GATESHEAD HEALTH NHS FOUNDATION TRUST
GATESHEAD HEALTH NHS FOUNDATION TRUST OPERATIONAL PLAN 2016/17
FOR PUBLICATION
1 Contents
Page
1. Background 3
2. Planning approach 4
3. Approach to activity planning 5
4. Approach to quality planning 7
5. Approach to workforce planning 13
6. Approach to financial planning 17
7. Link to the emerging ‘Sustainability and Transformation Plan’ (STP) 23
8. Membership 28
9. Appendices (1-5) 30-40
2 OPERATIONAL PLAN 2016/17
1 Background
Gateshead Health NHS Foundation Trust is a small sized DGH with revenue of just over £200m p.a. The Trust serves a local resident population of approximately 200,000 and other people in surrounding areas, who choose to access its services. The population is concentrated in Central and Eastern Gateshead with widely dispersed population to the West. Significantly wider populations are served for specialist screening services and Gynaecology-oncology services. These include South of Tyne, Northumberland, Humberside, Cumbria and Lancashire.
Trust services are provided principally from the Queen Elizabeth Hospital, although it is working towards increasing the proportion of care delivered in a community setting and delivered in close cooperation with others in the health and social care system. A significant step towards this strategy is the Trust’s recent success in securing the provision of Community services, commencing [1 October 2016 with mobilisation work in the period 1 April-30 September 2016].
The Trust delivered a deficit of c. £3.4m in 2014/15 and an unaudited accounts deficit of c. £7.29m in line with the reforecast plan for 2015/16. At month 9 2015/16, the Trust reported a green GRR and a 2 CoSRR to Monitor.
1.1Demography
There has been no significant change in the underlying assumptions on the local demography included in our 2014/15-18/19 Strategic Plan. An overall population increase of 5.6% to 211,500 is anticipated by 2037 and the proportion of people from black or minority ethnic groups remains relatively low at 3.7 %, although this has increased by a third since 2001.
3 2 Planning approach
2.1The basis of the 2016/17 plan
Our 2016/17 plan is the result of bringing together a range of service line specific thinking, national mandates and robust dialogue with our health economy partners
2.2Strategic review undertaken in 2015/16
This operational plan is fully aligned to our strategy and underpinned by a range of detailed analysis to ensure the Trust focusses on the most appropriate operational priorities in 2016/17.
The Trust’s strategic priorities are outlined below and remain relevant in addressing the challenges the Trust faces in the short and medium term:
1. To provide high quality, sustainable clinical services to our local population in new and innovative ways
2. To develop new effective partnerships with organisations in health and social care to offer high quality, seamless care
3. To optimise opportunities to extend our business reach in the delivery of high quality clinical care
4. To deliver the proposed portfolio of services and quality of care within the agreed financial envelope
The work to develop this Operational Plan has confirmed that the Trust faces a range of short term operational issues, which will be addressed through the actions outlined in this plan.
4 3 Approach to activity planning
The Trust recognises the importance of aligning demand and capacity in order to safeguard delivery of its operations and secure longer term sustainability. The commentary on demand trends below are supported by charts which can be found in Appendix 1.
The pattern of A&E attendances at the Trust tracks marginally below previous year, driven in part by a greater volume of minor activity flowing to the Trust’s Blaydon Walk in Centre. The overall trend of non-elective admissions is upwards. The pattern across the past 2 years appears to demonstrate:
Admissions from A&E have broadly tracked above prior year for the majority for Q1 to Q3 Marked increase in admissions in the 65yrs+ category, less so in the 85+ category Although lower volumes, admissions from other sources show a sustained increase
Our projections for demand in 2016/17 take these non-elective trends into account, including:
A marginal but consistent increase in acuity reflecting in large part our elderly demographic but also lifestyle factors; Increasing number of appropriate patients managed through ambulatory care; Some displacement of minor activity to the Trust’s Blaydon Walk in Centre;
Our detailed service line review programme, undertaken in 2015/16 has highlighted operational pressures across some services linked in part to capacity issues and in part to non- elective surge.
The Trust is responding throughout 2015/16 by producing a demand and capacity model based on a comprehensive review of the demand that will be placed on its services and the required capacity to deliver its services to key operational and quality standards.
3.1 Understanding demand
Review of activity trends (including seasonality) and expected future demographic changes; Discussions with commissioners (based on the application of Monitor’s Demand Guidance and associated Toolkit) to align medium term assumptions over growth (including acuity changes and non-demographic growth) and demand management assumptions; Bottom up activity projections for each service (prepared with the assistance of Ward to Board Consulting Ltd): Conversions of activity into forecast beddays, day case sessions, outpatient appointments and theatre sessions based on assumptions on conversion rates (including overlay of required escalation / surge demand to flex for seasonality and peak demand periods);
5 Translation of primary activity assumptions into “secondary” demand assumptions including diagnostic tests and rehabilitation / step down capacity using conversion rates based on previous experience.
There remain a number of risks relating to demand. Key amongst these is the potential impact of reductions in Local Authority budgets. The Trust expects this to impact primarily in terms of higher elderly care admissions and increased difficulty in discharging. The Trust is engaged in discussions through the HWB and direct discussions between senior officers of affected organisations to better understand this risk and the joint actions required by system leadership. The local CCG is leading discussions with the Council to identify potential solutions.
3.2 Aligning capacity
The Trust is in the process of completing a bottom up analysis of the required capacity for each service (physical, staffing, beds) based on: Identifing current capacity deficits: current service performance, identifying where underperformance is driven by lack of capacity, scale and nature of capacity required; Analysis of future capacity requirements: conversion of beddays, day cases sessions, outpatient appointments and theatre sessions into: o Beds: by converting beddays based on length of stay assumptions o Physical estate: converting beds into estimates of number of wards . The Trust continues to invest in its facilities and equipment to ensure a safe, high quality environment for patients, visitors and staff. . Given the financialcontext, the available funding is mainly limited to retained depreciation which is being expended on infrastructure, including IT, medical equipment replacement and buildings and engineering backlog maintenance aligned to the strategic direction of the Trust and to support cash releasing revenue opportunities. . Trust is currently implementing a program to improve theatre productivity o Nursing / midwives: . Nurse/bed ratios, accepted midwifery levels and acuity modellers . Overlay from nursing and medical director to flex raw assumptions based on professional judgement of acuity o Medical staff: Assessment of national standards of consultant cover and review of required PAs as well as assumptions over time spent per procedure.
This work has highlighted a number of issues where further work is needed to better align demand and capacity and also the types of solutions around settings, workforce and collaboration which might be required in 2016/17 and beyond.
