University Hospitals Bristol NHS
Foundation Trust
ANNUAL PLAN:
CORPORATE OBJECTIVES
2009/2010
DRAFT FOUR: 24th MARCH 2009
D:\Docs\2018-04-05\0b17627649dcbedb6697dc30c16fe82b.doc PAGE: 1 Contents
Section 1: Introduction
Section 2: Context
Section 3: Objectives for 2008/2009
Section 4: Patient Experience
Section 5: Clinical Quality
Section 6: Operational Efficiency
Section 7: Teaching and Research
Section 8: Infrastructure and Facilities
Section 9: Finance and Information
Section 10: Workforce
Section 11: Organisational Development
Section 12: Conclusion
D:\Docs\2018-04-05\0b17627649dcbedb6697dc30c16fe82b.doc PAGE: 2 1. Introduction
University Hospitals Bristol NHS Foundation Trust is the largest acute trust in the South West. A major teaching Trust in the heart of Bristol, it provides local and specialist services to the population of Bristol and the South West, from eight hospitals and the Central Health Clinic.
The Trust employs 7,122 permanent staff and an additional 1,731 through our internal temporary staff agency and has a budget of £487.9 million, as per the Resources Book at March 2009. As the centre for education and research for the University Of Bristol Faculty Of Medicine and the University of the West of England School of Nursing and Midwifery our commitment to teaching and research is central to the life of the organisation.
On 1 June 2008 the Trust was authorised as a NHS Foundation Trust, recognising the clinical, governance and financial strength that the Trust has developed. With over 10,000 public members the Trust plays an increasing active role in the local community and looks to its members to represent the communities it serves.
This document provides a summary of the Trust’s key objectives for 2009/10. Together with the financial and activity plans laid out in the Financial Resources Book, it forms the Trust Annual Plan for the year. Detailed Clinical Divisional and other plans underpin the delivery of these key objectives. The Trust annual plan relates to other plans at health community and Trust level, including the Operating Plan for Bristol Primary Care Trust; the Bristol, North Somerset and South Gloucestershire health communities and the NHS South West Strategic Health Authority.
2. Context
The national priorities for 2009/10 have been laid out in the Department of Health Operating Framework. Regional Priorities are set out in the South West Strategic Health Authority Operating Framework. This sets out some local ‘stretch’ targets that are significantly more challenging than the national standards. Under the Operating Plan for 2009/2010, PCTs will continue initiatives to reduce reliance on hospital services and provide care closer to home. These include plans for managing hospital demand by establishing stricter criteria for the referral of patients to hospital and by developing alternative services in primary and community care (including the use of independent sector providers). This means that the Trust must be prepared to respond flexibly by reducing or altering its own services to match the commissioning plans of PCTs whilst still maintaining the quality of service to patients.
D:\Docs\2018-04-05\0b17627649dcbedb6697dc30c16fe82b.doc PAGE: 3 3. Objectives for 2008/2009
The table below summarises the corporate objectives for 2009/20010 under the main themes of the plan, with the associated Executive named alongside each. The subsequent sections set out the action plans that underpin each objective.
Key:
COO Chief Operating Officer MD Medical Director DoF Director of Finance DoCD Director of Corporate Development CN&DG Chief Nurse & Director of Governance DoW&OD Director of Workforce & Organisational Development
Theme Objective Owner
To enhance patient and public areas to provide a COO welcoming environment, including professional front of house services Patient To establish a coordinated approach to patient and public CN&DG Ex per involvement through an operational framework, ien encompassing with the new Quality / Patient Experience ce Structures and Governor Sub-groups The Trust will meet the recommendations as laid out in the COO new standard for Mixed Sex Accommodation (DH 09) To produce an Annual Quality Report for the Trust MD
Clinical Quality To improve patient safety by further reducing the incidence CN&DG of healthcare associated infections To ensure all nationally agreed performance targets are COO met and exceeded, achieving an ‘Excellent’ rating for 2009/10 To reduce unnecessary attendances to the Emergency COO Operational Department through close working with the Primary Care Efficiency Trust and Social Services To reduce length of stay by reducing the number of patients COO staying longer than 7 days by 10% To produce a comprehensive Civil Contingencies Plan to COO meet national requirements Teaching and To refresh the Research & Development Strategy, in line MD Research with the strategy of the Bristol Health Community
D:\Docs\2018-04-05\0b17627649dcbedb6697dc30c16fe82b.doc PAGE: 4 Theme Objective Owner
To develop an innovation and enterprise framework in the DoCD Trust aligned to key strategic priorities To work closely with the University of Bristol to implement COO the Clinical Research Imaging Centre project in preparation for opening in 2010 To ensure that teaching and learning metrics are DoW&OD embedded within the Trust performance framework To develop the Teaching and Learning Strategy in line with DoW&OD the national and regional agenda and clinical services strategy To review and refine the Nursing and Midwifery Research CN&DG Framework and implement 2009/10 objectives To implement year 3 of the assistant practitioner and CN&DG National Vocational Qualification teaching plan in support of Cash Releasing Efficiency Savings and skill-mix plans To ensure that the existing estate and facilities are fit for COO purpose and meet the needs of existing and developing services across the Trust To ensure that the existing estate and facilities are fit for COO purpose and meet the needs of existing and developing Infrastructure services across the Trust and Facilities To finalise plans for redevelopment of the Bristol Royal DoCD Infirmary and the centralisation of specialist children’s services at the Bristol Royal Hospital for Children To open the Bristol Heart Institute and reconfigure services COO within the Bristol Royal Infirmary To continue the development of clinical information DoF / MD systems to enhance the delivery of patient care and improve service efficiency, aligned to the National Finance and Programme for Information Technology Information To continue to develop and improve financial management DoF systems To fully realise the agreed Cash Releasing Efficiency COO/DoF Savings plans for 2009/10 Workforce To continue to attract and retain high calibre staff DoW&OD
To ensure robust workforce planning with all business and DoW&OD service plans to have workforce implications fully integrated. Carry out a risk assessment to identify any potential workforce capacity and capability issues. To develop a method of embedding Equality and Diversity DoW&OD into all aspects of Trust business To review the Occupational and Health and Safety DoW&OD standards to assure compliance, and the safety of staff and patients provides high quality services.
