Annual report 2014

A summary of our annual report 2013/14

About annual reports and quality accounts This document is a summary version of both these documents - you can read the full versions on our website, or request a copy by calling 0800 587 2108.

We are legally required to produce both documents and we are happy to share them as widely as possible. Our full annual report and accounts provides an overview of the period 1 April 2013 to 31 March 2014 as well as statutory information such as the Trust‘s financial activities, management costs, performance targets and strategic direction.

Quality accounts are annual reports to the public from providers of NHS healthcare services about the quality of the services we provide. This report provides an overview of our quality achievements and challenges throughout 2013/2014, showing how we are meeting our regulatory requirements as well as trying to meet the expectations of all our stakeholders. It also outlines our quality priorities for the next year.

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Contents Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 - 7 About our Trust Our Trust Board Our mission and values Message from our chairman and chief executive Looking back to 2013/14 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 - 24 A year in our services Creative Minds Transformation Our values Our quality account Summary of financial accounts Looking forward to the next five years A sustainable organisation Funding Key support Commissioner plans How we will achieve our plans

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25 - 31

Your comments are welcome We hope you find this document interesting and easy to read. We’d love to hear what you think about it and anything else you’d like to see, so please let us have your comments via comms@swyt.nhs.uk or by calling 0800 587 2108.

Our website Our website has lots of information about our organisation and our services. This is where you can also find the full versions of our annual report, quality account and other documents about our performance. If you have problems accessing the internet and would like to receive information in the post, please just call us on 0800 587 2108.

Otherwise, log on to: www.southwestyorkshire.nhs.uk

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Welcome to our summary annual report:

an introduction

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About our Trust We are an NHS Foundation Trust providing a range of community, mental health and learning disability services to the people of Barnsley, Calderdale, Kirklees and Wakefield. We also provide some specialist medium secure services to the whole of Yorkshire and the Humber and wellbeing services to other districts.

We employ over 4700 staff.

To provide the flexible, individually tailored care that local people have told us they want, we work from a variety of sites as well as with people in their own homes. Our community based services are well supported by inpatient services for when people need care or assessment in a hospital setting.

Our Trust Board The Trust Board is our governing body and is responsible for setting the strategic direction of our organisation. It is made up of executive and non-executive directors. Executive directors are employed full-time by the Trust. Non-executive directors are local people whose wide range of experience and skills contribute to the effective management and accountability of the Trust.

They work closely with executive directors to ensure the Trust runs in an open and transparent way, providing high quality services that meet the needs of local people.

Our business is conducted through quarterly public meetings.

Full information about our Board, meeting dates and minutes are available on our website,

www.southwestyorkshire.nhs.uk Our mission and values

Our revised mission and values were launched in April 2013.

Our mission Enabling people to reach their potential and live well in their community.

Our values • Honest, open and transparent • Respectful • Person first and in the centre • Improve and be outstanding • Relevant today, ready for tomorrow • Families and carers matter

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A message from our chairman and chief executive Welcome to this summary version of the Trust’s annual report for the year 1 April 2013 to 31 March 2014.

When we began life as a newly authorised Foundation Trust, we changed the title of the Trust to include ‘partnership’. At the time, we knew working in partnership would be fundamental to our future success but 2013/14 was the year we began to fully appreciate how central partnership is to everything we do.

Partnerships Our most important partnership is with people who use our services, their families and carers.

Re-visiting our mission has helped us be clear about why we exist: to enable people to reach their potential and live well in their community. Having this clear mission is critical given that we are operating in challenging times. The economic recession coupled with a changing population, which sees the number of older people increasing, is placing the Trust and its services under considerable pressure.

Over 2013/14, it has become increasingly clear that we not only need partnerships with our service users and carers and our staff but with other providers, such as acute trusts, local authorities, community interest and social enterprise organisations, the voluntary sector and other broader partnerships with, for example, housing, education and the police.

This year has seen the development of a number of such partnerships with the aim of developing a sustainable future for the whole health and social care system, not just that of the individual organisations that make up its constituent parts.

Our staff Throughout the year we have been privileged to meet with a range of staff and witness first-hand the excellent work they do. Their drive, passion and commitment is heartening.

The NHS often comes in for criticism, which we have seen in the media over the past year.

What often goes unreported is the fantastic work people do on a day-to-day basis and the real difference this makes to people’s lives. It is not surprising that, when surveyed, the general public cites the NHS as the main organisation that makes this country great. We play a small part in this, but whatever we achieve is based on the loyalty, hard work and endeavour of our staff, working in partnership with service users and carers.

Our achievements This year has been a demanding one, but we would like to highlight a number of our activities.

• We have transformed our forensic estate on the Fieldhead site in Wakefield, with an emphasis on recovery (read more on page 13).

• We’ve seen continued development of our telehealth and telemedicine services.

• We have developed our specialist services for stroke and neurological rehabilitation with the move of the service to Kendray hospital in Barnsley.

• We have continued to develop innovative approaches to the management of long-term conditions, with an emphasis on co-production with service users and their families.

• Recovery is a central part of our services and we continue to develop services and activities that work in a complementary way to mainstream services, including Creative Minds and Altogether Better.

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• We are moving from a maintenance model to one of self-care and empowerment for service users through the development of recovery colleges.

• Child and adolescent mental health services are now provided across the Trust and this creates opportunity for the future, particularly in enhancing the quality of the service we provide.

• We have worked in partnership with acute services to develop liaison services for people accessing accident and emergency services with mental health problems.