Next steps: The findings of this demand and capacity work are being used to:
6 o Engage with commissioners to secure funding for additional capacity; o Scenario plan to test assumptions, particularly demand management; o Define areas of focus for the key areas of the transformation programme, including length of stay, DNA rates and theatre productivity; and Drive targetted recruitment plans
3.3 Plans to achieve national targets
The Trust has assessed that its activity plans are sufficient to deliver, or achieve recovery milestones for all key operational standards, in particular (A&E), Referral to Treatment (RTT) Incomplete, Cancer and Diagnostics waiting times and include: o extra capacity as part of winter resilience plans (escalation beds) o arrangements for managing unplanned changes in demand. o Improved service delivery models
The key target risks the Trust is facing are:
4 hour A&E wait (the Trust has not met the target for two quarters in the past 12 months (3 in last 13 months)
The trajectory for achieving the A&E target as included in Appendix 2 has been discussed and agreed with our commissioners. They have confirmed that the trajectory meets the relevant guidance in terms of STP funding requirements.
Details of the key actions for performance risks and trajectories for compliance are provided in Appendix 2.
4 Approach to quality planning 4.1 Organisation-wide improvement methodology, including how quality and safety will be maintained and improved through the year
Quality is the organising principle underpinning the Trust approach to improvement. Our improvement approach is underpinned by a strong safety culture, through the delivery of the SafeCare Strategy.
Methodology utilised within the Trust involves use of LEAN principles to eliminate waste whilst improving the patient experience, National model for improvement incorporating PDSA cycles, Practice development and Safety Science.
The quality and safety improvement plan is set out each year as a series of quality priorities / objectives within the Trusts Quality Account.
4.2 Quality improvement governance systems
7 The Trust has a Quality Governance committee which is a board committee with overall responsibility for assuring the board on patient quality, risk and safety.
In 2007 the Trust adopted the term ‘SafeCare ‘ to describe its clinical governance programme. SafeCare is designed to reduce harm and improve patient safety and quality of patient care. There is a robust quality governance framwork through the Safecare annual plans, led and delivered by the business units against the six domains of:
Effective culture and inspirational leadership; Effective, efficient and innovative teams Safe and reliable care Right care; right place; right time Positive patient experience Safe environment and appropriate equipment and supplies.
This is further supported through the risk management approach . The key principles for risk management and improvement within the Trust focus on : Reporting and investigating incidents
Managing risk registers from ward to board
Being open (duty of candour)
Learning lessons when things things go wrong
The delivery of the nursing midwifery strategy is underpinned by a care quality assurance framework across the four domains of Patient experience, Patient safety, Clinical practice and Workforce.
The Trust was inspected by the Care Quality Commission in September 2015 which assessed services against the five domains of: safe; caring; effective; responsive and well–led. The report has now been received and the Trust rated as ‘Good’ with ‘Outstanding’ areas’ including maternity and overall care. There were no material concerns.
4.3 Named executive lead for quality improvement
Our quality improvement Senior Responsible Officer is Hilary Lloyd, Director of Nursing and Midwifery
4.4 Three quality priorities for 2016/17 are:
4.4.1. Delivery of clinically effective and safe patient care 4.4.2. Delivering excellence in patient care through workforce capacity and capability; and 4.4.3. Strengthen risk management approach within quality governance
8 The Trust is assured that these are the key priorities which were determined through consultation with staff through established forums and meetings, Governor engagement, review of internal and external data sources and intelligence and discussions with key stakeholders (including Commissioners, Carer and Patient groups). The milestones for delivery of these priorities are included in Appendix 3.
4.5 Top three risks to quality, together with key mitigations
Area Risk Mitigating Action Impact of Potential negative impact Managed through Trust recovery board and PMO Efficiency on the quality of services function. Impact assessment and Director of programme on being delivered Nursing and Midwifery and Medical Director sign service quality off. Ongoing dialogue with commissioners. Operational Potential negative impact Comprehensive and rigorous non-elective resilience on capacity and capability improvement programmes in place to manage to deliver high quality effective discharge and patient flow; robust services, arising from in- capacity and demand analysis of all services year activity surges and supported by pro-active workforce planning. winter pressures Active cross-system locally and regionally through the Local System Resilience Group and regional Surge group.
The Trust will hold a winter review session and lessons learned are factored into future winter planning to build in resilience and manage risk. Workforce Potential difficulty in Detailed workforce plans being developed at -recruitment recruiting and retaining a service line level, incorporated into business plans competent and skilled and internal business cases. Trust corporate workforce due to national People Strategy-in development-is going to Trust workforce shortages Board May 2016. issues for nursing and medical staff. These risks align to those reported through the Trust’s Board Assurance Framework (BAF).
4.6 Focus on the well-led elements
The Trust commissioned an external review against Monitor’s Well-Led Governance Framework in 2015/16. Work will continue to implement the recommendations and this is reflected in our quality priorities for the year (section 4.4). In addition the Trust has undertaken a review of its committee structures to ensure that the board is sighted on the most important quality issues across the organisation. Assurance is further underpinned by:
9 • Targetted analysis in specific areas to propose significant and sustainable improvement, share learning and build on best practice; • Use of ward to board quality metrics and dashboards: including monitoring patient experience, harm free care and other quality outcomes on a weekly / monthly basis.
4.7 ‘Sign up to safety’ priorities for 2016/17
The Trust fully signed up to the Sign up to Safety Campaign in August of 2014 and continues to develop a safety programme of events annually to include the priorities for patient safety based on our intelligence each year (incident data, Safety thermometer, clinical audit). Our local priorities for Quality moving forward include, continuous improvement of recognition, screening and appropriate management of sepsis, patient falls and mortality In line with national priorities and good practice We actively participate in patient safety projects including thinkSAFE and share and spread learning and developments where appropriate. We plan to continue to roll out thinkSafe in 2016/17 and utilise the learning in relation to patient safety.
4.8 Assurance that the Association of Medical Royal Colleges’ guidance on the Responsible Consultant has been adopted
The Academy of Medical Royal Colleges published guidance in June 2014 in support of the recommendation, entitled ‘Taking Responsibility: Accountable Clinicians and Informed Patients’. The guidance focuses on two key elements which Trusts must deliver:
a patient’s entire stay in hospital should be co-ordinated and caring, effective and efficient with an individual named clinician – the responsible consultant/clinician – taking overall responsibility for their care while retaining the principles of multi- disciplinary team working
ensuring that every patient knows who the responsible consultant/clinician with this overall responsibility for their care is, and also who is directly available to provide information about their care – the named nurse.
The Trust has fully taken this guidance on board and was instituted on each ward in 2014/15.
4.9 Seven Day Services
The Trust is an early adopter and is actively seeking to deliver 7 day working across key services. In April 2015, five Priority standards (“Keogh standards”) were identified as being those likely to have most impact on reducing variation in mortality for patients admitted on weekdays and weekends. Following the August 2015 national review of progress and priorities the Trust has agreed that it will concentrate on:
10 1. Time to consultant review (standard 2)
2. Access to diagnostics (standard 5)
3. Access to consultant-directed interventions (standard 6)
4. On-going review (standard 8)
In August 2015 the Trust self-assessed against these standards and has established a clinically led working group to progress the delivery of the standards.