D:\Docs\2018-04-05\0b17627649dcbedb6697dc30c16fe82b.doc PAGE: 5 Theme Objective Owner
To ensure compliance with European Working Time DoW&OD Directive by August 2009 To develop specific skill-mix change plans by ward and CN&DG department using the Audit Commission, Association of United Kingdom University Hospitals and internal data To produce a recruitment and retention plan for Nursing CN&DG and Midwifery To improve the profile and enhance the reputation of the DoCD Trust, regionally and nationally, and build a supportive stakeholder base. To develop a strong vision, brand and identity for the Trust DoCD that identifies why it should be the provider of choice for PCTs, GPs, patients, staff and the public. To establish a leadership framework to ensure the Trust DoW&OD has the future capacity & capability to deliver high quality care for all Organisational Development To engage staff in the vision and values of the Trust to COO/ ensure that the Trust can move towards and towards an DoW&OD inclusive ownership model where development and innovation is the norm To ensure that the Trust continues to meet the DoF/DoCD requirements set out by Monitor, the regulator for Foundation Trusts To deliver the Trust Corporate Social Responsibility COO / Programme including the carbon reduction programme DoW&OD
D:\Docs\2018-04-05\0b17627649dcbedb6697dc30c16fe82b.doc PAGE: 6 4 Patient Experience
4.1 Introduction
Patient Experience is the fundamental core to all the corporate objectives. The engagement of patients and service users in the shaping the future of the Trust is fundamental to ensuring that the Trust provides high quality services which are measurable and reflect the needs and expectations of patients.
This theme encompasses a wide range of activities designed to improve the ways in which patients experience services:
Improvements to the hospital environment
Cleaning
Privacy & Dignity
Patient & Public Involvement, Engagement & Experience projects
The developing roles of Governors and Members
4.2 Achievements in 2008/2009:
Bristol Haematology & Oncology Centre participation in the McKinsey / Monitor- led Patient Experience project (to be rolled out across Trust in 2009/10 and beyond)
Trust-wide roll-out of the Productive Ward initiative
Establishment of the Membership Council and Sub-Groups; subsequent involvement of Members in a range of initiatives including the development of the Patient Safety Strategy
The Trust has held a number of Patient Experience ‘listening’ events to gather views and inform future service improvement/development
Increased monitoring of environment and equipment cleanliness
Introduction of hydrogen peroxide decontamination system
Upgrade and refurbishment of the Trust viewing room and corridor leading to it.
Implementation of a Trust wide denture policy
Pictorial signage installed across the Trust on bathrooms and toilets
Do Not Disturb Sign audit completed
D:\Docs\2018-04-05\0b17627649dcbedb6697dc30c16fe82b.doc PAGE: 7 Trust wide Privacy and Dignity Day held for all Trust Staff
The Trust has achieved good and excellent ratings during 2008/09 in both the national in patient survey and the emergency care survey
4.3 Plan for 2009/2010:
One of the keys to improving patient experience in 2009/10 is the planned roll-out of the McKinsey Patient Experience model, complementing existing work including the Productive Ward initiative. Alongside this, plans for capturing routine ward and clinic- based patient feedback will be developed and rolled-out during the year, supporting both real-time improvements in the patient experience and Board-level quality reporting.
The Trust will ensure a comprehensive programme is developed in year to support the engagement of patients and service users to influence and underpin future initiatives and changes; this will include engaging and listening to Governors, members and service users, to improve service development.
A comprehensive action plan of enhancements to privacy and dignity is planned for 2009/10. The Trust plans to comply with the new national standards for single-sex accommodation in June 2009.
4.4 Action Plan:
Objective Actions Delivery: Owner To enhance patient The main entrances will be January COO and public areas to enhanced and appropriate 2010 provide a welcoming information immediately available environment, including professional Corridors will be clutter free September COO and monitored by execs on a front of house 2010 services; specifically: monthly basis and via patient and staff comments Minor works will be undertaken October COO in a timely fashion and performance monitored 2010 against an agreed criteria Cleaning will be to a high Continuous COO standard consistent with National Cleaning Standards
D:\Docs\2018-04-05\0b17627649dcbedb6697dc30c16fe82b.doc PAGE: 8 To establish a Embed Governors Quality July 2009 CN&DG coordinated approach Sub-Group with regard to to patient and public future working arrangements. involvement through McKinsey Patient Experience March MD an operational work and roll out of project in 2010 framework, which place with annual review works collaboratively report to Trust Executive with the new Quality / Group Patient Experience Structures and Implement the Trust’s Quality From April MD Governor Sub-groups Strategy 2009
Bring together patient May 2009 CN&DG experience feedback in the form of thematic reporting and ensure fit with proposed quality reporting indicators.
