Trust Board Meeting

TRUST BOARD 28th January 2009 MEETING TITLE Annual Plan 2008/9 – Progress Against Objectives

PURPOSE To inform the Board of in year progress against the Trust Annual Plan Objectives for 2008-9.

FORMAT Report for information

THE BOARD IS  To note the progress to date against the plan ASKED TO:  To review all objectives shown as Red or Amber on the plan and where appropriate seek further information from the appropriate Executive Director

1. Introduction This covering paper and the attached action plan outlines progress to date against the Trust Annual Plan objectives.

2. Update

The summary position is attached as Annex 1. The full action plan with progress shown is attached as Annex 2. There are 101 individual performance measures within the plan. Four of these are currently showing as Red issues. All Red issues fall within the category of Service Quality and Performance. They are as follows:

To achieve at least the national standard for cancelled operations and 28-day re-admissions:

Target 1 Percentage of patients whose operations are cancelled on the day of their operation for non-clinical reason (less than 0.8%)

Percentage of patients whose operation was cancelled at last-minute who were re- admitted within the 28-day standard (greater than 95%)

Progress Both cancelled operations and 28-day re-admission targets achieved during July and August but have not been achieved since. The main cause of cancellations and inability to re-book within target is lack of available beds within the Bristol Royal Infirmary (BRI). Improvements in performance will continue to be progressed through the 4-hour improvement programme and via weekly operational meetings.

of 18 To continue to reduce delays in communicating with referrers about patient care:

Target 2 Letters to be produced within 5 working days of the patient being seen in clinic (90%)

Target 3 To continue to reduce delays in discharge summaries being produced, in line with national performance indicators. - letters to be sent to GPs within 72 hours of the patient being discharged (90%)

Target 4 To standardise discharge summaries and clinic letters - Percentage of letters in the standard format (90%)

Progress (for Capital monies have been committed to procure an external electronic discharge Targets 2, 3, 4) summary system. Formal review of available discharge summaries systems complete. Visits to trusts that have implemented preferred system, undertaken. Procurement of system to be completed by end January 2009. The system to be procured is within same software portfolio as Order Communications and has been well received by GPs in other areas. It supports coding of procedures by clinicians and may improve coding quality. New system will be piloted in Q4, with roll-out during 2009/2010. A standard format for discharge summaries, as previously agreed with the PCT, will be applied.

3. Conclusions and recommendations

The Trust Board is asked:

 To note the overall progress to date against the plan  To review in detail all objectives shown as Red or Amber on the plan and where appropriate seek further information from the appropriate Executive Director

Prepared and presented by:

Ellen Rule

Head of Business Planning

20th January 2009

of 18 ANNEX 1

Annex 1: Summary Position:

Red Amber Green Nil Service Quality and Performance 4 11 18 0 Research and Development 0 1 3 0 Finance and Information 0 8 7 0 Teaching and Learning 0 0 5 0 Workforce 0 2 7 0 Organisational Development 0 2 14 0 Capital Development 0 3 16 0 4 27 70 0

Percentage Allocation of RAG status to Objectives:

of 18 ANNUAL PLAN 2008/09: REVIEW OF PROGRESS

Objective Aim Performance Indicator Target date Lead RAG Progress/Next steps Status

SERVICE QUALITY AND PERFORMANCE – IRENE SCOTT / LINDSEY SCOTT / JONATHAN SHEFFIELD To maintain a rating of a) achieving at least the Percentage of patients whose March 2009 IS R Both cancelled operations and 28-day re-admission ‘Excellent’ in the 2008 national standard for operations are cancelled on the day targets achieved during July and August but have not assessment of quality of cancelled operations of their operation for non-clinical been achieved since. The main cause of cancellations services by the Healthcare and 28-day re- reason (less than 0.8%) and inability to re-book within target is lack of Commission. admissions March 2009 available beds within the Bristol Royal Infirmary Percentage of patients whose (BRI). Improvements in performance will continue to operation was cancelled at last- be progressed through the 4-hour improvement minute who were re-admitted programme and via weekly operational meetings. within the 28-day standard (greater than 95%) b) consistency of Percentage of patients waiting less Monthly IS A Target met for year to date until end November, at achievement of the 4- than 4-hours in A&E during a 4- which point the Trust dipped below the required hour maximum week rolling average (greater than 98.0%. Key actions being undertaken to achieve the waiting time in A&E 98%) standard include: for at least 98% of  Use of Bed States and Estimated Date of patients Discharge (EDD) reports at daily Patient Flow meetings to manage discharges  Divisions planning and managing patient flow (i.e. the number of expected / planned admissions against discharges)  Improving support for early discharge including increasing phlebotomy support, and more prompt access to diagnostics  Establishment of 23-hour facility in Ward 1a, to manage interventional radiology and less complex inpatient surgery.  Refinement of the model of care for acute medicine, with acute physicians overseeing existing Medical Assessment Unit (MAU), supported by Ward 7 as an Admission and Short Stay Unit (subject to further review / funding). Page 4 of 18 Objective Aim Performance Indicator Target date Lead RAG Progress/Next steps Status