For the Trust this means that by the close of March 2017 we aim for 25% of our population to have access to acute hospital services that comply with four priority clinical standards on every day of the week and 20% of the population will have enhanced access to primary care. A number of service specific development / opportunities have already been identified towards achieving 7 day services and are included as Appendix 4.
4.10 Quality impact assessment process
Approach to CIP identification: In 2015, the Trust introduced a revised approach to Quality Impact Assessment (QIA) in line with national guidance and best practice. This approach meets national requirements to ensure that: The majority of CIPs represent changes to current processes, rather than top slicing Where possible CIPs have a neutral or positive impact on quality. CIPS do not bring quality below essential common standards. CIPs are categorised by their potential impact on quality. QIAs cover safety, clinical outcomes and patient experience. There is Board Assurance that CIPs have been assessed for quality during their development, implementation and following implementation. There is a mechanism for capturing front line staff concerns.
The Trust identifies ideas for CIPs through three key approaches: 1. Top down: Corporate review of efficiency and benchmarking; 2. Bottom up: Service line ideas to increase productivity; 3. Transformation: Transformational review of pathways improvement opportunities.
Assessing CIPs: The following criteria are used to assess proposed CIP schemes: • They will support the strategic objectives of the Trust; • They will not be to the detriment of Clinical Quality; more likely they enhance care; • They will not stifle innovation. More likely they will support our clinical teams in pushing The boundaries of excellent productive clinical care; • They will take into account key risks highlighted through the corporate risk register.
11 QIA process, including sign-off by the medical and nursing directors and plan for in-year monitoring of QIA: The QIA Group (the Star Chamber) is accountable and responsible for the formal consideration of each QIA. The Medical Director and Director of Nursing lead the Star Chamber and decision making process. This procedure applies to all proposals to significantly change services at the Trust. It includes the CIP programme plus all Business Cases (i.e. clinical investment/disinvestment plans and IM&T). It aligns quality and safety with business and financial planning and the role of the PMO which reports into the Trust’s weekly Recovery Board.
4.11 Triangulation of indicators 4.11.1 Its approach to triangulation
The Trust has an Integrated Dashboard in place which brings together indicators for workforce, activity and finance triangulated into a single report.
The Trust has a number of forums where workforce, finance and activity indicators and data are discussed and triangulated, including weekly Corporate Management Team and monthly Clinical Policy Group (CPG). In addition, using the integrated dashboard, Business Unit leads present to the executive team on a quarterly basis describing in year performance against plans for quality, access and financial performance including proposed efficiency schemes and assurance regarding their impact on quality.
The weekly Recovery Board meetings chaired by the Chief Executive are also used to review the effectiveness of efficiency schemes and to seek assurance from the managers responsible regarding their impact on quality.
The Board receives reports directly that support triangulation of indicators and also from its committees where points raised by the board can be explored in greater detail.
The triangulation indicators within the 2016/17 Operating Plan workbook have been completed and show no red flags.
4.11.2 Key indicators used in the process
The Trust has fully embedded the use of indicators within its risk monitoring processes. Key indicators used include activity volume, acuity levels, turnover, key financial metrics, sickness, vacancies, headcount/WTEs, nursing ratios, mandatory training, appraisal completion rates and equality & diversity monitoring including workforce age profiling.
No material issues have been identified when reviewing these indicators. The Trust does also rely on excellent communication channels from wards upwards and invests a significant
12 amount of time into ward and site visits to ensure it can triangulate indicators with feedback and local intelligence.
4.11.3 How the Board intends to use this information to improve quality and enhance productivity
In 2015-16 the Board underwent a routine review of its governance arrangements. Following the advice from this, a number of changes are being implemented to the committee structure and the reports they receive and consider. In addition to reviewing issues and data related to the business of the committee, greater use will be made of the board assurance framework (BAF) and Trust risk register to ensure that areas of identified risk are escalated to the Board for effective and timely consideration.
In parallel the executive members of the committees will ensure issues arising from committee discussions are addressed via the appropriate executive forum and reported back.
The Trust’s audit programme is also used to explore opportunities for improvement with learning picked up and progressed following an annual work plan.
The measures described above are used to support the delivery of the Trust’s ongoing drive for clinical and service excellence. Through its emerging performance contract between the Chief Executive and each clinical business unit, measures will be agreed designed to ensure quality and productivity are aligned and improved.
5 Approach to workforce planning
The Trust recognises the critical importance of the alignment of workforce planning to its service line strategies and associated capacity and demand planning.
The Trust’s approach to its workforce strategy and associated workforce plans reflects a need to recognise issues at a more granular service level and attach relevant milestones to drive and track actions. Lessons learnt from previous winters continue to inform our approach.
The Trust’s approach to workforce planning for 16/17 focuses primarily on:
1. Baseline of existing workforce issues by service and how these are expected to develop.
2. Understanding in detail the Trust’s core capacity and how this core capacity fits with current and projected demand for our services. We have relied on Monitor’s demand forecasting guidance and toolkit to support this work.
3. The credible range of actions which the Trust could rely on to manage the gap between demand and capacity.
13 4. The Trust’s ability to introduce, at short notice flex capacity to manage unplanned demand including Winter Planning.
In addition to these actions, the Trust is undertaking a detailed job planning exercise at individual and clinical team level. This work has identified the opportunity to achieve greater productivity through increased direct clinical care capacity.
5.1 Governance: The arrangements outlined below reflect a common approach employed by most providers. Our experience of workforce issues in the past year has reinforced the need for workforce plans to be developed and stress tested through meaningful clinical engagement, driven by information, evidence and best practice. For 16/17 the process is outlined below:
Trust Board agree workforce plan
Monitored HR Committee monthly through validate and B2Bs with service provide assurance line management to Board re where clinicians deliverability and and management QIAs are in attendance
Local professional Monthly HR education and Operational forum training forum to consider including HENE test workforce issues alignment and and risks support implementation
Identifying risk – key indicators
The Trust relies on a range of workforce indicators to identify risk, including turnover, sickness/vacancies, headcount/WTEs and performance against professional standards. More specifically:
For Nursing and Midwifery, the Trust undertakes an annual review of nursing & midwifery capacity and capability which reports to the Trust Board on staffing levels and skill mix, comparing established versus actual staffing.
Monthly Board nurse staffing exception report detailing the number of actual nursing & midwifery staff on duty during the previous month, compared to the planned staffing level, the reasons for any gaps and the actions being taken to address these.