Reconstitute the group First CN&DG formally known as the meeting “Involving People Committee” June 2009 as an operational group to co- ordinate patient and public involvement activities and feedback.
Establish reporting arrangements to and from the group, and address the question of lay representation.
Produce reliable patient April 2010 CN&DG experience metrics to improve ward-based care and inform annual Board Quality Report
The Trust will meet A programme of capital work July 2009 COO/CN&DG the recommendations will be undertaken to provide as laid out in the new physical division in wards to standard for Mixed provide single sex Sex Accommodation accommodation and bathroom (DH 09) and toilet facilities. Where possible and appropriate wards will become designated as single sex.
D:\Docs\2018-04-05\0b17627649dcbedb6697dc30c16fe82b.doc PAGE: 9 D:\Docs\2018-04-05\0b17627649dcbedb6697dc30c16fe82b.doc PAGE: 10 5. Clinical Quality:
5.1 Introduction
Lord Darzi’s Next Stages Review emphasised the requirement for a systematic approach to quality improvement in the National Health Service. Quality is defined in the NHS Constitution clearly establishes the rights and responsibilities of patients and staff. In the Summer of 2009 new legislation will require NHS Trusts (Foundation or otherwise) to produce an Annual Quality Report for 2009/10. The objectives reflect this need to deliver in these three domains over the next year.
5.2 Achievements in 2008/2009:
Participation in the Safer Patients Initiative II and enrolment in the Patient Safety Campaign.
Completion of the pilot for Patient Experience in the Oncology Centre with McKinsey Consulting and Monitor.
5.3 Plan for 2009/2010:
Develop a Quality Report.
Roll out the Patient Safety Campaign through the Trust.
Participate in the National Patient Reported Outcomes Project.
Roll out the Patient Experience Programme.
5.4 Action Plan: Objective Actions Delivery: Owner To produce an Annual Approve and implement Trust June MD Quality Report for the Quality Strategy to deliver a 2010 Trust Quality Report for 2009/10 To improve the patient Revise MRSA reduction action April CN&DG experience and safety plan to produce ongoing plan for 2009 by further reducing the 2009/10 incidence of healthcare Revise Clostridium difficile April CN&DG associated infections, reduction action plan to produce 2009 also meeting national ongoing plan for 2009/10
D:\Docs\2018-04-05\0b17627649dcbedb6697dc30c16fe82b.doc PAGE: 11 and locally agreed Revise Universal infection control April CN&DG targets action plan to produce ongoing 2009 plan for 2009/10
Ensure Divisions implement robust May CN&DG local infection prevention plans in 2009 support of the above (ongoing delivery)
D:\Docs\2018-04-05\0b17627649dcbedb6697dc30c16fe82b.doc PAGE: 12 6. Operational Efficiency
6.1 Introduction
For most aspects of service delivery the performance of the Trust continues to improve year-on-year. However, challenges remain in some areas of services provided to patients, which are essential features of high quality care and positive patient experience. The focus therefore in 2009/2010 will be on ensuring the remaining national targets are achieved, and progress is made on the delivery of local priorities. To ensure the continuity of service delivery, in the event of major incidents and disruptions to supplies that the Trust relies upon, further work will be undertaken on contingency planning. In addition there will be continued focus on improvements in the timeliness and quality of communications with GPs, which are critical for the effective management of patient care within the community.
6.2 Achievements in 2008/2009: The Trust continued to sustain and improve performance against many of the national access standards during 2008/2009. These included the maximum waiting times standards for outpatient appointments, elective admissions, rapid access chest pain clinic appointments and cardiac revascularisation procedures. During the year the Trust also achieved the national 18-week Referral to Treatment Times standards, for both admitted and non-admitted pathways, six months ahead of the December 2008 target. In addition, progress was made in going further with Referral to Treatment Times, by achieving the local target of 13 weeks for over 80% of admitted and 90% of non-admitted pathways at year-end.
Challenges remain around achievement of the 4-hour, cancer and last-minute cancelled operations standards, upon which significant further attention will be focused in the coming year. Following the procurement this year of a system for producing discharge summaries electronically, further work will also be undertaken in 2009/2010, to improve referrer communications and to fulfil our commitment to provide copies of letters to all patients who request them.
