NELFT strategy update: Final report

NELFT strategy update: Final report
16 October 2018

Contents 1 2 4 5 6 7 9 10 Introduction 3 Why update our strategy? 8
A fast changing world 12 4 Our services, the people we serve and our partners 17 5 What’s not changing and our learning from the 2015 strategy 31 6 Our Vision - what we want NELFT to be 37 7 Turning our challenges into opportunities 42 What we’ll do - our objectives 46 9 Reporting progress 56 10 Appendices 59 Contents

Introduction This section of the report introduces the strategy with: An overview from our Chairman and Chief Executive, outlining why the strategy is important to everyone in NELFT A summary of our strategy on two pages, to provide everyone with a simple guide to this strategy Signposting of the content of this report, so readers can see where to find the detail that supports the two page summary of the strategy We’ve also produced a separate two page summary of the strategy and a short, plain English, easy read version for our people and the public Section 1

Joe Fielder John Brouder
Overview Why we need to update our strategy Our strategy exists to give everyone a clear view of where NELFT is going and what we want NELFT to achieve – how we’ll deliver best care to the people we serve. A strategy with genuine clarity is essential, especially where there’s a tide of change happening almost daily, from top to bottom in health and care. What won’t change Some things in our strategy won’t change: Our values which have helped shape NELFT and how we deliver care will remain a key part of our culture Our Mission – the Best Care by the Best People will still be the way we deliver care We will be agile - a more modern way of working that’s improved efficiency and flexibility in people’s working lives. What you said you wanted from the strategy When we started to update our strategy, we wanted to learn from what worked and what didn’t in the strategy. We engaged with people in NELFT who said they wanted four big things: A clear vision for NELFT A bold, ambitious and aspirational strategy A strategy that reflected the strength of our appetite to change and improve care delivery A strategy that is visible and relevant to everyone. How the strategy does what you want it to do This strategy delivers on those “asks”: Our new Vision is clear – NELFT will actively shape, develop and deliver, locality based care for the populations we serve Our actions that we’ve committed to are bold and ambitious – they reflect people’s aspirations for NELFT and deliver continuous improvement in the quality of care we strive to provide We’ll make change happen by working with our people in NELFT, our partners outside NELFT and the people we serve across London, Essex, Thurrock, Kent, Medway and beyond so that change brings real improvements in the care we deliver together. Why we might do even more that we’ve planned We see this strategy as permissive - so much is happening, that we can’t just be confined to the things we’ve said we’ll do in this document. We can’t predict everything that’ll change within the wider system and these changes will present opportunities as well as risks. This strategy gives us permission to work as NELFT or with partners to seek out opportunities and take advantage of them, and our new commercial framework will also help us to manage risk. This will enable us to deliver Best Care to more people. How we’ll make it relevant to you Finally, you asked for the strategy to be visible and relevant to everyone in NELFT. In the coming weeks and months we’ll be meeting with people across the whole of NELFT to publicise this strategy. We’ll also work through our leaders and leadership teams so every person in NELFT understands what the strategy means to them. Everyone will see what part they’ll play in making the changes we’ve planned so we all help to deliver Best Care for patients. We look forward to meeting you, so together we bring this strategy to life and through our efforts deliver Best Care for the people and communities we serve, which is so important to us all. Joe Fielder John Brouder

QI and Continuous Improvement
Where we want to be Purpose: To improve the health and wellbeing of the populations we serve Vision: NELFT will actively shape, develop and deliver, integrated, locality based care for the populations we serve Mission: Best Care by the Best People QI and Continuous Improvement Our Values Through… CQC rating of ‘Good’ and move towards outstanding across the 5 CQC domains Use of Resources rating of 2, achieve financial break even and maintain liquidity Grow turnover as far as market conditions allow, in line with our new commercial framework Make NELFT the NHS employer of choice by engaging with and developing our people What we will achieve…

Turning challenges into opportunities
STPs & Integration Best Care Best People Finance Identity We know what our challenges are…… Best care: Integrating physical & mental health; Standardising care/reducing variation; Patient centred outcomes Provider integration in BHR through the Provider Alliance Integrated community offer in Waltham Forest Partnerships with community providers Improving mental health services through partnership STPs & Integration …and we’ll use them as opportunities to deliver best care Primary care development in two communities ENABLERS Best People: Leadership competency and capacity developments Identity: Strategic narrative; What people think about us; Promoting our identity Finance: BI system; Commercial framework; Goodmayes redevelopment

What’s in this report The key areas in this report are highlighted in the diagram below, so you can quickly and easily find what you want to read. Sets out the background: How our services, the people we serve and our partners are changing The things that won’t change in our new strategy Discusses why we’re updating our strategy How we’ll report progress on the strategy 10 9 8 7 6 5 4 3 2 Highlights key developments in the fast changing world of health and care Three core elements of the strategy: What we want NELFT to be The challenges we face Actions to address those challenges Supporting detail for the strategy: The six aims supporting the vision The five challenges Detailed action plans

Section 2 Why update our strategy?
This section of the report summarises why we’re updating our strategy, by discussing: What we said in the 2015 strategy What’s happened since 2015 How we’ve updated our strategy Section 2

What we said in the 2015 strategy
Our 2015 strategy was developed to address a range of strategic pressures by unlocking a big opportunity. The big opportunity at the heart of the strategy was to provide care at home or in the community, as an affordable, safe and effective alternative to inpatient care in hospital. Our Mission of “the best care by the best people” set out the way we would deliver care to unlock this opportunity which would also improve care. Through our role of thought leader, partner, innovator and integrator, we committed to actively working with partners in health, social care and the Third Sector to put in place better care through integration, so people spend less time in hospital and go less often. Partnerships would be a key vehicle for delivering integrated out of hospital care and by working together, NELFT would deliver a wide range of integrated care services and grow the size of the organisation. Developed to provide goals for NELFT and a plan to achieve them against a background of increasing financial pressures, change and uncertainty Identified the big opportunity - to improve the quality and sustainability of care by delivering more care in out of hospital settings Set out a new Mission for NELFT – The Best Care by the Best People A new role for NELFT in the wider care system – thought leader, partner, innovator, integrator Goals of working proactively with partners to improve care quality through integration and to grow the size of the organisation

Highlights of what’s happened since 2015
Even in the current turbulent environment, there is a clear consensus that radical change is needed to make care both financially and clinically sustainable. Integration is the agreed way forward, but there is no legislative framework to underpin these changes, which is often seen as a barrier to progress. Despite this, a small number of organisations such as Frimley Health and Care have made significant strides in integration and improved care, showing what is possible, even without a change in legislation. Since 2015, NELFT has achieved notable operational successes, such as the Thurrock Provider Alliance which includes third sector partners and the Brookside Home Treatment Team model. But there has been no big breakthrough to deliver more care in out of hospital settings on a large scale. This volatile and uncertain environment is an opportune moment to update our strategy, to provide a clear picture of where NELFT wants to be, the challenges we face and the actions to address those challenges. The underpinning theme of the strategy will be how NELFT will move forward on the road to integration and how we will use this journey to fulfil our purpose of improving the health and wellbeing of the populations we serve. Highlights of what’s happened since 2015 Within NELFT - operational successes CQC rating moving from “Requires Improvement” to “Good” within 18 months High levels of positive feedback from patients on Friends and Family Test – up to 95% in mental health and 97% in community services Increased staff survey responses highlighting improvements in communication, involvement in decision making and feeling secure to raise concerns about unsafe practice NHSI Single Oversight Framework rating of 1 giving NELFT maximum autonomy - only 17% of NHS organisations have this rating Outside NELFT - a turbulent environment A volatile and uncertain political environment dominated by Brexit Consensus on integration as the way forward for care, but no legislation to provide the statutory framework for integration Many STPs including those locally have not made big steps to deliver integration Majority of NHS organisations locally focusing on delivering financial and operational targets only Contrast with Frimley, Dorset and other ICS pathfinders that have moved forward significantly on integration No big breakthroughs to deliver additional large scale care in out of hospital settings by NELFT and our partners

How we’ve updated the strategy
We see an almost daily series of policy pronouncements, think tank ideas and proposals for change which can make it hard to see clearly what the future holds for NELFT. What remains unchanged is the direction of travel set out in the Five Year Forward View – a shift to integrated out of hospital care, centred on localities within STPs. In developing our updated strategy we found that people in NELFT were committed to high quality care and to use integration as a vehicle to deliver not just improved care but Best Care. Our updated strategy sets out a clear vision for NELFT and an honest assessment of the challenges we face. We have formulated actions to meet these challenges. These actions are bold and ambitious, and our people have the appetite and energy to succeed, to achieve our Vision and Mission, fulfilling NELFT's purpose – to improve the health and wellbeing of the populations we serve. How we updated our strategy Critically reviewed the 2015 strategy identifying learning for the updated strategy Re-evaluated the environment to understand the challenges we face Set a clear picture of where we want NELFT to be in 3 to 5 years time Identified a small number of impactful changes to deliver our Vision Our updated strategy sets out: A clear and compelling Vision for NELFT An honest assessment of the challenges we face A small number of achievable actions which address our challenges, delivering our Vision and Mission, to fulfil our organisational purpose

Section 3 A fast changing world
This section of the report sets out the background to the work to update NELFT’s 2015 strategy: The direction of travel for care – the shift away from the 2012 Health and Social Care Act along an agreed path, but with no end point defined through statute What’s been happening in NELFT – showcasing some of NELFT’s successes over the past two years What’s happening outside NELFT – the difficult environment NELFT faces with highlights of the pressures facing care systems What we did – how we engaged with people and the benefits of the engagement Section 3

The direction of travel in care
The direction of travel for the NHS to develop integrated, locality based Out of Hospital care was set out in 2014 and reflected in NELFT's 2015 strategy. Organisations such as Frimley Health and Care* have taken advantage of freedoms and flexibilities to move forward at pace and deliver improved care through new integrated care models. A strategic issue for NELFT is the extent to which it wishes to take advantage of freedoms and pursue integration. Whilst the vocabulary is constantly changing (STPs are now partnerships; ACOs became ACS’ and are now ICS’), the direction of travel remains the same A vision of comprehensive and fundamental change across health and care Reality of living within financial means whilst delivering the new vision Some** organisations and systems have moved forward at pace New legislation will eventually provide a legal framework for these new forms Care systems reorganised to “fit” the new structures set out in legislation What will NELFT become during the next seven years before a new legislative framework is fully implemented? Oct 2014 March 2017 April 2018 2023? 2025? Prototype Integrated Care Systems established New Health and Care Act Systems reorganised Additional funding of 3.4% announced in June 2018 will not fully address all the underlying pressures facing the NHS, making the need to fundamentally change the way care is delivered as important as ever * Frimley Health and Care ICS is one of eight pioneers approved in 2017, prototyping new integrated care approaches. Frimley ICS works with 13 organisations through an Integrated Systems Board based on a collaborative agreement. Frimley shows a high level of maturity in its development and delivery of integrated care.

What’s been happening in NELFT…
CQC rating moving from RI to Good in 18 months CQC rating for Brookside moved from Inadequate to Outstanding NHSI Single Oversight Framework rating of 1 Continued roll out of Agile Working Upper quartile rating against the Workforce Race Equality Standard Over the past two years we have enjoyed a range of successes in quality and finance. Our successes with people not only included positive results on WRES, but big improvements in staff communication and involvement. Patient feedback has been positive with high approval in the Friends and Family Test for mental health (highest 95% in December 2017) and community services (highest 97%). These show that we are succeeding in a broad range of areas including service quality, finance and people. Some of NELFT’s successes

…what’s happening outside NELFT
Alongside our successes, we are operating in a volatile, uncertain and complex environment, where health and care services face big strategic challenges. There is a genuine consensus on the need for system wide change. The recently announced 3.4% average annual funding increase will not fully address the impact of demographic and financial pressures facing the NHS, especially in the challenged systems we operate in, where additional funding is likely to be directed to the hospital sector. The fundamental challenge therefore remains - how to make NELFT's services both clinically and financially sustainable. To address this challenge, we need to reassess where the organisation is going and what it is doing, particularly how to change the way care is delivered, not just within NELFT, but across all care systems we work in. Finance – growing system deficits Projected deficit in NEL STP by 2021 = £336m, even after £242m efficiency savings In Mid & South Essex STP, projected deficit by 2021 is £430m Fundamental service change is needed to achieve sustainability, rather than “Salami slicing” Population –becoming older and sicker Between 2015 and 2035 the proportion of people with four or more conditions will double, including more than half of people aged 65-74, the majority having both physical and mental ill health People in deprived or ethnic minority groups are more likely to develop more conditions, and get them years earlier, than people in affluent areas 3.4% additional funding will not solve all the NHS’ problems “…it’s simply not enough to address the fundamental challenges facing the NHS” The Health Foundation “…not enough to bring about equality in mental health” Centre for Mental Health “…a welcome shot in the arm that will get the NHS back on its feet but not … the long term cure that would restore it to full health” The Kings’ Fund NELFT's purpose is to improve the health and wellbeing of the populations we serve – to do this, our services must be sustainable

Interviews and meetings
What we did An important part of our approach was the conscious decision to involve a range of people and staff groups in the development of the updated strategy through meetings, workshops and 1:1 interviews. The purpose of the engagement was to develop a deeper and more rounded understanding of the challenges we face, the appetite for change and the strength of our ambition as an organisation. This open and collaborative approach was successful, as the feedback from people involved in the engagement is that they “recognise their voices” within the strategy. Workshops Trust Board London ICDs & senior leaders Essex, Thurrock, Kent & Medway senior leaders Chief Nurses Group AMDs Corporate Directors Interviews and meetings Executive Directors Non Executive Directors Governors People unable to attend workshops Engagement The people and groups we engaged with are set out in Appendix A

