Agenda item

To receive a presentation from Peter Miler, Chief Executive, Leicestershire Partnership NHS Trust (LPT) on the Trust’s strategic priorities and current challenges.

 

Dr Peter Miller, Chief Executive, Leicestershire Partnership NHS Trust (LPT) gave a presentation on the Trust’s strategic priorities and current challenges.  A copy of the presentation had been published with the agenda for the meeting.

 

During the presentation the following comments were noted:-

 

a)         The Trust had four strategic objectives:-

·           Deliver safe, effective, patient-centred care in the top 20% of the Trust’s peers.

·           Partner with others to deliver the right care, in the right place, at the right time.

·           Ensure sustainability.

·           Staff will be proud to work here, and we will attract and retain the best people.

 

b)         The current income was £2.31m with a planned surplus of £2.2m

 

c)         The Trust is working to provide the continued integration of clinical services to provide:-

·         Improved access to services, enhancing the service user experience and allowing earlier integration.

·         Reduced duplication of contracts and activities within and across agencies.

·         Earlier intervention with reduced escalation of health conditions, improved health of patient and reduced specialist service contracts.

·         Better health and social care system integration reducing administration and management costs across statutory agencies.

 

d)         The Trust’s services could be broadly divided into:-

·         Adult Mental Health and Learning Disability Services

·         Community Health Services

·         Families Young People and Children

 

e)         Adult Mental Health and Learning Disability Services

 

i)          Developing the Adult Mental Health Care Pathway, involving promoting care in crisis, reducing the time spent in hospital, reducing delays in discharge, keeping patients at home longer, and promoting alternatives to hospital admissions and remodelling the crisis services.

 

ii)         Enhancing integration of services working closely with the primary care and voluntary sector, focussing on recovery, increasing resilience and reducing escalation of health conditions. 

 

iii)        Supporting people with learning difficulties to remain in the community by improving access to services, treating in the home wherever possible and improving crisis management services.  The number of inpatients with learning difficulties was now a relatively small number compared to previous decades.  

 

f)          Community Health Services

 

i)          Improving prevention and early intervention by working with communities to enable people to stay healthy and help prevention of health conditions to avoid the early need for acute care services.  The Trust was also working with patients with long term conditions to manage their conditions and to make an early identification of patients with dementia.

 

ii)         Improving access to care and reducing waiting times.  There had been good partnership working with the primary care sector and early referrals to memory cafes.

 

iii)        Developing out of hospital care which was important for the Better Care Together Programme.  The Trust was growing the Intensive Support Services with the commissioners and an additional 130 virtual beds were being provided in the current year.

 

iv)        Integration of whole system provision of care by aligning the care pathways with both the County, Rutland and City areas and implementing Phase 2 of a programme to develop partnership working with the voluntary and third sectors and carers to access services. 

 

v)         Numerous measures were being introduced and developed for Out of Hospital Care including:-

·         Developing the capability and capacity to provide sub-acute care in community hospitals.

·         Providing integrated community based specialist services for patients recovering from the acute phase of a stroke or neurological illness.

·         Establish an In-Reach team to expedite the prompt and smooth transfer of patients into community based sub-acute care and Intensive Community Support Service beds.

·         Providing enhanced health in care homes for people diagnosed with dementia and mental health care in order to reduce their need for a hospital admission.

 

vi)        Funds have been secured through the Nursing Technology Fund to implement technology advances in nursing practices to connect nurses across the community hospitals and acute trusts. 

 

vii)       The Trust will be pioneering a Robotic Telepresence Solution to enable a clinician to be virtually present in another location.

 

viii)      Bed use will be optimised to provide the same or increased volume of activity with fewer beds.

 

g)         Families Young People and Children

    

i)         Develop Asset Based Community Development (ABCD) to strengthen, support, co-ordinate and build capacity within families and communities for self-help and to support each other.

 

ii)        Increase knowledge and skills across the workforce through introducing new roles and integrating practice across teams. This will increase practitioner’s capacity for service users, reduce referrals to specialised services and reduce the number of practitioners involved in the care of a child or a family.  It would also lead to an increased quality of intervention at an earlier stage improving the service user’s health and reduced workforce costs through the safe delivery of interventions by lower banded qualified and trained staff.