6.3 Plan for 2009/2010:
The Trust will meet all standards established and set by the Care Quality Commission and ensure and monitor the clinical safety of service users. It is planned that by year end the Trust will be in a strong position to expect an excellent rating in the quality of service it provides
D:\Docs\2018-04-05\0b17627649dcbedb6697dc30c16fe82b.doc PAGE: 13 6.4 Action Plan:
Objective Actions Delivery: Owner To ensure all nationally Robust action plan continuously Continuous COO agreed performance reviewed and in place to achieve Measured targets are met and 98% of all patients accessing emergency department services quarterly exceeded, achieving an will be seen, treated and ‘Excellent’ rating in discharged or admitted within 4 2009/10, specifically: hours (action plan available) 85% of all category 1 and 2 December COO patients accessing emergency 2009 department services will be treated and discharged within 2 hours (action plan available) Improve patient flow to ensure all March COO patients referred are treated or 2010 discharged within 13 weeks of referral, where appropriate, to meet the local 90% (admitted pathways) and 95% (non-admitted pathway) access standard All cancer patients referred to and June 2009 COO treated by the Trust will meet the national target for both 31 day and 62 targets (standard to be confirmed by the Department of Health) No more than 0.8% of patients will July 2009 COO have their surgery cancelled on the day and a minimum of 95% of Continuous those cancelled will be offered a alternative date within 28 days. 90% of patients to have any March COO diagnostic tests they need within 2010 two weeks of referral. 90% of all GP’s will receive an March COO electronic discharge summary 2010 within 24 hours, with all patients receiving a copy – New IT system to be installed and training rolled out across the Trust To reduce unnecessary Working with the Primary Care March COO attendances to the Trust, Ambulance Trust, Social 2010 Emergency Department Care and other acute local through close working D:\Docs\2018-04-05\0b17627649dcbedb6697dc30c16fe82b.doc PAGE: 14 with the PCT and Social providers agree actions to reduce Services to ensure patients are cared for outside of the acute organisation To reduce length of stay Run a detailed discharge audit to October COO by reducing the number inform action plan 2010 of patients staying longer than 7 days by Increase numbers of consultant 10% and junior doctors into the acute medical model To produce a Revised Major Incident Plan July COO launched and tested through a comprehensive Civil 2010 Contingencies Plan to table top exercise meet national Pandemic Flu Plan approved and June COO requirements, including: understood across the Trust 2010 Biochemical Plan revised and March COO approved 2010 Business continuity plans for all March COO major departments available on the internal web site and in hard 2010 copy Major incident Training plans in March COO place and implemented across the Trust 2010
D:\Docs\2018-04-05\0b17627649dcbedb6697dc30c16fe82b.doc PAGE: 15 7. Teaching and Research (“Academic partnerships”):
7.1 Introduction
The Next Stages Review has reaffirmed the commitment to Teaching and Research. In response to the report the NHS organisations in Bristol and the South West are collaborating to develop an Academic Health Science Centre and Health Innovation and Education Cluster with University partners. This has led to constructive dialogue and better organisation across the city, of the Research Strategy
7.2 Achievements in 2008/2009:
Full implementation of the Comprehensive Local Research Network hosted in the Trust.
Establishment of the National Institute for Health Research Biomedical Research Unit for Cardiovascular Disease between the NHS and Bristol University.
Comprehensive Cancer Research Strategy Day to develop a Bristol-wide Cancer Research Strategy.
7.3 Plan for 2009/2010:
Delivery of a Bristol Health Research Strategy.
Delivery of a Bristol-wide Cancer Strategy.
Further progress to integration of Dental Research between the Trust and the University of Bristol.
7.4 Action Plan: Objective Actions Delivery: Owner To refresh the Work with Bristol partners to Autumn MD/ Director of Research & deliver a co-ordinated Health 2009 Research Development Record Strategy strategy, in line with a core theme for the whole of the Bristol Health Community
D:\Docs\2018-04-05\0b17627649dcbedb6697dc30c16fe82b.doc PAGE: 16 To develop an Agree strategic aims and a July 2009 DoCD innovation and governance framework for enterprise innovation and enterprise framework in the projects to inform investment Trust aligned to key decisions strategic priorities. Create a web-based portal to July 2009 DoCD showcase selected enterprise activities and signpost partners to relevant stakeholders Conduct comprehensive December DoCD survey of existing enterprise 2009 activity To work closely with As chair of the Clinical Continuous COO the University of Research Imaging Centre Bristol to implement Project Board, support and the Clinical monitor delivery of plans Research Imaging Centre project in preparation for opening in 2010 To ensure that Expand and develop the October DoW&OD teaching and existing teaching and learning 2009 learning metrics are metrics to demonstrate return in investment. embedded within the Trust performance framework To develop the Build upon the existing June 2009 DoW&OD Teaching and teaching & learning strategy to Learning Strategy in ensure it reviews the training needs of all staff, developing a line with the training plan that meets the national and national and regional agenda, regional agenda and clinical services strategy and clinical services Develop and build upon July 2009 DoW&OD strategy existing academic partnerships
To review and re- Review and finalise framework May 2009 CN&DG define the Nursing for 2009/10
D:\Docs\2018-04-05\0b17627649dcbedb6697dc30c16fe82b.doc PAGE: 17 and Midwifery Plan for improved access to August CN&DG Research existing resources 2009 Framework and implement 2009/10 Establish more formal and August CN&DG/MD objectives effective relationship with 2009 Academic Partners and in particular the University of the West of England
Re-define Grand Rounds to May 2009 CN&DG share evidence and research practice
To implement year . Implement and monitor April 2009 CN&DG 3 of assistant training contract for new practitioner and permanent 2 and 3 NAs NVQ teaching plan . 100 new registrations in support of Cash for NVQs (2 and 3s) March Releasing . 15 registrations for A1 2010 Efficiency Savings . Continuation of 4 and skill mix plans practice facilitators to Ongoing continue to work across Divisions to support and assess NVQs . Recruit and retain 9 March CN&DG nursing trainee 2009/11 Associate Practitioners to the March 2009 cohort of the Foundation Programme December . Recruit 3-5 Allied 2009 Health Professional trainees to the January December 2010 cohort of the 2009 Foundation Programme . Recruit a further 15-17 nursing trainee Associate Practitioners to the January 2010 cohort (including 2 from Ongoing theatres) . Continuation of Associate Practitioner Facilitator role to recruit and support trainee Associate Practitioners
D:\Docs\2018-04-05\0b17627649dcbedb6697dc30c16fe82b.doc PAGE: 18 . Communication and September CN&DG dissemination 20 09 programme to ensure all wards are aware of training contract and teaching plan . Implement and monitor April 2009 CN&DG training contract for new permanent 2 and 3 Nursing Auxiliaries . 100 new registrations March for NVQs (2 and 3s) 2010 . 15 registrations for A1 . Continuation of 4 Ongoing practice facilitators to continue to work across Divisions to support and assess NVQs
D:\Docs\2018-04-05\0b17627649dcbedb6697dc30c16fe82b.doc PAGE: 19 8. Infrastructure and Facilities:
8.1 Introduction
The Trust has a very diverse building stock and is determined to move towards renewing and regenerating buildings in a timely fashion. This plan outlines improvements both to the services to the Divisions in maintaining the buildings, and a commitment to patients and staff to improve the Trust’s buildings.