Section 4 Our services, the people we serve and our partners
This section of the report discusses a range of strategic drivers and issues facing NELFT: Our services and how they’ve developed since the 2015 strategy How the populations we serve are changing, creating additional demand for care The implications of service reconfigurations that have already begun in two of the three STP areas we operate in Changes happening within Primary Care, Providers and Commissioners in the three main STP areas we work in This section of the report concludes by highlighting: The big strategic opportunity these issues open up for NELFT The direction of travel we’ll take to respond to this opportunity How we’ll incorporate technology into our strategy Section 4

Our services, the people we serve and our partners
This part of the strategy provides an overview of our services, the people we serve and our partners, to highlight the key strategic issues in each area. The principal implication for NELFT is that the mix of strategic challenges and changes happening across care systems provide the right circumstances and environment for NELFT to actively develop and support the expansion of integrated locality based care. People STPs Overview of our services, the people we serve and our partners Changes that are already underway Strategic implications for NELFT Our direction of travel Primary Care Providers Commissioners

Our services: commissioner analysis
NELFT’s income (£367.1m in 2018/19) is now spread across a wider geography than ever before. We have reached out from our traditional base of North East London and Essex as far as Kent & Medway and North West London. Our income is dominated by two blocks of commissioners in North East London, who combined, account for £245m (69.3% of NELFT’s 2018/19 income. NELFT’s commissioners North East London These commissioners are the largest component of our portfolio, accounting for £254m (69.3%) of 2018/19 budgeted income. In North East London, the BHR CCGs and Councils are the largest block of commissioners, with £179.7m (49%) of NELFT’s 2018/19 income. The second largest block of commissioners in North East London are Waltham Forest CCGs and Councils, who account for £74.6m (20.3%) of 2018/19 income. Essex and Thurrock Although smaller than London, Essex and Thurrock commissioners are nevertheless a significant part of NELFT’s business at £63.7m (17.3%) of 2018/19 income. Kent & Medway Kent & Medway have made an immediate positive impact on NELFT’s income base, making up £21.9m (6%) of 2018/19 income. Mid & South Essex £63.6m (17.3%) North East London £254.5m (69.3%) Other £27.0m (7.4%) Kent & Medway £21.9m (6.0%) The table shows NELFT’s income at the end of May 2018 from the Trust’s SLR system. A more detailed breakdown is set out in Appendix B1

Our services: category analysis
NELFT’s service base reflects the two main types of services NELFT has traditionally provided – mental health services and community services. Between April 2015 and March 2018, services expanded through new contracts - £20.1m of children’s mental health services in Kent & Medway and £16.8m of Emotional Health and Wellbeing Services (EWMHS) in Essex and Thurrock. These changes represent the change in our service mix outside London, from a provider of general community services for children to a more specialist EWMHS provider. Research and development is a small (£2.8m) but important component of services, demonstrating NELFT’s thought leadership and service innovation. Services making up NELFT’s 2018/19 income In North East London, the three biggest services make up £211.9m (57.8%) of our 2018/19 income: Mental health, Adult (£102.8m) Adult services (£66.8m) Children’s services (£42.3m) In Mid & South Essex, the three biggest services account for £45.1m (12.3%) of our 2018/19 income: Mental Health, Children’s (£16.8m) Adult services (£14.6m) Long Term Conditions (£13.8m) Outside London, children’s mental health services are a significant service, totalling £36.9m (10.1%) of our 2018/19 income: Mid & South Essex (£16.8m) Kent & Medway (£20.1m) Children’s services including therapies £59.5m (16.2%) Adult services including community nursing and beds £81.9m (22.3%) Mental Health, Adult - CRT, BED, HTT, EIP £108.1m (29.4%) Mental Health, Children's - EWMHS, Brookside, CAMHS £55.5m (15.1%) Other services £62.2m (16.9%) The table shows NELFT’s income at the end of May 2018 from the Trust’s SLR system. A more detailed breakdown is set out in Appendix B2

Developing our services
Our 2015 strategy set out the components of Best Care and highlighted integration of physical and mental health as key elements of Best Care. Since then, we have pursued integration as well as the development of new care models. One aspect of our success is reflected in a number of contract wins, with NELFT now delivering services for children and young people in Kent & Medway, using an innovative care model. How our services have developed since 2015 More integration We have pursued the integration agenda with local authority partners, finding ways to improve care through extending joint delivery of services New care models We have actively developed new care models and are accelerating this using the QI process to drive clinical service developments Contract successes We have used our innovations to help us with new business such as EWMHS, because our innovative care models deliver higher quality care than existing models

The people we serve All geographies where NELFT operates expect to see large growth in population, particularly in older age adults, who consume the most healthcare resources per head of population - typically around three times more than working age adults. Demographic issues such as population diversity, levels of deprivation and health conditions linked to deprivation are also significant factors driving higher levels of demand for care across these geographies. In the next ten years, demand for healthcare will grow rapidly and is likely to quickly outstrip resource growth, even after the planned 3.4% of additional funding. This means systems will need to adopt different ways of providing care to meet people’s needs, rather than relying on traditional admitted patient care models. North East London’s population was 1.9m in and expected to grow 18% by 2031 5 of 8 of NELs boroughs are in the lowest (worst) 20% for deprivation in the UK 25% of children will have excess weight when they start school and 40% will be overweight or obese when they leave school BHR has 0.78m residents, expected to increase by 28% (216,000) in ten years and over 75s increase by 19% between 2015 and 2025 Barking & Dagenham is the 3rd most deprived borough nationally BHR’s BME population is projected to grow by 49% by 2025 0ver 25% of over 40s have one LTC. Over 50s have at least one LTC and the number of people with LTCs is expected to increase by 45% by 2030 Kent & Medway’s population was 1.8m in with projected growth of 167,200 (9.3%) within ten years. An additional 92,000 will be over 65 by 20226 Life expectancy varies for example men in Tunbridge Wells have an average life expectancy of 82 years, compared with Thanet, where this figure is 78 years The difference between life expectancy and healthy life expectancy is even more stark, with a difference of 22 years (82 v 60) in Thanet 29% of the population have long term conditions. In the over 70s, 37% have three or more long term conditions Mid & South Essex’s population was 1.17m in 2016, projected to grow by 136,000 (11.6%) by The number of over 75s will increase 75% from 30,000 in to 53,000 in 2031 The geography includes a mix of affluent areas such as Brentwood and Chelmsford and deprived areas such as Basildon and Southend Life expectancy rates vary by as much as 9.1 years between the most deprived 10% in Thurrock ( years) and the least deprived 10% in Southend ( years) The number of LTCs is increasing with 81% of GPs reporting a rise in complexity in the conditions of patients who they see

Sustainability & Transformation Partnerships
Sustainability and Transformation Partnerships remain the vehicles for developing, organising and delivering system wide change and service integration. All STPs that NELFT operates in are financially challenged, requiring more radical action that the traditional focus on efficiency and cost reduction to resolve structural service, quality and financial challenges. This means that future care models across all systems will move away from simply providing a greater volume of traditional inpatient hospital based care. There are three health systems within the East London Health and Care Partnership (North East London STP) covering eight local authorities: BHR – which includes boroughs of Barking & Dagenham, Havering and Redbridge City & Hackney - comprising City of London and Hackney Borough Council West and East London – covering the London boroughs of Newham, Tower Hamlets and Waltham Forest Analysis projects a system deficit of £336m by 2021 if all system actions to increase efficiency, restructure services and achieve 2% efficiency are successful If improvements and efficiencies are not achieved, the deficit will worsen by £242m The Kent & Medway STP covers two local authority areas – Kent County Council and Medway Unitary The main items of care expenditure include £1.69bn on acute hospital care; £751m on primary and community care and £204m on mental health services Analysis projects a system deficit of £456m by 2021 if the system does not take action to increase efficiency and restructure services The STP is currently working to obtain approval for a plan to reconfigure acute care in East Kent The Mid & South Essex STP covers three local authority areas – Essex County Council; Southend on Sea Borough Council and Thurrock Council In 2016/17 the system’s health care income was £2.45bn Analysis projects a system deficit of £523m by 2022 if the system does not take action to increase efficiency and restructure services. Even if change proposals are implemented, there is still a system gap of £82m The STP has recently concluded its consultation on service reconfiguration across Essex and Thurrock

Changes that are already underway
Acute service reconfiguration is well underway in two of the three STPs we operate in. Centralisation of specialist acute care is a key component of the planned changes. Alongside this, are plans to move some care out of acute hospitals, into integrated local care centres, with some of these being GP led. This could also happen within BHR once the future of services on the King George's Hospital site is agreed. These changes reflect the direction of travel of centralising specialist hospital care alongside developing a range of out of hospital integrated care, centred on local communities as an alternative to traditional inpatient based care. The East London Health and Care Partnership is leading a programme of change set out in “Better care and wellbeing in East London” Plans are wide ranging and include prevention; urgent and emergency care; primary care services and mental health The programme also includes care specific work related to cancer and maternity plus enabling work on digital and workforce 2017 successes include: Improving access to urgent care The launch of programmes to improve standardisation and quality of primary care Receiving additional funding to increase mental health support for people in acute hospitals The case for change setting out the rationale for changing services in Kent & Medway was published in 2017 This was followed by proposals to reconfigure acute care services, outlined in the document “Developing sustainable hospital services in East Kent” Since November 2017, two options have formed the core of proposals which include: Centralising specialist care Developing GP led 24/7 urgent treatment centres Consultation has also recently closed on the future of stroke services In summer 2018, proposals to reconfigure acute services set out in “Your care in the best place” were agreed. These include: Designating Basildon and Thurrock University Hospitals (BTUH) as a specialist emergency hospital Centralising specialist activity such as stroke and vascular surgery at BTUH The proposals also include moving some services closer to people’s homes: Creating four integrated medical centres in Thurrock Developing new facilities in Basildon and Brentwood for locality based care

Primary Care Primary care is a key component of effective integrated community services, but across all three STPs NELFT operates in, there are high levels of variation in the level and quality of primary care, often because there are simply not enough GPs to support people’s needs. These issues are reflected in reported levels of patient satisfaction, that are below the national average in many areas. The standard of primary care remains a particular challenge for NELFT and our ambitions for integration, which require strong primary care to make integrated locality based care services effective. NELFT may need to explore new solutions to help address this challenge. NEL has 1,769 patients per GP, making the average list 6.6% higher than the London average of 1,660 6 of NEL CCGs report patient experience in the lowest quartile compared to the rest of the country Within BHR, there are 134 practices with the number of GPs 24% lower than the average number per 1,000 weighted population In Barking & Dagenham, 30% of GPs are over London average 15%, national average 9% In BHR, all 3 CCGs report below average in the patient survey for success in getting a GP appointment There are 249 GP practices in Kent & Medway The national average is 6.5 GPs per 10,000 weighted population - there should be an additional 245 GPs in Kent & Medway just to meet the national average 4 of 8 CCGs are below the national average of 6.5 and in 47 practices, the number is as low as 4.1 GPs/10,000 weighted population 30% of GPs are over 55 and will retire in the next 10 years compared to 22% nationally An average of 76% of patients would recommend their GP surgery to a friend, in some cases falling to 68% - national average 78% There are 172 GP practices in Mid and South Essex In 2016 nearly ¾ of practices were rated Good or better, with 13% rated Inadequate Patient satisfaction in primary care within all CCGs is below the national average of 85% In 47% of practices satisfaction ranges from 84% to as low as 64% A pre consultation business case for service change in the STP stated that “there are areas of excellent practice, but there remains too much variation in performance and outcomes between GP practices”

Providers There are two significant features of the provider landscape across all three care systems we operate in. Firstly, high levels of inappropriate use of emergency care, particularly from frail, elderly people. Secondly, large recurrent financial deficits within the provider sector, which are in part, driven by the high levels of inappropriate demand for urgent care. Efficiency measures alone cannot resolve these issues. The answer lies in alternative ways of meeting demand, a significant part of which, has been acknowledged to be through improved provision of integrated primary and community care services in local communities. In NEL’s three care systems, the provider landscape is dominated by Barts in West & East London and BHRUT in BHR. The Homerton in C&H is a comparatively smaller provider. Community and mental health services are delivered by NELFT and ELFT Recent analysis showed that in East London, 100 people each hour were seen at A&E with relatively minor problems that could be treated elsewhere The ACO business case for BHR highlighted “a high reliance on A&E for primary care conditions” Barts and BHRUT are judged to have the most challenging provider financial positions in England Kent & Medway has four main acute providers (D&G NHST; EKHU FT; Medway FT; MTW NHST) Two community providers (KCH FT; MCH CIC) and one mental health provider (KMPT) It is estimated that every day 1,000 people who are in a hospital bed no longer need to be there – 1/3 of the bed base 40% of emergency admissions could be avoided if right care was available outside hospital 60% of £486m projected deficit is within provider organisations The main acute providers BTUH, Southend University Hospitals and Mid Essex Hospitals have operated as a single group since 2017 Community and mental health services are provided by EPUT (a merger of two Essex Trusts), NELFT, Provide ( a Community Enterprise), ACE (Anglia Community Enterprise) and Virgin Care Analysis shows that 15% to 18% of A&E attendances are referred elsewhere and 20% to 26% of A&E attendances are discharged without treatment 1/3 of emergency admissions and bed days are for frail elderly patients £251m (47%) of the £532m system deficit is within the provider sector

