Growing our capability to deliver

A focus on these capabilities will be critical to the delivery of our long-term aims and objectives. COVID-19 has demonstrated how we can grow our capabilities so that we can adapt and respond to change whilst continuing to deliver outstanding care. We will focus on:

1. Building a resilient, healthy, and happy workforce
2. Strengthening partnerships with people who use our services and their loved ones
3. Evolving our culture and leadership with people’s safety and wellbeing a top priority through a culture of learning and improving
4. Optimising the use of resources and people’s expertise to learn, drive change and improvement and be focused on what matters most
5. Investing in system leadership.

Aim: Building a resilient, healthy and happy workforce

At KMPT we employ brilliant people; they are at the heart of everything that we do. As set out in KMPT’s People strategy we want to build on this by focusing on:

• recruitment and retention – we will address our vacancy rate by creating a workforce model that better supports attracting, recruiting, and retaining brilliant people
• making the best of our staff – listening to them, supporting them to drive innovation and test new ideas in a safe environment through a ‘just and learning culture’ that enables reflection
• developing our leaders so that they can ‘lead across Kent and Medway’, supporting devolved responsibility, encouraging proactivity, but making sure support is there when people need it
• investing in the health and wellbeing of our people so that they have the resilience to work at pace whilst doing all we can to prevent burnout. In 2020 we achieved the Kent and Medway Workplace Wellbeing Bronze award and we are now actively working to achieve Gold accreditation. The Gold award will provide KMPT with a comprehensive health and wellbeing offer to help attract and retain our staff.

The NHS People Plan, published in July 2020 alongside the People Promise, set out what NHS people can expect from their leaders and each other. Building on the creativity, drive and determination shown by the NHS in its response to the COVID-19 pandemic, it focuses on fostering a culture of inclusion and belonging as well as taking action to grow the workforce, train our people and work together differently to deliver care. Refreshed
annually, our People Plan will be developed in alignment with the NHS People Plan and emerging Kent and Medway ICS workforce strategies.

An integral part of this will be developing and strengthening our approach to diversity and inclusion. In 2019 we were proud to hold our second diversity and inclusion conference, which provided a platform to celebrate the diversity of our people and encouraged staff to join our diversity networks. Our networks provide an opportunity for people to speak up and we want them to thrive and grow over the next five years. Our diversity networks include:

• Black, Asian and Minority Ethnic (BAME) Network The Black, Asian and Minority Ethnic (BAME) Network is a vibrant and progressive forum where staff can discuss issues and seek solutions. The forum actively promotes initiatives that create awareness to all staff and looks to celebrate key dates such as Black History Month.
• (dis)ABILITY Network The (dis)ABILITY Network continually looks to improve equality in the provision of healthcare, other services, and employment. The network aims to be the vessel for staff to discuss issues that relate to disability – including mental health – and promote disability awareness.
• The Faith Network The Faith Network works to promote understanding and good relations between all religions and beliefs across our trust. The network links and shares good practice, and provides advice, guidance and information. It raises awareness of interfaith initiatives and looks to promote key faith days to raise understanding. Inclusive of all religions and beliefs, it welcomes members to join and to educate all.
• LGBTQ+ Network This is a place for KMPT staff to discuss their views and experiences, share ideas, and promote LGBTQ+ initiatives such as LGBT History Month, pride month and trans awareness, as well as host campaigns that encourage staff to be themselves and be safe at work.

Aim: Strengthening partnerships with people who use our services and their loved ones

We want people who use our services and their loved ones to be involved in how we plan for, and deliver, the best possible treatment and care for people with mental ill health. Making sure the voices of those who use our services are heard is vital in shaping a modern mental health service that truly meets the needs of local people.

To facilitate this engagement, we have developed a Participation and involvement strategy which aligns with the National Survivor User Network’s National Involvement Standards, which were coproduced with mental health service users and carers. The participation and involvement strategy has been informed by an internal review of our engagement activity and outlines our commitment to working closely with people who use our services and their loved ones.