Daily reporting of actual staff on duty on a shift to shift basis compared to planned staffing via the ‘e-tool’, with discussion at bed meetings (three times per day), plus displayed on the ward ‘time to care’ boards alongside key quality and outcome metrics i.e. safety thermometer; infection measures.
14 The Trust’s Care Quality Accreditation Framework provides a quality marker for wards. Nurse staffing and good roster management is a key quality measure for successful accreditation. Nurse staffing related incident reports are presented to the Director of Nursing, Midwifery and Quality on a regular basis.
General Workforce: A quarterly workforce performance information report is considered by the Trust Board, highlighting the following KPIs: - Turnover - Sickness absence rate - Mandatory training and appraisal completion rates - Equality & Diversity monitoring including workforce age profiling. The workforce indicators above are reviewed as part of the regular B2B performance reviews between the corporate directors and the Business Units / service lines.
Pay expenditure is reviewed monthly at Trust, business unit and service line level. Agency spends and compliance with national controls is reported weekly and monthly with the purpose of actively managing the pay bill, securing substantive roles and containing bank usage.
5.2 Risks and opportunities
2016/17 and beyond will see a number of growing workforce challenges and opportunities, driven by both the national and local agenda for quality, transformation and efficiency, including:
1. Embedding “Seven Day Working” and specifically the delivery of the four key standards within the context of financial constraints.
2. Capability and capacity of staff to work across providers and settings to develop appropriate patient centred care and integrated care pathways to ensure those with greatest risk of admission to hospital are cared for and supported appropriately, both closer to home, when possible, and also effectively when admitted to hospital.
3. Recruitment challenges (driven by retirement, service change and ‘hard to fill’ posts).
4. Mobilisation and transformation of community services following the Trust’s successful tender for the community service contract.
5. The implementation of the Five Year Forward View locally, in particular through the introduction of Sustainability and Transformation Planning (STP).
5.3 Priorities for 2016/17 include:
Operational resilience and sustainability informed by capacity and demand analysis will ensure staffing levels in patient areas are safe and in line with national guidelines and our standards for high quality care. Moreover, specific workforce priorities for 2016/17 are:
15 Recruitment and Retention including development of People Strategy
Integration of Community Services
Seven Day working (early adopter actions)
Productivity and efficiency
5.3.1. Recruitment and Retention
5.3.1.1 Nurse Workforce: the Trust utilises published guidance from the National Quality Board (NQB) and NICE to ensure its nurse staffing levels are safe and efficient.
Recruitment and succession planning for midwives will be a workforce priority in 2016/17 and to support the extended role of some of the midwives, who perform the primary examination of the new-born, instead of the paediatrician, improving the flow on the ward by facilitating prompt and effective discharge planning, contributing to efficiency. Specialist midwifery roles have also been developed including midwife sonographer roles, public health, clinical risk and safeguard roles. Midwives will increasingly be rotational so that they can work both in the community and hospital settings, therefore strong clinical mentorship and supervision in practice will be essential.
The Trust has successfully recruited over 100 registered nurses over the past 12 months and will continue to use its current recruitment approaches throughout 2016/17. Current vacancy factor is 4.3%.
Nursing workforce productivity will remain a priority, utilising the Trust’s e-rostering system to maximise the deployment of both unregistered and registered staff, whilst ensuring effective and appropriate use of the internal bank to cover staff shortages. The use of agency nursing staff will remain the exception, with use restricted to activity peak & performance targets as experienced during 2015/16 winter, with clear protocols in place to support this.
The Trust will continue to work with partners including Health Education England North East (HEENE) to forecast and commission future nursing workforce to secure staff in line with our workforce requirements. The Trust’s Director of Nursing & Midwifery chairs the HEENE nursing workforce group identifying demand for education and training commissions through HEENE. The Trust is involved in HEENE’S community nursing taskforce and is delivering opportunities as part of the Talent for Care programme to support the development of the future nursing workforce. Development of new roles and working practices in both the short and medium terms will continue with activity focusing on the further development of nurse led clinics, nurse practitioner and advanced practitioner roles in the emergency department, paediatrics and neonates and speciality nurses for complex elderly/frail care, reflecting increasing frail elderly with multiple comorbidity.
16 5.3.1.2 Medical Workforce: Demand will remain stable over the period however continuing transformation of the medical workforce is critical to address service areas where ‘difficult to fill’ posts can place a strain on service provision.
5.3.1.3 Allied Health & Healthcare Science Workforce: Work will continue to develop skill mix models in therapy services for staff with generic skills that can support physiotherapy, occupational therapy and dietetics to support integrated care pathways. Specialty training in injection therapy, independent prescribing and imaging referral will be developed to underpin the development of MSK services.
5.3.2. Focus on integration and community services: Strategic shift in activity from acute to community settings arising from transformation and delivery of new integrated models of care. There should be further potential given the Trust’s successful contract award in partnership with the local GP Federation and Local Authority for community services.
There will inevitably be a number of risks relating to Trust acquiring community services, including the transfer and integration of staff. The Trust is currently in the process of mobilising the community services contract. The Trust is currently working with the incumbent provider to understand the profile and natures of all of the resources transferring across.
5.3.3. Seven day services: In line with national ‘must dos’ focus on improving urgent and emergency cover across the 7 days. As described earlier, GHNFT is one of four North East Trusts designated as ‘early adopters’ to deliver on four priority standards of seven day working (Keogh standards) by April 2017. Specific action is outlined in section 4.9.
5.3.4. Productivity and efficiency: Ensuring that workforce becomes as efficient as possible whilst balancing quality and safety remains central to the Trust’s approach to productivity and will focus in 16/17 on:
5.3.4.1 The use of the Trust’s e-rostering system to roster and manage time & attendance of nursing, other clinician staff and non-clinical staff to make sure the right staff are in the right place at the right time to ensure patients get the right care and non-clinical time is kept to a minimum
5.3.4.2 Adherence to the central guidance on the employment of agency staff including rates of pay
6 Approach to Financial Planning
6.1 Financial forecasts and modelling
17 6.1.1 The 16/17 financial projections are derived from and are consistent with the financial modelling that the Trust carried out during Qtrs 1/2/3 of 15/16 to inform and respond to Monitor’s financial investigation.
6.1.2 The Trust worked closely with external advisors during this period to derive a detailed understanding of the underlying recurrent financial position and run rate for 15/16 which was used to derive the baseline 16/17 position and forms part of the Financial Recovery Plan that is to be submitted alongside this plan.
6.1.3 This baseline analysis has subsequently been updated to reflect the impact of the national planning guidance, the 16/17 PbR tariff and the recent notification of the Trust’s planned share of the £1.8bn transitional support fund and associated control surplus.
