Executive summary

Kent and Medway NHS and Social Care Partnership Trust (KMPT) is a mental health trust that provides mental health, learning disability, substance misuse and specialist services to approximately 1.8 million people across Kent and Medway. We work in partnership with Kent County Council and the unitary authority in Medway, and are commissioned by 8 CCGs and NHS England. The trust is one of the most geographically spread mental health trusts in England, covering an area of 1,450 square miles. We are planning to have annual revenue of £195 million and employ approximately 3,500 staff who work across 66 buildings on 33 sites.

Vision

To provide brilliant care through brilliant people. The strategic objectives of our 2016- 20 strategy are to:

• Consistently deliver an outstanding quality of care
• Recruit, retain and develop the best staff making KMPT a great place to work
• Put continuous improvement at the heart of what we do
• Develop and extend our research and innovation work
• Maximise the use of digital technology
• Meet or exceed requirements set out in the Five Year Forward View
• Deliver financial balance and organisational sustainability
• Develop our core business and enter new markets through increased partnership working
• Ensure success of our system-wide sustainability plans through active participation and leadership.

Our core principle is to provide brilliant care through brilliant people. This is underpinned by 6 cores values:

• Respect
• Open
• Accountable
• Working together
• Innovative
• Excellence

2018/19 Key achievements

The CQC’s comprehensive inspection in January 2017 rated the organisation as Good overall and Outstanding for Caring. At the end of 2018, the CQC undertook a Well Led inspection

The full inspection report was published at the end of February 2019. Feedback from the CQC acknowledges phenomenal improvements to quality of care: The overall Trust rating has remained Good with noticeable improvements in forensic inpatient services which improved from Good to Outstanding overall and older people community mental health teams which improved from Good to Outstanding in their caring domain. No CQC domains have deteriorated since the last comprehensive inspection in 2017; improvements were noted in 9 domains.

Ratings for hole trust:

• Safe - Good
• Effective - Good
• Caring - Outstanding
• Responsive  Good
• Well-led - Good
• Overall - Good

Whilst as always, the CQC highlighted areas for improvement, their recognition of the significant progress made by KMPT since the last inspection was heartening.

• “Every member of staff we spoke to, without exception, spoke of how much the culture had improved since our last inspection in 2017”.
• “Staff at all levels from a wide range of disciplines reported feeling proud of the care and treatment they provided to patients”.
• “Staff were motivated and inspired to improve patient care in every way possible”.

We are exceptionally proud that Caring retains a rating of Outstanding – this provides a strong foundation and evidences that our core principle of brilliant care through brilliant people is having positive impact on patients and their loved ones.

By improving quality we are also having a positive impact on our financial management:

• We have reduced agency spend from £9.5m in 2016/17 to £6.1m forecast in 2018/19
• We will perform better than plan with a deficit of £1.1m instead of £1.8m. This will attract incentive funding and is good news for 2018-19.

2019/20 Key priorities

• We are excited to play a leading role in the development of Integrated Care System and Integrated Care Partnerships for Kent & Medway, and contributing to achieving STP workstreams.
• Aim to achieve financial stability by delivering breakeven in 2019/20 and addressing the underlying deficit through recurrent efficiencies to ensure our income is equal to expenditure
• Maintain our focus on sustainability of improvements to ensure we are responsive, have clear metrics and adherence to single operating model.
• Define and implement modern care pathways co-produced and delivered through partnerships to best help patients with their wellbeing and/or on their journey to recovery.
• We are confident that by increasing quality of service, we will both reduce cost, drive out unwarranted variation and improve patient experience and outcomes.

We have focussed our priorities into four key areas with 10 enablers. Empowering service users, carers and teams threads through all our work in order to achieve brilliant care through brilliant people.

Our Services

Improve quality Save time and money.

• Priority: Maximise opportunity for service users to safely achieve and sustain positive outcomes, whilst driving delivery of efficiency and productivity gains
• Priority: To sustain quality improvements within our Community Mental Health Teams
• Action: To improve how we use data to drive improvements to performance and quality our across our service through the development of a Clinical Informatics Strategy
• Action: Co-produce and implement the St Martins Inpatient Changes programme and the Clinical Care Pathways programme to ensure we deliver the right practice, in the right place at the right time

To achieve:

• Reduced need for admissions, especially those of 7 days or less
• Reduced number of bed days used
• Reduced length of stay in Older Adults Wards by 26%
• Reduced comparative service user contact with KMPT
• Improved and quicker access to services – 7 day working with improved patient flow, plus earlier initial interventions and improved offer for people with enduring conditions and personality disorder
• Clearly defined pathways focussed on recovery and value added care

Action: Develop and deliver a co-ordinated approach to quality improvement and assurance across KMPT

To achieve:

• Improved patient safety, patient experience and clinical effectiveness
• Quality strategy and improvement plan with clear structure and range of methodologies
• Drive out unwarranted variation across services
• Implement quality account priorities and the CQC improvement plan
• Improve ability to share learning and best practice across KMPT]Quality objectives for all staff and clear offer of quality training

Our Future

Effective partnerships

Priority: To generate the greatest possible positive impact on the big issues for our population: Specialist access to perinatal mental health; improved mental health urgent and emergency care; better access to primary and community teams for adults with moderate and severe mental illness; veterans mental health and addiction services; suicide prevention.

