1. Briefing Presentation – February 2010 Service line management proposals

2. Monitor Definition Service lines are an NHS Foundation Trust’s equivalent of a commercial company’s business streams. They are the units from which the trust’s services are delivered. Each unit also has clearly identified resources, including support services, staffing and finances.

3. What are Service Lines? (Semi) Autonomous service groupings Clinically led (or jointly led with local manager) Allowed to develop services Able to make decisions based on knowledge of local services Spend resources (e.g. recruit staff) Encouraged to be innovative and entrepreneurial

4. Reasons for Service Line Management Effective clinical leadership and engagement Patient safety, outcomes, experience and quality An organisational culture that encourages local autonomy with clear accountability and support. Improved efficiency and productivity Commissioner requirement and MH & LD contract

5. Benefits A greater devolution of power and responsibility A smaller corporate centre Change in culture and greater customer focus Improvement in quality and patient experience Leadership that is based on competencies Clinical engagement and ownership Act quickly with service improvement, productivity gains and service developments. Bring together clinical, operational and financial objectives and outcomes, in order to understand service performance and benchmark against other services.

6. Proposals These proposals are the first stage in a two year programme to implement Service Line Management. A Partnership model of collaborative leadership between the clinical and non-clinical managers for Directorate & Service Lines will be developed. To achieve this, the following new roles will be created: Clinical Director for each Service Directorate (except Social Care) Deputy Clinical Director (for AMH & OPMH) Business Development teams in each Service Directorate Clinical Service Director for each locality, area or service

7. Proposals (contd) Patient Experience and Stakeholder Management team to be in place for 2 years Substance Misuse and Eating Disorders services will transfer from AMH to Specialised Services Directorate. Reduce OPMH localities from 5 to 4 areas, by merging Fareham & Gosport with SE Hants. The configuration of service directorates will be reviewed, if in the future there are potential benefits for patient care and cost efficiency. CPA lead manager to transfer to IM&T dept.

8. Proposal (contd) Greater Devolution of corporate operational functions to support Service Line Management –Finance and HR – with professional support from Corporate Services Restructuring of business development and strategy directorate –Devolve functions to directorates, retaining some Trust wide functions Restructuring of Executive Director portfolios –Medical Director –Director of Nursing and Operational Services –Deputy Chief Executive/Director of Corporate Services –Director of Finance and Commercial Development

9. SERVICE LINE AMH Specialised Services DIRECTORATE TEAMS Acute Care Perinatal EIP Recovery Acute care EIP Proposed Structure for Service Lines Soton SW SE N Adult Forensic Eating Disorders Adolescent Forensic Substance Misuse Adolescent Tier 4 LD Inpatient Integrated Comm Team Localities x 5 OPMH Soton SW SE N Recovery Acute Care EIP Psychological Medicine Recovery Acute care EIP Liaison Comm Memory Clinic Inpatient Liaison Comm Memory Clinic Inpatient Liaison Comm Memory Clinic Inpatient Liaison Comm Memory Clinic Inpatient Campus Reprovision Social Care

10. Leadership Roles Clinical Leadership RolesManagerial Leadership Roles Directorate Roles Clinical DirectorDirector of Operations Deputy Clinical Director (AMH & OPMH Directorates Only) Service Improvement, Business Development & Performance Posts (number to be determined for each Directorate) Area/Service Line Clinical Service DirectorArea Managers Matrons (Inpatient & Community Settings

11. Changes to leadership roles The following leadership functions will be included within the new clinical leadership posts: –Directorate Chairs –Associate Directors of Nursing (Trust & Directorate) –Directorate Deputy Medical Directors –Lead Clinicians –Professional Leads (Trust & Directorate) –Associate Medical Directors

12. Management/Clinical Leadership Savings 2007/8 – 2010/11 2007/08 (£’000) 2008/09 (£’000) 2009/10 (£’000) 2010/2011 (£’000) (Before CIPs) *Reinvested from Management savings to Clinical Leadership posts, in addition to £100k for Leadership Development Management4846301,087330 Clinical Leadership 8523285+*130 5696531,372200

13. Directorate Investment/Savings for SLM (2010/11 before CIP) Management (£’000) Clinical Leadership (£’000) Total OPMH-21+48+27 AMH-15*-19*-34 LD-35+42+7 SSD+28*+59*+87 TOTAL-43+130+87 * Includes proposal to transfer EDS and SMS from AMH to SSD

14. Professional Advice and Accountability Principles: All clinical staff in each service line will be accountable for their clinical & professional practice to the Clinical Service Director Appropriate professional advice will be available to Clinical Directors & Clinical Service Directors, relating to: –Interpretation of national professional strategies & standards –Impact & implications of local change & service development –Professional performance & disciplinary issues

15. Accountability of Service Lines FT Executive will develop an accountability framework to define the level of decision making within each directorate across the following practices: –strategic, –financial, –operational –employment Service lines will need clear ‘freedom to act’. It will include the performance targets and compliance requirements; FTE will work with directorates on trust-wide cross division issues, and provide facilitation and arbitration across directorates. Structured process between the FTE Team and Directorate Management Team to monitor the accountability framework and performance. Implementation of SLM will result in a significant change in the governance of the Directorates. FT Executive will agree the infrastructure of the Directorates and Areas/Service Lines, including their proposed meetings and their Terms of Reference

16. SLM pilots Establish a pilot in the Social Care Directorate during the summer to examine the feasibility of the devolution of the following arrangements: –Recruitment. –Training and development –Dedicated information analytical support. –New models of accessing estates, supplies and administrative support services that are more customer responsive. –Contracting –CQC relationship management –Risk management and operational compliance Pilot to report by the end of 2010 with recommendations on the potential for the next phase.

17. SLM pilots Additionally each of the other service directorates can apply to put forward a service line area to pilot some aspects of the freedoms set out above, subject to agreement by a panel of the Executive Directors of the FT based on clear criteria. Applications to be received and considered by end of 2010 for roll out from early 2011.

18. Training and development Leadership competencies developed. Individual development programmes will be shaped around meeting these competencies. £100k funding for leadership development found from savings in management costs. Major individual and team development programme from Autumn 2010 to provide: –Understanding leadership competencies & their consequent development needs. –Impact of personal leadership style on others. –How to develop the Service Line vision & aspirations. –Strategy development.

19. Summary - SLM proposals New Clinical leadership roles based on partnership working with managers Future Service Lines to based on areas/services in current directorates Substance Misuse & Eating Disorders services transfer to Specialised Services Directorate Changes to OPMH localities Patient Experience & Stakeholder Management team. Business Development at directorate level Changes to Executive Director portfolios SLM pilots Investment in leadership development.

20. Consultation For 8 weeks from 24 th February to 21 st April 2010 Responses to SLMConsultation@hantspt-sw.nhs.uk