risk.
• Realising improvements in our Staff Survey results for 2018 (S.E.1.4.), indicating our renewed focus on our staff is having a positive effect.
• Progressing well to a fully embedded QI culture by 2020 (See S.E.1.5.). We are committed to continuing to face our challenges head-on to deliver our strategic vision, values and goals (S.E.1.6.), prioritising:
• A model of care that identifies problems at an early stage and works with patients to tackle them via integrated services.
• Financially sustainable services built on sound integrated models of care
• An effective, sustainable and affordable workforce that delivers high quality, safe, patient-centred care through a renewed focus on Organisational Development.
• Embedded QI Culture

Outcome:

• Co-produced Vision, Values and Strategic Goals act as the Golden Thread that passes from our Board to all staff via their Professional Development Reviews. This approach, introduced in 2017, has influenced our 2018 staff survey result; showing an increase in staff that feel the team they work in has a set of shared objectives (S.E.2.1.).
• Devolved process of financial planning, with frontline services embracing the Budget Reduction Scheme and recognising that budgeting is more inclusive (S.E.2.2.).
• Consistent achievement of performance targets, including IAPT access standards and recovery rates (S.E.2.3.1), EIP access standards (S.E.2.3.2) and Core 24 response times (S.E.2.3.3.).
• In the top five most improved trusts for increased seasonal flu vaccine uptake (S.E.2.4.).
• Development of a Community App to allow community staff to engage with colleagues and headquarters (S.E.2.5.1).
• Equality and Diversity Strategy that focuses on addressing low levels of representation across characteristic groups through engagement (S.E.2.5.2).
• A commitment to supporting staff through our Programme of Organisational Development (Proud) (S.E.2.5.3).
• Sharing good practice across teams through our Mental Health Practice Development Days (S.E.2.5.4).
• Introduction of daily Safety Huddles to ensure potential risks are identified and addressed (S.E.2.6.).
• System Leader for Humber Coast and Vale Health and Care Partnership (HCVHCP) (S.E.2.7.)

Spread:

• Mental Health Delivery (MHD) Board established to support the HCVHCP, for which the Trust is the system leader
• MHD Board is representative of all 28 partners within the HCVHCP, including NHS providers, commissioners and voluntary sector providers
• MHD Board also works closely with the NHS England Yorkshire and Humber Clinical Network Teams, NHS England Specialist Commissioning, the Academic Health Sciences Network, University of Hull and the National Institute of Clinical Excellence
• This network enables best practice to be shared across the region and improved engagement with clinicians and commissioners (S.E.3.1.)
• Always Events are being rolled out across Mental Health Services, allowing patients, carers and staff to decide what things should always happen in our services - empowering them to make the most important changes themselves rather than having them imposed from above
• Our Always Event lead was accepted onto the NHS England’s Always Event National Mentorship Course and completed her training in September 2018. She is now the mentor for the Lincolnshire Partnership NHS Foundation Trust and co-mentor for Sheffield Health and Social Care NHS Foundation Trust. In September, she presented at the London Always Events (S.E.3.2.).

Value:

Patient and carer experience is of the utmost importance and their input into service planning and delivery is essential to our success (S.E.4.1.1.). Our approach has led us to be chosen by NHS Improvement as national exemplar for PACE. We have achieved this through:

• Creating forums to engage and involve our patients, carers, staff and partner organisations in Trust activities, allowing us to hear lived experiences and what individuals think about our services
• 82% of teams have Staff Champions of Patient Experience
• The Trust’s Patient and Carer Experience (PACE) Strategy set us on a journey to make PACE the business of all Trust staff. Other ways patient experience influences service quality include:
• Friends and Family Test Interactive Dashboard that’s used across teams to share good practice and learn lessons (S.E.4.1.2)
• ‘Building our Priorities for 2019/20’ took place in January 2019 to gather patient, service user and carer views for Equality and Diversity objectives (S.E.4.1.3.)
• Suicide and self-harm training package co-produced by staff with patients and carers (S.E.4.1.4.). Service Initiatives designed to improve efficiency and reduce variation include:
• Humber Dialectical Behaviour Therapy Service (S.E.4.2.1)
• SMASH (S.E.4.2.2.) o Acute Care Pathway (S.E.4.2.3.)
• Primary Care Service in Secure Units (S.E.4.2.4)

Involvement:

Patients, carers and staff are involved in our vision via a number of our PACE forums (S.E.4.1.1.). The Trust Strategies and Operational Plans are co-produced with staff. Other ways staff are engaged include:

• Participation in the Staff Friends and Family Test. o Month Chief Executive Officer Blog/Vlog
• Midday Mail – Global email issued to all staff twice weekly
• Midweek Global – email issued to all staff
• Weekly “Headlines from the Executive Management Team” – updates to be provided via email to all staff each week (coming soon!).
• Visibility Programme – Programme of executive visits to all teams/units/services. To ensure our teams have the skills and confidence to take up the mantle of “shared leadership”, we have made a commitment to supporting our staff through our Programme of Organisational Development (Proud). It was developed in response to what our staff said in the staff surveys (S.E.5.2.).

It aims to:

• Recognise and enhance the skills of our staff
• Celebrate the strengths of individuals and teams
• Promote collaborative working
• Be solution focussed. Initiatives with other organisations include:
• Frequent Attenders Service (S.E.5.3.1.)
• Step-down Provision (S.E.5.3.2.)
• Crisis Pad (S.E.5.3.3.)