We have a clear roadmap for implementation, covering the following key areas:

• Training and support for those with a lived experience perspective to help them fully contribute to improving and transforming our services
• Communication and marketing: including recruiting an ‘engagement pool’ of diverse and representative voices to help inform our work
• Process and practical issues: co-producing standards and procedures to guide our engagement work with services users, their carers and loved ones.

The strategy has been informed by ‘business as usual’ engagement activity and insights as well as specialist, targeted research. In Autumn 2020, we commissioned Engage Kent, the independent engagement arm of Healthwatch, to complete a review of our existing engagement forums. The review, which was undertaken using co-production methodology, highlighted the need for change and gave us clear recommendations to improve the effectiveness of our engagement activities.

These included:

• developing and agreeing principles for engagement
• the ongoing development of the engagement pool to reflect the diversity of our patient and carer populations
• the implementation of an engagement panel to formally agree and monitor priorities for engagement annually – this would have the following groups shown in the diagram

Our Participation and involvement strategy is also supported by our continued commitment to the ‘Triangle of Care’ approach which advocates for a strong carer voice in the design and delivery of mental health services through six key elements:

• Carers and the essential role they play are identified at first contact or as soon as possible thereafter
• Staff are ’carer aware’ and trained in carer engagement strategies
• Policy and practice protocols on confidentiality and sharing information are in place
• Defined post(s) responsible for carers are in place
• A carer introduction to the service and staff is available, with a relevant range of information across the acute care pathway
• A range of carer support services is available.

We have now been successfully audited for our commitment to the Triangle of Care both for inpatient and community services. There are carer champions in every team in KMPT, who undertake this role in addition to their usual responsibilities.

They help promote carer awareness to their colleagues as well as being a designated point of contact for carers.

They keep carers in mind and champion the carers’ voice. The views, experiences and insights of carers are reflected in our transformation work and will continue to be a strong voice in co-design and co-production projects and initiatives in the future.

Aim: Evolving our culture and leadership

Over the lifetime of this strategy, we will be working to enhance the culture of our organisation. This is set out in our cultural heart which includes three key principles:

1. A ‘just and learning’ approach

We continuously strive to improve our services. We accept everyone makes mistakes, especially in pressured environments, we review our systems and our processes, we focus on safety for all and quality of care, not blame.

We demonstrate trust and meet hurt with healing. We learn from experience and share this with others. We ask, ‘what should we do differently’?

2. Living our values

We act according to our shared values; we recruit, develop, reward, and manage by them. We respect the contribution of everyone, openly working together and we value people for their individuality and the difference they bring. We demonstrate positive and respectful behaviours. We seek, listen and act on feedback to help us work together more effectively. Everyone counts, everyone has a voice.

3. An empowered ‘team of teams’

We are one team with a shared purpose but to operate effectively and remain agile we organise ourselves into smaller teams with clear roles and responsibilities. These teams are empowered to make decisions and work together, always with service users at the heart of what we do.

We grow strong networks with other teams and align our goals and efforts to deliver the KMPT aims and vision.

By delivering the three elements of our cultural heart we will create a fair environment where colleagues feel well-led, involved, engaged, valued, developed, supported and heard.

Our strategy reflects the national NHS People Promise:

Looking after our people by:

• Collaborating with KMPT colleagues to introduce innovative approaches to support health and wellbeing
• Encouraging belonging in the NHS
• Embracing co-production to work with KMPT colleagues to develop and embed our ‘cultural heart’
• Being readily accountable for progress on our action plans and responses to feedback from our people
• Increasingly attracting diverse and talented candidates through recruitment events here and internationally,and by developing our employer brand
• Being open about our Workforce Race and Disability Equalities Standard priorities and progress

New ways of working and delivering care by:

• Challenging our thinking to create innovative workforce models for the future
• Enhancing technological developments for learning and development delivery
• Championing a quality improvement (Qi) approach to our learning and development interventions
• Ensuring we have clear management and leadership career pathways and future fit leadership development programmes

Growing for the future by:

• Reaching out to potential employees to meet us and understand our services
• Developing pro-active approaches to support and retain our people throughout their careers
• Developing clear career pathways across all employee groups
• Supporting all employees as they strive for excellence, by enabling access to learning and development opportunities
• Developing our coaching and mentoring culture across KMPT.