Transforming our services Given the capacity and economic challenges we face, remaining as we are is not an option. What we need to do is revise our service offer guided by our mission. Over the past year, we have continued to engage with key stakeholders, service users and carers, and our staff with a view to establishing the vision and key principles to underpin our services. During 2013/14, we developed the vision for services in mental health, general community, forensic and learning disability services. This has been achieved through a process of partnership working with clinical staff and managers engaging with service users and carers.

The future 2013/14 has been a ‘year of discussion’ where the Trust has had a critical look at where we are and where we want to be in the future. The transformation programme looks forward and 2014/15 will, therefore, have a greater emphasis on delivering the visions in all areas and will be characterised by two key elements – our values and delivery.

In terms of delivery, this means making the necessary changes to services to build a successful future, aligned to the transformation work led by commissioning bodies to ensure the Trust is playing a key role within partnerships and the wider health and social care economy.

It will not be good enough just to make changes to our services; what is equally important is how the changes are made, which is why working to our values is so crucial. This is why, during 2014/15 we are committed to focussing on how we live our values, and the ‘our values’ programme of work is helping us do this.

We certainly face significant challenges going forward, but we have a strong platform to work from, built on a track record of achievement, putting service users at the heart of everything we do. We know we do not always get this right but we continue to learn from the times we do not.

We remain confident that we have a strong future and we can enable people to reach their potential and live well in their community.

Steven Michael OBE Chief executive

Ian Black Chair

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Looking back to 2013/2014 A year in our services

In a typical month we provide c are, advice or treatment to 36,000 people across our local communities We do this in a variety of ways - from advice on wellbeing to prevent ill-health, care in people’s homes and in community settings, to care in hospital. These pages are just a snapshot of some of the work that took place in each of our areas in 2013/14.

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Barnsley Stroke rehabilitation unit opens The new unit in Barnsley was officially opened by the Mayor of Barnsley Cllr Ken Richardson and his wife Mrs Nadia Richardson.

The unit was an investment of just under £2 million in local services, relocating from Mount Vernon Hospital to Kendray Hospital. The move meant care for stroke patients could be enhanced by offering new and innovative technology. Some of the new facilities on the unit include overhead hoists in each of the 16 bedrooms, en-suite bathrooms and a large physiotherapy area to help the rehabilitation of patients.

Sean Rayner, district director said, “This is not just about what we do, it’s also about how we do it. Our committed and dedicated teams and the brilliant new facilities on the unit go hand in hand. People on the unit receive fantastic quality care which is a real credit to our staff.”

Reel lives, real voices - film premiere A series of short films that feature over 50 Barnsley people were premiered by the Trust at a special event; the ‘Changing Lives’ film premiere. The Trust is committed to helping people find out and learn more about what we do in a range of ways. Information can be made available in a variety of formats and, with advancing digital technology, the use of film is becoming increasingly popular as a cost-effective and valuable way to communicate. The event launched films for both Barnsley therapy services and the care navigation and telehealth service.

You can view the films at www.youtube.com/swypft

To view our films, visit the Trust website at www.swyt.co/films or go straight to our YouTube channel: www.youtube.com/swypft

Swap with me event was an “eye-opener” Events that helped people have a greater understanding of sight loss issues when using buses took place in South Yorkshire. Swap with me events have been held in partnership with Stagecoach and FirstBus company, local sight loss organisations and the Trust’s Barnsley equipment, adaptations and sensory impairment service. The event let bus drivers and operators swap places with their blind and partially sighted customers, so they could really understand why organisations are calling for accessibility improvements.

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Calderdale Recognising excellent care in memory services Calderdale’s memory service was recognised by the Royal College of Psychiatrists for the care they provide to people with memory problems or dementia and their families.

The service applied for the Memory Services National Accreditation Programme (MSNAP), which works with services to assure and improve the quality of memory services. Beginning the journey to accreditation in 2013, the service and all staff involved have worked to demonstrate how they meet the standards required.

Five ways to wellbeing The health improvement service in Calderdale launched the five ways to wellbeing campaign to help people of all ages and backgrounds in Calderdale boost their physical and mental wellbeing. The five ways to wellbeing are a set of realistic, achievable actions that anyone can adopt in day to day activities to help boost your wellbeing and feelings of wellness.

Gym boost for Elmdale Ward Inpatients on the Elmdale Ward at The Dales in Halifax have benefitted from access to a state of the art gym. Individuals are encouraged to use the facility as an additional form of exercise and activity to aid their recovery. The occupational therapy team offer one to one sessions in the gym so that they can monitor safe and effective use. They look at the current physical abilities of individual service users and work with them to establish goals with a matched programme of activity.

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Kirklees The power of reading An exciting partnership between Pathways Day Service and Mirfield library resulted in the development of a regular bibliotherapy bookchat group being set up for those who access mental health services in Kirklees. John Butler, service manager explained, “It is widely recognised that creative activities, such as reading are beneficial for people. The library also offers a welcoming and relaxing environment, giving people the opportunity to mix with others in their local community.”

Splash of colour for Dewsbury wards Following the renovation of the Priestley Unit at Dewsbury and District Hospital a project group was set up to produce artwork to add some colour to the walls. The Priestley Unit includes adult acute and older people’s services. Through the activities programme on Ward 18 some inspirational work has been created using methods including media, photography, painting, drawing and woodwork.

