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Strategic Plan 2014‐2019 Summary 


Tees, Esk and Wear Valleys NHS Foundation Trust 



1. Executive Summary

As a Trust we are committed to being a recognised centre of excellence with

high quality staff providing high quality services that exceed people’s

expectations. This strategy sets out how we will continue to achieve this in light

of the following challenges in our Local Health Economies:

 The changing demographic population and the impact that this will have on the demand for mental health and learning disability services;

 The increased focus on delivery of high quality services;

 The need for high quality urgent and emergency care;

 The implementation of wider primary care services provided at scale;

 The implementation of models of integrated care;

 The increased expectations of the public, commissioners and regulators;

 The constraints on public finances, together with the increasing cost of providing care.

In responding to the above we believe that our long term financial and clinical viability is best promoted through continuing to focus on further improving our quality and hence the value that we provide to service users, their carers, GPs and the commissioners of mental health and learning disability services. We believe that a focus on quality and value will safeguard our market position in the short to medium term and provide opportunities for expansion in the longer term.

Our strategic plan therefore sets out the initiatives / plans that we have identified to provide that focus on improving the quality and value of the services we deliver. This document summarises our plans, which are aligned to the plans of our commissioners and the local Health and Wellbeing Strategies.

The Board declares that, the Trust will be sustainable according to current regulatory standards in one, three and five years time.


Lesley Bessant Martin Barkley Chairman Chief Executive TEWV Strategic Plan 2014-2019 Summary page 1 2 Overview of the Trust Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV) was established on 1st July 2008. Our mission is: To improve people’s lives by minimising the impact of mental ill-health or a learning disability.

The Trust provides a range of mental health, learning disability and substance misuse services for 1.67 million people across a wide geographical area of approximately 3,600 square miles as shown in the map below. The Trust also provides learning disability services to the population in Craven and a wide range of regional specialist services (e.g. specialist eating disorder services, forensic low and medium secure services and Children and Young People’s Tier 4 inpatient services) to the whole North East and Cumbria region.

We primarily serve 8 Clinical Commissioning Groups (CCGs) across Durham,

Darlington, Teesside and North Yorkshire. These are:

 Darlington CCG  Durham Dales, Easington and Sedgefield CCG  Hambleton, Richmondshire and Whitby CCG  Harrogate and Rural District CCG  Hartlepool and Stockton CCG  North Durham CCG  Scarborough and Ryedale CCG  South Tees CCG We work with 7 Local Authorities and their Health and Well Being Boards. These


 Darlington Borough Council  Durham County Council  Hartlepool Borough Council  Middlesbrough Borough Council  North Yorkshire County Council  Redcar and Cleveland Borough Council  Stockton Borough Council Figure 1 shows the area we serve (this includes the Wetherby town area which is covered by Leeds North CCG and which is within Leeds Local Authority, and Craven district, where we deliver community Learning Disability services which is covered by Airedale, Wharfdale and Craven CCG).

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In 2013/14:

 Our annual income was £286 million.

 The Trust employed 6,052 staff or 5,415 whole time equivalents (WTE), of which 4,518 staff or 4,127 WTE were clinical staff.

 These staff delivered treatment and care for 47,540 people over the year.

 5,889 service users received inpatient care from 12 locations across the Trust.

 In the community our staff provided over 1.4 million face-to-face or telephone contacts with service users.

3. Environmental Analysis

3.1 Introduction In preparing the Strategic Plan the Trust has undertaken a robust analysis of the current and future environment within which it operates. The analysis has

identified 4 key areas that have significant impact on the Trust:

 Anticipated Demographic Change (and the impact on demand for services);

 Financial Context;

 National Policy drivers;

 Local commissioner and stakeholder priorities;

3.2 Demographic Change Population Size The Trust currently serves a population of 1.67 million people. The forecast by the Office for National Statistics (ONS) predicts that there will be an increase in the population in the areas we serve with a significant increase in the over 65s population (and particularly in the number of people 85 years or older). Table 1 summarises the projected population changes.

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Prevalence Studies such as the 2007 adult psychiatry morbidity survey2 found that the proportion of the English population aged between 16 and 64 meeting the criteria for one common mental disorder increased from 15.5% in 1993 to 17.6% in

2007. If these increases continue then we would expect this figure to rise to 19.25% by 2018. The increased prevalence rate is influenced by changes in society, such as fragmentation of communities and families; changed working roles and reduced work security and therefore it is reasonable to expect prevalence to have increased since 2007 given the changes we have seen.

Other factors which are likely to increase referrals into mental health services


 GP / CCG focus on reducing underdiagnoses of conditions such as dementia and Children and Young People’s mental disorder;

 Increased cultural acceptance of mental illness as “normal” and less concealment, as campaigns such as Time to Change have reduced stigma.

The demand for Learning Disability (LD) services is affected by a slow growth in prevalence of between 0.5% and 1.0% per year arising from a higher number of children born with learning disabilities, and reduced mortality of adults with LD.3 Using previous year’s data together with the anticipated change in populations and prevalence we have estimated the potential impact on referrals to our services and caseloads. Whilst it is difficult to be completely accurate in forecasting future demand as it is difficult to predict the impact of any changes within commissioning, primary care provision or the development of different models of care it is anticipated that referrals and caseload will increase for older people’s, children and young people’s and learning disability services. We expect less change in the demand for adult services and forensic services.