c) achieving the new Percentage of cancer patients being December IS A National definitions for new cancer targets published cancer waiting times treated within 31 days for 2008 on 15/09/08. Local review completed and action plan standards indentified subsequent cancer treatment being implemented. in the Cancer Reform requiring chemotherapy or surgery New Cancer Primary Targeting List (PTL) developed Strategy (greater than 98% - tbc) and launched. This is being used to operationally Percentage of cancer patients being December IS A manage waiting times and track progress with treated within 62-days of being 2008 achievement of targets. referred from a national screening programme with a suspected Two dedicated Cancer Service Improvement Leads cancer (greater than 95% - tbc) for the Cancer Reform Strategy have been appointed Percentage of cancer patients being December IS A from external national monies. These roles are treated within 62-days, who were 2008 leading cancer service improvement across the cancer not referred urgently by their GP sites. but for whom cancer was New operational thresholds have not been published suspected by the specialist (greater by the Department of Health, and are expected to than 95% tbc) come into effect in shadow form in Q4. To achieve a maximum To achieve in full the Maximum wait of 18 weeks from December IS G National standard of 85% and 90% for admitted and 18 week referral to maximum 18 week referral to treatment for 2008 non-admitted pathways, respectively, achieved from treatment time by referral to treatment time, admitted/non-admitted patients June 2008 onwards, ahead of December target. December 2008 and make progress (greater than 90% / 95%) towards achievement of Maximum wait of 13 weeks from March 2009 IS G December 13-week target achieved for both admitted an 8-week wait by March referral to treatment for all patients and non-admitted pathways. On target for 2010 (90% admitted; 95% non-admitted) achievement of 90% / 95% targets in March. To continue to reduce To continue to reduce Letters to be produced within 5 March 2009 IS R Capital monies have been committed to procure an delays in communicating delays in clinic letters working days of the patient being external electronic discharge summary system. with referrers about the being produced seen in clinic (90%) Formal review of available discharge summaries care of their patients and To continue to reduce Letters to be sent to GPs within 72 September IS R systems complete. Visits to trusts that have to improve the quality of delays in discharge hours of the patient being 2008 implemented preferred system, undertaken. information provided summaries being discharged (90%) Procurement of system to be completed by end produced, in line with January 2009. The system to be procured is within national performance same software portfolio as Order Communications indicators and has been well received by GPs in other areas. It supports coding of procedures by clinicians and may To standardise discharge Percentage of letters in the September IS R improve coding quality. New system will be piloted summaries and clinic standard format (90%) 2008 in Q4, with roll-out during 2009/2010. A standard letters format for discharge summaries, as previously agreed To give patients the Process in place to give patients March 2009 IS A with the PCT, will be applied. Page 5 of 18 Objective Aim Performance Indicator Target date Lead RAG Progress/Next steps Status