Ultimately, we see the empowerment of our teams as critical in helping to drive up the quality of care we deliver and the partnerships we build across Kent and Medway.

Supported by our quality improvement approach we are confident that our culture will help teams identify opportunities for transformation based on need and act on those opportunities without judgement.

Rather than working in silos across KMPT, our teams will develop effective internal partnerships. Our corporate teams and functions will better integrate with our clinical teams, supporting them to deliver the best care and support to our service users and their loved ones.

Our culture will support us all to be outward facing and open to partnering with others and exploring new opportunities.

Aim: Optimising the use of resources

We must make the best use of all our resources to ensure organisational stability, seek to deliver efficiencies where possible whilst considering opportunities for innovation and development. We will plan for future demand and deploy our resources and capacity to ensure timeliness and equity of access to our services.

Finance

There is now a ‘system by default’ approach to the collective management of financial resources across Kent and Medway. This includes the delivery of an overall health and care system financial improvement trajectory and identification and delivery of system-wide efficiencies to achieve financial improvement at the system level.

Underpinning this are financial principles agreed by the system leadership that set out how we will manage the financial resource effectively and efficiently.

Prior to the pandemic the health and care system in Kent and Medway had been set financial trajectories by NHS England and NHS Improvement aligned to the NHS Long Term Plan. The Kent and Medway system and KMPT trajectory is outlined below:

Financial Trajectory Pre-Central Funding (£)

N/A	2019/20	2020/21	2021/22	2022/23	2023/24
Kent and Medway system trajectory surplus/deficit	117.8m	106.7m	89.9m	77.4m	66.8m
KMPT trajectory excluding support funding surplus/deficit	6.1m	5.4m	4.6m	3.6m	2.6m
KMPT trajectory with support funding surplus/deficit	0	0	0	1m	0

Both are important for us because as an organisation we must think about our own financial position and how that can best support the Kent and Medway health and care system as a whole.

2020 has been an unprecedented year with the global pandemic. The NHS has implemented a new financial regime in response. All NHS providers have been asked to break even in 2020/21. To deliver a break-even position providers have received COVID-19 financial support for additional costs incurred by responding to the pandemic and also top up funding to support delivering a break-even position.

This has been mainly for providers with underlying deficits like KMPT. This is shown in the second row of the table above.

As we move into 2021/22 the finance regime is yet to be confirmed, however it is expected to be similar to that of 2020/21 whilst we continue to live with the pandemic. KMPT will be starting its annual planning process shortly, and will be setting out clear guidance that includes the national planning assumptions. The national assumptions will include a level of efficiency that all providers are required to deliver year on year. We will include this in our KMPT planning assumptions.

KMPT will continue to focus on delivery of the NHS Long Term Plan which includes expansion of a number of services. The NHS Long Term Plan includes five financial tests to ensure that taxpayers’ money is used to maximum effect and our approach to finance will be aligned to these tests. The NHS will:

1. return to financial balance
2. achieve cash releasing productivity growth of at least 1.1 per cent per year
3. reduce the growth in demand for care through better integration and prevention
4. reduce unjustified variation in performance
5. make better use of capital investment and its assets to drive transformation.

We have worked hard to reshape the way our finance team operates across KMPT, embedding a business partner model that has members of the finance team working alongside the clinical and operational teams to manage resources effectively.