Good Mood rugby league kicks off A new initiative was launched to encourage people who use Trust services in Kirklees, as well as members of the local community, to take part in physical activity. The initiative saw the Trust joining sides with Huddersfield Giants Community Trust to launch the Good Mood rugby league.

Mark Wisbey, Creative Minds co-ordinator said, “Getting involved in physical exercise has both psychological and physical benefits. It’s also a great opportunity to raise awareness of mental health issues and reduce stigma as people from different backgrounds were brought together while playing the game.” This initiative compliments the Good Mood football league which has been running successfully for some time.

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Wakefield Programme re-launched A programme which is part of the Trust’s health and wellbeing service in Wakefield, that helps people who have an ongoing illness or condition was re-launched.

The Wakefield Expert Patient Programme (EPP) is a self-management programme designed to give people more control by teaching new skills for managing and improving their health. To help local people and professionals find out more a series of short films have been made. Lynn Daniel, EPP co-ordinator who also told her personal health story on film, explained, “The films powerfully convey the difference that our tools and techniques can make to day-to-day lives.

By sharing our experiences we hope it will lead other local people to an EPP course so they too can discover the fantastic life-changing benefits it can offer.”

Find out more at www.WakefieldEPP.co.uk

Relaxation rooms Two relaxation rooms, located on Trinity and Priory units at Fieldhead, have helped to boost wellbeing and improve mental health. The rooms have a variety of sensory and relaxation equipment and are designed to offer a quiet and stress-free space away from the wards.

Therapeutic labyrinth A therapeutic labyrinth opened at Fieldhead in Wakefield so that all visitors to the site can benefit from the alternative therapeutic activity. A labyrinth is a pattern with a single winding path that leads from the entrance to the centre. Rev Mike Gartland, head of pastoral and spiritual care, said, “The process of walking a labyrinth is based on the idea of the journey of life and although the path twists and sometimes appears to go backwards, it eventually takes us to our goal. Our labyrinth is used for reflection, contemplation, meditation, concentration and focus.”

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Forensic Cricket coaching for service users Yorkshire County Cricket Club provided a 10-week course of cricket coaching to people who use our forensic services.

The cricket sessions were just one of the external sports sessions set up after service users on the Newhaven advocacy group came up with the idea. Occupational therapist Anthony Pickering said, “It’s great that we’ve been able to work with the cricket club to deliver new experiences that can lead onto future opportunities. The sessions have helped improve physical health as well as social and emotional wellbeing.”

Sharing opportunities to work in forensic LD services To raise awareness amongst student learning disability (LD) nurses of the care services for people in a forensic setting, an open day was held for students at universities in York and Huddersfield.

Students were invited to explore the Appleton and Chippendale wards at Newton Lodge and find out about different staff roles. Anne Todd, advanced nurse practitioner explained, “The open days were a really positive experience for the students as not only did they have the opportunity to explore the environment in which we care for people, but they also got to a meet a number of service users – who were happy to talk and show the students around.”

£15m redevelopment complete For the last three years the Trust has been carrying out a £15 million redevelopment of Newton Lodge which provides mental health care in a medium secure environment.

The development of a £4.8 million activity centre was a key part of the scheme and features a full size sports hall, gym, art room, workshops and a music room. A primary healthcare suite is also included which boasts treatment and consulting rooms as well as a dental suite. This means people in Newton Lodge can get exactly the same standard of NHS care as the rest of the country, but within a medium secure environment. To view a film of the unit as well as a photo gallery visit www.southwestyorkshire.nhs.uk/newton-lodge

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Specialist services Cook and Eat We launched our Cook and Eat books to a crowd of over 200 at Pennine Camphill Community, where people had the opportunity to taste a recipe, watch people cooking, and see a film highlighting why and how the books were made. The Cook and Eat books have been created to help people with learning disabilities cook independently, with little assistance from others. The books were created by an occupational therapist, in partnership with people with learning disabilities. Find out more at www.cookandeatmeals.co.uk

Forensic CAMHS Our Forensic Child & Adolescent Mental Health Service (CAMHS) attended a prestigious conference in Edinburgh to share their good practice at a workshop they facilitated.

Service manager and clinical nurse specialist Paula Phillips has since been shortlisted for several national awards; well done Paula!

Excellence 2013 To recognise and celebrate the enormous contribution staff make to the running of the Trust and to the lives of local people, we held our Excellence awards in November 2013. Ian Black, the Trust’s Chairman, hosted the awards and said “Excellence gave us an opportunity to celebrate the extraordinary work that our staff do every day.”

The Wakefield health and wellbeing development worker team won the overall ‘winners of winners’ award with their Knit-a-thon challenge.

In 2014/15 our awards programme is focusing on how staff live our values.

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We established Creative Minds three years ago and it has gone from strength-to-strength during this time. We formally launched Creative Minds late in 2011 to show our commitment to fostering and developing a creative approach to delivering our services.

Creative Minds challenges the traditional way health services are provided as well as building and supporting a community of people committed to developing creative approaches. It also exemplifies our partnership approach to helping people reach their full potential in a way that best suits them in the very heart of our local communities.

Working in partnership with other organisations and groups means we are able to offer a wide range of innovative wellbeing opportunities.

During the year, we began a review of Creative Minds with the aim to ensure that its alternative approaches are incorporated into the core business of the Trust. The future includes development of a Creative Minds Academy, which will provide the infrastructure to implement the ethos into our service delivery across the Trust.