option to receive copies of the option to receive copies of Copy letters project in progress and should achieve discharge and treatment correspondence in relation to their standard by end March 2009. letters sent to their GP in care. Patient satisfaction survey relation to their care. conducted to establish Work to standardise clinic letters, which will speed- effectiveness of process (100%) up production times, underway. To continue to develop Board approved Service The Trust Board will have signed June 2008 IS G Lean Improvement Projects – 2008-09 Improvement the programme of service Improvement Programme off a Service Improvement Programme priorities signed off by TEG with a roll- improvement across the for 2008/09 Programme for 2008. The out plan for projects in place and implementation Trust including: Programme has been underway. communicated to all Key  patient pathway Stakeholders Monitoring of Key Performance Indicators happening improvement projects Successful delivery of Progress against targets monitored March 2009 IS A locally but needs to be reported centrally. Innovation using the ‘lean Service Improvement and recorded by the Innovation Board to be re-launched as Service Improvement thinking’ methodology Programme, as defined by Board and reported to the Trust Committee in 2009/2010.  adoption of best programme objectives Board practice in ‘Focus On’ Implementation of the Progress against target will be March 2009 IS G Productive Ward – roll-out underway. All wards will areas identified by the Productive Ward monitored by the Innovation Board have introduced foundation modules and have begun NHS Institute for foundation module in Divisions will be able to identify to review individual process modules by March 2009. Innovation and each Division with an champions who are proactively Improvement implementation action leading implementation Application Skills - development focussed on  whole system plan developed. Roll out Innovation Team and project teams at present. In improvements to commenced and on target addition, Lean skills development underway at ward address inappropriate Trust’s capacity and Divisions will have a core team of March 2009 IS G level through involvement in Productive Ward A&E attendances and capability for undertaking trained change agents who are Programme. Elements of the Knowledge and Skills admissions service improvement, actively engaged in supporting and matrix developed and plans in place to complete. This  the Productive both within the leading change in the local will inform the Training Plan in development phase Ward initiative aimed Innovation Team and the Divisions to support spread of skills. Exploring the option to at increasing ward Divisions, measurably develop a UH Bristol Lean Academy that includes an staff time available for increased, with core teams option of NVQ accreditation. direct patient care trained in each Division To implement the privacy Establish a corporate Action plans for 08/09 agreed from April 2008 LAS G Action Plan is in place and refreshed quarterly and dignity action plans framework to lead work audit conducted end of 07 agreed following the to support Divisions to Establish corporate framework for March 2009 Trust-wide audit in improve the privacy and leading this work. 2007/08 dignity experience of patients Compliance with Core Trust is compliant Quarterly LAS G Action plans continue compliant Standards 13a and 20b in Page 6 of 18 Objective Aim Performance Indicator Target date Lead RAG Progress/Next steps Status

quarterly assurance framework report. Compliance declaration at Trust is compliant April 2009 LAS G Action Plans continue compliant. year end for Core Standards 13a and 20b. Specific / Measurable / Actions completed as defined in March 2009 LAS G In progress. Achievable / Realistic / the action plan Timed (SMART) objectives in action plan Members and Governor Members and Governors aware of August LAS G Patient Experience Events held August 2008 involvement directly in action plan and able to define their 2008 work role in relation to it. To evidence that patient Examples of improvements March 2009 LAS G Feedback boards in place feedback is taken into displayed on You Said We Did account in improving boards services

To review the Trust’s Review of 07/08 action Review completed April 2008 LAS G A complete review is underway and on target to performance against the plans complete by autumn to lead to next stage recommendations arising Undertake analysis of Analysis completed April 2008 LAS G from the Healthcare children and young Commission people activity by Improvement Review of division / specialty for Children’s Services and 07/08 data implement the necessary Agree Action plan for Action Plan in place and agreed June 2008 LAS G second stage of actions 08/09 To ensure that the Meet MRSA bacteraemia Trajectory met. March 2009 LAS / G MRSA on target 2008/09 targets for trajectory for hospital JS reduction in healthcare- attributable cases acquired infections in the Meeting the Clostridium Trajectory met. March 2009 LAS / A Clostridium Difficile is above trajectory – see Trust are met. difficile trajectory for JS monthly board reports for details of issues and hospital attributable cases actions. Overall hand hygiene Compliance maintained at 95% Monthly LAS / A Shifted from green to amber due to discrepancies levels monitored to minimum. JS between the Trust monthly results and the Dept of reduce hospital acquired Health Observational Audit. Actions in place to infections remedy To demonstrate Compliance with Core Standard 4a Quarterly / LAS / G Compliant. Internal audit to review against hygiene compliance with Core in quarterly assurance framework April 2009 JS code. Page 7 of 18 Objective Aim Performance Indicator Target date Lead RAG Progress/Next steps Status