Commissioners The commissioning landscape is changing with groups of commissioners developing ways of working collectively, rather than individually. They are exploring ways of operating more effectively as strategic commissioners to support the drive for system level change. NELFT will actively work with commissioners to align our ambitions for expanding out of hospital care, and support of deeper integration with partners, through a new commissioning agenda. The opportunity for NELFT is as a key player in the development and delivery of integrated locality based care, building on the role of “Thought Leader, Partner, Innovator, Integrator” which we set out in our 2015 strategy There are seven CCGs within NEL covering three systems – Barking & Dagenham, Havering and Redbridge in BHR; Newham, Tower Hamlets and Waltham Forest in West and East London; City & Hackney CCG for the City of London and Hackney area A single Accountable Officer has overall responsibility for commissioning across all of NEL The three main objectives of the new commissioning arrangements in NEL are to: Integrate commissioning around people’s needs Deliver the expectations set out in the Five Year Forward View Harness the benefits of CCGs working together and collaboratively with other NHS bodies, local authorities and the voluntary sector In Kent & Medway there are eight CCGs – Ashford; Canterbury & Coastal; Dartford, Gravesham & Swanley; Medway; South Kent Coast; Swale; Thanet and West Kent In February 2018, CCGs reported that they were exploring options to develop as a single strategic commissioner, who would then take on and manage programme responsibility for the STPs plans There are five CCGs in Mid & South Essex – Basildon & Brentwood; Castle Point & Rochford; Mid Essex; Southend and Thurrock In 2016, CCGs recognised the need for a governance forum to enable commissioners to collectively take decisions that cover the whole STP footprint In April 2017, CCGs formed a joint committee empowered to take decisions on behalf of all CCGs including STP wide service reconfigurations and leading public consultations on STP level service changes The committee also has delegated responsibilities for commissioning acute services; NHS 111 and Out of Hours services

Strategic implications for NELFT
Since 2015, we have seen the negative impact of strategic drivers becoming more pronounced, resulting in lost opportunities for the systems we operate in to deliver better patient care. In the same period, NELFT has been working to develop new services to improve patient care, where possible through collaboration with partners, including the Third Sector. The adverse effects of the four main strategic drivers, together with organisational and service changes happening across the care systems we operate in means there is consensus around how care should change – greater service integration and more locality based care – as well as a commitment from partners to transformative change. This consensus provides the right circumstances and environment for NELFT to work with our partners as “Thought Leader, Partner, Innovator and Integrator”. Whilst this collaboration will involve all partners taking risks, it opens up an opportunity for us to work together to actively develop and support the expansion and delivery of integrated locality based care. Strategic drivers Opportunity Demographic pressures Inadequate primary care Financial deficits Over use of urgent care Strategic opportunity The right environment for NELFT to actively develop and support the expansion and delivery of integrated locality based care The need for service reconfiguration and changes to care models Development of STPs and changes in commissioner roles

Our direction of travel
The strategic environment facilitates partnership working to achieve service integration and greater use of locality based care. This ties in with the NHS’ broader priorities of developing Integrated Care Systems, more integration of health and social care, achieving parity of esteem and improving productivity. These trends align with the direction of travel of our strategy – we will build on our successes to extend further, integration and best care, facilitated by technology to deliver high quality care, cost effectively. Our ambition is to touch all the geographies we work in and for these changes to be genuinely transformative, making a real difference to people’s lives Out of Hospital experience Partnership working EWMHS/new services QI/continuous improvement Our successes – we are ahead of many systems The direction of travel in this strategy builds on our successes and ambitions Integration Increasing demand – particularly frail elderly & children/young people Strategic drivers that influence our direction of travel Touching all the geographies we work in Best care Technology Integrating health & social care Parity of esteem Improving productivity Technology NHS development priorities for non acute care

Making technology part of our ambition
Technology already plays a strong role in NELFT through our development of IM&T. Within this strategy, we will improve business intelligence to help manage our business better and as part of our planned service changes, such as making primary care centres technology enabled to take advantage of connectivity and new technologies. This is not enough. We will actively and fully exploit the benefits from technology to make care delivery more efficient and to improve care quality. As part of this strategy we are instituting a structured approach to identify, assess and evaluate potential new technologies – apps, devices, analytics and connectivity. We will use technology to improve care at all stages from prevention to treatment to ongoing self management. Barry Jenkins will confirm the arrangements, budget and delivery plan before the end of 2018, making this a part of a cycle of work to support current strategic objectives and to generate new opportunities that will become future strategic priorities. Actively identify opportunities through… Care City Academic Health Science Networks Professional networks NELFT horizon scanning STPs and partners Assess and evaluate opportunities Adopt in existing strategic objectives Generate new strategic priorities

Section 5 What’s not changing and our learning from the 2015 strategy
This section highlights the existing organisational building blocks that we’ll retain in this strategy: Our values - which have become embedded in our people and culture Our purpose and mission - that define what the organisation is for and how we work Our role in the care system - originally developed in 2015 and still relevant to how we will operate within the wider care system This concludes with a summary of the learning from the 2015 strategy which has become woven into this updated strategy Section 5

Our values are deeply embedded in NELFT
The values set out the core principles that NELFT and our people continue to work by. The values were developed and adopted in following the creation of NELFT, reflecting: Respect for patients, service users and carers – seeing them as people, encouraging them to be active participants in their care An emphasis on high quality care, which became part of our Mission (Best care) A forward looking and progressive approach to services, highly professional and committed to innovation and improvement The values are deeply embedded in NELFT – recognised and understood by people, reflected in their behaviour and work. They will underpin NELFT's development alongside this updated strategy. People first Prioritising quality Progressive, innovative & continually improving Professional and honest Promoting what is possible - independence opportunity & choice Our Values

Our purpose and mission
NELFT's purpose and mission are well established: Our purpose is the same as that of all care organisations – outward looking with a focus on people and why we serve them. Our Mission was developed in the strategy, reflecting the ambition for our people to be best and provide best care for the people we serve. Both our purpose and mission are rooted in the organisation and provide sound building blocks for this strategy. Our purpose and mission are clear Purpose Mission The reason NELFT exists What NELFT does to achieve its Vision To improve the health and wellbeing of the populations we serve The best care by the best people

Our role in the care system
Our role in the care system was developed in the strategy, which recognised: How important integration would be to the development of health and care That NELFT wished to go further and faster on the road to integration. The roles of Thought Leader, Partner, Innovator and Integrator reflect: How we wish to work with partners not just in health but across the wider care system Our ambition to develop new ideas and approaches to care Our commitment to work in partnership with others, to use these innovative ideas and approaches to deliver deeper service integration and high quality care. Our role highlights the ambition of our people and organisation as well as the importance of integration in the development of new approaches to care. Our updated strategy confirms that we will continue with our role of Thought Leader, Partner, Innovator and Integrator in the wider care system. Thought leader, partner, innovator, integrator strategy

Learning from the 2015 strategy
The first part of the engagement process was designed to identify learning from people’s experience of the development, delivery and content of the 2015 strategy. The conclusions and recommendations from our workshops, 1:1 interviews and discussions were used to frame the work on the strategy and have been woven into this document. Participants highlighted four main elements of NELFTs 2015 strategy - Best Care/Quality; development of Out of Hospital Care; the integration and collaboration agenda; commercial growth. Outside the Executive Team, people could not clearly articulate NELFTs vision, often citing commercial growth as NELFTs vision or principal organisational objective. The updated strategy should: Set out a clear vision for NELFT Show how the four principal strategic issues relate to the overall vision Use the strategy as a reference point in decision making Reflect the strength of appetite to change and improve care delivery Show how QI and continuous improvement and innovation are used as a “super enabler” to deliver Best Care universally Include development of outcomes to measure and demonstrate success The most powerful comments on the content of the strategy suggested that NELFT’s strategy should not be about survival, but a bold, ambitious and aspirational vision for the organisation, rooted in what NELFT is good at - high quality care, integration and development of out of hospital care. Good implementation was seen as key, making the strategy highly visible and relevant to everyone in their day to day work. The updated strategy should be: Bold, ambitious and aspirational Visible and relevant to everyone in NELFT Actively promoted to generate both understanding and buy in to the vision for NELFT – this requires a step change in the approach to promoting the strategy across the organisation Best Care was cited as the core element of both the existing and future strategy. There was consistent feedback on the variability within services across NELFT. However positively, there was a strong appetite to move from episodic to holistic care. It was also suggested that QI could be used as a “super enabler” to achieve Best Care universally, with success measured through outcomes. Key conclusions Recommendations Understanding the strategy Learning from the 2015 strategy Progress on the strategy & achieving Best

What needs updating The remainder of this report addresses the four areas where we have brought our strategy up to date. It provides a clear and ambitious picture of where we want NELFT to be, the challenges we face and the opportunities these challenges create. The report then shows how we’ll deliver the vision by achieving the objectives that address our challenges and the way we’ll report on the delivery of our objectives. Our Vision Where we want NELFT to be in 3 to 5 years time Our Challenges The challenges we face and the opportunities they create Our Objectives Addressing the challenges to deliver the Vision Reporting progress How we’ll show what we’ve achieved Section 6 Section 7 Section 8 Section 9

Section 6 Our Vision – what we want NELFT to be
This section of the report discusses the new Vision for NELFT: How we developed the vision through active engagement with our people The six strategic aims that underpin our Vision The new Vision, which reflects our ongoing commitment to moving forward on the journey to integrated care The section concludes by setting out the three key components of this updated strategy – our Purpose, Vision and Mission Section 6

“Where should NELFT be in three to five years time?”
Developing our Vision Through the engagement process we discussed the learning from the 2015 strategy and considered where NELFT should be in three to five years time to help develop the Vision. By engaging with a wide range of clinical and non clinical staff, we developed a rich and balanced view of where NELFT should be in 3 to 5 year’s time. NELFT's Vision Engagement What’s the Vision? We asked: “Where should NELFT be in three to five years time?”

Developing the Vision NELFT in 3 to 5 years time NELFT’s Future
Patients and Care People and Teams Improving Care Working with Partners Sustainability Six themes emerged from the engagement, to describe what NELFT will be in 3 to 5 years time. The themes range from the future shape of NELFT to how we will work with our people and partners to deliver on our commitment to improve the care we provide. The themes are comprehensive and balanced, touching on all of the key aspects of what we do and how we do it both within and outside the organisation. Appendix C sets out these themes in detail, summarising each theme in an aim, which supports our overall Vision

Our Vision Six aims define our Vision - NELFT will actively shape, develop and deliver, integrated, locality based care for the populations we serve The Vision reflects our ongoing commitment to moving forward on the journey to integrated care, showing we are: Bold and ambitious Outward looking Committed to continually improving the quality of care. The nature of the Vision is permissive, so we are free to actively identify and exploit opportunities to work with partners in an organisation agnostic way throughout the care sectors we work in. The Vision allows us to use these opportunities to progress and where possible accelerate the development and delivery of integrated locality based care.

Our Purpose, Vision and Mission
Purpose: To improve the health and wellbeing of the populations we serve Vision: NELFT will actively shape, develop and deliver, integrated, locality based care for the populations we serve Mission: Best Care by the Best People Having developed our Vision we have clearly defined three key component of our strategy: Our purpose – why NELFT exists Our Vision – where we want NELFT to be in the future Our Mission – what we do to achieve our Vision These reflect directly, the issues discussed during the engagement process, where people said that our strategy should: Be clear to everyone in NELFT Show we are bold, ambitious and aspirational Reflect the strength of our appetite to change and improve care delivery Be visible and relevant to everyone in NELFT

Section 7 Turning our challenges into opportunities
This section of the report sets out the challenges facing NELFT: How we identified the challenges through the engagement process The five key challenges and how they link to the strategic issues discussed in sections 3 and 4, particularly service integration and Best Care How we’ll use challenges as opportunities to help us achieve our Vision and deliver best care Section 7

Using engagement to identify our challenges
By engaging with a range of clinical and non clinical people in NELFT, through workshops, meetings and 1:1 interviews, we formulated a clear and rounded view of the challenges facing NELFT. Engagement Challenges we face NELFT's Challenges We asked: “what are the top challenges facing NELFT?”