 

iii)       Use of alternative technologies to change the way the Trust communicates with younger people through social media apps and virtual appointments to allow earlier intervention and reduce face to face contacts and improve service user experience.  Mobile working technology increases workforce agility and reduces estate usage and travel costs as well as improves productivity.

 

iv)       The Trust has recruited 7,000 people to research projects which will provide better quality improvement outcomes.

 

h)        The Trust faced the following Challenges and risks:-

 

i)          Financial stability of the health economy – the Trust Development Agency had given an extended target for the deficit recovery.  Currently approximately 80% of Trusts nationally were in financial deficit.

 

ii)         Workforce capacity, capability and engagement – the Trust was still heavily dependent upon agency and bank staff which had on going implications for staff skills and costs.

 

iii)        Demand continued to rise and the capacity was not always available within the health system to respond to it at times.

 

Following questions from Members of the Board the following responses were noted:-

 

a)         The Trust was working with commissioners to implement quality improvements to care for the physical needs of patients that had mental health illnesses.

 

b)         Waiting times for the CAMHS service were improving and currently the average waiting time was 7 weeks and, although many users were seen early, there were still a number who may have to wait for up to 40 weeks for behavioural or non-urgent related health conditions.

 

c)         Work was progressing with CAMHS Teams to have manageable workloads and it was hoped that in the forthcoming months everyone would be seen with 13 weeks.  Currently Autism Spectrum Disorder and Attention Deficit Hyperactivity Disorder support was not provided from the Adult Mental Health services and arrangements were being put in place for this to be provided for children moving into young adulthood.

 

d)         Dr Miller was leading on the Workforce Group in Leicester, Leicestershire and Rutland.  He fully recognised that that there was a challenge to ensure that staff resources moved with patients as the left shift in patient care took effect and fewer patients were treated in the acute sector and more in the community and primary care sectors.  He envisaged that staffing levels within the health sector would remain at current levels for a number of years and this would require some staff to receive additional training and acquire different skills to enable them to move from the acute sector and provide community based care.  Whilst this was fully recognised as a potential risk, he felt that all appropriate steps were being taken at the present to address the issues.  It also needed to be recognised that new entrants embarking on nursing training schemes would take three years to complete their qualification. 

 

The Managing Director, Leicester City Clinical Commissioning Group (CCG) stated that the CCG had recently taken over the strategic lead for children’s services and had met with the Director of Children’s Services to discuss the delivery of more integrated services.  As the CCG was also the lead commissioner for the UHL contract this would also assist this process.

 

Following questions from Board members, Dr Miller stated:-

 

a)         Although there was evidence to show that promoting resilience in an individual’s treatment and recovery programme had beneficial and long term effects, it was more difficult to measure resilience in a whole community. However, this would need to be developed and be better quantified in the future as it would be one of the indicators that would affect the setting of strategic priorities of the wider health economy in the future.

 

b)         An indication of progress in the next 12 months would be to be lower A&E admissions than present levels, that the new community capacity was fully utilised and that waiting times, especially in the CAMHS services, were achieving their waiting time targets. 

 

c)         The LPT priorities outlined in the presentation were aligned with the direction of travel of other partners in the health economy but there were some challenges to the delivery of the integration agenda by the simple virtue that partners were individual and separate statutory organisations which could present inherent challenges from time to time.                

 

In relation to community resilience, it was noted that as the Council moved towards ensuring services became more focused and targeted at those people who needed them it could lead to striping away parts of the universal offer.  This would affect the development of community resilience such as providing networks and the ability to support one another one and this had the potential to store up future problems and issues by trying to address current issues.  For example, the Play and Stay Sessions such as Toddlers Time in Libraries, where individuals develop friendships, relationships and networks to provide cross-peer support, can reassure young parents about child development matters and minor ailments and ultimately reduce the number of “worried-well” parents consulting GP and School services. 

 

The Chair thanked Dr Miller for his very useful presentation and for the openness to responses.  Whilst he acknowledged that LPT faced challenges, he wished to recognise that the organisation had improved and developed from its previous position 2 years before and he recognised Dr Miller’s leadership role in that process.