The Trust will be investing in its premises and equipment to deliver clinical and environmental benefits, particularly in support of patient privacy and dignity and the control of infection. At the same time, long-term redevelopment schemes continue to bring major improvements in patient and staff facilities, with the clear objective of transferring clinical services out of the Old Building of the Bristol Royal Infirmary.
8.2 Achievements in 2008/2009:
The project to develop a new building for cardiac services achieved a significant milestone, shortly before the end of the financial year, when the Bristol Heart Institute got to Practical Completion. A three month operational commissioning programme follows, which will result in the building opening to patients in May 2009. In addition to the cardiac services, the new building provides a new ward for medical respiratory patients, a much-needed second access and drop-off point for patients and visitors to the BRI and a second cycle centre. The increase in clinical capacity on the precinct permits the start of a programme of ward moves and decants which will finally see the closure of medical wards in the BRI Old Building later in the year.
The Trust is now in partnership with the Carbon Trust and a plan has been developed and signed off by the Trust Boar, to reduce the Carbon Footprint over the next 10 years.
8.3 Plan for 2009/2010:
In 2009/10 investments will be made in improving the patient environment, particularly around protecting the privacy and dignity of patients and removing mixed sex wards.
The Trust will start to move services out of the Bristol Royal Infirmary Old Building when space becomes available in the Queen’s Building and the King Edward Building, as services move into the Bristol Heart Institute.
Business cases will be developed in 2009/10 for the following major schemes:
Redevelopment of the Bristol Royal Infirmary, including plans for an elevated air ambulance landing deck
D:\Docs\2018-04-05\0b17627649dcbedb6697dc30c16fe82b.doc PAGE: 20 Transfer of a range of specialist children’s services from Frenchay Hospital to the Bristol Royal Children’s Hospital
Work will also continue with local health community partners over the planned development of the South Bristol Community Hospital.
8.4 Action Plan: Objective Actions Delivery: Owner To ensure that the To ensure all service June COO existing estate and development is managed within 20090 facilities are fit for an agreed framework purpose and meet the To have a comprehensive October COO needs of existing and capital plan for the location and 2009 developing services relocation of services to meet across the Trust the changing landscape of capital over the next 5 years To continue the programme of Continuous COO updating bathrooms and toilets across the Trust To have a comprehensive June 2009 COO minor capital upgrade programme agreed and implemented To have a minor works and October COO estates facility that is 2009 responsive, timely, efficient and effective. To finalise plans for Implement Phase I of the March COO/DoCD redevelopment of the Bristol Royal Infirmary 2010 Bristol Royal Infirmary redevelopment by re-occupying space released by occupation and the centralisation of the new Bristol Heart of specialist children’s Institute services at the Bristol Royal Hospital for Children. To open the Bristol Bristol Heart Institute Project June 2009 COO Heart Institute and Manager and Team to arrange develop a plan for the move into the Bristol Heart Institute
D:\Docs\2018-04-05\0b17627649dcbedb6697dc30c16fe82b.doc PAGE: 21 relocation of services Service Relocation Committee March COO within the Bristol to manage transfer of services 2010 Royal Infirmary as a into vacated facilities result of the opening of the Bristol Heart Institute
D:\Docs\2018-04-05\0b17627649dcbedb6697dc30c16fe82b.doc PAGE: 22 9. Finance and Information:
9.1 Introduction
The Trust’s financial plan is described in the Resources Book as approved by the Finance Committee and the Trust Board on 31st March 2009. The Trust plans to achieve a break-even position for 2009/10.
The plan relies on achieving efficiency savings and achieving performance targets to avoid fines levied by the PCTs. The maintenance of good financial control and sound financial management are prerequisites. Other objectives include the implementation of Patient Level Costing and Service Line Reporting and the introduction of new core financial systems.