As part of our planning there will be a continued focus on the Mental Health Investment Standard (MHIS). This was previously known as Parity of Esteem (PoE) and is the requirement for CCGs to increase investment in mental health services in line with their overall increase in allocation each year. KMPT is using this additional funding to support the development of:

• Community teams
• Crisis and liaison services
• Perinatal services
• Early intervention in psychosis.

Clinical technology

The NHS Long Term Plan set out wide-ranging ambitions to upgrade technology and digitally enable more care across the NHS. At KMPT, we are developing a clinical technology strategy that benefits our staff and supports clinical change that will help to deliver outstanding quality care to our service users. Based on the following ten
key objectives, our technology strategy is a vital opportunity to take advantage of the potential of our digital age:

1. Develop our clinical engagement practices to ensure we digitise the correct processes
2. Develop and extend our commitment to interoperability
3. Develop and extend our cyber security capabilities
4. Develop our workforce’s digital capabilities
5. Develop co-production processes to ensure the design of our systems and services are user-centred
6. Ensure easy access to systems and data at the point of care
7. Develop and deploy technology which will support a paperless operating environment
8. Develop systems which support research and clinical audits
9. Deploy technology which minimises negative impact of our activities on the environment
10. Deliver improvement through continuous digital development.

In developing our new Clinical technology strategy, we have engaged with more than 500 people, including service users and their carers, to understand what people want from technology. Staff told us that they want to work in a more mobile fashion, with better integration across different systems and easier access to records and information when they need it. Service users and carers said that they wanted more involvement in their care through the use of digital technologies although it is clear that we will need to build their confidence in the use and benefits of changing from a largely paper-based system.

When we roll out new technologies, we will ensure they add value, reduce the administrative burden of today, and enable better quality care. Examples of the projects we are running as part of our strategy are:

• Mobilising the RIO electronic patient record system that will give us a more holistic picture of the people we care for and allow greater interoperability across teams and organisations
• Bed Management System (FLOW) - This supports our management of patient flow to ensure people’s needs are appropriately met as part of acute admissions and our discharge process.

Kent and Medway Care Record

Work is underway countywide around the creation of a Kent and Medway integrated health and social care record. Accessible through RiO, the Kent and Medway Care Record (KMCR) will bring together securely NHS and social care data from across the county, involving GPs, local authorities, acute trusts, community trusts, and mental health service providers.

The work countywide is progressing well and in KMPT we are now beginning to take decisions around what patient information we will be securely sharing via the shared record.

One of the primary aims of the KMCR is to help health and social care providers make better more informed decisions for the people they are caring for. Other benefits include:

• Patients no longer having to repeat their medical and social care history when seen by different services
• More detailed and timely information allowing for faster clinical decisions to be made, improving communications between referrers and service providers, and improving continuity of care
• Enabling clinicians and social care professionals to see what care our patients are receiving from other services, for example saving time for clinicians, viewing any medication prescribed, alerts or allergies, hospital test results and if the patient has a social care package
• In the next phase of the project, patients will have the opportunity to access their own data, helping them feel more involved and engaged in their own care.

By April 2021, KMPT will be securely sharing data via KMCR and accessing data from other organisations. From April 2021, work will start on the next phase of the project to enable patients to view their own care record.

Informatics

Health informatics is the intelligent collection, management, use and sharing of information. When done effectively this can play a significant role in supporting the delivery of our vision and objectives. The KMPT Informatics strategy aims to ensure that we value our data, seeing it as an asset that will support us to make informed decisions and deliver the best quality care. It includes nine objectives:

1. Develop a centralised database for KMPT that holds all trust data where feasible, to act as ‘one single source of truth’
2. Make evidence-based decisions
3. Extract intelligence from data
4. Ensure ease of access
5. Improve data governance
6. Improve data literacy
7. Improve data quality
8. Enhance user experience
9. Create an analytical workforce.

Our Informatics strategy is ambitious and will help us future proof the way we work. By changing the way we record, use and store data, we can make this information work harder, informing the wider Kent and Medway system through increased information sharing with our partner organisations.

