Improving Health and Wellbeing

Our Strategy

1.0     Foreword: By the Chair and Chief Executive

Our strategy explains how we intend to deliver our six strategic goals in the next five years.

It spells out how our objectives will lead to lasting changes on the ground, and the benefits that these will bring to our patients, carers and their families.

A successful organisation is one that recognises the need to regularly review and refresh its commitments and objectives. Our strategy seeks to achieve this aim by outlining the Trust’s strategic direction for the next five years. It takes into account feedback from key stakeholders and national healthcare targets set by NHS Improvement, the Department of Health and NHS England.

Our primary purpose is to improve the health and wellbeing of people in Hull, the East Riding of Yorkshire, Whitby and beyond. Our patients, their carers and families are therefore at the heart of everything we do. Our relationship with them is very important to us and we take our responsibilities to them extremely seriously. We will continue to act on their advice and ensure they play a key role in planning and delivering our services.

We know that to achieve our goals, we must give our staff the skills and opportunities they need to learn and grow by ensuring they benefit from our status as a teaching Trust and from our in-house and joint research. We are committed to working with our partners to ensure we achieve our main aim: to deliver the safest and best possible services in the right place, at the correct time and via our most appropriate staff.

Our transformation programme will complement the work overseen by our commissioners and outlined in our regional Sustainability and Transformation Plans (STPs).

We are working hard to improve the way we work in the knowledge that many of the changes we have introduced have not had enough time to take root. We will continue to do everything we can to deliver improvements with our most important asset: our hard-working, loyal and committed staff.

One of our most important aims is to ensure they have the skills they need to adapt to, and prosper in, a healthcare environment which must continue to change if it is to meet the increasingly complex needs of a growing and ageing population.

These skills will be essential if they are to achieve our ambitious goals which include the radical overhaul of our mental, health forensic and community services and the continued expansion of our primary care portfolio.

2.0     Our mission, vision and values

The way we deliver our services has a direct bearing on our patients and carers’ experience of the Trust and – most importantly of all – their health. It also affects the morale of our staff and their job satisfaction.

Our staff have been consulted on, and have agreed to, a new set of core Trust values; caring, learning and growing.

These values shape the behaviour of our staff and are the foundation of our determination to:

  • Foster a culture in which safe, high-quality care is tailored to each person’s needs and which guarantees their dignity and respect;
  • Achieve excellent results for people and communities;
  •  Improve expertise while stimulating innovation, raising morale and supporting good decision-making;
  •  Unify and focus our services on early intervention, recovery and rehabilitation;
  •  Engage with and listen to our patients, carers, families and partners so they can help shape the development and delivery of our healthcare;
  •  Work with accountability, integrity and honesty; nurture close and productive working relationships with other providers and our partners.

3.0     Our Trust, services and the people we serve

3.1 Our Trust

Awarded ‘foundation trust’ status in 2010, the Trust has grown and diversified over the past five years to provide health and social care. We work hard to ensure we are accountable and deliver the best possible services in a highly competitive market.

 

Our governance and management arrangements are robust and consist of a Council of Governors, Trust Board and Executive Management Team. They are supported by skilled medical, clinical and non-clinical staff.

We are regulated by NHS Improvement (NHSI), the organisation responsible for improving healthcare and ensuring NHS foundation trusts and NHS trusts are well led and can deliver high-quality, sustainable care.

The Care Quality Commission (CQC) assessed our services in 2016 and identified examples of good practice and areas requiring improvement. This feedback and subsequent evidence of clear improvement has helped us develop our strategy and transform services.

Most of the Trust’s income is generated through block contracts held with clinical commissioning groups in Hull, the East Riding of Yorkshire and Whitby. Our key contracts are renegotiated annually and their value is based on predicted activity. Our income exceeds £100 million and helps us deliver clinical services across a large geographical area which is predominantly rural and coastal.

We strive to be an open and transparent organisation which engages with and listens to our patients, carers and their families to ensure their experience of our services is as positive as possible.

3.2 Our services

We provide community, mental health, primary care and specialist services to almost 650,000 people.

Our services help children, young people, adults and older people, supporting their physical and mental health needs and the requirements of those living with a learning disability.

We operate across many sites and in a range of settings including a specialist forensic unit, community hospitals, inpatient mental health units, health centres, GP practices and people’s own homes.

Our workforce is trained to deliver services in new ways to ensure people can live independently for as long as possible in their homes. We provide care which is tailored to each person’s needs and which focuses on prevention, self-care, rehabilitation and recovery.