9.2 Achievements in 2008/2009:
The Trust is on target to achieve a surplus of £13 million for 2008/09. This is £2.4 million better than the planned surplus of £10.58 million. A key factor in the better than planned outturn has been the significant improvement in meeting the Service Level Agreement performance targets. Using the latest available information this is likely to result in a net reward payment to the Trust rather than a fine.
A noticeable achievement was the repayment of the Department of Health working capital loan taken out in March 2007. Following the repayment of £12.8 million in 2007/08, the balance of £7.5 million was repaid in March 2009.
The Trust achieved Cash Releasing Efficiency Savings totalling £15.2 million. The delivery of divisional Cash Releasing Efficiency Savings programmes was tracked using monthly financial reviews between the Chief Operating Officer, Director of Finance, Heads of Division, Divisional Managers and Divisional Finance Managers. Monthly reports were also produced for the Finance Committee.
The Trust managed a capital programme of almost £40 million during the year. The highlight of which is the Bristol Heart Institute, which is on schedule to open in the first quarter of 2009/10.
D:\Docs\2018-04-05\0b17627649dcbedb6697dc30c16fe82b.doc PAGE: 23 9.3 Plan for 2009/2010:
The total Cash Releasing Efficiency Savings requirement for 2009/10 is £12.4 million. The approach to delivering this challenging target is as follows:
Ensuring that savings are identified and delivered evenly across the year.
Delivery of savings is tracked on a monthly basis through financial review meetings with Divisions.
Progress made each month is reported to the Trust Board via the Finance Committee.
Corporate support for Cash Releasing Efficiency Savings delivery is established.
The new financial year already poses significant challenges with a revenue budget projecting a break-even position for the year. 2009/10 sees the introduction of HRGv4 (Version 4 of the Healthcare Resource Group tariff system) as the basis of the new tariff. An assessment of the clinical activity provided, shows that this change will have an adverse impact on our income to a value of £4 million. There are a number of service changes taking place which will also affect the Trust’s income and expenditure position e.g. the opening of the Bristol Heart Institute, the transfer of the Somerset oncology service to Taunton, the transfer of the Child & Adolescent Mental Health Service to North Bristol NHS Trust, and the opening of the Independent Sector Treatment Centre at Emersons Green. The financial plan also includes provision for a number of non-recurring costs including fixed asset impairments. A forward look to later years suggests some improvement but this will be subject to change in the light of availability of financial resources to public sector services.
The Trust has set a challenging Cash Releasing Efficiency Savings target of 4% to meet the efficiency gain assumed in the 2009/10 tariff (at 3%) together with further requirements to meet at least part of the tariff change cost (0.5% or £2 million) and other cost pressures, including research and development funding (at 0.5% or £2 million).
A proposed capital programme has been prepared for 2009/10 with an indicative programme for 2010/11 – 2016/17. Discussions will continue with colleagues in Divisions to ensure agreement on high priority schemes for the year.
The capital programme for 2009/10 is partly funded by an injection of cash from the Trust’s cash balances to give a total programme value of £31.8 million.
9.4 Action Plan:
D:\Docs\2018-04-05\0b17627649dcbedb6697dc30c16fe82b.doc PAGE: 24 Objective Actions Delivery: Owner To continue the Implementation of the InView Data April 2009 DoF/MD development of clinical Warehouse product to replace the information systems to Patient Activity Database. enhance the delivery of Upgrade the Electronic Data April- patient care and Systems Patient Administration October improve service System to a modern cache 2009 efficiency, aligned to platform. Will bring both improved the National performance and functionality. Programme for Information Technology Order Communications April 09- implementation to commence mid March April. 2010
Service Line Reporting project Ongoing plan has been agreed and is moving forward
To continue to develop Introduction of Service Line Rollout to DoF and improve financial Reporting Phase 1, patient level commenc management systems costing e Oct 09 Introduction of new Core Financial November DoF Systems 2009 Demonstrable open procurement April 2009 DoF process for systems described above To fully realise the To deliver the financial plan for March DoF /COO agreed Cash Releasing 2009/10 2010 Efficiency Savings Cash Releasing Efficiency March DoF / plans for 2009/10 Savings Management Committee 2010 Executive to provide support to divisions to Officers delivery plans, identify actions to reduce risk against plan and to determine corporate plans Indentify and deliver 50% of Septembe DoF savings within the first six months. r 09 Any expected under-achievement March DoF of savings plans offset by other 2010 measures taken in year.
D:\Docs\2018-04-05\0b17627649dcbedb6697dc30c16fe82b.doc PAGE: 25 10. Workforce:
10.1 Introduction
This section describes objectives to ensure the Trust has a workforce that is responsive to the needs of patients and reflects the population served by the Trust. In addition, the Trust shall ensure that all staff are aware of their responsibilities in terms of health, safety and well being during employment.
10.2 Achievements in 2008/2009:
During 2008/09 the Trust focussed on ensuring front line administrative staff were trained in customer services to improve the patient experience. Significant progress was also made in developing and implementing the Skills Pledge 2010 for National Vocational Qualifications and Skills for Life for all staff.
The development of the Trust’s intranet was supported with the launch of the ‘Staff Map’, providing access to information for staff on all aspects of their employment with the Trust.
The Trust also implemented a comprehensive people-management training programme, designed to equip line managers with key people-management skills, and to keep them up to date with current practise and employment legalisation.