Creative Minds is altering perceptions of how we deliver our services and has started to extend our service pathways. Throughout the coming year, we will develop a business case to put Creative Minds on a more sustainable footing so it can continue to grow and develop.

Creative Minds is about the use of creative approaches and activities in healthcare; increasing self-esteem, providing a sense of purpose, developing social skills, helping community integration and improving quality of life.

For more information on our innovative approach and the many projects and organisations we have supported, visit our website where you can also view a number of films which demonstrate the value of Creative Minds and showcase many of our community partners.

• www.creativemindsuk.com • creativeminds@swyt.nhs.uk • 01924 328656 15

Transforming our services Part of our strategic approach in 2013/14 was to lay the foundations for the transformation of our services in mental health, general community, forensic and learning disability services across all our districts. This reflects the need to make some radical changes to the way we deliver services.

During 2013/14, we held a number of engagement events with people who use our services, carers, staff, partners and stakeholders.

The key themes from these events have influenced and informed our vision for services to ensure that: • we provide services that keep service users at the centre and which focus on people’s potential • if people choose to make use of technology, we need to make it available • all organisations, both big and small, should work together so that the joins cannot be seen • people recognise early on if someone is having problems so that we can provide help and support • we offer as much choice as possible and help people to understand those choices • we support families and carers.

Building on these themes and based on our values and priorities, clinicians and support staff working together have created high level visions for our services. These include: • care closer to home • supporting people to live independently in their own homes rather than living in institutional settings in the Trust or in private sector placements • improved outcomes for people with long-term conditions, both in mental health and general community services • supporting people to be more in control through the use of technology • establishing recovery colleges, which offer more creative approaches to recovery through education, confidence-building and participation • increased emphasis on self-directed support, self-care and prevention of ill-health • building alternative capacity through links to social networks, community groups and peer support • use of lean principles across all services, improved community locations and increased agile working.

During the summer of 2013, we talked to over 450 people about their opinions and ideas and what is important to them

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Our values • Honest, open and transparent • Respectful • Person first and in the centre • Improve and be outstanding • Relevant today, ready for tomorrow • Families and carers matter

All that we do is underpinned by our values Our new values were launched in April 2013 and have led to 2014/15 being the year that will see the embedding of these values throughout the organisation. We will do this via the ‘Our values’ programme, a festival of learning and reflective opportunities, events and resources to enable staff to engage, or re-engage with the Trust’s values through our period of transformational change.

In July 2013, the Trust achieved accreditation against the Customer Service Excellence standard, the first Trust in Yorkshire and the Humber to achieve the award and the third in the country.

Earlier in the year, we also held a number of ‘Right First Time, Every Time’ events. These events asked staff who first meet, interact and help people who use Trust services to walk in their shoes in order to re-think the approaches, attitudes and processes applied in our everyday interactions.

This is how we can create the right impression of the Trust, first time, every time.

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Quality counts - a summary of our Quality Account 2013/14 We are committed to making information about the quality of our services easily available so that anyone who is interested in our work can take a closer look. This encourages debate and reflection; something we very much welcome.

What is a Quality Account?

Quality accounts are annual reports to the public from providers of NHS healthcare services about the quality of the services we provide. The full account provides an overview of our quality achievements and challenges throughout 2013/2014, showing how we are meeting our regulatory requirements as well as trying to meet the expectations of all our stakeholders.

The full account is available on our website www.southwestyorkshire.nhs.uk or you can request a copy by calling 0800 587 2108.

Towards the end of 2012-13 we worked with service users, carers, partners and colleagues across the Trust to define our priorities for the year 2013-14; together we identified seven key quality priorities.

Throughout 2013-14 we measured how we were doing on each of these priorities and reported them to our board of directors. On the following pages we take a look at just a couple of examples of improvements under each of these priorities during 2013-14. These are just a small glimpse into the continuous improvements we aim to make and a snapshot of the quality of our services – you can read more in the full report.

Priority 1: Listen and act – the people who use our services are central to everything we do

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During 2013-14 we have continued to gather feedback from people who use our services. We have monitored key performance indicators and also analysed other feedback. We have been achieving all our patient experience goals, with the exception of the inpatient survey where satisfaction scores are slightly lower and we continue to work in this area.

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We asked carers to complete a questionnaire about care planning. Nearly 75% of respondents had been given information about the assessed needs of the person they cared for, 87% knew how to contact the care co-ordinator, 83% felt listened to by staff and 96% felt staff showed them consideration.

• A carer’s forum has been set up on a Kirklees ward to obtain feedback and help improve services. The forum meets every two months and attracts around 30 carers.

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Priority 2: Timely access to services

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It is essential that people can access the most appropriate service to meet their needs, in a timely way. We have seen that we are good at gatekeeping admissions to our mental health inpatient bed, treating people within 18 weeks of assessment (Barnsley), seeing people who are referred for psychological therapies within 14 days of referral (Calderdale, Kirklees and Wakefield) and seeing people for treatment within 6 weeks of a face to face contact (Barnsley). We need to make improvements in improving access for people with mental health problems.

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In Wakefield, Kirklees and Calderdale we have developed new services in partnership with acute care hospitals. This ensures that hospital inpatients with mental health problems receive timely 24hour access to specialist support and appropriate pathways of care.

• In 2013 the Stroke Rehabilitation Unit was relocated from Mount Vernon Hospital to Kendray Hospital. The move was evaluated positively by patients in terms of both satisfaction and effectiveness. Read more on page 9.

Priority 3: Care and care planning

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In all our services, care planning is fundamental to providing the right support.