The challenges for NELFT going forward are to:
Key challenges we face We identified five strategic challenges facing NELFT which are being taken forward in this updated update. These challenges reflect what’s happening both within and outside NELFT - the wider environment we work in, how we want to develop our care and people as well as challenges around being effective through our relationships with organisations and people we work with. We believe these challenges provide us with a range of opportunities to transform our services, to achieve our vision and deliver best care Manage the change from a competitive market to a more collaborative and partnership approach, leading to integrated care delivery across care systems through service developments that provide holistic person centred care Deliver Best Care across all NELFT's services and reassess the role of QI and continuous improvement in the journey to make Best Care universal, with success measured through outcomes Retain, develop and engage with our people, so they effectively deliver Best Care through existing and new care models, making NELFT the NHS employer of choice Make NELFT financially sustainable against a background of demographic pressures and low resource growth Create and promote a clear identity for NELFT within and outside the organisation that reflects the breadth of NELFT's services and ambition during a period of significant change STPs & Integration Best Care Best People Finance Identity The challenges for NELFT going forward are to: The detailed issues discussed in workshops and 1:1 interviews that underpin each challenge are shown in Appendix D

Turning challenges into opportunities to achieve our Vision
STPs & integration Identity Finance The five challenges facing NELFT are directly linked to the six aims that support our new Vision. We will use the opportunities these challenges present to address the six strategic aims and therefore deliver the Vision for NELFT. The next section of this report sets out the actions that will meet our strategic challenges and shows clearly, how each action is linked to a strategic aim and opportunities which helps deliver our Vision. Best Care Best People STPs & Integration Best Care

Section 8 What we’ll do - our objectives
This section of the report sets out the actions we will deliver and how they present opportunities to improve services for patients and achieve our Vision: The Executives that are responsible for delivering actions to address the strategic challenges A small number of impactful, strategic actions we’ve planned that touch all the geographies we work in How the actions will genuinely improve the care we deliver and the way they link to our strategic aims Detailed action plans are set out in the appendices to this report Section 8

What we’ll do Each member of the Executive Team will take forward actions that address our strategic challenges. These actions create opportunities to deliver our vision to actively shape, develop and deliver integrated, locality based care for the populations we serve. The following pages show how the actions we developed were shaped by the direction of travel described in Section 4 and the system context of those actions. The remainder of the section sets out the actions and opportunities for each challenge and which strategic aims they support. STPs & Integration Best Care Best People Finance Identity Stephanie Dawe (Essex, Thurrock Kent & Medway) Jacqui Van Rossum (London) Caroline Allum Bob Champion Barry Jenkins John Brouder Manage the change from a competitive market to a more collaborative and partnership approach, leading to integrated care delivery across care systems through service developments that provide holistic person centred care Deliver Best Care across all NELFT's services and reassess the role of QI and continuous improvement in the journey to make Best Care universal, with success measured through outcomes Retain, develop and engage with our people, so they effectively deliver Best Care through existing and new care models, making NELFT the NHS employer of choice Make NELFT financially sustainable against a background of demographic pressures and low resource growth Create and promote a clear identity for NELFT within and outside the organisation that reflects the breadth of NELFT's services and ambition during a period of significant change

How the direction of travel shaped our ambition and our strategic objectives
The direction of travel set out in Section 4 is shaped by our successes – out of hospital care, development of EWMHS and new care models. This direction also aligns with wider trends and the themes likely to form the core of the NHS 10 year plan. Our objectives are driven by our ambition to build on, and expand our successes. Our ambition is to make big, impactful changes in all the geographies we work in, incorporating and exploiting technology to create exemplars of best practice and transformational change. These changes will be difficult and complex, however, we are determined to succeed, because of the opportunity these changes present – an opportunity to make a real and positive impact on people’s lives through step change improvement in the care we and our partners deliver Our ambition is to make transformative changes touching all the geographies we work in to create leading edge services Enablers Best People Identity Finance Integration Best care Services Acute care Social care & communities Primary care Other MH care providers Standardising care delivery Integrating physical & mental health Outcomes Technology Shaping our strategic objectives The direction of travel in this strategy builds on our successes and ambitions Integration Best care Technology Touching all the geographies we work in

A system view of our strategic actions
System leaders in health and social care all wish to move forward on service integration, with NELFT as an active partner. We will encourage partners to invest part of the 3.4% growth monies into transformational change. This partnership opens up an opportunity to genuinely transform care through integration and Best Care with care models that provide more prevention, easier and faster access to services an deliver care more efficiently and cost effectively. We will make changes in each of the three geographies we work in, building on our experience and successes, and exploiting technology, to prototype new models and approaches to services that have a real and positive impact on patients Best care: Integrating physical & mental health; Standardising care/reducing variation; Patient centred outcomes Provider integration in BHR through the Provider Alliance Primary care development in two communities Integrated community offer in Waltham Forest Partnerships with community providers Improving mental health services through partnership STPs & Integration NELFT enablers – Best People; Finance; Identity STP enablers – Technology for patient care; IM&T infrastructure; Estates We’ll work actively in the system through our roles of Thought Leader, Partner, Innovator and Integrator to deliver our strategic objectives Working in partnership means we achieve our vision for NELFT and help our partners and the system as a whole become more integrated – so we achieve mutual success We’ll co-operate and collaborate to overcome barriers, bringing fragmented care together to deliver better care for patients Some of this is uncharted territory, which means both we and our partners will take risks and we’ll share some of those risks. Through these practical actions and partnerships, we’ll improve the health and wellbeing of the people we serve

STPs and Integration (Essex, Thurrock, Kent & Medway)
There are two strategic actions to address the STP and Integration challenge in Essex, Thurrock, Kent & Medway (ETK&M). These actions support the strategic aim of working with partners and help to deliver NELFTs Vision – to actively shape, develop and deliver integrated locality based care in ETK&M (Essex, Thurrock, Kent & Medway). Stephanie Dawe is responsible for delivering these actions Southend, Essex and Thurrock Community Partnerships Develop partnership working with community and acute providers in Essex & Thurrock Partnership relationships in Kent and Medway Improve mental health services in Kent & Medway with partners through the STP Strategic Action Strategic Aim Working with partners Working with partners Care needs identified earlier and services delivered more quickly Care provided more efficiently and effectively More people are able to mange their conditions themselves Simpler, faster access to care through a single point of access Risk managed more effectively through local community support networks More care closer to people’s homes rather than out of area Positive impact on patients Action plans are set out in Appendices E1 and E2

STPs and integration (London)
There are three strategic actions to address the London STP and Integration challenge. These actions all support the strategic aim of working with partners and help deliver NELFTs Vision - to actively shape, develop and deliver integrated locality based care in London The first two priorities will be delivered through our collaboration with the BHR Provider Alliance. Jacqui Van Rossum is responsible for delivering these actions Provider integration Deliver integrated services through the BHR Provider Alliance Primary Care development Work with Primary Care in two communities to develop integrated community services Community Partnerships Develop an integrated community offer with partners in Waltham Forest Strategic Action Strategic Aim Working with partners Working with partners Working with partners Frail elderly people spend less time in hospital People are supported to live independently in their own homes, not in care homes Fewer unnecessary A&E visits and hospital admissions Primary care services are the default setting of care, not an acute hospital Simpler access to care for a range of needs through a single point of access More community and home based care for frail elderly people and those with long term conditions More prevention and earlier intervention Shorter hospital stays through more effective discharge and community care Lower demand for emergency acute care Positive impact on patients Action plans are set out in Appendices E3 to E5

Best Care The strategic actions that address the Best Care challenge in this strategy are drawn from the Best Care strategy. These actions are the most complex and far reaching of all the actions identified in this strategy. Dr Caroline Allum is responsible for delivering these actions, which are aligned to two strategic aims that support the Trust’s Vision. Positive impact on patients Strategic Action in Best Care Strategic Aim Integrated care No physical health without mental health – and vice versa Patients and Care No disparity in health outcomes for people with serious mental illness, with support for people that have long term conditions as well as mental illness Standardise care and reduce variation: core offer Develop and roll out a single model of services that deliver Best Care Patients and Care No difference in the way that services are delivered, so all patients receive an equitable, high standard of care regardless of where they live Patient centred outcomes Develop and roll out outcome measures that define Best Care Improving Care Adopting outcome measures means that we measure how effective care has been using measures that are meaningful and important to patients Action plans are set out in Appendices E6 to E8

Strategic action for Best people
The strategic actions that address the Best People challenge in this strategy are drawn from the Best People strategy, to make NELFT the NHS employer of choice. They build on our successes with people, particularly our track record of developing a diverse and inclusive workforce. Bob Champion is directly responsible for the delivery of two strategic actions (leadership capacity and leadership competence) and will work within teams responsible for delivering a further two actions (engagement and skills for new care models). Best people strategy Best people theme Leadership Engagement Skills Make sure we have the right Capacity, Competency and Capability to lead the organisation at all levels Effectively engage with staff and patients so people are committed to our values and goals, and motivated to contribute to NELFT’s success Make sure people have the right service delivery and technical skills to deliver Best Care and to support people delivering care What it means Trust strategy Direct action: Develop and implement a leadership competency framework Undertake leadership capacity assessment Supporting action: ** Support the development of Identity (Challenge 5) by participating in actions to engage with our people and promote NELFT Supporting action:** Support work on STP/Integration (Challenge 1) to develop new care models – skills to deliver these models will be included in new competency frameworks Strategic action for Best people Strategic Aim NELFT’s future People and teams People and teams Action plans are set out in Appendices E9 and E10 ** Supporting actions are not described in action plans

Finance There are three** strategic actions to address the finance challenge, which support the strategic aims of Sustainability and Improving Care. Barry Jenkins is responsible for delivering these actions. Our commercial development also includes the target for NELFT’s turnover – to grow turnover as far as market conditions allow, in line with our new commercial framework. This will be delivered alongside the overall financial objectives – to achieve a Use of Resources rating of 2, financial break even and maintain liquidity. Disposal of Goodmayes Deliver strategic gain from Estate rationalisation Replacing NELFT's BI system Better care and assurance through Business Intelligence Continuing commercial development Optimise commercial opportunities through a new commercial framework Strategic Action in Finance Strategic Aim Sustainability Improving Care Sustainability Action plans are set out in Appendices E11 to E13 ** The detailed plan for technology set out on Page 30 will be completed before the end of 2018 and discussed as part of the January 2019 Board progress review of the strategy

What do people think about us? Promoting our identity
There are three strategic actions to address the identity challenge, which impact on people within NELFT and our wider stakeholder community, in a range of organisations across STPs. These actions all support the delivery of the Vision. John Brouder is responsible for delivering these actions. What we say about us Understand our identity and developing a strategic narrative What do people think about us? Understand what people think about us within and outside NELFT Promoting our identity Use insight, engagement and dialogue to promote our identity Strategic Action Strategic Aim Vision Vision Vision Action plans are set out in Appendix E14

Section 9 Reporting progress
This section of the report discusses how we’ll report progress: The cycle for review of progress and assurance of delivering strategic actions and the overall strategy The approach to Board oversight of strategic developments and actions This will help to keep our strategy at the top of NELFT’s agenda, aligning what we do with what we plan to achieve, so we’re always up to date with strategic developments, whether local or national, which affect NELFT and the services we provide Section 9

How we’ll report progress
We’ll put in place a structured approach to mange progress of strategic actions to maintain momentum within each project and provide appropriate strategic oversight of delivery by the Board There will be three layers of responsibility: Executives overseeing individuals and teams delivering actions, engaging with people to discuss progress and develop wider buy in Overall progress review by EMT Board review as part of their ongoing oversight of strategic developments and actions – discussed further in the next page Cycle for oversight and review of progress in delivering strategic actions and the overall strategy Executive oversight, engagement & delivery EMT Progress review Executive oversight, engagement & delivery EMT Progress review Executive oversight, engagement & delivery EMT Progress review 2018 2019 Sept Oct Nov Dec Jan Feb March April May June July Board sign off Strategy Board Progress review Board Progress review Board Progress review

Board oversight of strategic developments an actions
The environment we operate in is fast moving, with constant changes both nationally and locally. The Board’s review of the progress of strategic actions must therefore be closely tied to a good understanding of any changes and developments that might have an impact on NELFT and our strategic plans. The quarterly review of strategy by the Board will therefore be in three parts, so: We know what’s happening and what’s changing- the Board has up to date information, so everyone knows about changes and their potential impact on us and our plans. We know what the changes mean for NELFT - there is a clear understanding of the links between and implications of, strategic developments and our strategic actions and plans. We can adapt quickly and effectively - we can operate in an agile way, quickly adapting our strategic actions in response to changes in the wider environment, so our strategy has the greatest possible impact. Three part agenda for Board Progress Reviews of the strategy Changes to the local and national strategic landscape This might be legislation or key policy announcements and how they impact upon NELFT; regulatory changes/initiatives; changes to commissioner or provider structures or changes in key leadership roles; new STP initiatives Progress on strategic actions Executive Directors to confirm progress on the strategic actions they are responsible for delivering, highlighting material issues and the impact of the initiatives on NELFT and the wider care system Changes needed in light of 1 and 2 Discuss and agree whether any of the changes in the strategic landscape or position on strategic actions means that these actions need to be redrawn or new actions developed

Section 10 Appendices A - Who we engaged with
B1 to B2 - Detailed commissioner and service category analysis C1 to C7 - The themes and aims underpinning our Vision D1 to D5 - Feedback on NELFT's strategic challenges E1 to E14 - Detailed action plans to support delivery of strategic actions Section 10

Appendix A A - Who we engaged with

Appendix A – who we engaged with

Appendix B: Detailed commissioner and service category analysis
B1 - Detailed commissioner analysis B2 - Detailed service category analysis

Appendix B1 - Detailed commissioner analysis
2 3 4 6 5 Data drawn from NELFT’s SLR system at the end of May Consists of Waltham Forest CCG; LB Waltham Forest; Newham CCG and Tower Hamlets CCG Consists of West Essex CCG; Castle Point & Rochford CCG; Southend CCG; Colchester CCG and Essex County Council Specialist services commissioned by NHS England Income from CCGs who do not have a contract with NELFT, but where NELFT delivers services to their residents Other is mainly £2.8m of R&D income (0.77% of NELFT’s budgeted income in 2018/19) Geography NEL STP Mid & South Essex Kent & Medway Other

Appendix B2 - Detailed service category analysis
1 £108.1m (29.4%) £81.9m (22.3%) £59.5m (16.2%) £55.5m (15.1%) £19.6m (5.3%) £13m (3.5%) £7.9m (2.1%) £7m (1.9%) £6.8m (1.86%) Other services comprises: Specialist Nursing - £2.82m (0.8%) Research & Development - £2.82m (0.77%) End of life care - £1.21m (0.3%) City & Hackney CCG - £0.16m (0.04%) 1

Appendix C: The themes and aims underpinning our Vision
C1 - What people talked about C2 - Theme 1: NELFT’s future C3 - Theme 2: Patients and Care C4 - Theme 3: People and Teams C5 - Theme 4: Improving Care C6 - Theme 5: Working with Partners C7 - Theme 6: Sustainability

Appendix C1 - What people talked about
Six themes emerged from the engagement, which describe what NELFT will be in 3 to 5 years time. In the following pages, each theme is shown in detail and summarised in an aim, which supports our overall Vision. NELFT in 3 to 5 years time NELFT’s Future Patients and Care People and Teams Improving Care Working with Partners Sustainability The nature of the Vision is permissive, so we are free to actively identify and exploit opportunities to work with partners in an organisation agnostic way throughout the care sectors we work in.