3.3 Financial Context It is well documented that the financial context within which the Trust operates is one of limited growth in terms of NHS funding and is extremely challenging to both commissioners and providers. This is further compounded by the


“North Yorkshire” in this chapter refers to the area covered by TEWV, which is the local government district council areas of Richmondshire, Hambleton, Scarborough (including Whitby), Ryedale, Harrogate and the town of Wetherby. It does not include Craven or Selby districts.

NHS Information Centre (2009), Adult Psychiatric Morbidity in England, 2007. [the 2014 survey is currently at the fieldwork stage] Centre for Disability Research (2008), People with Learning Disabilities in England, pp4-5.

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The introduction of the Better Care Fund (BCF) will see resources transferred from CCGs to Local Authorities to help move care out of hospital and into the community. The BCF has the potential to improve mental health services as some areas are using it to support psychiatric liaison services. However there is a risk that CCGs’ budgets are reduced but demand for acute services increases, creating additional financial pressures in the system.

Some of the CCGs that commission our services spend more than the English median on mental health services and LD, but others spend less. There are also differences between CCGs in the proportion of their mental health and LD spending that is placed with TEWV rather than other providers.

3.4 National Policy Drivers In analysing the various national policies published over recent years we have identified a number of key drivers which will impact on the Trust over the lifetime of this plan and these are discussed below.

 Quality: There has been significant attention in national policy over recent years on the need to improve the quality of services provided to patients, linked to the Mid Staffs (Francis) and Winterbourne View inquiries.

 Development of Primary Care Services at Scale: National guidance states that over the next few years, those patients with a moderate mental or physical long-term condition (about 20 per cent of the population) will increasingly need to secure access to all the support and care they need from wider primary care, provided at scale. This will mean access to a broader range of services in primary care, in their own homes and in their communities, centred on a much more pivotal and expanded role for general practice to co-ordinate and deliver comprehensive care in collaboration with community services and expert clinicians.

 Integration of Services: Nationally and locally it has been recognised that maintaining the health and independence of people in the community results in better health outcomes and patient experience. This means that services, be they physical health, mental health or social care, are increasingly being aligned into integrated teams (usually around GP practices) to improve outcomes and reduce fragmentation across services.

 Parity of Esteem: An important element of recent government policy has been “parity of esteem” between physical and mental health. This is about ensuring that the delivery of services for people with mental health issues is seen as equally important as those with physical health issues, and that the poorer physical health of people with mental health conditions is addressed.   Payment by Results (Pricing and Currency): This is the introduction of a method of reimbursing providers for the level of services and outcomes

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3.5 Local commissioner and stakeholder priorities The Trust holds its main contracts with 8 CCGs and NHS England, and serves an area covered by 7 Local Authorities and Health and Wellbeing Boards. We work closely with these stakeholders to ensure that we have a robust understanding of their priorities in order that we can ensure we play our part in improving the health and wellbeing of the populations which we all serve.

All our CCG commissioners have recongised the need to invest further in

developing mental health services and Table 3 outlines their identified priorities:

–  –  –

NHS England is also an important commissioner of our services and it has

identified a number of priorities that are relevant to TEWV. These include:

 Extension of the IAPT approach to long term physical conditions, MUPS4, Personality Disorder, and further piloting of outcome based payment;

 Publication of service specifications for Tier 2 and Tier 3 CAMHS, and transitions to adult teams (by Dec 2014);

 Development of commissioning guidance for post diagnosis dementia care by March 2015;

 Development of “fully costed waiting times options for mental health services”;

 Continuation of work to deliver the Winterbourne View commitments (LD);

 Further roll out of Liaison and Diversion services at police custody suites and criminal courts, with 100% coverage achieved by April 2016;

 Strategic Plan for Health and Criminal Justice services published by Sept 2014;

 Common service specification developed and implemented for Armed Forces veterans mental health services by Dec 2014;

 Specialised Services Strategy published (Sept 2014) with systematic market review and a procurement work plan developed by March 2015;

 Balancing the specialist services commissioning budget by March 2015;


MUPS – Medically Unexplained Physical Symptoms

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4. Our Strategy

4.1 Our Strategic Direction The previous chapter outlined the key environmental context within which the Trust will operate over the next 5 years. The Board, supported by senior clinical and operational directors, reviews this context on an annual basis and identifies if the Strategic Direction of the Trust remains appropriate or requires amendment.

At its last review the Board acknowledged that the environment was increasingly challenging due particularly to the changing demographics, financial context and potential changing commissioning and provision landscape. However having considered this the Board’s assessment is that our core vision, mission and

strategic goals remain appropriate. Therefore, our mission remains:

To improve people’s lives by minimising the impact of mental ill-health or a learning disability

and our Vision is:

To be a recognised centre of excellence with high quality staff providing high quality services that exceed people’s expectations

Our strategic goals are:

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