This overview provides a summary of the Trust’s performance, explains where information on the key risks can be found and comments on the Trust’s achievements and performance in the year.
We are proud to work in partnership with our staff, service users, carers, governors, commissioners and public to deliver excellent mental health and learning disability services for the people of Lincolnshire. We strive to improve the services we offer and are pleased to do this as part of the health and care system, in collaboration with others.
Given the changing healthcare landscape and a real ambition to reduce health inequalities, part way through 2022/23, the Trust’s Board commenced a piece of work to review its strategic objectives and, following consultation with staff, service users and carers, governors and stakeholder organisations, the Trust will be relaunching its strategy during 2023.
Having foundation trust status has enabled the Trust to influence the wider system and ensure a continued focus on, and investment in, mental health, dementia, learning disability and autism services, through our Board of Directors, Council of Governors, and Trust membership. This has led to new investment in children and young people’s mental health services to increase access and reduce waiting times, as well as provide additional investment in Improved Access to Psychological Therapies (IAPT), perinatal services and Individual Placement & Support (IPS), in order to expand capacity to achieve increased access, in line with the targets set out in the NHS Long Term Plan.
The Trust has also used its ability to build and utilise cash reserves to improve the quality of the Trust’s estate. Whilst there are now greater controls on NHS capital expenditure and a requirement to co-ordinate capital expenditure across systems, the Trust has been able to commit significant investment to improving the quality of its inpatient estate and make significant progress towards achieving the national priority to eradicate dormitory ward accommodation in mental health settings.
The key risks for the organisation are reported in a risk register at every Board of Directors’ meeting and as part of the Annual Governance Statement later in this report. The Board monitors its performance across a range of indicators that relate to service quality, demand, and staff. This is presented in an integrated performance report (IPR) received at every meeting of the Board of Directors and published on the Trust’s website.
The IPR provides the Trust’s performance against key measures, including those related to our overall Trust Strategy and those within the Long-Term Plan (LTP) standards. There is also a more detailed Executive summary of the most pressing issues to draw to the Board’s attention, evidenced by triangulation of the data, to enhance this governance process
There have been developments to the Integrated Performance Report (IPR), in order to align with the updated NHS oversight framework for 2022/231, outlining NHS England’s approach to NHS oversight for 2022/23, aligned with the ambitions set out in the NHS Long Term Plan and the 2022/23 NHS operational planning and contracting guidance. It also reflects the significant changes enabled by the Health and Care Act 2022 including the formal establishment of integrated care boards to support the ambition for system-led delivery of integrated care in line with the direction of travel set out in the NHS Long Term Plan, integrating care: next steps to building strong and effective integrated care systems across England and the government’s white paper on integration – Joining up care for people, places and populations.
1 The Trust has been rated in segment one of the framework throughout 2022/23.
We also contribute to national monitoring programmes which allow our performance to be benchmarked against similar NHS trusts.
The Trust’s financial performance for the year, as reported in the financial statements, was a net deficit of £390,000. On an NHS reporting basis, which uses an adjusted surplus/deficit metric, the Trust delivered a surplus of £8m in 2022/23. This performance was £4.75m better than planned for by the Trust. Whilst pay increased by 15% to £121.5m, the Trust was unable to spend to planned levels due to recruitment challenges. This had an impact for both the Trust’s position and the delivery of the Mental Health Investment Standard for Lincolnshire, with full potential unable to be realised.
With regards to capital, we successfully fully utilised the capital available to the Trust investing £16.9m in new buildings and other prioritised commitments. This was for the Lincoln Eradication of Dormitories programme.
The Sustainability, Quality and People Committees review performance exceptions, together with other areas of potential risk, using analysed data to provide these insights. This includes the use of deep-dive reports to fully understand where performance is off track and what actions are in place to mitigate and resolve this.
Over the year however there have been several services that did not meet the Long Term Plan (LTP) targets set nationally and these are highlighted below.
The number of adults entering Improving Access to Psychological Therapies (IAPT) service determined nationally on a prevalence basis. The data shows a significant in year improvement, but this remains below the Long-Term Plan target trajectory
IAPT Access Rate - cumulative figures
IAPT Access Rate - quarterly total
The number of children and young people (CYP) that should be coming forward to access mental health services is determined nationally on a prevalence basis. Access is then counted using the Mental Health Service Data Set (MHSDS).
CYP Access rate 2022/23
The Long-Term Plan also states that children and young people with an eating disorder (ED) who are deemed routine should start treatment within 4 weeks of referral, with urgent referrals within 1 week. This is measured on a 12-month rolling basis and reported quarterly via a national submission. The data shows a significant increase in children and young presenting with an eating disorder, and this is impacting on the service’s capacity to meet demand.
Rolling 12 month charts - CYP Eating Disorder waits
Access to specialist perinatal mental health services is defined under the national metric as women who have had one face to face or video conference contact with the service.
The Access Rate performance has been impacted by recruitment and sickness in this financial year and the Perinatal Trauma and Loss Team that was launched on 1st February which support improved access going forward. National performance for access is 7% compared to 7.9% at LPFT.
Perinatal Access Rate by Quarter
Individual Placement and Support (IPS) is a model of employment support which helps people with serious mental health conditions into employment. Access is defined by the number of people who have had an attended contact and started a vocational profile. Population prevalence is used to set this access rate.
IPS Access Rate 2022-23
All other Trust level indicators within the National Long Term Plan were achieved.
The Trust has, again, had a good response from the staff survey of 53.4%. Themes arising from the survey have been analysed and are highlighted within the staffing section of this report.
The Trust continues to collaborate with partners within the system to meet system targets for dementia diagnosis and annual physical health care checks for those with serious mental illness (SMI).
This year has seen a significant growth in the demand for information analysis to Improve mental health data evidencing the expansion and transformation of mental health services, and the impact on population health, with a focus on activity, timeliness of access, equality, quality, outcome data, and support for digitally enabled practice to improve patient care.
These additional demands and changes to analytic requirements have been supported through a review of existing resource provision and digital infrastructure. Further developments will be implemented in the coming year to ensure the organisation is able to build on existing approaches to data and analytics, replacing traditional high-effort, low-value processes to improve the quality of our data to support decision-making, policymaking and performance management identified as key digital success measures.