Appendix C2 - Theme 1: NELFT’s future
WHERE WE WILL BE We continue to operate as NELFT - we believe that voluntary partnerships that focus on high quality care, rather than organisational structures, are the best way to deliver good outcomes for patient. OUR AIM We will continue to be an independent organisation, as well as working in close partnership with other health and social care bodies. We work in partnership with other health and social care organisations to deliver the best care for patients. We actively identify and exploit partnership opportunities to progress and accelerate the development and delivery of integrated locality based care.

Appendix C3 - Theme 2: Patients and Care
WHERE WE WILL BE We believe that patients should treated as a whole person and supported with their physical and mental health needs and their social care needs. We put patients at the centre of care. We aim to deliver the best services for the communities we serve. We want patients to be empowered to manage their own health and wellbeing. We now measure the quality of our services through outcomes because these measures are more relevant to patients. OUR AIM We will always put patients at the centre of care. We will deliver Best Care across all of NELFT, empowering patients to manage their own health and wellbeing and doing this close to, or in, patient’s homes. We have taken models of Best Care and make them universal across NELFT so most of our services are Best. We provide care closer to home. We have retained our CQC rating of Good. Some service areas are now externally accredited to show they are good. Our care has moved away from a paternalistic approach to one that engages and empowers the patient. The style of care delivery relies as much on supporting and influencing patients as it does on giving direct treatment. We deliver more care virtually, using a range of technology platforms to engage effectively with patients.

Appendix C4 -Theme 3: People and Teams
WHERE WE WILL BE In many of our teams, we work with care professionals from other organisations - health, social care and the voluntary sector. Teams have been set up to focus on peoples needs within communities, recognising that peoples needs differ, depending on where they live. OUR AIM Our functionally integrated teams deliver care based on patient’s needs, regardless of which organisation the member of the team works for - we see our teams as organisation agnostic. Our teams will deliver care for local communities. We will work with care professionals from other organisations and use our many skills optimally to better support our patients. We have developed staff who have many skills across a range of areas to better support our patients. Every person who works for and with NELFT is respected and valued for the skills and professionalism they bring to patient care. People work to the top of their license - not spending time doing something that could be effectively done by someone else.

Appendix C5 - Theme 4: Improving Care
WHERE WE WILL BE We have developed systems that collect and report outcomes, using these measures to assess how far we have improved and how close we are to delivering best care. We used QI to establish a culture of continuous improvement across all staff within NELFT. This has been supported by learning from national and international best practice as well as research and innovation. OUR AIM We will use QI to generate continuous improvements in the services we deliver, demonstrating improvement through better outcomes. This culture has not only spread throughout NELFT, but has become adopted by the partners and systems that we work with. We use data to provide evidence for us to make clinical and managerial decisions. We are rolling out more digital infrastructure in the community to facilitate digital care delivery. Our people represent the diverse populations we serve, so we understand their needs and provide care that meets those needs.

Appendix C6 - Theme 5: Working with Partners
WHERE WE WILL BE Through our collaborative partnerships we have co- produced services that improve care. These services address system problems, often through the expansion of integrated out of hospital care. We continue to support the development and growth of Primary Care , who are an essential element of genuinely integrated out of hospital care. OUR AIM We actively collaborate with partners within and across systems including STPs, health commissioners, acute and community health providers, local authorities, social care, public health and the third sector. We will collaborate with partners using our experience and expertise to improve care across the systems we work in. We have shared our experience in delivering Best Care, using innovation and continuous improvement to increase the quality of care delivered. We also share our experience widely through the Academic Health Science Network and UCL Partners, so people and organisations are aware of what we have done to improve care. Partners often call on NELFT to share experience of innovation and provide advice to help them develop new approaches to care delivery.

Appendix C7 - Theme 6: Sustainability
WHERE WE WILL BE We deliver best value care for the taxpayer. People and teams have become more efficient so we deliver best care within available budgets. OUR AIM We have completed the roll out of Agile Working which has changed the way many of our people work by increasing productivity and unlocking time to provide better and more responsive patient care. Agile has also become a feature of integrated teams, helping them work together more effectively. We will make the best use of resources through greater efficiency , showing that we deliver good value for money to taxpayers. NELFT delivers services across a wider geography than before. Expansion has helped us spread best care and to accelerate service integration in these new geographies. We have modernised our Technology, IM&T and Estates infrastructure to make care delivery more efficient.

Appendix D: Feedback on NELFT’s strategic challenges
D1 - Challenge 1: STPs and Integration D2 - Challenge 2: Best Care D3 - Challenge 3: Best People D4 - Challenge 4: Finance D5 - Challenge 5: Identity

Appendix D1 Challenge 1: STPs and Integration
The Five Year Forward View and Next Steps on the Five Year Forward View set the direction of travel away from competition and the market to integration and collaboration through STPs. This represents a fundamental change in how care is delivered as well as the nature of care. NELFT should: Develop a clear understanding of how integration and collaboration should work. How NELFT can work most effectively within and across STPs to achieve integration and deliver holistic, patient centred care. Patient focus and the role of the Third Sector is often poorly represented – we should bring these into the centre of the change. The FYFV has set a direction of travel for integration and collaboration across health and care STPs promote and facilitate integration and collaboration – how should we work with STPs? Need to clearly define the meaning of integration and collaboration, then determine what our approach should be within and across STPs Clarify the relative priority between integration and growth; if there are opportunities for growth, sufficient capacity should be in place Promote an organisation agnostic approach to integration and working with partners Explore how we can collaborate with Primary Care – an essential component of integrated care What people said The challenge: Manage the change from a competitive market to a more collaborative and partnership approach, leading to integrated care delivery across care systems through service developments that provide holistic person centred care.

Appendix D2 Challenge 2: Best Care
Best Care will be a key component of the updated strategy, with Best a universal standard for care across NELFT, not just represented through pockets of best practice. QI should have a broader role within NELFT through the updated strategy. QI should be deployed as a “Super Enabler”, embedding innovation and using external learning to deliver Universal Best Care through continuous improvement. Universal Best Care should also reflect changes in care delivery across the system, moving from episodic care to engaged, person centred care. High quality Business Intelligence should be developed to make NELFT a data driven organisation, using outcomes and/or healthcare value to measure success. Best care should be universal, across the whole of NELFT Our services don’t need to be outstanding, but we do need to show continuous improvement. Outstanding services should be sustainable We should measure Best and the level of improvement over time through outcomes and how these reflect our impact on patients QI be a “Super Enabler”, driving innovation to deliver continuous improvement , helping address issues such as productivity and efficiency We should become a data driven organisation, using good Business Intelligence and outcomes to measure progress towards Best What people said The challenge: Deliver Best Care across all NELFT's services and reassess the role of QI in the journey to make Best Care universal, with success measured through outcomes.

Appendix D3 Challenge 3: Best People
The approach to workforce should recognise that Best Care can only be delivered by the Best People. Our approach to workforce needs to go beyond good practice in recruitment and retention. We need to proactively manage the impact on the workforce of integration and the shift to holistic, person centred care. These fundamental changes in care approaches will impact on the skills our people need to deliver this type of care. Best people is the mirror of Best Care, not something separate Continue to positively engage with the workforce – should be embedded in BAU as a standard We need innovative solutions to known recruitment and retention hotspots Fundamental changes driven by integration and expansion of holistic person centred care, will have a huge impact on our workforce over the next 3 – 5 years The challenge: Retain, develop and engage with a workforce that can effectively deliver Best Care through existing and new care models. What people said

Appendix D4 Challenge 4: Finance
NELFT continues to face financial pressures from low income growth, exacerbated by increasing demand from a growing population and higher acuity in patients reflecting demographic changes in the communities we serve. There should be a continuing emphasis on efficiency using enablers such as Agile, IM&T and Estates to drive efficiency and improve services. The annual CIP round, characterised by “salami slicing” is not a sustainable way to deliver sound finances. The solution lies in transformational service change within NELFT and across wider care systems. Low resource growth continue to increase financial pressure on NELFT Services are becoming leaner and more efficient using Agile as a way of dealing with financial pressures. Annual CIP “salami slicing” is unsustainable – we need to deliver transformational change to make NELFT and care systems sustainable Increasing demand and acuity have an ongoing impact on finance – just doing more of the same is not a solution Commissioner/Provider relationships are not currently mature enough to quickly develop the level of innovation and integration required What people said The challenge: Make NELFT financially sustainable against a background of demographic pressures and low resource growth.

Appendix D5 Challenge 5: Identity
An unclear organisational identity is an issue both within and outside NELFT: Staff are not always clear about what NELFT does, as well as what NELFT's aims and ambitions are. Externally, NELFT is still commonly perceived as a mental health provider, rather than an integrated care provider. We need to promote a clear organisational identity that is understood by all staff. We should also develop a clear external identity, tailored to the different STPs we operate in. The identity should reflect a balance between success and organisational humility, so NELFT is not perceived as arrogant or a threat. Identity is an issue both within NELFT and outside NELFT NELFT still perceived by some as a Mental Health provider; others are unclear about what NELFT does We need to tailor our identity to take account of the different relationships/requirements of each STP NELFT can be perceived as a threat because not clear what NELFT does Organisational humility important so NELFT not perceived as arrogant Internally, simply explaining what our portfolio of services is and what we are aiming to do e.g. through growth What people said The challenge: Create and promote a clear identity for NELFT within and outside the organisation that reflects the breadth of NELFT's services and ambitions during a period of significant change.

Appendix E: Detailed action plans
E1 - STPs and Integration (Essex, Thurrock, Kent & Medway): Southend, Essex & Thurrock community partnerships E2 - STPs and Integration (Essex, Thurrock, Kent & Medway): Partnership relationships in Kent & Medway E3 - STPs and Integration (London): Provider integration E4 - STPs and Integration (London): Community partnerships in Waltham Forest E5 - STPs and Integration (London): Primary Care development E6 - Best Care: Integrated care E7 - Best Care: Core Offer E8 - Best Care: Outcomes E9 - Best people: Leadership competency framework E10 - Best people: Leadership capacity assessment E11 - Finance: Delivering strategic gain from Estate rationalisation E12 - Finance: Better care and assurance through Business Intelligence E13 - Finance: A new commercial framework E14 - Identity

Appendix E1: STPs and integration (ETK&M) Southend, Essex & Thurrock community partnerships (1)
Out of hospital care for adults and children has begun to change, but these services are not yet genuinely integrated. We will work with community and acute partners as well as communities themselves, to deliver services earlier in the care cycle, prevent deterioration and reduce the severity of long term conditions. This holistic care will be more clinically effective, making better use of resources by reducing duplication and ineffective contacts with people Why do this? Providers and agencies work in silos – people have care delivered by a range of providers and carers, so there is significant duplication, for example with assessments Care is fragmented as providers deliver episodic care rather than understanding the people’s whole needs taking into account both physical and mental health Currently, people’s needs are identified when they become unwell, often once their conditions become severe, so care is more intensive and therefore more expensive People’s care needs can also be better addressed by understanding how they relate to wider determinants of health and wellbeing Late interventions mean that people lose the opportunity to live well for longer, which would have happened if care had been started earlier What’s the opportunity To deliver services in Essex and Thurrock that help avoid people becoming patients and to support them to live well for longer, by: Identifying and addressing care needs earlier through care delivered by integrated teams from integrated facilities that provide primary and community care Involving a wide range of partners including Social care, voluntary sector organisations and community pharmacists, who can help to deliver care more quickly, through shorter and more direct care pathways Engaging people to take responsibility for their own care and support them to manage their conditions themselves, through community assets such as neighbours and local support groups Using co-production to engage with people to facilitate the development of individual and bespoke care approaches Providing holistic care through integrated teams and hybrid roles, so care is efficient and effective, reducing duplication and genuinely making every contact count Delivering care against an agreed unified outcome framework so integrated teams are working to common outcome measures - we’ll measure what genuinely matters to people These services will be supported by clinical, financial and administrative processes which work seamlessly across organisations and sectors to facilitate integration of care delivery Key statistics: Mid & South Essex population – 1.17m 2018/19 income = £63.7m, mainly Children’s mental health (£16.8m/26.4%), Adult community (£14.5m/22.8%), Long term conditions (£13.8m/21.7%) Budgeted WTE staff = 707

Appendix E1: STPs and integration (ETK&M) Southend, Essex & Thurrock community partnerships (2)
The plan shows separate timelines for Essex and Thurrock, with both requiring internal development and approval by NELFT before detailed system wide development starts. Estates, IT and workforce issues will be addressed system wide through existing STP groups. As these enabling developments will be managed at a system level, the timescale to complete enabling actions is judged to be up to two years 2018 2019 July - Sept Oct - Dec Jan - March April - June July - Sep Internal development & decisions Estates, IT and workforce through existing STP groups – Estates, Digital and Local Workforce Advisory Board Two years is likely and will depend on commitment of partners to work effectively at pace ESSEX Board decision to proceed NELFT evaluation of provider relationships Plan alignment of adult & children’s services and structures with community and acute partners to avoid duplication System wide enabling developments – 2 YEARS Complete March 2021 Alliance agreement Delivered through the same STP groups as the Essex development and to similar elapsed time of two years, depending on commitment of partners to work at pace THURROCK Financial business case and Board approval Formulate Alliance contract in Thurrock, subject to commissioner agreement Complete June 2021 Develop business case – up to six months to complete and approve System wide enabling developments – 2 YRS