10.3 Plan for 2009/2010:
Focussing on recruiting and retaining a high calibre workforce to deliver a high quality patient experience, is a key priority. Workforce plans must be robust to support service development and a proactive approach to recruiting and retaining staff.
D:\Docs\2018-04-05\0b17627649dcbedb6697dc30c16fe82b.doc PAGE: 26 10.4 Action Plan: Objective Actions Delivery: Owner To continue to attract Scope out all operational April 2009 DoW&OD and retain high calibre Human Resources processes staff with a view to ensure efficiency and provision of high quality of (implemented services, supporting an : January improved patient experience. 2010) Recruit internal Project Manager to scope project, test and implement, enabling the Electronic Staff Records system to be used to its full functionality Develop a robust and proactive July 2009 DoW&OD recruitment plan for all staff groups to support operational delivery and patient safety. Ensuring that the plan aligns with workforce planning and teaching and learning. Ensure the Trust is maximising October 2009 DoW&OD the use of national and local terms and conditions by developing appropriate reward and retention strategies to support the Trust’s mission. To develop and implement a December COO bespoke training course for 2009 portering staff to enhance their image and create a front of house example of good practice To ensure robust Ensure robust divisional April 2009 DoW&OD workforce planning workforce and training plans to with all business and support all business cases as part of the annual planning service plans to have round workforce implications Align the workforce plans to July 2009 DoW&OD fully integrated. Carry shape the recruitment and out a risk assessment development plan and identify to identify any shortfalls in roles, working with potential workforce key stakeholders to address capacity and appropriate strategies to close the gaps. capability issues.
D:\Docs\2018-04-05\0b17627649dcbedb6697dc30c16fe82b.doc PAGE: 27 To develop a method Ensure Equality Impact April 2009 DoW&OD of embedding Equality Assessment is completed with and Diversity into all clear measured impacts for all changes & developments aspects of Trust Procure Cultural Awareness December DoW&OD business training for all new staff, roll out 2009 on line training for existing staff. Ensure all board members April 2009 DoW&OD aware of their equality and diversity responsibilities and this is reflective in behaviours and processes. Continue to develop and work Continous DoW&OD with the local community and service users on the Trust’s Single Equality scheme, working to enhance opportunities and services for all members of our diverse community. To review the Produce a detailed action plan July 2009 DoW&OD Occupational and and implement. Health and Safety standards to assure compliance, and the safety of staff and patients provides high quality services. To ensure compliance Project steering group to work July 2009 DoW&OD with European with and support divisions on Working Time local action plans to overcome gaps to achieve compliance Directive by August and within financial envelope. 2009 July 2009.
To develop specific Receive Audit Commission May 2009 CN&DG skill-mix change plans Report and develop action plan by ward and in response department using the All wards and departments to End CN&DG Audit Commission, review current skill mix and December Association of United define strategic plan for skill 2009 Kingdom University mix changes Hospitals and internal data Integrate Paediatric September CN&DG dependency and acuity system 2009
D:\Docs\2018-04-05\0b17627649dcbedb6697dc30c16fe82b.doc PAGE: 28 Embed Association Of United December CN&DG Kingdom University Hospitals 2009 acuity system
To define a Confirm workforce predictions April 2009 CN&DG Recruitment and for 09/10, including Bristol Retention Plan for Heart Institute opening, Nursing and Midwifery progress towards South Bristol Community Hospital
Scope the next 3 years June2009 CN&DG workforce predictions including Bristol Royal Infirmary redevelopment project and 2013 plans
Work with education September CN&DG commissioners and providers 2009 to develop sustainable Associate Practitioner workforce
Work with Human Resources April 2009 CN&DG and Jobs @ to define the Recruitment and Retention plan, including: delivery on recruitment microsite, continuing to plan staff nurse band 5 and Nurse Assistant recruitment, to include open days and external recruitment events.
Formally assess the Midwifery June 2009 CN&DG requirement and approach needed
D:\Docs\2018-04-05\0b17627649dcbedb6697dc30c16fe82b.doc PAGE: 29 11. Organisational Development:
11.1 Introduction
This section describes the Trust’s ambitions to build on the achievement of Foundation Trust status by further developing the Trust’s reputation, increasing leadership capability throughout the organisation, delivering corporate social responsibility programme and engaging staff and other stakeholders to help drive forward positive change.
11.2 Achievements in 2008/2009:
The Trust was authorised as a Foundation Trust in June 2008, following a rigorous assessment by the independent regulator, Monitor, to ensure that the Trust is legally constituted, well governed and financially viable. (Foundation Trusts are a new form of public benefit corporation which are firmly part of the National Health Service but have greater freedom to invest in service development, greater accountability to local people, patients and staff and greater autonomy to take local decisions).
During 2008/09 the Trust increased its patient and public membership to over 10,500 members and maintained its staff membership at over 99%. During 2009/10 there are plans to continue to grow patient and public membership especially focussing on young members and those from under-represented communities.
In 2008/09 the Trust focussed on two key areas of membership:
Engaging members in a range of health related issues including patient experience listening events and a special young members’ event which will lead to the setting up of a Youth Council in 2009/10.