6.1.4 The detailed financial model for 16/17 is based on:
The draft annual accounts outturn for 15/16 and underlying recurrent position after removing non recurrent and capital to revenue measures;
Internal Capacity and Demand modelling at service line level taking account of the normal range of demographic data and local commissioning intelligence linked to the recurrent and non-recurrent infrastructure required to ensure delivery of performance targets and maintenance of the quality of services delivered by the Trust;
Workforce and manpower levels informed by the above to limit reliance on agency staffing – the Trust continues to have minimal reliance on agency nursing and has plans in place to reduce reliance on Admin agency and adhere to medical agency caps;
Efficiency and cost reduction plans derived from the detailed work of the Trust’s PMO that was enhanced as part of the recovery programme in 15/16 and has been maintained for 16/17;
Projections of contract activity with Commissioners that reflect activity levels consistent with the capacity and demand modelling and a limited amount of growth in NEL & EL activity and repatriation of EL activity.
The impact of the award of the tender for the provision of Community services for the Gateshead population (previously provided by South Tyne FT) effective from 1/10/16. The contract entails a 6 month mobilisation period incorporating the TUPE transfer of staff into the trust and the transfer of elements of service that previously formed part of the Acute contract in 15/16. There is a significant amount of work to be delivered in relation to both the mobilisation phase and then over the 5 year period of the contract to transform services to deliver the needs of the increasing and ageing population demographic; the aspirations of the LHE GPs and the delivery cost efficiencies. The pathway synergies from the vertical integration of acute and
18 community services are essential enablers to improving patient flow; prompt discharge and minimising the adverse impact of the reductions to intermediate care capacity resulting from reductions in LA funding.
6.1.5 The following sections summarise the key movements between the 15/16 forecast outturn and 16/17 plans and the key risks, sensitivities and mitigations to delivery.
The 15/16 draft annual accounts outturn is a deficit of £7.29m which, after adjusting for non-recurrent, full year effects and the impact of the capital revenue transfer, increases to an underlying recurrent deficit of £10.9m;
The full year effect of 15/16 activity increases and planned 16/17 increases from commissioners of £2.8m (before marginal costs of delivery) reduces the underlying deficit to £8.1m;
The impact of tariff efficiency at 2%; the significant local increase in NHSLA contributions (36% compared to national average of 17%) and the costs of delivering planned activity and cost pressures equates to £6.3m which increases the recurrent deficit to £14.4m. In addition, the plan incorporates £3.6m of investments and cost pressures associated with meeting performance targets and progress towards 7 day working, offset by the tariff inflator of £3.3m;
This results in a deficit plan of £14.7m, prior to impact of planned recurrent cost efficiency / reduction schemes of £6.6m and income generation from repatriation and growth of circa £1m (primarily orthopaedics, Maternity and IVF), yielding an operational deficit £7.1m, prior to non EBITDA pressures of £0.7m, resulting in a recurrent deficit £7.8m;
Delivery of the notified control surplus of £0.4m is achieved by the planned delivery of a further £1.8m of non-recurrent cost reduction schemes (that Trust will look to develop recurrent schemes to offset via the PMO during 16/17), £0.1m of strategic initiatives and receipt of £6.3m of non-recurrent support from the national strategic transformation fund.
6.1.6 The SOCI, SToP and Cash flow statement in the detailed financial model that are derived from the surplus plan and Capital plans (refer to section 7.4) result in the following key metrics:
Financial sustainability Risk rating of 3;
Retained cash at 31/03/17 of £2.9m, with no recourse to distressed finance during the year;
Operational surplus of £0.4m;
CRP delivery of £8.4m (3.54%)
19 6.1.7 There are a number of risks to delivering the plan and some downside sensitivities outlined in the detailed financial model. At this juncture there appears to be very limited upside sensitivity available other than the potential non recurrent income from the sale of the Dunston hill site that is proving difficult to close and accordingly has not been included in the base draft plan.
6.1.8 The key risks inherent in the 16/17 plan are as follows:
Contracts are close to sign off with CCG’s based on PBR and reflect the planned levels of activity included in the plan, however the Newcastle & Gateshead CCG have identified a £2.6m planned reduction to these activity levels on the premise that they will work up and action pathway transformation / QIPP schemes in year that will reduce demand estimates. The trust, whilst committed to working with the CCG to ensure safe quality care is provided in the most appropriate setting, is of the view that there will be minimal impact on plans in 16/17.
Delivery of front of house A&E performance and back of house bed capacity during winter 15/16 has been very challenging and management of these pressures during the 16/17 winter period, within the resources committed by the CCG (£1.1m compared to £1.8m in 15/16) will continue to be challenging and may potentially impact on receipt of the non-recurrent Strategic Transformation Fund in 16/17;
Delivery of CRP/ efficiency savings.
6.2 Efficiency Savings for 2016/17
6.2.1 During 2015/16 the Trust appointed a recovery advisor and enhanced its existing PMO set up and governance arrangements as part of its overall response to Monitor’s financial investigation with the primary objective of minimising the 15/16 deficit and developing a robust cost efficiency/ reduction programme for 16/17 onwards. The overall recovery programme is summarised in the schematic below.
20 6.2.2 The PMO has focused to date on the internal CRP/Efficiency element of the recovery plan and set up a programme of 12 work streams as follows:
Length of stay;
Workforce (Including agency & back office functions);
Theatre efficiency & productivity;
Outpatient efficiency & productivity;
Medical job planning & productivity;
Non ward based nursing resource;
QEF estates & facilities;
QEF procurement;
Pharmacy & medicines optimisation;
Pathology - marketing of South of Tyne laboratory;
Service growth & repatriation;
Clinical coding.
6.2.3 The PMO worked with external consultants on Theatre, Outpatients and coding work streams and appointed dedicated work stream leads to work with clinical and corporate
21 business units to develop detailed project initiation documents for each work stream covering –
Background and aims;
Strategic fit and objectives;
Plans;
Clinical engagement & communications;
QIA;
Governance & Key risks;
Milestones and timeline;
Financial deliverables & phasing.
6.2.5 A summary of the 16/17 scope of opportunities is provided in the table below
6.2.6 Agency – The Trust has incorporated Monitor’s initiative on Agency caps into its overall workforce work stream.
The Trust has very low levels of reliance on nursing agency, the primary usage linked to supporting winter / surge bed capacity;
The main recourse to admin agency has been to support key vacancies in Finance and Informatics and will be significantly reduced during 16/17;
The Trust has implemented a rigorous review of medical agency staffing and via master vendor frameworks will adhere to the medical agency rates and is in the process of
22 exploring setting up / sharing internal medical bank staffing to avoid agency other than in exceptional clinical circumstances.
6.2.7 Procurement – The Trust has a specific procurement work stream with a detailed programme of contract renegotiations in place, with clinical involvement to inform decisions. In addition, the Trust, as part of utilising its freedoms, has transferred management of the estate and the majority of non-pay spend to QE Facilities, the Trust’s SPV. This will enable significant non pay savings via improved ordering and as a result of VAT savings resulting from the provision of a managed facilities contract to the Trust by QEF.