Appendix E2: STPs and integration (EK&M) Partnership relationships in Kent & Medway (1)
Kent and Medway STP is currently focusing more on adult and acute inpatient services than children’s service and mental health. We are still building our relationships within the STP as we are a new and relatively minor provider in the area. Our aim is therefore to work with partners to improve care through an effective single point of access and identify further partnership opportunities to improve care Why do this? In 2017, NELFT won contracts to provide children and young people’s mental health services in Kent and young people’s wellbeing service in Medway plus an All Age Eating Disorder Service (AEDS) emotional health and wellbeing services for 0-19 year olds and an all age Eating Disorder Service in Kent and Medway Some progress has been made to improve joint working and care quality by collaborating with partners such as Kent Community Health NHS FT to develop a single point of access (SPA) Services are still not sufficiently joined up to provide best care for year olds and people with eating disorders in Kent and Medway – there is significant scope to improve care for these people NELFT is represented in two STP working groups, Mental Health and the Children's’ Group, but is not a member of the overarching STP Board – we need to work with partners in the STP to prioritise improvements in these services What’s the opportunity To build on work underway to transform existing pathways by developing partnerships to deliver genuinely integrated and better care. We wish to move from providing care in part of the pathway by: Enhancing the children and young people’s emotional wellbeing and mental health services by creating a single community/inpatient pathway Working with partners in both Kent and Medway to streamline and improve initial patient contact, by implementing a single point of access (SPA) – in Kent, with Kent County Council, in Medway , with Medway Council and Medway CIC Working with partners to create a new S136 Suite in Kent and Medway to enhance the care to children and young people’ Deliver an effective transition between Children and Adult services through closer working with Kent & Medway Partnership Trust Manage risk more effectively through links with communities and people including schools, voluntary groups, young people and their families Providing seamless care by reducing duplication to increase the effectiveness of care Reducing out of area placements by delivering comprehensive care within Kent and Medway, to improve care for people as well as carers and families that support them, through care closer to home Key statistics: Kent population = 1.5m, of which 0.35m are children and young people Medway population = 0.26m, of which 67,000 are children and young people 2018/19 income = £21.9m of which £20.2m/92% is for Children’s MH services Budgeted WTE staff = 311

Appendix E2: STPs and integration (EK&M) Partnership relationships in Kent & Medway (2)
The plan shows the work to complete the mobilisation and harmonisation of existing care services in Kent and Medway. Alongside this, we plan to develop and implement a single point of access for 0-19 services and people with eating disorders, with partners in Kent and replicate this approach in Medway by the end of We will also transform the acute pathway as part of the development of a unified service 2018 2019 July - Sept Oct - Dec Jan - March April - June July - Sep Mobilisation complete We will implement consistent pathways across all existing services Existing services We will complete mobilisation before the end of 2018 Harmonising pathways Kent Single Point of Access Kent Single Point of Access We will also transform the acute pathway Developments We already work with Kent CC through a SPA. We will extend this through collaboration with Kent Community Health NHS FT Complete March 2020 Acute pathway transformation – anticipated 1 year We would replicate our work in Kent to deliver a SPA in Medway with Social Care (Medway Council) and Medway CIC, who provide children’s services Medway Single Point of Access

Appendix E3: STPs and integration (London) Provider integration (1)
This priority is part of our work with the BHR Provider Alliance. We will work together to implement better support to frail elderly people so they remain independent and when needed, receive the right care at the right time. Our partners include BHR CCGs, BHRUT and domiciliary care providers. It builds upon our successful work rolling out the Significant 7, which has demonstrated both a reduction in A&E attendances and non elective admissions from care homes. Why do this? Many frail elderly people want to live independently in their own homes for as long as possible. However: In the BHR system there is a high reliance on A&E for primary care conditions, which could be managed in the community or people’s homes There are issues around length of stay in hospital, which means frail elderly people often stay in hospital longer than they should Frail elderly patients are often discharged to care homes rather than their own homes, because of the length of time they are in hospital A significant proportion of referrals to NELFT’s Intermediate Rehab Service are not being referred to the correct Discharge to Assess pathway What’s the opportunity Using the “home first – getting you home” model, develop an integrated Intermediate Care Service for frail elderly patients that would promote their independence and increase choice around the care they receive, to: Put in place a service that supports frail elderly people across the whole care cycle Deliver earlier, safe and effective discharge of frail elderly patients, reducing the time they spend in hospital Increase the number of patients discharged to their own homes rather than care homes Increase the number of frail elderly people being effectively supported to live independently in their own homes Reduce unnecessary A&E visits and hospital admissions through effective home care support Key statistics: The over 75 population in BHR is projected to increase by almost 19% from 48,779 in 2015 to 58,001 in 2025 Care needs will become more complex as the number of people with Long Term Conditions is expected to increase by 45% by 2030 Our Significant 7 work has demonstrated the potential for improved clinical decision making to avoid hospital admissions – 30% winter reduction from care homes. We believe this would be replicable in a service supporting frail elderly people to live independently in their own homes

Appendix E3: STPs and integration (London) Provider integration (2)
This the first of three agreed Provider Alliance priorities. The principles underpinning this action are understood and the evidence accepted, however, partners have not yet come together to develop and agree a plan. We expect that a plan will be agreed by October 2018 and will then update this action plan with the agreed timeline. 2018 2019 July - Sept Oct - Dec Jan - March April - June July - Sep Confirm scope and approach The delivery timetable will be developed by Provider Alliance partners, currently scheduled for October 2018

Appendix E4: STPs and integration (London) Primary Care development – Barking Riverside (1)
There is no established primary care provision in the Barking Riverside community. Experience shows that much of the demand for care that can be safely and effectively delivered in the local community, instead flows into the acute sector. As the Barking Riverside community grows, there is an opportunity to establish an enhanced primary care team to provide genuinely holistic care for people within the community and reduce pressure on local acute hospitals Why do this? Barking Riverside is a growing community of young families and working age adults in the Barking/Rainham area In this geography, patient flows for urgent and planned care are mostly to Queens and King George’s Hospital (BHRUT) and maternity care to Newham Hospital (Barts). Both Trusts are under severe service and financial pressure There is no established primary care or community provision in the community It is expected that patient flows into the acute sector will rapidly increase as the community grows, with the acute sector delivering care that could instead be safely and effectively managed within primary care What’s the opportunity As the Barking Riverside community grows, new residents will need to access care. Developing and promoting highly integrated local primary care service with our partners, to be implemented from 2020/21, means we can: Manage people’s care needs through an enhanced primary care team Provide a single point of access to care, so care needs are delivered in the community and people’s homes Use the enhanced skill mix of the primary care team to deliver genuinely holistic care and begin to address some of the underlying cause of ill health in the community Reduce inappropriate referrals into acute care, reducing pressure on overstretched providers There is also a “once in a lifetime” opportunity to establish patterns of access to care within a new community, so primary care services become the default setting for care Key statistics: Barking Riverside is a 443 acre residential development with planning permission for 10,800 homes and an expected population of some 23,300 people Some 900 homes were occupied in 2012 but the number of homes is capped at 1,200 until improved public transport links have been put in place, expected by 2021 Experience has shown that communities with inadequate primary care rely heavily on acute hospitals for care that could be delivered in the community - for example, in Tilbury and Chadwell, is was estimated that in one year 77% of A&E attendances could have been safely managed in the community

Test Model of Care in Thamesview
Appendix E4: STPs and integration (London) Primary Care development – Barking Riverside (2) This is the third of the agreed Provider Alliance priorities. The work programme is being overseen by the Barking Riverside System Development Board and managed by the Barking Riverside Steering Group. An outline concept has been agreed that includes a hub with a shared front of house and back office; flexible health space delivered through “universal rooms” with technology built in and linked to people’s homes. The business case should be completed by March 2019 and set out the delivery timetable for implementation by 2020/21 2018 2019 July - Sept Oct - Dec Jan - March April - June July - Sep Models of care The delivery timetable will be developed once the business case is approved in March 2019 Workshops to develop models of care and understand enabling requirements Review requirements for enablers such as estates and IT – develop workstreams and specifications so they can be included in the business case Confirm model Test the model of care and approaches to care in Thamesview so learning can be incorporated into business case Enabler workstreams Review of workshop outputs and outcomes to confirm model of care that will be adopted Test Model of Care in Thamesview Formulate business case – this will be alongside a stakeholder co-design approach to get buy in from stakeholders and users Develop business case

Appendix E4: STPs and integration (London) Primary Care development - St George’s, Hornchurch (1)
Primary and community services in Havering, particularly in Hornchurch are fragmented and in unsuitable accommodation. Commissioners wish to improve primary urgent care services to ease pressure on Queen’s A&E and better meet the local community’s current and future local primary, community and social care needs. There is an opportunity for partners, working through the Programme Board, to achieve these aims through a collaborative integrated service in a new facility on the redeveloped St George's site Why do this? Primary and community services are fragmented, located in unsuitable accommodation and in some cases outside the borough: Many of the 52 GP practices in Havering deliver services are small and delivered from converted houses. These buildings do not offer scope for improved operational efficiency, delivery of services at scale or service integration Community services delivered by NELFT are based at health centres in South Hornchurch and Elm Park, with service provided across a number of properties across the borough. Many are unsuitable for current or future services, and present a rationalisation and disposal opportunity After St George’s site was closed in 2012, step down and rehab beds were transferred to the King George’s hospital in Redbridge, further from the local population Some services for elderly people in Havering such as falls and the day hospital are based in Barking and Dagenham What’s the opportunity Working with Commissioners to fulfil their vision of bringing together primary, community and social care into an integrated locality based care model, with services delivered from a new health hub developed on the old St George’s hospital site A recent option appraisal recommended that the facility include: A complex care practice to support patients with multiple LTCs in their homes An 8am to 8pm primary urgent care hub Community health teams providing multidisciplinary support to frail elderly patients and people with LTCs Secondary care community services to increase the volume of conditions managed in an ambulatory care pathway A location for voluntary and community sector providers The scope of services within the facility is likely to change through the bid process currently underway, but the core services will include primary and community care, to fulfil the opportunity to integrate and improve care Key statistics: The site at St George’s Hospital is a 29 acre former community hospital which had a £19m maintenance backlog and was decommissioned in 2012 The site is owned by NHS Property Services and in June 2016 planning permission was granted for a health hub and residential accommodation The development is managed by a Programme Board which is led by the CCG. NELFT is a member of the Programme Board

Facility completed during 2021
Appendix E4: STPs and integration (London) Primary Care development - St George’s, Hornchurch (2) A bid for the redevelopment of the St George’s site has been submitted to NHS Improvement/NHS England and is expected to be approved by November If the proposed facility is built using ProCure22 (P22) , the building should be completed during The service content of the new facility and how care will be delivered to maximise the opportunity to improve services through integration will be confirmed in the business case. The timeline below is indicative and will be updated once the bid is approved and the project team mobilised 2018 2019 July - Sept Oct - Dec Jan - March April - June July - Sep NHS Improvement/NHS England are scheduled to approve the bid for the capital costs of the development as part of a round of STP capital bids by November 2018 Bid approved This schedule will be updated once the bid is approved and a project plan agreed The facility is likely to be built using ProCure 22, a Construction Procurement Framework administrated by the Department of Health and Social Care for the development and delivery of NHS and Social Care capital schemes in England Agree care model & confirm services Once the bid is approved, the Programme Board will start to mobilise the project team who will develop the care model further, agree the services to be delivered from the new facility and formulate the business case Business Case approval Construction Facility completed during 2021

Appendix E5: STPs and integration (London) Community partnerships in Waltham Forest (1)
NELFT is a member of the Better Care Together Partnership Board, which includes Barts Health, Waltham Forest CCG, London Borough of Waltham Forest and the Waltham Forest GP Federation. The Board is leading the development of an Integrated Care System in the borough through three workstreams – ICS Communities, led by NELFT and Waltham Forest Council, plus End of Life Care and Integrated Urgent and emergency care, both led by Barts Health. The Board is aiming for an Alliance Agreement to be in place from 1 April 2019 Why do this? Services in West and East London are fragmented, with a range of providers delivering aspects of care in silos The principal acute provider, Barts Health is judged to have one of the most challenging financial positions in England In November 2017, the CQC rated Barts Health as Requires Improvement overall, which was an improvement from its previous rating of Inadequate The East London Health and Care Partnership reported in that many people attending A&E don’t need to be there, as they have relatively minor problems that can be treated elsewhere There is scope to reduce reliance on acute inpatient based care through delivery of integrated care services in the community What’s the opportunity The overall opportunity is to deliver improved services through an Integrated Care system that will work in three main areas – Communities; Integrated urgent and emergency care; end of life care. NELFT and Waltham Forest Council are jointly leading the ICS communities workstream which is focused on: Prevention and early intervention – through work on the early intervention pathway Optimising community care following a crisis or admission to hospital – through work on the Integrated Discharge pathways , the Rehab and reablement pathway and optimising use of community beds The developments will exploit Waltham Forest’s new ‘system model’ - the Managed Network of Care & Support, which is designed to improve connections between services so that transfers of care are managed in a more ‘seamless’ way. The precise scope of services that will be delivered through the Alliance Agreement will be developed and refined through the ICS Communities workstream over the coming months Governance arrangements for the Alliance Agreement are also being developed and will be reported once more concrete proposals are in place