3.3 The people we serve


Assessments (Joint Strategic Needs Assessments and Health and Wellbeing Strategies) of the health and social care needs of the populations we serve show large variations in the levels of deprivation across Hull the East Riding and Whitby. Strikingly, some are among the top 25 per cent of the poorest areas in England. We understand the impact that deprivation has on physical and mental health and the link this has to social isolation, low employment rates and premature death.

The defining characteristics of the populations we serve are its:

  • Rurality: East Riding covers more than 1,000sq m and in Whitby 70.6 per cent of people live in rural areas, some of which are extremely rural and isolated;
  • Ageing and growing population: over the next 20 years in Hull, East Riding and Whitby more people will live longer and older people will therefore make up a larger proportion of the population. In these areas there will be more older people than in other parts of the country.

As well as the assessments, we also use information from the Department of Health to predict changes to the local population’s health needs. This supports the work we are doing with our staff, patients, carers, their families, our commissioners and other partners to redesign our services. The region’s key health data is displayed in the grid below (Source: Humber Coast and Vale Sustainability and Transformation Plan).

 There are also several significant national health and social care challenges. The number of older people is increasing and more people are living with complex health needs. There has been a notable rise in the number of people affected by mental ill health, particularly children and young people seeking access to crisis support, and older adults facing the difficulties of living with dementia. Meanwhile, lifestyle choices are having a huge impact on disease-related illnesses. Consequently, prevention and intervention initiatives designed to reduce gaps in health inequalities and support our most vulnerable communities are being rolled out.

3.4 People as partners

We will endeavour to address the challenges outlined above through our strategic goals and supporting objectives, and also by listening to our patients, their carers and families and responding positively to their feedback. We reviewed our Patient and Carer Experience Strategy following our CQC inspection last year. It now includes new commitments to make sure we put people at the centre of the way we design and deliver services by:

  •  giving patients and carers a key role in the recruitment of our staff and the reviews of our services;
  • capturing carers’ stories so we can learn from their experiences and provide them with the best possible support;
  •  developing patient and carer experience targets for all of our care groups so they become part of our day-to-day work and influence our relentless drive to improve the quality of our services.

These commitments will help us remain focused on the things that matter most to the people we serve and assist us to show we can use their feedback to deliver measurable improvements.

4.0     Our goals and objectives

We have identified six strategic goals, key objectives and supporting measures to achieve our ambitions and deliver key improvements. They are linked to government initiatives, regulatory findings and local health needs assessments based on discussions with STP representatives, patients, carers and families, staff, governors and partners.

Our headline strategic goals are in line with national requirements relating to improving quality and access, delivering transformation and securing finances. They are designed to tackle the challenges presented by an ageing population with changing health needs, including those linked with long-term conditions and triggered by lifestyle choices.

These challenges mean health and social care systems must change from the traditional ‘see, treat and discharge’ model to one which ‘identifies problems at an early stage and works with patients to tackle them via integrated services supported by shared technology and information’. 

Our six strategic goals, key objectives and supporting measures all have equal importance and are presented below:


 Goal 01     Innovating quality and patient safety


What we will do

We will:

  • Deliver high-quality, responsive care by strengthening our patient safety culture;
  •  Demonstrate that we listen, respond and learn;
  • Achieve excellent clinical practice and services;
  •  Capitalise on our research and development;
  • Exceed CQC and other regulatory requirements

How will we know we have achieved it

We will demonstrate:

  • An ‘outstanding’ CQC rating;
  • Timely access to safe services delivered by excellent clinical staff;
  • National recognition for best practice through specialist research and benchmarking.

Goal 02     Enhancing prevention, wellbeing and recovery


 What we will do

We will:

  • Ensure patients, carers and families play a key role in the planning and delivery of our services;
  • Empower people to work with us so they can manage their own health and social care needs;
  • Deliver responsive care that improves health and reduces health inequalities;
  • Develop an ambitious prevention and recovery strategy.

How will we know we have achieved it

There will be:

  • Pioneering innovation that promotes access, patient/carer engagement, empowerment, self-management and peer support;
  • A zero suicide death rate in our inpatient services;
  • A jointly managed transformation of services based on people’s needs;
  • Nationally recognised leadership demonstrated across all health and social care pathways.

 Goal 03     Fostering Integration, partnership and alliances


What we will do

We will:

  • Be a leader in delivering Sustainability and Transformation Partnership plans;
  • Foster innovation to develop new health and social care service delivery models;
  • Strive to maximise our research-based approach through education and teaching initiatives;
  • Build trusted alliances with voluntary, statutory/non-statutory agencies and the private sector.

How we will know we have achieved it

There will be:

  • System-wide solutions to long-term problems with our partners;
  • Recognition of the Trust as a world-class specialist education and teaching provider;
  • Joint ventures that enhance our ability to deliver excellent services.