81.4% of people were recorded as being offered a copy of their care plan but we would like this to be higher. That’s why we carried out pilot training sessions on care co-ordination competencies and this will now be rolled out Trustwide.

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We are part of Implementing Recovery through Organisational Change (IMROC) and this will bring many benefits to our organisation. It recognises that each person is a unique individual who has a unique view on what living well means to them. Our role is to help people gain greater control and responsibility for their future; fundamental to care planning.

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We must make sure we are meeting people’s needs by delivering services that are outcomes focused. Throughout 2013-14 we participated in a national pilot to determine a universal outcome tool that could be used as a measure for mental health currency and payment.

Priority 4: Improve the recording and evaluation of care

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As part of our approach to quality we have adopted the practice of holding “Quality Forums”. The aim is to build motivation against a specific topic, focusing on people’s key priorities and personal responsibilities. The first Quality Forum was held in December 2013 and focused on clinical record keeping.

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Clinical records are among the most basic of tools which are used in almost every consultation, providing an accurate picture of the care and treatment given to an individual. In May 2013 a Trustwide record keeping (task and finish) group was established and delivered against all their objectives, developing nine standards for generic use across all professional groups with a Trustwide audit taking place in February 2014.

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Our internal auditors (KPMG) have undertaken two clinical record keeping/data quality audits throughout 2013-14. The latest audit (March 2014) recognises the progress we have made in this area and acknowledges that we have clear plans in place for improvement to continue.

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Priority 5: Transitions across pathways

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We monitor the number of Delayed Transfers of Care (DToC) in our bed based services and throughout 2013-14 we consistently achieved our targets. We have also worked with our partners to develop a Standard Operating Procedure: Minimising Delayed Transfers of Care that sets the expectations for clinical practice.

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Our Creative Minds programme continues to promote partnerships with services in the community. One example of this is equine therapy, a partnership between the Trust and Wakefield Riding for the Disabled. Feedback from the first programme was extremely positive both in terms of participant comments and facilitator impact.

Priority 6: Ensure that our staff are professionally, physically and mentally fit to undertake their duties

• In April 2013 we introduced a new system to appraise our staff which is based on the values of our organisation; ensuring that the attitudes and behaviours of our employees match Trust and service user expectations. Almost 100% of Trust staff have been appraised using the new values-based system since its launch (over 4,000 individuals).

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Every year we take part in a national staff survey. Our overall score has increased by 0.9 between 2011 and 2013 surveys, and an increase of 0.5 reflecting an upwards trend in how our staff feel able to contribute to improvements at work, that they are willing to recommend us as a place to work or receive treatment and that they feel motivated and engaged. Our wellbeing at work partnership group continue to oversee our staff survey action plan.

Priority 7: Improve the safety of our service users, carers, staff and visitors

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Never events are defined as ‘serious, largely preventable patient safety incidents that should not occur if the available preventative measures have been implemented by healthcare providers.’ During 2013-14 there have not been any ‘never’ events.

• Throughout the year we monitored the effectiveness of our medicines management system. 100% of our medication errors have been reviewed by relevant clinical and managerial senior staff and appropriate action taken.

•

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We have also monitored the effectiveness of our safeguarding reporting system and, again, 100% of incidents were reviewed and appropriate action taken. A strategic safeguarding group was established in 2013 to provide strategic oversight to compliance requirements. This group will ensure effective monitoring as well as providing an expert advisory function to help ensure effective outcomes for children, young people, adults and families.

2014/2015 Priorities for improvement We needed to set our priorities for the coming year and so, in February and March 2014 we once again consulted with our partners, staff and people who use our services on quality priorities for 2014 - 15. We asked them to review our 2013 - 14 quality priorities and comment on their relevance for 2014 -15. We also asked what actions people thought we should focus on. We are grateful for the feedback we received and we used it to plan for 2014 - 15.

Our priorities have been confirmed as:

Priority 1: Listen to our service users and carers and act on their feedback

Listen and act on service user feedback, with the aim of making demonstrable

improvements to our services.

Priority 2: Timely access to services

Improve the access times for people who are referred into our services to ensure the

right support from the right service at the right time.

Priority 3: Improve care and care planning

Ensure that each service user has appropriate assessment, care plans and treatment

options to enable them to achieve their goals

Priority 4: Improve the recording and evaluation of care

Ensure each intervention is accurately recorded in a timely manner so that there is

appropriate communication across the care team.

Priority 5: Improve transfers of care by working in partnership across the care pathway

Ensure service users who are ready to move along the care pathway are supported

across service boundaries in a timely way or those services that are seeing the same

person communicate effectively to prevent duplication or gaps in service provision.

Priority 6: Ensure that our staff are professionally, physically and mentally fit to undertake their duties

To ensure we have appropriately qualified, skilled, competent and professional staff

to undertake the role that they are required to do and to support their health and wellbeing.

Priority 7: Improve the safety of our service users, carers, staff and visitors

To ensure that the people who work with us and visit us are safe from harm

Do you want to read our full Quality Account?

A full version of our 60 page Quality Account is available on our website:

www.southwestyorkshire.nhs.uk You can also request a copy by calling us on

0800 587 2108

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Summary of our annual accounts On these pages you can read more about our finances throughout 2013/14. We realise this information is complex - if you have any questions or would like further assistance or information, please just get in touch with us and we’ll be happy to help. Contact details are on page 3.