Action: To increase and improve effectiveness of partnership work at both strategic and operational levels

Action: Be a leading partner in the development of the Kent and Medway Integrated Care System (ICS), Integrated Care Partnerships (ICP); delivery of the Mental Health Investment Standard (MHIS),Sustainable Transformation Partnership mental health programme; and the West Kent Alliance.

Action: To lead the STP suicide prevention programme

To achieve:

Over the lifetime of to the strategic partnership to:

• Deliver the 5YFV and NHS Long terms plan relating to mental health
• Reduce the prevalence of mental health
• Reduce the number of suicides
• Increase positive mental health outcomes

This year to:

• Contribute to the ICS and ICP’s being set up in the best way possible to improve system effectiveness
• Support deliver the Mental Health Investment Standard and develop aligned incentive contracts

At an operational level to:

• Develop partnerships with the third sector, housing associations and volunteers to increase mental health support and services within communities

Priority: To increase high performing services and opportunities for new business developments.

Action: To develop a commercial strategy

To achieve:

• Increased surplus to offset the financial deficit
• Greater reach in high performing services
• Development of new services which support the local population closer to home through improve integrated car pathways.
• Defined new business opportunities aligned to the NHS Longterm Plan and new care models

Research and innovation

Priority: To increase staff and service user involvement in research and innovation. Priority Work with Kent & Medway Medical School to develop clinical academic posts

Action: Submit 3 research project bids (oriented to service delivery) which have been proposed and initiated by KMPT staff.

Action: To launch our R&D Strategy and set out clearly our ambition for next 5 years

Action: Develop a KMPT Innovation forum

To Achieve:

• Increased awareness of research and development
• Improved service quality
• Increased staff morale
• Improved reputation of KMPT
• Increased participation in local and national research

Our People:

Side by side with service users and carers

Priority: To ensure services and strategy are co-produced with service users and carers

Action: To develop a new participation and involvement strategy

To achieve:

• Modern, best practice methods for co-production
• Increase the % of people with lived experience employed by KMPT

Productive skilled workforce

Priority: To ensure we have a fit for future workforce

Action: Carry out workforce planning exercise

Action: Develop succession planning and talent identification strategy

Action: Develop KMPT nursing academy

Action: Roll out new leadership training programme and improve induction

To achieve:

• Improved leadership skills throughout KMPT
• Remodelled workforce with new roles and expertise e.g. peer suport, advanced practitioners, non-medical prescribers, non medical approved clinicians/ responsible clinicians
• Reduced number of vacancies, quicker time to hire, reduced agency use
• Increased retention

Great clinicians, managers and teams

Priority: Ensure all staff are engaged, feel supported, accountable and that KMPT is a great place to work

Action: Define and implement a Just and Learning Culture

Action: Develop Health and Wellbeing strategy; Develop Diversity and Inclusion strategy

Action: Develop our staff engagement and communications strategy

To achieve:

• Increased staff engagement
• Staff feel able to speak up if they have concerns
• Implement the KMPT Perfect Day initiative
• Increase in compliments,
• Staff contribute ideas and suggestions
  • WRES Priority

Our Resources

Finances

Priority: To deliver breakeven in 2019/20 where income equals expenditure

Action: To ensure we have a robust, sustainable CIP programme with recurrent savings

Action: To develop strong financial management, supported by a robust financial training programme and embed the finance business partner role

To achieve:

• Service ownership and input to - Delivery of CIP programme budget management and CIP delivery

Technology that helps us provide better care

Priority: Become a more digitally enabled organisation to support management and delivery

Action: To agree and implement an innovative Clinical Technology Strategy

Action: Co-produce and develop applications which support service users to manage their own care and support

Action: Deliver Electronic Prescription Management and Electronic Clinical Observation Applications

Action: Increase digital capability of clinicians to support deliver of clinical interventions through digital media

To achieve:

• Effective and fit for future IT functionality
• Increase digital capability of clinicians
• Development of applications and resources which support service users to improve access to self management tools;
• Increased efficiency and effectiveness of care

Buildings that work for us

Priority: To make the best possible use of the Trust’s estate (land and buildings), ensuring they are safe and fit for the future.

Action: Safely manage the transitions required to deliver our inpatient and community estate improvemnet programme.

Action: Invest capital proceeds from St Martins sale into building upgrade work as part of overall estates improvement programme.

To achieve:

• Safe and good quality environments that support the delivery of care in clinical wards
• Good quality community bases that support patient care and staff wellbeing