Goal 04     Developing an effective and empowered workforce 

What we will do

We will:

  • Develop a healthy organisational culture;
  • Invest in teams to deliver clinically excellent and responsive services;
  • Enable transformation and organisational development through shared leadership.

How we will know we have achieved it

We will demonstrate:

  • Teams built around their members and which deliver services tailored to individual needs;
  • Staff who are nationally recognised as excellent leaders;
  • Motivated staff influencing decision-making and delivering change.

Goal 05     Maximising an efficient and sustainable organisation


What we will do

We will:

  • Be a flexible organisation that responds positively to business opportunities;
  • Be a leading provider of integrated services;
  • Exceed requirements set by NHS Improvement regarding financial sustainability;
  • Build state-of-the-art care facilities.

How we will know we have achieved it

We will be able to demonstrate:

  • Business growth that exceeds £30 million;
  • A physically and financially efficient business built on sound integrated models of care.

 Goal 06     Promoting people, communities and social values


 What we will do

We will:

  • Apply the principles outlined in the Social Value Act (2013);
  • Ensure our human resource priorities and services have a measurable social impact;
  • Improve recruitment and apprenticeship schemes and promote career opportunities;
  • ‘Make every contact count’ via an integrated approach designed to make communities healthier.

How will we know we have achieved it

There will be:

  • A robust social values policy implemented across the organisation;
  • Social impact measures as core performance measures for all services;
  • A clear demonstration of the social impact return on investment for apprenticeship schemes;
  • Reduced demand for services.

 It is important we monitor these objectives to make sure we deliver them. We will  identify methods of evaluation so we can regularly demonstrate and report on progress. Our Board will spearhead this approach by overseeing strategic performance management and will, of course, be closely engaged with processes designed to stimulate change.

5.0     Our staff

We employ people from many professions, including practising clinicians. Nurses are the largest professional group, followed by therapists, psychologists, medical staff, pharmacists, social workers and business, administration and support professionals. Our wider workforce includes volunteers, students and people on work placements.  As a teaching trust, we are proud to be in  a position where we can inspire and influence learners while promoting the organisation as a desirable place to work.

     

Our Workforce and Organisational Development Strategy outlines four key priorities which support our overall strategic goal of having ‘effective and empowered staff’.

We want to support our employees’ physical and mental health and give them values and skills so they can work across boundaries in new service models while maintaining excellent practices and standards.

 To work in a culture that increases opportunities for integration and allows health and social care teams to deliver services differently, we will ensure we employ, support and develop highly  skilled and trained staff to meet the individual needs of our patients, carers and their families.

 We are keen to ensure our values are embodied by our staff and to recruit and develop people who can share these principles and put them into practice. The Trust is determined to help its leaders and managers enable all staff, regardless of their professional status, to acquire the skills needed to work in our new models of care. Our staff are our greatest asset and employing the best people is one of our key objectives.

We know that good employment practice is the key to ensuring we meet our engagement and equality and diversity responsibilities. We ensure we achieve the best from people by valuing our differences and developing a workforce which represents all sections of society, the community it serves and the Trust’s values.

 We are committed to listening to our staff and regard this as a cornerstone of an open and transparent working culture. We provide regular opportunities for our staff to give us their views. We measure ourselves against the experience of staff in similar organisations and use case studies and guidance from NHS Employers and the Chartered Institute of Personnel and Development.

6.0     Our market position and sustainability

Competitive tendering is now an established part of the NHS, with competition increasing from public and private sector providers. We are seeking stronger relationships with partners including the   voluntary   and community sector, other healthcare organisations and the private sector. We believe we will deliver our commissioners’ requirements through collaborative working.

We recognise the need to protect and invest in our business and want to be regarded as a  leader  in the healthcare sector. Our  commercial strategy will provide a greater insight into market intelligence that defines how we respond to business opportunities.

We have already formed partnerships that link to our services and adopt the Sustainable Transformation Partnership (STP) principles of working together. For example, we are part of the Humber Transforming Care Partnership, which is working to deliver the right services for people with learning disabilities. We contribute to local Health and Wellbeing boards, listening to their feedback and making improvements when required. We  are working with other providers to support their transformation programmes, such as Hull City Council’s Transforming Adult Social Care plan, and are developing partnerships with MIND to deliver place-based care. These partnerships span our geographical areas and share a common aim to improve, transform and integrate services.

As an accountable organisation, we will still have our own plans and identity which will need to demonstrate that we can still deliver high-quality services with the resources available to us. 

We have several financial targets relating to: 

  • Delivering a financial plan that meets the target, known as the Control Total, set by our regulator, NHSI;
  • Ensuring our spending on agency staff meets NHSI’s targets;
  • Improving our annual financial position so we can reinvest in services;
  • Looking after our assets so we remain in good financial health;
  • Remain viable as a business able to operate in the future, one known as a ‘going concern’.