6.2.8 Lord Carter’s provider productivity work programme – The key components of Lord Carter’s programme are covered by the work streams the Trust set up as part of its recovery plan. Upon receipt of the scope of opportunity and supporting methodology the Trust engaged with the national team to gain a fuller understanding of the approach, reviewed and resubmitted the underpinning ESR data and is currently partaking in a national audit of its reference cost process to better understand and assess the realisable scope of opportunity highlighted in the initial correspondence. The Trust fully recognises the need to take this work forward and is in the process of assessing and evaluating what new opportunities can be added to the current PMO work streams and financial savings plan summarised at section 6.2.5 above.
6.3 Capital Planning
6.3.1 The 5 year capital programme is based on utilising cash from internal depreciation and is primarily designed to:
maintain current estate condition status
replace essential medical equipment and service developments
maintain and replace IT infrastructure and legacy systems from NPFIT programme as well as making incremental steps towards paperless systems and IT enabling efficiencies.
6.3.2 The 16/17 programme is based on retained cash from internal depreciation of £5.5m plus utilisation of £1.6m of retained cash to fund planned slippage from the 15/16 programme associated with the national capital revenue transfer scheme.
6.3.3 In addition to the core elements of the programme outlined above the Trust needs to redevelop the bowel screening hub as part of the JAG accreditation requirements – screening is an essential element of the services the Trust provides on a sub-regional basis.
6.3.4 The draft programme for the remaining 4 years currently does not provide sufficient resource for key transformation schemes / strategic service developments. These will need to
23 be developed as part of the LHE wide strategic plan and demonstrate ROI and financial sustainability.
6.4 Summary
6.4.1 Delivery of the 16/17 financial plan is essential to enable the Trust to focus on developing strategic transformation plans with LHE partners to ensure that the increasing financial challenges that will impact from 17/18 onwards can be managed.
6.4.2 Although there are a number of ongoing risks to delivery of the plan, the steps that the Trust has taken to identify new CRP and income opportunities and the more robust PMO arrangements should enable delivery of the plan subject to mitigation of the risks identified.
7.0 Link to the emerging ‘Sustainability and Transformation Plan’ (STP) 7.1 Collaborating effectively with our LHE
Like the whole of the NHS, our local health system recognises that it will be unsustainable without radical transformation of services across primary, community and secondary care. To enable these required local changes to be made we recognise that it is essential for the local health economy to deliver a robust System Transformation Programme and for our local operational plan to be consistent with this.
In order to ensure this, we have set up local governance arrangements (Appendix 5) to allow the following: Evaluation of the nature and scale of our strategic challenges; Identification and evaluation of the strategic options available to us1; Forcing the required strategic decisions to be taken on a timely basis; Operationalising the strategic plans into plans with objectives and milestones (including aligning local operational plans with the STP); Sharing of our view of operational risk with other providers in an open book fashion to ensure a system approach to mitigating the risks; Monitoring delivery of progress against strategic and operational objectives.
Within the Trust, both strategic and operational objectives are developed and agreed with the Board and monitored throughout the year with quarterly progress reported to Board.
7.1.1. Clinical Engagement and Scrutiny In recognition of the importance of engaging our clinical leaders in strategy development and shaping new models of care/service delivery the Trust has established two new groups: The Strategic Clinical Advisory Forum and Strategic Transformation Group:
1 The Trust recognises the importance that our clinical leaders have in shaping local new models of care. To suppor t this, the Trust has established a clinical advisory forum to lead on identifying clinically sustainable models of care that will address the strategic challenges across our health economy.
24 Strategic Clinical Advisory Forum - a proactive and participative group whose role is to confirm and challenge, providing robust, evidence-based advice regarding the clinical achievability of the Trust strategy.
Strategic Transformation Implementation Group- to co-ordinate and oversee the Trust’s implementation of strategic planning and (external) transformation programmes; delivery of the Trust’s annual objectives (including consideration of progress, risks and barriers to implementation); support the board Assurance Framework and implement an organisational communications plan on the work programme.
7.2 Transformation, integration and community services
The Trust will collaborate with Gateshead Newcastle CCG Alliance (NGCCG), in implementing its successful bid for Vanguard status (ref: ‘Forward View into Action - co-creating new models of care’). This will build upon the successful Gateshead Care Home Initiative in which Trust consultant community geriatricans and older persons’ pyschiatrists work alongside designated GPs and community nursing staff to manage the care of frail people with complex needs in the community. Plans for 16/17 include the development of intermediate ‘step up; step down’ care and expansion of services within the community, supported by Trust nursing staff.
The Trust is a member of the North East Urgent and Emergency Care Vanguard. A detailed work programme has been agreed for year 1 with discussion ongoing at present regarding priorities and workstreams for 2016-17. While much of the work currently planned is targeted at primary care and community services with a view to hospital attendance/admission avoidance the Trust is keen to participate in developing new models of care. The work being led by this Vanguard on new models of payment for non-elective activity is an area the Trust will actively engage with during 2016-17.
NGCCG has tendered for the delivery of a new community service model. The Trust is committed to the model that has been described and this aligns with its strategic objective of integrated and seamless pathways of care. Having been awarded the contract for the delivery of community services from 1 October 2016 in partnership with the local GP federation and Local authority the Trust will be working to ensure the vision of the CCG is delivered.
7.3 New models of care
Our Sustainability and Transformation Programme will set out an ambitious vision for our local health care services. This will include:
1. Effective out of hospital services to ensure patients can stay fit and healthly but when ill, patients will stay out of hospital for as long as possible;
25 2. Integrated services across all aspects of care including primary, community, secondary and tertiary care, which may require different organisational models; 3. Efficient and effective acute services, with a bed base which is more responsive to demand; 4. Joined up decision making across all aspects of the health and social care economy with incentives and levers aligned to ensure collaborative working.
Whilst our System Transformation Programme is still being developed, this vision is likely to lead to the adoption of new models of care as described in the Five Year Forward View, e.g. ACO models. This operational plan is fully consistent with this strategic vision and we are engaging fully with our commissioners in the production of the STP.