Managed network of care & support
Appendix E5: STPs and integration (London) Community partnerships in Waltham Forest (2) The plan shows a mix of actions around pathway development and service rollout that will be completed by December 2018, plus the neuro rehab pathway work to be completed by March Alongside this, governance structures are being developed so these services can be commissioned and delivered through an Alliance Agreement. Governance actions will be added into the plan before the end of 2018 2018 2019 July - Sept Oct - Dec Jan - March April - June July - Sep D2A Extend Discharge To Assess to more complex patients Rehab & reablement Rehab Complete review of pathways for bedded and community services Complete development of complex neurological pathway and improving community neurological services Neuro rehab This plan will be updated with details of governance actions by the end of December 2018 Discharge IDT rollout The Integrated Discharge Team review was completed at the end of July. The actions in this area are now focused on rolling out the model Model & resources The updated Managed Network of Care & Support model should be agreed in August and resourcing for interventions confirmed by the end of September The business case will set out the structure of an at scale system model that has a material impact on people’s independence and wellbeing, reducing use of more expensive crisis services Managed network of care & support Mobilisation & Planning Complete mobilisation for “Safer Home” developments and planning for Integrated Information Advice & guidance Business case Develop business case for ongoing funding of wellbeing pathways

Appendix E6: No Mental Health without Physical Health/ No Physical Health without Mental Health
What we want to do? We will work to eradicate the unacceptable disparities in health outcomes for people with serious mental illness. We will support people with Long Term Conditions who have coexistent mental illness Why is this important? People with serious mental illness die years earlier than the general population 1/3 of people with long term conditions (LTC) have mental health problems and worse physical health outcomes. This raises costs by at least 45%. Providing integrated holistic care will improve outcomes for the patients we serve. How might we measure success? (examples) Outcome measures Process measures Balance measures life expectancy of patients with mental health diagnoses Cessation of damaging lifestyle choices in those with MH diagnoses incidence of anxiety & depression in patients with LTC improved outcomes (TBC) in patients with LTC Consider measures for children/ LD health checks screening patients with holistic care plans including physical and mental health assessment and care plans Interventions Physical health CQIN referral rates waiting lists Our primary drivers: Our NELFT aim: Our aim is to provide the best care to our patients, families and communities who use our mental health and community services. Our best care means improving the health of our population by providing high quality, effective, safe care, delivered by staff who are caring, compassionate and treat patients with dignity and respect, whilst providing the best value. Our specific aims: -to reduce/ eradicate the mortality gap -to improve/ optimise the mental health of those with LTC Physical Health Mental Health Social/ Community

Appendix E6: Services that deliver best care How will we achieve this?
PLANNING PHASE QI REVIEW GROUPS – MAPPING AND TESTING EMBEDDING SCALE UP AND SPREAD Mapping (Months 3-9) what is commissioned/ KPIs what is delivered/ how is it delivered similarities and differences between services – can we link service delivery model with outcomes Agreement (Months 10-12) agree standardised service model (within commissioning boundaries) Embedding (From month 12) culture of continuous review and improvement QI Review Groups This plan will be updated with a definitive timeline by the end of following patient and staff engagement and resources being put into place Planning (month 1) Confirm QI staff in post Working with CoPs to identify service areas to prioritise for cohorts 1-3. To identify up to 5 teams from each service area and a lead from each o join QI Review Group. Confirm dates/ venues Define specific aim Define measures Clinical engagement Patient engagement Further scale up and spread To be planned depending on the evaluation of outcomes and learning from the QI Collaboratives. This may include continuing the cohorts, starting new cohorts and further trustwide change ideas. Month 3 6 12 15 24 Deliverables -Clear plan for collaborative by end of month 1 -Review Groups to commence in month 3. Update reports at 6, 9 and 12 months. -Cohort o continue reporting every 3 months -Clear plan for scale and spread -Update report at 115, 8 and 21 months -Final report at 24 months

Appendix E7: Services that deliver best care (defining our core offer)
What we want to do? We want all patients to receive an equitable high standard of care regardless of where they live in the NELFT geography. We want any inconsistencies in the delivery and outcomes of services to be due to commissioning differences rather than through clinical inconsistencies. Why is this important? There is likely to be unwarranted variation in the way some services are delivered and the outcomes across NELFT Defining the core offer of clinical teams that ensures the delivery of best care across all our services will support our workforce to provide an equitable high standard of care. Our NELFT aim: Our aim is to provide the best care to our patients, families and communities who use our mental health and community services. Our best care means improving the health of our population by providing high quality, effective, safe care, delivered by staff who are caring, compassionate and treat patients with dignity and respect, whilst providing the best value. Our specific aim: Delivering and evidencing that we deliver best care. Outcomes that define best care Services that deliver best care Our primary drivers: How might we measure success? (examples) Outcome measures Process measures Balance measures Teams have standard operating procedures, understand their core functions and how this relates to the delivery of best care

Appendix E7: Services that deliver best care How will we achieve this?
PLANNING PHASE QI REVIEW GROUPS – MAPPING AND TESTING EMBEDDING SCALE UP AND SPREAD Mapping (Months 3-9) what is commissioned/ KPIs what is delivered/ how is it delivered similarities and differences between services – can we link service delivery model with outcomes Agreement (Months 10-12) agree standardised service model (within commissioning boundaries) Embedding (From month 12) culture of continuous review and improvement QI Review Groups This plan will be updated with a definitive timeline by the end of following patient and staff engagement and resources being put into place Planning (month 1) Confirm QI staff in post Working with CoPs to identify service areas to prioritise for cohorts 1-3. To identify up to 5 teams from each service area and a lead from each o join QI Review Group. Confirm dates/ venues Define specific aim Define measures Clinical engagement Patient engagement Further scale up and spread To be planned depending on the evaluation of outcomes and learning from the QI Collaboratives. This may include continuing the cohorts, starting new cohorts and further trustwide change ideas. Month 3 6 12 15 24 Deliverables -Clear plan for collaborative by end of month 1 -Review Groups to commence in month 3. Update reports at 6, 9 and 12 months. -Cohort o continue reporting every 3 months -Clear plan for scale and spread -Update report at 115, 8 and 21 months -Final report at 24 months

Appendix E8: Outcomes that define best care
What we want to do? We want to identify outcome measures that are meaningful to the people who use all our services. These are required to support us in our quest for continuous improvement and the delivery of the best possible care. Why is this important? All patients should receive an equitable high standard of care regardless of where they live in the NELFT geography. There is likely to be unwarranted variation in some outcomes across NELFT Being clear about key patient outcomes will enable us to understand the variation and identify improvement opportunities Our NELFT aim: Our aim is to provide the best care to our patients, families and communities who use our mental health and community services. Our best care means improving the health of our population by providing high quality, effective, safe care, delivered by staff who are caring, compassionate and treat patients with dignity and respect, whilst providing the best value. Our specific aim: Delivering and evidencing that we deliver best care. Outcomes that define best care Services that deliver best care Our primary drivers: How might we measure success? (examples) Outcome measures Process measures Balance measures number of services with identified outcome measure number of services with routinely collected outcome measure key indicators (TBC) using SPC Time taken for staff to complete measures.

Appendix E8: Outcomes that define best care
How will we achieve this? Priority: Outcomes that define best care PLANNING PHASE QI REVIEW GROUPS – MAPPING AND TESTING EMBEDDING SCALE UP AND SPREAD This plan will be updated with a definitive timeline by the end of following patient and staff engagement and resources being put into place Planning (month 1) Confirm QI staff in post Working with CoPs to identify service areas to prioritise for cohorts 1-3. To identify up to 5 teams from each service area and a lead from each o join QI Review Group. Confirm dates/ venues Define specific aim Define measures Clinical engagement Patient engagement Further scale up and spread To be planned depending on the evaluation of outcomes and learning from the QI Collaboratives. This may include continuing the cohorts, starting new cohorts and further trustwide change ideas. Mapping mapping of current outcome measures in use Gap analysis - - evaluate whether these cover PROM/ PREM/ CROM/ CREM Testing Identifying and testing out new outcome measures. Agreement on family of outcome measures for each service area. Embedding Integrating into normal practice Ongoing measurement Month 3 6 12 15 24 Deliverables -Clear plan for collaborative by end of month 1 -Review Groups to commence in month 3. Update reports at 6, 9 and 12 months. -Cohorts to continue reporting every 3 months -Clear plan for scale and spread -Update report at 115, 8 and 21 months -Final report at 24 months

Appendix E9: Best people – Leadership competency framework (1)
Our leaders need to have appropriate skills and capabilities to effectively meet the challenges we face, as we navigate through a period of increasing uncertainty and change. This action plan sets out how we ensure our leaders have the right skills and capabilities to help us meet our strategic and operational challenges and to deliver our vision. Why do this? The care environment is increasingly complex, characterised by constant uncertainty and ongoing change within NELFT and across the wider care system Within this environment, effective leadership, at all levels, is essential. As responsible employers, we must be certain that our leaders have the right skills and capabilities to lead teams, services and the whole of NELFT effectively We need to put in place an objective measure of leadership skills and attributes required, by role, to allow us to deliver effective, holistic and compassionate leadership at all levels of the organisation What’s the opportunity To make a fundamental change in the approach to leadership development by using an objective leadership framework to set out the competencies required for effective leadership. This means that: Everyone knows what skills and capabilities are required for effective leadership in roles at all levels of the organisation The competency framework facilitates an objective assessment of an individual's’ skills and capabilities before they are put into a leadership position, so we know people have the right skills and capabilities to be effective leaders when they are appointed to leadership positions We use the competency framework to provide an objective assessment of an individuals’ development needs so people can move from being good leaders to best leaders in a structured and well managed way Key statistics: Some 300 clinical and non clinical leaders across NELFT Leadership roles range from team leader/supervisor to Executive Director Leadership competencies developed through Apprenticeship Levy interventions to Higher Education accredited programmes sourced from professional bodies and the NHS Leadership Academy

Appendix E9: Best people – Leadership competency framework (2)
The development of the leadership competency framework is one of the core elements of NELFT’s Best People strategy and going forward will need to take account of the National Health and Social Care Workforce strategy. The overall timeline for this action is 18 months and once the competency framework has been developed and rolled out, it will be managed on an ongoing basis as part of business as usual. 2018 2019 2020 Oct - Dec Jan - March April - June July - Sep Confirm scope and approach Model best practice competency framework Confirm and challenge through stakeholder engagement Baseline assessment Detailed evaluation & gap analysis Confirm actions and implement Becomes BAU

Appendix E10: Best people – Leadership capacity assessment (1)
Making sure we have enough clinical and non clinical leadership capacity is essential as we navigate through a period of increasing uncertainty and change. This action plan sets out how we will manage our leadership capacity to ensure there is sufficient quality leadership in place to help us meet our strategic challenges and deliver our vision Why do this? Alongside clarity around skills and capabilities required for effective leadership, we also need to ensure that there is sufficient leadership capacity within the organisation Using industry models and benchmarks we can formulate an objective approach to measuring leadership capacity Once the approach has been developed and the first assessment completed, we can manage this as part of business as usual on a cyclic basis through the Strategic Workforce Group What’s the opportunity This approach will provide an objective assessment of leadership capacity gaps at all levels of the organisation, so we can prioritise and address critical capacity gaps by: Identifying gaps in leadership capacity on an objective basis at all levels of the organisation Facilitating a structured approach to addressing gaps so there is sufficient leadership capacity available With sufficient leadership capacity, we can support individuals and teams to be the best they can be, achieve our vision and deliver best care for patients Breakdown of the five layers of our leadership structure: Executive directors – 6 ICDs/Directors – 15 Deputies/ADs – 20 Operational, clinical and team managers - +/- 70 Team leaders - +/- 190

Appendix E10: Best people – Leadership capacity assessment (2)
The leadership capacity assessment will be undertaken in parallel with the development of the leadership competency framework. Explain why not dependent on each other. The plan will take 15 months to complete and once completed, will be managed on an ongoing basis through the Strategic Workforce Group 2018 2019 2020 Oct - Dec Jan - March April - June July - Sep Confirm scope and approach Develop baseline benchmarks Confirm and challenge through stakeholder engagement Baseline assessment Detailed evaluation & gap analysis Confirm workforce model and implement Becomes BAU + review cycle

Appendix E11: Delivering strategic gain from Estate rationalisation (1)
Following the move of inpatient care into Sunflowers Court and NELFT’s corporate functions to an off site HQ, much of the Goodmayes site is surplus to requirements. This presents an opportunity to explore options for the Goodmayes site that will deliver strategic gain for NELFT and the wider community, greater than that from a simple site disposal. Goodmayes Hospital is situated in the Goodmayes area of Ilford within the London Borough of Redbridge. The total site extends to an area of 25.3 Ha. The site incorporates inpatient facilities at Sunflowers Court and Brookside along with services still resident in the Old Goodmayes building, Tantallon House, Maggie Lilly and Block 8 Three phases for redevelopment/disposal of 13.4 hectares of the Goodmayes site Phase 1 Old Goodmayes building and surrounding land Area = 7.62Ha Potential for residential development Phase 2 3.84 Ha of land which has been released from Green Belt Opportunities for residential, school, key worker accommodation, retain part of site for NELFT or other care partnership development opportunity Phase 3 1.94 Ha of land which currently accommodate a ground source heat pump Reviewing solutions to re-site the unit to allow for maximum disposal/development opportunity

What’s the opportunity
Appendix E11: Delivering strategic gain from Estate rationalisation (2) Traditional NHS approaches to estate rationalisations have concentrated on maximising receipts from land sales. Our approach is to exploit opportunities for the Goodmayes site, which might involve working with and through wider partnership, joint development of facilities and becoming a landlord, managing facilities. This would deliver strategic gain through direct financial benefits to NELFT as well as providing a positive impact on the community beyond our role as a care provider What’s the opportunity Acting as landlord through partnership with other public bodies and stakeholders Drawing on a wide range of advice and expertise to develop and fully exploit new opportunities Marketing advisors Master planning Legal Maximising value from any land sales by agreeing overage on resale or other gain/share mechanisms Supporting partnership developments on site that benefit the wider community such as affordable housing or community facilities Collaborating with partners and other stakeholders to identify options for the site that have a wider positive social impact as well as delivering financial benefits to NELFT Developing facilities for NELFT to reduce our rental costs or backlog maintenance on our current estate Identifying potential income streams from developments such as key worker housing or other facilities on the site