We are developing our own sustainability plan to support our approach in terms of:

  • Assumptions we have made to prepare for pay and price increases (inflation);
  • Expected levels of contract income for the services we provide;
  • Opportunities to expand our business;
  • Ensuring the Trust has enough cash;
  • Prioritising spending on technology so we can develop a flexible workforce and support new methods of delivering care;
  • Developing our buildings so they are fit for purpose, operate efficiently and meet the needs of our staff and the people we serve.

To achieve our plans, appropriate sources of investment funding are extremely important. Access to external sources of finance will be required but this could prove difficult if capital controls are introduced.

7.0    Our supporting plans

We have a robust business planning and performance management framework. This helps monitor the implementation of our Strategic Plan and is supported by enabling strategies developed across our operational and business teams. These documents describe key initiatives for implementation and link to measures that demonstrate which milestones have been achieved.

Our key supporting strategies are listed below.

Operational service plans have been produced by each care group. These are refreshed annually and are linked to staff personal appraisals to ensure corporate and personal objectives are aligned.

 

 

8.0     The future

This strategy takes into account national and local influences. The NHS faces significant financial pressure due to increased costs and rising demand. Unless action is taken, it is forecast that by 2020-21 there will be a £22bn gap between demand and the resources available. To ensure it is financially sustainable, the NHS must therefore save £22bn during the next four years. Achieving these savings will require a major overhaul of health and social care provision.

Of particular importance is the NHS Five-Year Forward View and the Five-Year Forward View for Mental Health and General Practice, the Carter Review and the CQC’s strategy developing a Single View of Quality (Shaping the Future). The NHS is committed to narrowing three gaps, or ‘Triple Aims’, relating to Health and WellbeingQuality of Care and Efficiency.

These changes will be delivered nationally through the 44 NHS STPs across the country. The STPs describe some initiatives that are already under way and others that are planned.

Our STPs cover wide geographical areas:

  • The Humber, Coast and Vale (HCV) STP supports North East Lincolnshire, North Lincolnshire, Hull, the East Riding of Yorkshire, the Vale of York, and Scarborough and Ryedale. The area delivers services to approximately 1.4 million
  • Whitby is part of the STP for Darlington, Durham Dales, Easington and Sedgefield, Hambleton, Richmondshire and WhitbyThe area delivers services to approximately 1.3 million people

The STPs provide further opportunities to align our vision and operations with those in their respective areas. Their main objectives are to address the Triple Aims. We understand the requirements and our strategy identifies areas of work that will help us play a key role in meeting them. Commissioners, local authorities, public and private health and social care providers are joining forces to implement  the STPs and their new, integrated models of care.

Both STPs have collated information from national patient surveys and local campaigns. Co-ordinators have also worked with Healthwatch groups and held many engagement events to give people an opportunity to voice their views and concerns about health and social care provision. They have also consulted the staff and teams who provide the services.

The HCV STP has identified challenges that require a collective response:

Health and wellbeing
  • Mortality - Standardised mortality is significantly worse than the national average. On average, the death rate of under 75 years is 153 per 100,000 population;
  • Prevention - Smoking, alcohol abuse and obesity rates are higher than the national average;
  • Cancer - is the leading cause of death in under 75s, killing over 4,000 people a year in the HCV patch, with lung cancer being the biggest contributor;
  • Mental Health  - 14 per cent of people aged 16-74 have mental health disorders;
Quality of Care
  • The Right Care - 40 per cent of A&E patients do not need any treatment. Up to 50 per cent of hospital beds are used by people who do not need to be there;
  • The Right Place -  27 per cent of people seen by GP's could have had their issue resolved in another way. 36.5 per cent of A&E patients went there because their GP practice was unavailable or closed;
  • The Right Time - Citizens will wait over four weeks to access some mental health services;
  • Elective Care - 51 per cent of patients said they could not have an appointment with thier GP on the day they wanted it;
Efficiency
  • Deficit - If partners in the Humber, Coast and Vale STP do nothing, there will be a deficit of £407 million by 2021;
  • Turnover - Annual turnover of the Humber, Coast and Vale STP footprint is £3 billion; 
  • Estates - Total running of £208 million, which includes estates which are not used to thier full capacity.

 

Their five headline themes are outlined below: 

 

The Whitby STP area has also identified challenges that require a collective response:

 

and their vision for 2020 is to deliver better outcomes for people based on the four key principles outlined below:

Our ultimate aim is to bring about transformational change that contributes to the delivery of both STP's ambitions.