There has been one significant transaction during the financial year 2013/14 in relation to Trust Board approval of the transfer of estate and buildings from NHS Barnsley to the Trust on 1 April 2013, these relate to our provision of community and mental health services in Barnsley. A review of the transaction was undertaken by Monitor, the independent regulator, which supported the Trust Board’s decision.

Overview of our financial performance Most of the money given to us is a fixed payment; however, 2.5% of our income (so in 2013/14 that was £4.7 million) is only given to us if we achieve certain key quality indicators (targets).

In 2013/14, the Trust had an annual income of £235.4 million and an overall surplus of £3.75 million for the year.

This surplus equates to 1.6% of our income.

In 2013/14, the Trust achieved 88% of these targets.

Of the total income, 83% comes from healthcare contracts with local healthcare commissioners and 10% is from local authorities.

You can view where we get our money from (income) and where we spend it (expenditure) in the table opposite.

If you would like to view our full accounts, please visit our website and you will find them in the full version of our annual report.

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Income & expenditure performance for 2013/14 2012/13 Full Year £k

2013/14 Full Year £k

Income from activities

219,300

220,093

Other operating income

13,146

15,353

Total income

232,446

235,446

Operating expenses

224,981

230,253

Interest received

374

88

Public dividend

1,538

1,529

Asset impairment

256

2,833

Surplus

6,045

3,752

LESS

Capital expenditure and our estates In 2013/14 our budget for buildings and assets (which is classified as capital expenditure) was £8.99 million but we actually spent £8.77 million.

This programme delivered a number of notable schemes, including the start of work on the Fieldhead site in Wakefield to ensure its infrastructure can support future service developments, the start of improvements to inpatient areas, continued work on the Trust’s medium secure services (see page 13) and the purchase of Laura Mitchell House in Halifax to create a community hub for Trust services in Calderdale.

The Trust planned and maintained a healthy cash balance throughout the year with an average balance of £33million. These cash funds have been built up over time to fund future investment in estates and technology which are key to providing sustainable services.

Our savings We need to ensure we make savings so we can contribute to the overall savings target of the NHS and remain a sustainable organisation. The Trust achieved a savings target of £8.4 million during the year. This includes a shortfall of £1.80 million against the original savings programme, which was offset by £1.50 million met through replacement schemes.

Did you know?

The Trust has targets for how quickly we pay invoices - these are known as the Better Payment Practice Code and the CBI Prompt Payment Code.

In 2013/14 we met these targets as we paid over 95% of valid invoices within 30 days for non-NHS invoices and paid 92% on NHS invoices within 30 days. We also made sure that 75% of local suppliers were paid within ten days.

Monitor’s financial score for us in 2013/14 Monitor is our regulator and they keep a close eye on our finances. They score our financial performance on a scale known as the Continuity of Service Risk Rating. The score in the Annual Plan was 4; the score achieved was 4.

The maximum score achievable is 4 and is planned to be 4 going forwards.

Did we need to use our overdraft?

The Trust’s cash balance during the year was sufficient to meet our operational and capital outgoings so we did not use an overdraft facility.

We do have an overdraft arrangement with a commercial bank which would allow us up to £9.2 million should we ever need cash to meet our obligations. Our long-term financial plan shows that the Trust has sufficient cash to fund all our outgoings without using this facility.

Recording investment property Buildings and estate that the Trust no longer needs is recorded as investment property and its value is updated annually to the current market value. As at 31 March 2014 these assets were Aberford Field, Southmoor and Hyde Park.

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Our financial future The key issues for the Trust which will impact on future financial viability include: •

The continuing impact of reduced levels of funding for public sector services caused by the economic downturn both in health and social care.

•

Creating further efficiencies and productivity gains in current service models will not be enough to meet the ongoing challenge. We must undertake transformational change in services to deliver different service models which maintain quality at reduced cost.

We need to continue to make ongoing efficiency savings of 4% to 5% for the foreseeable future.

• Work with commissioners (Clinical Commissioning Groups) and other providers to create sustainable pathways of care across providers which are patient centred, offer good outcomes and value for money.

• Sustained improvement in clinical record keeping and data quality to ensure clinical IT systems support evidence of good quality care and value for money through the introduction of Payment By results for mental health services.

The Trust continues to work in partnership with key stakeholders to develop a joint approach to delivering improved quality, innovation and productivity in services and prevention of ill health and to make best use of resources in a period of significant economic challenge. Our partnerships include Clinical Commissioning Groups, local authorities and other NHS and non-NHS providers including social enterprises.

The Trust has developed an internal transformation programme with key workstreams in mental health, forensic services, learning disability and community and wellbeing services.

Read more on page 16. Transformation aims to improve outcomes, deliver improved services and achieve best use of resources.

In 2014/15, our overall cost improvement requirement is £12.9 million and, in 2015/16, it is £11.8 million. To reduce recurrent expenditure to meet this requirement, we will have both a cost improvement programme and a transformation programme.

In 2014/15, £500,000 of the overall cost improvement programme will be met through the transformation programme, and in 2015/16 at least £4.85 million (41%) will be achieved through transformation.

The Estates Strategy approved by the Trust Board remains the strategic framework for the capital plan in the coming year and specifically focuses on: • development of community infrastructure; • development of inpatient estate linked to acute care pathway; • ensuring compliance with national standards and the requirements of our regulators; and • disposal of surplus estate.

