Our Improvement Plan

Our aim:

Our approach to care and treatment will focus on maximising the things that go right and minimising the things that go wrong. We will protect all of our service users from avoidable harm and create the conditions in which our staff can deliver care safely.

Our immediate priorities:

To meet these standards, we will focus on:

Safe Staffing – making sure there are enough qualified, competent, skilled and experienced staff who feel supported and able to develop in their roles and deliver high standards of care.

We will:

• Use evidence-based tools to gather data on staffing requirements (numbers and skill mix) across all our inpatient and community services
• Bring together staffing data with service user, carer and staff feedback to determine future safe staffing establishments
• Have contingency plans in place across clinical services to address any shortfalls
• Recruit and retain staff and develop new roles which support patient care

 

Reducing Restrictive Practices – prevent the need to use restrictive practices through the implementation of reduction strategies and the promotion of a human rights approach. This will include looking at alternatives to restraint, seclusion, rapid tranquilisation and blanket rules in our clinical services.

We will:

• Work with service users, through person-centred care planning and in the context of the care setting, to actively reduce the likelihood of situations arising where restrictive practices may be used
• Only use restrictive practices as a last resort and for the least amount of time possible
• Review our current use of restrictive interventions, in partnership with service and carers, and deliver the agreed improvements
• Make sure all staff are properly and fully trained in all interventions, including those which involve restrictions
• Ensure we accurately record and learn from all incidents where restraint or other restrictive practices are used

 

Medicines Management – promote the safe and effective use of medicines including how we prescribe, handle and administer them to service users.

We will:

• Review the systems we have in place to make sure we use and store medicines safely and effectively
• Review our Self-Medication Policy and make sure all requests for self-medication are authorised by a pharmacist and that the service userunderstands how to take their medication and store it safely
• Ensure that observations post-rapid tranquillisation are completed in line with Trust Policy
• Make sure the Pharmacy service can safely support all our services

 

Sexual Safety – protect our service users from any unwanted and inappropriate behaviour of a sexual nature and ensure they feel safe from sexual harm. 

We will:

• Review and update our Sexual Safety Guidance, and the way in which we manage sexual safety risks, learning from the National Sexual Safety Collaborative
• Support our staff to use a trauma-informed approach to proactively manage sexual safety
• Ensure we learn from all sexual safety incidents and complaints
• Review our remaining mixed sex accommodation and agree plans to eradicate it where possible  

 

Safe and Therapeutic Environments - making sure our environments are always safe, clean and regularly monitored so that any issues are dealt with quickly and effectively

We will:

• Maintain and invest in our physical environments to ensure our service users receive care in settings that are safe, welcoming and clean, and appropriate to their needs
• Address identified high-risk ligature items, make sure staff are aware the ligature risks in their environment and how they should be managed to maintain patient safety
• Embed the new National Standards of Healthcare Cleanliness and make sure we review and monitor our cleanliness levels very closely
• Strengthen our fire safety management system and ensure all staff are up to date with their Fire Safety Training
• Support staff to follow our Smoke Free Policy and provide tobacco-dependent service users with access to helpful resources

Our aim:

We will make sure that the care, treatment and support we provide meets need and achieves positive outcomes for our service users. We will set clear standards for ourselves, that are shaped by service users and clinicians and based on best practice and evidence.

Our immediate priorities:

To deliver this aim, we will focus on:

Working together with different professional groups, service users and carers and our partners to reshape and improve the way we deliver care. 

We will:

• Redesign our models of care – we will make changes to how we deliver care to ensure that service users receive the right care, at the right time and in the right place. This includes developing our adult forensic services, and transforming our community mental health services to deliver specialist care that is co-produced, place-based and trauma-informed  
• Make sure our staff have the right skills and experience to deliver care to our required high standard
• Adopt a collaborative and trauma-informed approach to care, in agreement with those who use and deliver our services
• Put our research into practice to inform clinical decision-making and help us provide the best possible care

Being clear about what we expect

We will:

• Clearly define all core clinical and professional standards across all our services and use formal accreditation methods as one means of checking we are meeting those standards
• Set up a system of clinical networks to support consistent practice and standards of care
• Review and improve our clinical skills training offer, making sure that we get it right from the start and that staff are supported to keep their skills up to date
• Roll-out a programme of reflective practice to support our staff and help us learn and improve our services

Our aim:

We will create a safe and supportive working environment for all staff. Of utmost importance will be their wellbeing and development. We will foster open communication, set clear direction and enable our staff to play a vital part in improving both the service they work in and the Trust as a whole.

Our immediate priorities:

To achieve this, we will focus on:

Ensuring the safety of our staff – both physically and mentally – through direct safety interventions and easy access to learning and development.  We will support our leaders to lead with compassion and make the development of staff their focus. 