The Trust’s local STP footprint has recently completed two checkpoint submissions, outlining its approach to strengthening working relationships with Newcastle NHS FT in terms of initial areas for corporate and service level collaboration and also how local governance arrangements are being firmed. Discussions are now evolving across the full STP footprint of Northumberland Tyne and Wear to ensure the opportunities that are generated across this wider planning footprint can be delivered. A whole system workshop is planned for April 2016. Our STP programme is progressing to explore 3 broad areas:
1. Collaborative commissioning
2016/17 Exploring collaborative commissioning
GLA Joint Commissioning
• LAs + Health – scale, pace, budgets,
Joint whole-person care, could be NHSE Commissioning NLA explored via segmentation (e.g. populations and interventions): • Older People CCG • Children, Young People and Families • Mental Health Principles • Prevention, early interventions + No decision in isolation (indirect impacts) Responsive Care Status Quo not an option Population segmentations – needs-based Targeted interventions • CCG + NHSE: Life Course approach • Primary: Care – level 3 Investment in prevention, early interventions and responsive care • Specialised Commissioning Place-based (planning footprint NECA/STP) Whole person approach – payments aligned
26 2. In-hospital provision
2016/17 Exploring In-hospital Provision
• NuTH NuTH Cancer • NuTH Specialist Clinical services Collaboration Collaborative Trust Model Networks • NuTH Trust /NTW Model Research NTW GHFT
High-value pathways e.g. Breast, ENT, hyper-acute stroke, Vascular, orthopaedics Principles • GHFT Specialism owned by etc. pathology excellence • NuTH Smaller in-bed units /GHFT Specialty diagnostics High-value practice – Franchise • NTW – Kite Marks, : Deciding Accreditation, reduced Right variation model Efficiency opportunities Alliances + Networks
3. Out of hospital provision
27 2016/17 Exploring Out-of-hospital Provision
NUTH Federated Working Model • List-based provision: LAs CBC • Personalised care Public and • LTC care – self-care/care + Patients NWGP support planning NTW • Inter-GP provision: Fed • 7-day provision + resilience GHFT • Urgent Care – ‘same-day’ • Care Homes/Intermediate care • Specialist care – inter-referrals Principles • Back office – referrals, QOF, HR, High-value practice(s) reducing variation Expert generalists within the community enhanced services, contract etc. managing complexity/EOL/frailty/LTCs • Closer: to home specialism: Population-based needs planning – • prevention + wellbeing + care/support LTC delivery – Diabetes etc. planning Multi-level, interdisciplinary working Information sharing
Work has already started at a local level (through the Integrated Care Programme Board) and regional level to explore a shared approach on:
1. Workforce 2. IT 3. Leadership; and 4. Engagement More specific areas of service collaboration between Newcastle NHS FT and the Trust which build on respective provider strengths include:
Stroke Vascular ENT Orthopaedics Pathology Diagnostics Community services; and Back office functions
Our work to define these areas will also recognise changes occuring in neighbouring footprints, in particular the stated ambition for more formal collaboration and partnership working between South Tyneside and Sunderland Foundation Trusts.
7.4. Assessment at provider level against the 16/17 ‘Must dos’
28 The Trust has undertaken an assessment of our current position against the relevant 16/17 ‘Must Dos’ based on our current performance, risks and actions. The table below provides a summary of this assessment.
Must dos Status (Mar Projection Gross risk Description of risk Actions to mitigate risk Residual board report) for 16/17 risk 1. Development of STP Checkpoints On track achieved
2. Aggregate financial £7.3m deficit £0.4m surplus Under-delivery against Robust PMO arrangements in place balance income and FRP plan
3. Achievement of 90.4% (Q4) Compliance Range of issues including Detailed action plan in place access standards for flow, base wards and A&E discharge planning
4. Achievement of NHS 93.2% Delivery of Non-delivery of RTT 18 Continued delivery demonstrated Constitution referral to national weeks access target for and assurance rec'd through robust treatment standards access target all specialties demand and capacity modelling.
5. Achievement of NHS Access targets Progress in Non-delivery of cancer Q4 on track for compliance Constitution cancer achieved achieving one access targets standards and one year year cancer survival survival rates
6. Make improvements in 2015/16 CQC Deterioration in quality 1. Action plan in place following quality. inspection generally or as a result of CQC findings and 'good with financial recovery recommendations oustanding program 2. Corporate objective to achieve an care' 'outstanding rating' filtered through detailed actions at service level. 3. Continued robust QIA arrangements
8.0 Membership and elections
The Trust’s annual Elections to the Council of Governors began in October 2015 and the results were declared on 10th December 2015. This election was held to fill 12 posts; nine elected and three staff. All but three posts were filled.
In order to attract members to the role of governor, an information session was held in October 2015 for all potential candidates to attend. The presentation gave an overview of the Trust, the role of the governor and the expectations of the role. The Trust plans to only hold annual elections and fill any vacancies in this round of elections.
8.1 Examples of governor recruitment, training and development
Governors undertake regular training and development which includes four half day workshop sessions and a full day development session. In addition to this, governors attend regular visits and attend any relevant in-house events. Other dates are arranged throughout the year and include events such as quality account indicators and an annual planning workshop with the Non-Executive Directors.
8.2 Facilitating engagement between governors, members and the public
29 Membership and ensuring diversity: current and next 12 months
The Trust has a membership of 13,010 from across four public constituencies and 3,400 staff members. The membership of Gateshead Health NHS Foundation Trust is made up of two membership constituencies; Public and Staff.
Engaging with members and the general public is one of our main priorities. We work with groups throughout the local community to share information on our services and hold dialogue on planned service changes and developments. This includes engagement in major schemes such as the Emergency Care Centre that opened in early 2015.
Recently we have engaged with our members at 14 Community Events which were attended by over 400 members. We have commenced a new programme of engagement with local schools, giving student members the opportunity for work experience at the Trust and in 2016 we plan to hold a careers event offering students one to one sessions with a range of Trust employees. The programme of community events will continue to be organised as our Governors are committed to listening to what our members and the public are saying and ensure, through our governance processes, that these views are considered in the planning of our services.
We also organise regular member events each year on relevant health topics. These events are called Medicine for Members and in 2015/16 we held four. The topics were asthma, emergency care, inflammatory bowel disease and prostate cancer. These events are very well attended and the average attendance is around 50.
Members also receive a newsletter, QE News, three times each year. They receive this as a printed newsletter, as an emailed copy or access the newsletter via the Trust’s website. The newsletter contains news and events from around the Trust and has specific pages for membership information.