The capital programme is aligned to the Trust’s long-term financial plan and provides for capital expenditure of £11.8 million in 2014/15 and £7.4 million in 2015/16. All new capital developments will be designed to support service transformation and will be based on agile working principles supported by greater use of information management and technology.

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Looking forward to the next five years

In June 2014, our Trust Board agreed a five year plan – setting out what we will achieve and by when. Our plans keep our mission and values central, read our mission and values on page 5.

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A sustainable organisation Our mission and values underpin all we do. As a partnership organisation we work together with people who use our services, and those who care for them, to ensure we take account of the things that are important to them to maintain and improve their health and wellbeing. Our plans are influenced by ongoing engagement with local communities and by the service offer they have told us will best meet their needs. Over the past year, six themes have emerged which underpin our plans: • Services that keep the person in the centre and focus on their potential • Making technology available to those who choose to make use of it • All organisations, both big and small, working together so that individuals don’t see the joins • Recognising early on if someone is having problems and helping them • Offering as much choice as possible to an individual and helping them understand those choices • Supporting family and carers Our Board has formally declared that, so long as we follow our plans, our organisation will be clinically, operationally and financially sustainable (able to carry on) for the next five years.

However, we are working in challenging times. The needs of our communities are changing and finances are shrinking. So, to ensure our organisation can continue (is sustainable) at the end of the next five years we need to make some changes.

We must reshape what we do, how we do it and what it costs, by looking at our workforce, service models and infrastructure over the next two years – this is our transformation programme. By the third year we believe we will then be in a strong position to use our resources differently, in particular building on our work around recovery and the success of our Creative Minds initiative, see page 15.

After three years – to help guarantee our sustainability – we believe we will need to develop core NHS services across a wider geographical area eg. West Yorkshire or Yorkshire and Humber for specialist services. This would help to reduce back office costs but also ensure local services can continue to respond to local needs and promote self-care, support and recovery for local people.

All this would mean that, by the time five years has passed, we anticipate that the Trust would cover a larger area, focussing on the provision of specialist mental health and community services.

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Funding Where does our money currently come from?

Other activities 0.6% Other operating income 6.5% Local Authorities 9.8% CCGs and NHSE 83%

•

• • •

83% of our income comes from Clinical Commissioning Groups (CCGs) and NHS England (NHSE) contracts 10% is from Local Authority contracts Less than 1% relates to activities undertaken for other NHS organisations 6.5% ‘other operating income’ includes education and training and research and development.

This breaks down across our different service areas like this:

Learning disabilities 5% Forensics 11% Community services 24% Mental health 60%

Mental health includes CAMHS, older peoples, adult acute and community, rehabilitation and recovery.

Community services include community nursing and therapies, long term conditions, intermediate care and health and wellbeing services.

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How do we spend our money?

Capital 3% Non pay 8.5% Quality Academy 17% Direct costs 71.5%

• Direct costs include clinical and support staff involved in direct service provision, agency and bank staff costs, other pay costs • Non-pay costs include drugs, supplies, sub-contracted services, travel and vehicle costs, utilities and property costs • The Quality Academy is the way we describe all our non-clinical support services (eg. human resources, finance, information technology) • Capital charges include depreciation costs

Our future costs We know that the next five years are going to be more challenging. The difficult financial climate is heightened by an increase in the number of people requiring support as well as an increase in expectations.

We therefore need to reduce our costs and deliver significant efficiencies through changes to services, increased productivity and changes in the skill mix of our staff. At the point when other parts of the social care and health sector are being squeezed we will prioritise our efforts on those people who require the service the most whilst looking for creative alternatives to support community and individual resilience.

Our financial plan is complex but ambitious. It sets out to reduce what we spend over the next three years to provide a strong base for future growth. To do this we need to make cost improvement savings of 5% as well as cope with the impact of 7 day working and investment in technology. After that point we are unlikely to find any more savings internally. However, if we then take on new services across a larger area we expect our support services to be able to work more efficiently to release savings whilst also providing us with greater resilience and the capacity to respond to and effectively engage with our stakeholders.

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Key support for the next five years There are some key areas of support we need to get right to help support our plans and deliver them. Here’s a brief overview.

Estates Our estates strategy ensures that we are using the properties we own and occupy to the very best effect ensuring high quality environments for high quality care as well as value for money.

Wherever we invest in our buildings (known as capital developments) the work will be designed to support clinical service transformation and be based on agile working principles, making better use of technology.

The focus of our schemes will be to support integrated team working closer to communities – in line with the transformation vision of the Trust and of our partners.

Where we develop inpatient facilities we will design them in a way that is not only best for patients but also for staff. This will mean we can increase staff resilience and provide the best possible care whilst keeping overheads down. We would ensure that all new accommodation meet national standards, particularly around same sex accommodation as well as providing en-suite facilities. We will also carefully examine and make best use of our two main sites – Fieldhead in Wakefield and Kendray in Barnsley.

We will also look for opportunities to bring together support staff to further reduce overheads, whilst minimising any impact on the delivery of front-line services.

Information management and technology (IM&T) We plan to work in a more agile way which will help improve how productive, accessible and responsive our services are. It will also improve the working lives of our colleagues by reducing unnecessary journeys.

We will look to improve the amount of time clinicians spend with people as well as support more personalised care and enhanced safety. We will do this, for example, through the use of hand held devices (tablets) and real-time updating of clinical records. We will also improve how different systems work alongside each other (eg. health and social care) so staff can spend more time caring for people and see less duplication.

With better use of new technology people will be able to access our services in new ways – for example, booking appointments, reviewing helpful information or accessing online support.