We are making the shift to live reporting, that tells us not just about last month’s activity but about real time activity allowing us to model, predict and forecast demand for the future, helping us plan more effectively.

Estates

It is critical that we deliver outstanding care in environments that are appropriate and that anyone would be happy to use.

Our Estates strategy sets out our ambition and our priorities but more importantly it links them straight back to people; those who use our services and those of us who work in them.

We use benchmark measures for the utilisation of the estate set by the Carter Review, and information available from the Model Hospital resource to ensure best value for money from these facilities.

"Our aim is to achieve a consistently high standard of accommodation for patients and staff while managing resources effectively. This means using our estate well and looking for opportunities to optimise it."

As the result of an extensive listening exercise in 2018 with service users, their carers and staff, the following aims for our estate have been identified:

• Provide safe, secure, effective, and therapeutic environments
• Use the right kinds of buildings in the right location
• Reduce overall costs
• Constantly improve the appropriateness and quality of environments for patients and staff
• Develop more environmentally-sustainable buildings and services
• Generate income from surplus accommodation where possible
• Provide staff with safe and healthy workplaces
• Ensure links between our use of buildings and emerging technologies.

Whilst working to deliver our aims we recognise the new context in which we’re working and the need to effectively partner with others across the system to plan our estate at a Kent and Medway level. KMPT is the lead for the ‘One Public Estate’ initiative in Kent and Medway which seeks to increase collaboration across public sector bodies and agencies to improve strategic estates planning.

KMPT has outsourced its catering service over the past two years with the objective to ensure that we could offer our patients a consistent method of catering services across all our sites, offering a 21-day menu cycle and bespoke menus for each care group.

We have established a strong relationship with the catering provider, ensuring that the contract is managed rigorously and are working with them to consistently improve the standard of food on offer with notable improvements over the last two years. Work is underway to help ward staff ensure that service users’ food experiences continue to improve, for example through the provision of napkins on tables, water provided, correct cutlery and the presentation of food. We are also considering implementing the clinical environmental role in place in our Older adults care group across all the care groups to support clinical staff in food service delivery.

"The NHS Long Term Plan provides an important opportunity for mental health services, nationally and locally with investment in mental health over the next five years promised at a faster rate than for the overall NHS budget. KMPT needs to ensure the mental health estate is improved as part of that investment. KMPT has registered two major areas for capital investment: the eradication of dormitory accommodation and a female Psychiatric Intensive Care Unit."

Aim: Investing in system leadership

With the move to a Kent and Medway ICS comes the opportunity to review and reflect the way we lead within our organisation and as a system partner. 

As this strategy describes, we have a key role to play in supporting system wide improvement, ensuring sustainability of our system, managing risk, and sharing resource and experience.

Our Board and sub-committees will support systems leadership and contribute to effective assurance across the system. We will develop our role as an influencer across the partnership boards that exist across Kent and Medway, providing specific leadership and stewardship around issues related to mental health, learning disabilities and substance misuse. We are already starting to change the way our clinical leaders demonstrate system leadership, with a number of them sitting as members of the ICPs’ Boards to advise on issues related to mental health, learning disabilities and substance misuse.

We will continue to find opportunities to develop our leaders. We recognise that a wide range of providers are required to deliver mental health, learning disability and substance misuse services and we will embrace collective leadership to support delivery of effective, high quality services.

Our work to establish the Mental Health, Learning Disability and Autism Improvement Board and supporting workstreams demonstrates how this approach can bear fruit. With a focus on providing leadership, oversight and partnership working the Board will work on priority areas including, dementia, urgent and emergency care, community mental health, out of area placements and learning disabilities and autism, to drive forward improvements for local people. Working as a system board gives us greater capacity for integration with accelerated growth and innovation, access to better analysis and real time data as well as the potential for cost savings through system-wide efficiencies.

"KMPT is engaged in the Kent and Medway Organisational Development Network which is working to develop a framework for Organisational development within the emerging Integrated Care System structure."