Setting up the new governing body, the Membership Council, and inducting and developing 38 governors and providing support in several of the statutory and strategic aspects of the Governors’ role including appointing new Non- Executive Directors and contributing to divisional clinical strategies. This is to be further developed in 2009/10.
In 2008 the Trust was extremely proud to win the South West C+ Carbon Positive Award and it has also taken significant steps to manage and reduce its carbon footprint and achieve energy savings.
In order to reduce the stress associated with cancer treatment the Bristol Haematology and Oncology Centre piloted community clinics at Whitchurch Health Centre for 3 days per week. This has increased the convenience for patients to receive treatment locally and allows more appointments to be available within the Oncology Centre to meet the increase in demand for this service.
D:\Docs\2018-04-05\0b17627649dcbedb6697dc30c16fe82b.doc PAGE: 30 Demonstrable progress was made last year in improving the level of positive media coverage of the Trust and its services. A new intranet site for staff, known as “Connect”, was launched and its success will be evaluated this year. A research exercise was undertaken to understand from staff how effective internal communications are and where improvements can be made in the future.
11.3 Plan for 2009/2010:
Communications activities will be further developed, supporting the delivery of excellent patient care through high quality, consistent communications which help patients to understand the benefits of choosing to come to the Trust and engaging and involving stakeholders in our strategic development.
In line with the planned service transformation programme, a review of the vision and values of the organisation will be undertaken so staff and the public are clear about the Trust’s identity and purpose.
In line with the Darzi Next Stage Review of the NHS the Trust will be establishing a leadership framework to ensure that the Trust has the future capacity and capability of managers and leaders to deliver high quality care for all patients.
The Corporate Social Responsibility programme for 2009/10 will build on the success of Trust’s three year programme, and in particular support the five year programme to reduce carbon emissions.
D:\Docs\2018-04-05\0b17627649dcbedb6697dc30c16fe82b.doc PAGE: 31 11.4 Action Plan:
Objective Actions Delivery: Owner To improve the profile Produce a comprehensive April 2009 DoCD and enhance the communications plan, including reputation of the Trust, commitments to: regionally and increasing positive media nationally, by coverage increasing the amount further development of electronic of positive media communications tools for staff, coverage and patients and the public minimising the impact wider stakeholder of negative media communications and more coverage by ensuring proactive engagement with charitable partners fairness, accuracy and improved two-way balance, and by communications with staff building a supportive routine monitoring of the stakeholder base. success of the plan throughout the year To develop a strong Develop a staff engagement July 2009. DoW&OD vision, brand and framework and a meaningful action identity for the Trust plan to respond to the staff survey, ensuring that recommendations of that identifies why it the Black report, the outcome of should be the provider patient complaints and the patient of choice for PCTs, survey are all considered GPs, patients, staff and Undertake research with staff, December DoCD/. the public. patients, the public and other key 2009. DoW&OD stakeholders about the the vision and values of the Trust and refine these as necessary To establish a Development of a transparent December DoW&OD leadership framework succession planning mechanism to 2009 to ensure the Trust has identify future talent. the future capacity and Mapping of the subsequent March DoW&OD development needs and production capability to deliver 2010 of a delivery framework. high quality care for all. Establish a Talent Management March DoW&OD Centre to support delivery of the 2010 leadership framework. Identify existing spend on December DoW&OD Continuing Professional 2009 Development in order to support the establishment of a leadership framework Trust Engagement Events Continuous COO
D:\Docs\2018-04-05\0b17627649dcbedb6697dc30c16fe82b.doc PAGE: 32 To engage staff in the Ensure that staff feel involved and July 2009. DoW&OD vision and values of the engaged in all aspects of their Trust to ensure that the working lives – by developing an engagement framework and a Trust can move meaningful action plan to respond towards and towards to the staff survey, ensuring that an inclusive ownership recommendations of the Black model where report, the outcome of patient development and complaints and the patient survey innovation is the norm are all considered Following the outcome of the December DoW&OD involvement and engagement 2009. exercise, develop values that are reflective of the Trust’s mission and demonstrate a behavioural change that you can see and feel in the organisation and is evidenced within the patient experience. To ensure that staff at University Continuous DoCD Hospitals Bristol NHS Foundation Trust understand the objectives and vision of the Trust and their role within it to deliver excellent patient care and outcomes, by engaging staff and developing a culture of open, two-way communication. To ensure that the To develop the Monitor Annual Plan May 2009 DoF/ Trust continues to meet for the period 2009/10 – 2011/12 DoCD the requirements set To ensure that the Board is Continuous COO/ out by Monitor, the provided with the information they CN&DG regulator for require to make robust declarations Foundation Trusts on performance to Monitor as required To deliver the Trust To tackle the effect that the March COO Corporate Social activities of the Trust has on 2014 Responsibility Climate Change by means of a five Programme including year programme to reduce delivery of the carbon unnecessary or excessive sources reduction programme of carbon emissions and to develop a programme of improvement.
D:\Docs\2018-04-05\0b17627649dcbedb6697dc30c16fe82b.doc PAGE: 33 12. CONCLUSION:
The Trust has set out an ambitious plan to ensure the delivery of all its statutory responsibilities. As the economic climate becomes ever more challenging the organisation will need to continue to embrace new and innovative ways of working to ensure that service quality continues to improve. This plan will be monitored through updates submitted to the Governors Council and the Board on a quarterly basis.
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