We’ll also look at how we can support clinical consultations through the use of video links, helping people avoid unnecessary travel and offering greater convenience.

Our existing telehealth and telecoaching services will be made available to more people helping them take control of their own health and wellbeing. And we’ll monitor how well this is working and the impact it has on people having to use urgent care services. In fact, we’ll use data more effectively throughout the Trust, identifying improvements and measuring benefits as well as working closely with our partner organisations.

Our non-clinical support services will also explore the wider use of technology, supporting clinical services to quickly and efficiently carry out routine office work. It will also mean our support services are best placed to meet the needs of a larger organisation that works across a wider geography.

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Our staff As we move to a recovery focused model of service this will inevitably impact on the required skills and roles of our workforce. This includes the development of peer support worker roles both within the Trust and in local partner organisations as well as existing staff further developing existing partnerships. We will also make greater use of volunteers, review our medical models so we can provide a greater range of sub-specialities and also review our administrative workforce.

We are considering how to support staff who work at lower bands in the organisation (making up around half our workforce) and would like to implement a healthcare support worker career structure, as well as more apprenticeship posts and potential assistant practitioner roles.

This will allow for greater flexibility in terms of rostering opportunities and help us provide more services outside of 9 - 5 Mon Fri working hours. However, it will also put pressure on pension costs and we also expect to see a greater number of staff retire – so we must plan for this.

As we will look to continue a move to 7 day working for all services we’ll make best use of technology to support flexible working and communications as well as measure the impact of safe staffing levels on our wards, ensuring investment in skills and staff numbers where required.

In the last 4 years the Trust has seen an increase of 10.3% in staff, reflecting growth in our clinical areas, our provision of community based alternatives to hospital and our health and wellbeing teams. However, based on our strategic plan, cost improvement and transformation programmes we need to reduce staff numbers during the next five years. But if we grow the number of services and the area in which we deliver them, as planned, this would be offset as we would need more staff.

As the average age of our staff members increases (in line with rising age profiles in our communities) we expect to continue to see more people work flexibly and part-time.

Understanding the plans of our commissioners We mainly operate in Barnsley, Calderdale, Kirklees, and Wakefield as well as across the whole of Yorkshire and Humber for forensic services. It’s important therefore that we not only understand the commissioning intentions in these areas but also try to align our plans with them.

In drawing up our plans we looked at a number of relevant documents, including:

• Clinical Commissioning Group (CCG) 2 year and 5 year plans

• Health and wellbeing strategies

• Better Care Fund submissions

• Published service line commissioning intentions

• Pre Qualifying Questionnaires (PQQs) and invitations to tender

We have tried to incorporate any assumptions in commissioning plans into our own plan.

This means that commissioning intentions with regards to mental health service strategy are relatively well understood but we are less clear on services that may be decommissioned as well as financial assumptions.

We currently enjoy very good working relationships with commissioners and other local health partners and we actively participate in a wide range of strategic planning and service development activities, including provider-led strategic reviews. This means we can work with our commissioners and partner organisations for a collectively sustainable future.

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How we are going to achieve our plan Each of our service lines have been analysed in terms of the market conditions as well as our own strengths, weaknesses, opportunities and threats (SWOT). We have considered any risks and issues and explored possible future scenarios.

For all our service lines we will: • Build upon and make existing services stronger and more sustainable • Continue with transformation work, including a significant shift towards recovery and self-care We are actively looking to grow: • Acute mental health • Community mental health • Forensics • Health and wellbeing We will look to shrink some parts of what we provide in: • Community mental health • Rehab and recovery • Substance misuse We are looking to strengthen existing partnerships and introduce more in: • Community mental health • Rehab and recovery • Dementia • CAMHS • Substance misuse • Forensics • Learning disabilities

To achieve our plans we know we will have to work hard to achieve our cost improvement programmes (CIPs) in the next three years (years 1-3) building an infrastructure that is fit for the future.

We will then look to increase our business in years 4 and 5 and must focus on the changes to our workforce that will be needed to ensure we have the right skills, role types and number of staff to carry out our plan in these later years.

We expect to grow through partnerships, seeing a wider range of services being provided over a wider geography and with more efficient and cost-effective support services. This is expected to result in better access to highly specialised services. Technology will enable access to skills and expertise over a greater number of hours per day, 7 days per week, which will enhance access for service users. Service improvement and practice governance coaching will support the spread of best practice, and oversight of quality will be maintained through current Trust Board committee structures.

We will also continue our journey towards enabling recovery and promoting self-care, seeing a continued clinical shift from a service to person centred delivery model. This means we will need a significant redesign of clinical workforce, promoting an ‘enabling’ professional culture, rather than the current ‘fixing’ culture. In practice this will require substitution of some current roles and activities with peer support.

Can we achieve our plan?

Our plan has some very challenging areas – both in terms of service delivery and finance – and whilst it is more challenging than previous plans, we are confident that it is achievable.

This five year plan is a key part of our ongoing strategic planning work where we continually look to the future and make adjustments as necessary.

Involving people is central to our mission and we will continue to work in partnership and engage with all our staff, services users, carers, partner organisations, stakeholders and the public as we further refine and implement our plans.

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Get connected and find out more about our services!

We are proud to highlight and celebrate the work of all our services.

We frequently send stories to local media as well as include them on Facebook, Twitter and LinkedIn. You can also watch films made about Trust services and inspirational personal stories on our YouTube channel.

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