Appendix E11: Delivering strategic gain from Estate rationalisation – Phase 1
Phase 1 of work on Goodmayes involves the largest parcel of land (7.62Ha) which has potential for residential development. We will explore options and opportunities to develop solutions which have a wider positive social impact as well as maximising financial benefits to NELFT. The preferred approach and timeline will be confirmed by March 2018 2019 2020 July - Sept Oct - Dec Jan - March April - June July - Sep Site masterplan Strategy & options for all phases Confirm options Marketing Evaluation, negotiation and due diligence to confirm bidder Indicative completion Dec 2020 Planning, depending on option

Appendix E11: Delivering strategic gain from Estate rationalisation – Phases 2 and 3
The options for phases 2 and 3 will be agreed as part of the strategy shown in the Phase 1 plan. The timeline is indicative and may change once the options are confirmed in early 2019. 2019 2020 Jan - March April - June July - Sep Oct - Dec Phases options confirmed Marketing Evaluation, negotiation and due diligence to confirm bidder Indicative completion Dec 2020 Planning, depending on option

Appendix E12: Better care and assurance through Business Intelligence (1)
NELFT’s Business Intelligence system is coming to the end of it’s life. A new BI system provides an opportunity to use Clinical Intelligence to improve the direct delivery of patient care and use outcomes to demonstrate improvements in care. There are also opportunities to improve Corporate Reporting through implementation of simplified automated dashboards and improve strategic decision making. Why change? Opportunities Technical – system at end of life Where Business Intelligence could be used Little BI here Currently most BI is focused here Little BI here Patient care – not sophisticated enough for a changing care model Decision making – not an effective decision support tool for day to day business Delivery of patient care Managing delivery of patient care Providing assurance on management & delivery of services Strategic decision making Commercial – competitors’ BI becoming more sophisticated Assurance – not aligned to assurance requirements Opportunities Improve services by providing BI on patient care Outcomes data to demonstrate improvements in care Data for peer review of performance Opportunity Simplify and automate BI to improve efficiency and quality of reporting Opportunity Provide strategic planning and decision making information, for big decisions within NELFT and for NELFT within the wider system Key statistics: Number of MIDAS users – 983 (16.9% of staff) – expected to increase as MIDAS training is rolled out in Kent & Medway Directs costs £0.18m (pay). Server and IM&T infrastructure costs not included

Appendix E12: Better care and assurance through Business Intelligence (2)
The proposed approach for developing BI is to focus on Executive and ICD level dashboards in a first phase, followed by an AD level dashboard in a second phase. The Business Case is scheduled to be completed at the end of October 2018 and will provide a more definitive timeline and assessment of the resource requirements. The BI team will support the development of outcome indicators as part of the Best Care challenge, shown in Appendix E8 2018 2019 July - Sept Oct - Dec Jan - March April - June July - Sep Complete Business Case This plan will be updated with a definitive timeline in October 2018 following approval of the business case and development resources required Mobilisation Phase 1 - Scope and develop Executive & ICD Dashboards Roll out Exec & ICD dashboards Phase 2 - Scope & develop AD dashboards Roll out AD dashboards

Appendix E13: A new commercial framework
We will grow turnover as far as market conditions allow in line with our new commercial framework. A range of Local Authority contracts will be tendered over the next three years, so commercial developments will continue to be part of NELFT’s approach to working within care systems and partners. There are two elements to the commercial framework. Firstly, a more nuanced approach to evaluating commercial developments, which should help NELFT to deliver a broader range of opportunities and benefits from new contracts. Secondly, instituting a cyclic review of existing contracts to evaluate what action needs to be taken to address uneconomic contracts in NELFT’s portfolio. Why do this? Since its inception, NELFT has been commercially active, bidding for and winning a range of contracts within and outside its core geography The revenue from these contract wins has more than offset the reductions in revenue from contracts that have been decommissioned, so NELFT has expanded since 2015, maintaining both size and influence within the wider care system NELFT will continue to explore new commercial opportunities, recognising that: The scale and type of commercial opportunities are changing Financial constraints, even after increases in NHS funding, means it is still challenging to deliver services that are financially viable Alongside new opportunities, we recognise that our portfolio still includes contracts that are not profitable. This is not a sustainable position and needs to be addressed What’s the opportunity The opportunities from commercial developments are not just financial, encompassing a range of benefits, including: Improving quality of patient care Facilitating service integration in line with the strategy Maintaining critical mass for effective corporate services Increasing organisational stability through greater size and scale Promoting NELFT as an effective service improvement provider and system partner There could also be similar opportunities if we re-evaluated our current service portfolio and the uneconomic services we currently provide Adopting a more sophisticated and nuanced commercial framework should therefore help us deliver these opportunities successfully Key statistics: 2018/19 budgeted income £367m Annual value of new contracts won between April 2015 and March £44.9m Annual value of contracts previously held by NELFT won by other providers (including NELFT “no bid” contracts) between April 2015 and March £22.2m

Appendix E13: A new commercial framework - new business
The commercial framework for new business provides a more robust approach to evaluating potential contract bids. This method links explicitly to our strategy, so bids should not just be commercially viable and deliverable, but amongst other criteria, improve significantly the quality of patient care and promote NELFT’s role as a credible and active partner to help develop and deliver integrated care. Able to manage stakeholders Effectively manage new stakeholder relationships to promote NELFT as a credible partner Capacity to deliver There must be capacity to effectively deliver the service at all stages of the business cycle Good Business The contract must make business sense Strategic alignment Proposed contracts should align with NELFT’s Vision and role within the system Outline commercial framework for new business Understanding the prospects of success in all four criteria, to formulate a balanced judgement on whether to bid for contracts The detailed framework is shown at the end of this Appendix

Portfolio review using Service Line Reporting (SLR)
Appendix E13: A new commercial framework - review of our existing contract portfolio Within our existing contract portfolio, some contracts are uneconomic. This is not sustainable in terms of both service quality and finance. This commercial approach recognises that simply cancelling all uneconomic contracts would not be appropriate in an environment of developing partnership and collaboration. Using SLR, we will regularly evaluate our contracts and for those that are uneconomic, decide whether to terminate them, renegotiate the contract or develop a transformational approach to the service. Portfolio review using Service Line Reporting (SLR) Actions Issues NELFT currently delivers some services that are uneconomic – in some cases, such as IAPT services in BHR, they do not even cover direct costs. The quality of care in these services would not be as high as we would wish it to be – for example through longer waiting times – which does not align with our objective of delivering Best Care In a climate of increasing collaboration and integration, it may damage NELFT’s reputation to simply cancel contracts for uneconomic services and could open up the market for NELFT’s competitors Existing contracts Using SLR, review NELFT’s contract portfolio to identify contracts that are uneconomic Decide whether to terminate, renegotiate or transform the services provided Where there is scope to renegotiate or transform contracts, explore partnership solutions to address both cost and quality issues New opportunities Develop an ongoing programme of commercial opportunities, including renewal of existing contracts, with decisions to proceed based on the new commercial framework Grow turnover as far as market conditions allow in line with our new commercial framework to support NELFT’s corporate expertise and capacity Approach Our Service Line Reporting system will become increasingly sophisticated , allowing us to identify contracts that are uneconomic. We will use SLR to undertake cyclic reviews of contracts and for uneconomic contracts decide whether to terminate, renegotiate of transform the services we provide Our approach to renegotiation and transformation will be to work positively with our partners to find ways to change the way the contract is delivered, for example through technology, or through collaboration with the third sector This would change the cost of delivering the service and improve the commercial viability of the contract as well as improving the quality of care

Appendix E13: A new commercial framework - action timeline
The main programmable action relates to the review of our current contract portfolio. This process should become part of the annual business cycle as our Service Line Reporting process becomes more developed and is embedded into BAU. 2018 2019 July - Sept Oct - Dec Jan - March April - June July - Sep Portfolio review to identify principal uneconomic contracts This plan will depend on planning guidance issued by NHSI and may need to be amended once guidance is issued Decision to divest, renegotiate or transform Becomes BAU, with quarterly review cycle as SLR evolves Contract negotiations

Appendix E13: Detailed commercial framework for new business
This framework provides a more robust evaluation approach for potential contract bids, whether new opportunities or the programme of existing contracts that will soon come up for renewal. The four criteria are designed to move beyond relying only on financial due diligence and to ensure the potential risks and benefits in each of the four criteria are understood and that the prospects of success are sufficiently strong in all four criteria. Understanding the prospects of success in all four criteria, to formulate a balanced judgement on whether to bid for new business/renew existing contracts Strategic alignment Good business Capacity to deliver Able to manage stakeholders The contract should align strongly with NELFTs strategy: Support the Vision and facilitate or accelerate service integration Deliver Best Care or significantly improve the quality of care delivered Commercially viable – at a minimum make an acceptable contribution to corporate overheads Defensive – protect other services from competitors Each proposal should meet the first three criteria The contract must make business sense: Size and/or nature of contract commensurate with effort of winning the bid A reasonable fit with NELFT’s core services Due diligence satisfactory, including ability to ameliorate or manage the impact of “unknowns” through the contract Early and overall profitability in the contract Impact on cash, I&E and capital of parallel new contracts understood and acceptable Location of services has easy access and serviceability There should be sufficient capacity to effectively deliver the contract without adversely impacting on current operations, throughout the business cycle: Due diligence/bidding Mobilisation/set up Transformation Business As Usual Capacity to manage opportunities in parallel should also be assessed The criteria apply to both operational and corporate capacity, particularly in the first three stages New business is likely to generate a series of new relationships, including patients, that need to be managed across: Commissioners Providers STPs There must be sufficient capacity and expertise to manage effectively and leverage these relationships, particularly actively promoting NELFTs vision of being a credible and active partner in the development and delivery of integrated care

Appendix E14: Identity (1)
We need to develop and promote a clear identity for NELFT to our people and external stakeholders, so they understand and buy into our values and goals and be committed to contributing to NELFTs success. Why do this? NELFT’s role in the wider care system is to be a Thought Leader, Partner, Innovator and Integrator, however: This role is not clearly understood within NELFT or by our external stakeholders Both internally and externally, there is a lack of clarity about the services we provide and our organisational purpose The updated strategy will need to be actively promoted so our people are committed to and understand our values and goals, and motivated to contribute to NELFT’s success What’s the opportunity To create a unified strategic narrative that promotes NELFT’s ambitions and successes to our people and external stakeholders, engaging them in the delivery of our strategy. The benefits we expect are that we will: Create a strong culture within the organisation Extend, develop and deepen stakeholder relationships to create genuine partnership opportunities Deliver our vision Key statistics: We employ over 6,000 people located across London, Essex, Thurrock, Kent & Medway We have more than 10,000 public members who we keep up to date about our services and plans for future care development We have collaborative relationships with 19 CCGs, 20 borough councils, 2 county councils, 1 unitary authority, 50 MPs, 8 acute trusts well as with primary care and third sector partners

We will develop and promote our identity with our people within NELFT and external stakeholders through a structured process starting with developing our identity. What people say about us Internal perspective What is our identity? Our identity is more than our logo – we will clarify: Our story Our successes Our values We will be able to articulate: Our purpose Our vision Our mission …and show how these are underpinned by our values External perspective Deliverables Our strategic narrative – NELFT’s “story” Our successes – where and how we have been successful across the organisation A service brochure, which sets out what our service “offer” is

Once we have developed our identity, we will move on to testing the narrative and finding the optimal engagement channels to promote our agreed identity. What do people think about us? Promoting our identity Internal perspective Understand what our people think about NELFT and why Work with key staff groups to test deliverables 1 to 3 Identify the difference between our identity and people’s perception, understanding why Develop remedial actions to address the gaps using insight Finding the best way to promote our identity to our staff Incorporate our strategic narrative and successes into business as usual internal communications/ engagement channels with consistent messaging across the organisation Evaluate channels to identify the optimal approaches to engage with our people and promote NELFT’s identity External perspective Understanding what stakeholders think about NELFT and why Complete external stakeholder mapping Agree key relationship managers Confirm stakeholder management objectives Undertake an external survey of key stakeholders Finding the best way to promote our identity with stakeholders Incorporate our strategic narrative and successes into our business as usual external communications/ engagement channels with consistent messaging across the organisation Evaluate channels to identify the optimal approaches to engage with our stakeholders and promote NELFTs identity Deliverables Internally – a gap analysis that identifies the difference between our identity and people’s perception and identifies remedial actions based on insight Externally – a gap analysis that identifies the difference between our identity and stakeholder’s perception and identifies remedial actions based on insight that are incorporated into relationship managers’ objectives Evaluation of the effectiveness of the different channels for promoting our identity and actions to optimise the process Implement structured briefing and feedback mechanisms for relationship managers

The plan shows three stages to the completion of the seven deliverables identified within the plan. All actions are scheduled to be completed by the end of June 2019 and will then be transferred into our business as usual processes. 2018 2019 July - Sept Oct - Dec Jan - March April - June July - Sep What we say about us Deliverables 1 to 3 What do people think about us? Deliverables 4 & 5 Promoting our identity Deliverables 6 & 7 Becomes BAU

NELFT strategy update: Final report

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NELFT strategy update: Final report

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