We will:

• Create a safe environment, supported by leaders. This means taking quick and effective action against abuse and violence against staff, with a particular focus on hate crimes
• Review our staff wellbeing offer and make improvements based on recommendations by staff

 

Making access to education and training accessible to all staff and ensuring that staff personal development plans are meaningful and supported.

We will:

• Improve our appraisal and supervision processes to ensure all members of staff are clear on expectations and able to access development opportunities and realise their potential
• Refresh our mandatory training offer for all staff to ensure it is fit for purpose, efficient and based on an up to date assessment of need
• Work with Health Education England and our local universities to strengthen our approach to recruiting student nurses and improve the rates of students joining our Trust and staying with us
• Support our Health Care Support Workforce to complete the Care Certificate as part of their induction programme, with a particular focus on those who are ‘new to care’

 

Developing leaders who will uphold the values of the Trust and provide a safe and supportive working environment. We will support them to focus on the fundamental standards of care.

We will:

• Launch a new leadership programme called Role-Model, Coach, Care which focusses on the development of our leaders at all levels
• Design and deliver a Ward Manager and Community Team Manager Leadership Programme
• Standardise and reinforce the critical role of our quality and operational matrons and support them to deliver their core matron responsibilities
• Review our progress on creating diverse leadership teams and find ways to increase and support these, based on our findings

Our aim:

We want to be a collaborative, inclusive and compassionate organisation that actively engages with our service users and carers, staff, the public and other stakeholders and involves them in building a more positive future for the Trust.

Our immediate priorities:

To achieve this, we will focus on:

Creating opportunities to empower the staff voice across the organisation, with the Trust Board playing a visible and pro-active leadership role. 

We will:

• Evaluate our current Freedom to Speak Up process to make sure it is effective. We will pay particular attention to the number of Guardians needed to be effective across the organisation. We will also introduce Freedom to Speak up Champions across all services.
• Promote Freedom to Speak Up – we want all our staff to feel safe and confident to speak up and for our leaders to take a pro-active role in encouraging this and using the opportunity to learn and improve.
• Explore the proposal to have an external, confidential ‘hotline’ for staff where they can raise concerns via an independent service
• Deliver the National Guardian’s Freedom to Speak Up Training as well as active bystander training for senior leaders and managers

 

Building more open and collaborative ways in which our service users and carers can provide feedback and play a part in shaping and improving our services.   

We will:

• Actively listen to feedback and show that we have acted upon it
• Work with service users and their representatives to improve and share learning from issues, concerns and complaints raised
• Review all key Trust committees/groups/projects to make sure service user engagement is embedded
• Consider creating service user councils or other similar mechanisms to strengthen the voice of service users and build this into our governance structures.

Our aim:

We want service users, carers, staff and the public to have confidence in our leaders and the systems and processes we have in place to help us achieve our goals. We want to promote and share learning and be able to evidence delivery of all our agreed standards of care.

Our immediate priorities:

To achieve this, we will focus on:

Reviewing and strengthening our corporate and quality governance arrangements, ensuring they promote fairness, transparency and responsibility and are supported by good quality data.

We will:

• Work with external experts to strengthen our governance systems from ward to board, ensuring they are fit for purpose and reflect best practice
• Improve data quality and visibility to give our service users, carers, staff and wider stakeholders greater confidence in our performance and the quality of services we provide
• Embed our Care Group model, including by taking action to clarify roles and accountabilities, strengthen our supporting infrastructure and develop individuals and teams
• Establish a robust Trust-wide approach to assuring delivery of our key compliance requirements
• Support the development of a more positive incident reporting culture
• Strengthen our lines of sight and systems for learning from incidents (all levels of harm), inquests, complaints and claims within our Care Groups and across clinically similar services
• Transition to the new national Patient Safety Incident Response Framework (PSIRF), including an increased focus on engagement with those affected by incidents and system-based response and learning  

 

Improving Trust Board and Committee effectiveness by undertaking targeted development work with all existing Trust Board members. We will recruit to the current executive vacancies and revise how we assess and manage key risks.

We will:

• Commission an external Leadership Development Programme for Trust Board members with a focus on organisational values and culture
• Involve service users, carers, staff and in the recruitment to the vacant Executive Director positions.
• Review our Board Assurance Framework and Trust-wide risk management process and develop a revised system which will be embedded from ward to board.

 

Increasing Board and Senior Leader visibility and connectivity to frontline clinical services.

We will:

• Refresh the Trust Board visit programme and take the monthly Trust Board meeting out to local services
• Create an Executive Advisory Group to provide feedback and insight from frontline services and a cross section of our workforce
• Assign Trust Board members to work alongside one clinical Division, helping to build insight and understanding of the challenges facing frontline services