30 Appendices
31 Appendix 1 – activity/demand charts
QE site A&E attendances Admissions from A&E 7800 1800 7600 1750 7400 1700 7200 1650 7000 1600 6800 6600 1550 6400 1500 6200 1450 6000 1400 5800 1350 5600 1300
2014/15 2015/16 2014/15 2015/16
Admissions from GP Admissions from Other 700 100 90 600 80 500 70 400 60 50 300 40 200 30 20 100 10 0 0
2014/15 2015/16 2014/15 2015/16
Total Non elective admissions Age Profile of A&E attendances (exc Maternity) 2000 3500 1500 3000 1000 2500 500 2000 0 1 2 4 5 6 4 6 6 7 9 9 0 1 0 0 1 3 3 4 5 5 8 8 0 2 5 7 0 3 6 5 8 1 0 3 7 0 1500 3 6 9 8 1 4 9 2 4 7 3 7 7 7 8 8 8 9 9 9 0 0 0 0 1 1 1 2 2 2 3 3 3 4 4 1 1 1 2 2 2 2 2 2 2 2 2 2 1 1 1 1 1 1 2 2 2 2 2 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 1000 65+ 75+ 85+ 1 2 4 5 5 5 7 8 8 1 0 0 1 3 3 4 6 4 6 6 9 9 0 2 5 7 0 9 2 1 4 7 0 3 6 9 8 1 4 3 6 5 8 0 3 7 7 7 7 8 8 8 9 9 9 0 0 0 0 1 1 1 2 2 2 3 3 3 4 1 1 1 2 2 2 2 2 2 2 1 1 1 1 1 1 2 2 2 2 2 2 2 Linear (65+) Linear (75+) Linear (85+) 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4
Non elective admissions (exc Maternity) by age 1400 1200 1000 800 600 400 200 0 1 2 4 5 5 5 8 8 1 0 0 1 3 3 4 6 4 6 6 7 9 9 0 2 5 7 0 9 2 4 7 0 3 6 9 8 1 4 3 6 5 8 1 0 3 7 7 7 7 8 8 8 9 9 9 0 0 0 0 1 1 1 2 2 2 3 3 3 4 1 1 1 2 2 2 2 2 2 1 1 1 1 1 1 2 2 2 2 2 2 2 2 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4
65+ 75+ 85+ Linear (65+) Linear (75+) Linear (85+)
32 Appendix 2 – operational performance and recovery milestones
2015/16 Performance against Monitor’s Risk Assessment Framework
1. Maximum Waiting Time 4 Hours in A&E – Current Position
In February 2016 the Trust did not achieve the 95% threshold with performance of 89.5%. The performance confirms the position predicted in the January board paper. The underperformance in January, February and early March will result in quarter 4 not being achieved. As a result of the underperformance for this National Access Target indicator the service has prepared an action plan and weekly escalation meetings are now in place in accordance with the Trust’s performance framework.
Figure 1. A&E performance in last 12 months
33 Maximum Waiting Time 4 Hours in A&E – Forecast Position
Analysis of data available to mid-March demonstrates under performance, the forecast position for March is that performance will not achieve the 95% threshold. Trajectories for performance against the A&E National Access target have been submitted and it is anticipated that recovery against this target will be delivered in quarter 1 of 2016/17. A graphical representation of the monthly trajectory submitted is given below and weekly monitoring of the submitted trajectories will take place.
The Trust Board is assured that the monthly performance trajectory above will deliver the quarterly national access target and compliance against the Risk Assessment Framework.
The Trust has in place a detailed A&E recovery plan which covers all aspects of flow, admission and discharge. The plan has a range of targetted actions in the following areas:
A&E Emergency Assessment Unit (EAU) Ambulatory Care Base wards Delays in Discharge
34 Appendix 3 – Top three quality priorities with milestones for delivery
Priority Quality Goals
1) DELIVERY OF CLINICALLY EFFECTIVE AND SAFE PATIENT CARE. - Delivery of year three - Successful achievement of all identified milestones of the trusts SafeCare - Active monitoring and gathering of assurance. strategy (2014-17)
- Delivery of the - Introduction of new electronic system for Clinical Clinical Effectiveness effectiveness (including clinical audit, NICE guidelines) improvement plan. - Continue to participate in 100% of all applicable national audits and utilise the new system to monitor and assure against action plans. - Ensure compliance with NICE guidance and implement a programme of work to gather further assurance of compliance.
- Successful - Continue to improve management of mortality in line completion of all with good practice and national priorities including the Quality Account reduction and timely management of sepsis by ongoing priorities. development of the sepsis screening process (front and back of house) and further development of training and education. - Continue to embed the process and learning following the maternity saving babies’ lives campaign.
- Continuous improvement of medication safety via the introduction of EPMA
- Implementation of thinkSAFE project within 2 new ward areas.
- Continuous reduction in harmful falls and no harm falls.
- Develop Trust Trust ‘People Strategy’ to be agreed by the Trust Board ‘People Strategy’ Regular monitoring of the Strategy at HRC
35 - Implementation of Robust recruitment practices underpinned by behaviours & values based values recruitment Recruiting managers trained and utilising behavioural & value based recruitment / selection techniques
- Develop service / Ongoing compliance with professional staffing guidance and specialty workforce standards plans to deliver identified capacity & capability Robust recruitment strategies are in place to address workforce capacity & capability gaps across the Trust
Participate in the annual Health Education England, North East (HEE NE) workforce planning round to inform the 2017/18 investment plan to ensure the Trust has access to the right people, with the right skills at the right time to support the delivery of excellent healthcare and drive improvement.
- Enhanced leadership Develop leadership behaviours aligned to the NHS Healthcare capacity and Leadership model & provide development & training capability to meet opportunities to support these to underpin service the organisational transformation and change need Develop and implement a framework to identify future leadership talent and succession plans.
- Develop behavioural Trust wide values & expected standards of behaviour are adhered based performance to placing patients at the centre. review process
- Develop trust risk Trust risk management strategy signed off at PQRS management strategy Regular monitoring at PQRS
- Embed governance Sign off of new process for delivery and sign off. arrangements in relation to Board Successful completion of BAF during each reporting cycle. Assurance Framework. Ongoing education and improvement - Strengthen risk Ongoing delivery and review of risk management training. management arrangements across Quarterly review of risk register and ongoing development the trust; specifically,
36 risk register following feedback from training/awareness sessions. development; incident reporting Delivery of incident reporting improvement plan (part of sign up and learning lessons to safety annual plan) where things go wrong. Development of corporate lessons learned bulletin.
37 Appendix 4 – Actions towards the delivery of 7 Day services
A number of service specific development / opportunities have been identified towards achieving 7 day services and focus on:
1. Radiology (business case approved at March Trust Board meeting)
a. Business case for increasing 7-day radiology services
b. Business case for extra radiology equipment
c. Outsourcing for out of hours reporting
d. Provide 6 hours on site consultant radiologist presence on Saturday and Sunday
2. A&E
a. Could provide 8-midnight cover on all days with additional (10th) A&E consultant post
3. Medicine
a. Look at how to improve base ward consultant cover at weekends for patients requiring on-going review
b. Work out how to define which patients require ongoing consultant review and which could be reviewed in other ways
4. Orthopaedics:
a. Business case for Sunday trauma list
5. Obstetrics & Gynaecology
a. Develop weekend early pregnancy clinics
b. Look at readjusting time of consultant presence to give more onsite coverage at weekends
38 Appendix 5 – STP Governance Arrangements
2
Progress
2
39 40