Standard 4a, relating to report and declaration at year end systems being in place to of compliance with 4a ensure that the risk of healthcare acquired infections is reduced Instigate MRSA Programme in place and objectives March 2009 LAS / G Programme in place. Screening programme to of programme met JS reduce infections To support the divisions Appoint a Director of Infection April 2008 LAS / G C. Perry re-established as Director of Infection in achieving the targets Prevention and Control JS Prevention & Control. Reports to Board monthly. for reducing Health Care Acquired Infections Regular reports to Board re Quarterly infection control To achieve demonstrable Maintain Hospital Dr Foster Hospital Standardised Throughout JS A  Second quarter demonstrates average HSMR of results through the Patient Standardised Mortality Mortality Ratio (HSMR) as year 80.4. Safety Initiative Ratio at 75 reported monthly Roll out Bristol Replacement of old charts September JS A  Training plan is developed. Implementation Observation Chart monitored on ward by ward basis. 2008 February 2009. throughout Adult services New chart fully piloted. Education and Training programme for full roll out. Introduction of Human Delivery of a training programme March 2009 JS A Formal planning stage. Factors Training in High to all paediatric cardiac theatre Risk areas staff

FINANCE AND INFORMATION – PAUL MAPSON / IRENE SCOTT To ensure that appropriate Critical Path of Outcomes All Divisions have completed April 2008 IS A CPOs completed for 2008/09. CRES plans in place Cash Releasing Efficiency (CPO) analysis is CPOs for their Cash Releasing and being monitored. On track to deliver savings plan Savings plans are in place completed to ensure Efficiency Savings schemes. in most areas. Key corporate CRES schemes being and that they are delivered interdependencies Target for 2008/09 is 100% supported by Lean programme. At month 8 the Trust on time. between Divisions. Plans achievement of all savings has a shortfall of £0.622 million against plan, with a are explicit and accounted forecast of £0.514 million shortfall at year-end. for in delivery

of 18 Objective Aim Performance Indicator Target date Lead RAG Progress/Next steps Status

Impact analysis is Analysis undertaken and presented June 2008 IS G Impact analysis undertaken. CRES workshop held in undertaken and an to the Finance Committee. December for 2009/2010 planning. Lean programme integrated planning cycle for 2009/2010 to underpin CRES delivery and is implemented, to ensure Integrated planning process December strategic objectives. Lean support required by the achievement of established and completed for 2008 Divisions identified as part of the 2009/2010 savings supports service 2009/10. Progress to be reported to Operational Planning Process. development and the TEG in year. strategic direction of the Trust. Indentify and deliver 50% 50% of total savings realised September IS A At month 8 the Trust has a shortfall of £0.622 million of savings within the first 2008 against plan, Remedial action is being taken and six months. progress is being reported through the Divisional Any expected under- Full delivery of savings plan March 2009 IS A reviews. Current forecast of £0.514 million shortfall achievement of savings at year-end. plans offset by other measures taken in year. To develop financial Production of Resources Resources book completed and March 2008 PM G Completed management, income Book 2008/09 presented to Trust Board for recovery and procurement approval systems to meet Delivering of Savings Savings delivered to plan (see 5.1) Monthly PM A Some areas of concern – continually being Foundation Trust Programme monitored. requirements, including Patient Level Costing Plan approved by finance April 2008 PM G Completed the introduction of /Service Line Reporting committee in March (ahead of patient-level costing and Plan target date) service-line reporting Patient Level Costing Implementation complete April 2009 PM G Inaugural meeting of Project Board held 3rd July. /Service Line Reporting Monthly reporting on progress to Finance Committee fully implemented – on target Meet requirement for new System procured and implemented October PM G Project on target. Financial system 2009 Revised capital Capital Process and Programme May 2008 PM G Completed programme agreed To continue the Implement National IT network to be fully accepted by Continuous PM A Awaiting national guidance on New National development of clinical Programme for the National Programme for Contract. Local Procurements continuing on information systems to Information Technology. Information Technology. Various schedule, ie, Order Comms enhance the delivery of enabling projects continue. patient care and improve Continue to develop Developments continue to benefit Continuous PM A On-going service efficiency aligned innovative web solutions and provide support to both to the National clinical and administrative staff Page 9 of 18 Objective Aim Performance Indicator Target date Lead RAG Progress/Next steps Status

Programme for Review processes for Review complete and action plan September PM A Project underway to deliver changes. Report to TEG Information Technology. coding and discharge in place 2008 4th February communication Procure new Contracting New Contract Management system December PM G Management system implemented 2008 In progress – will be implemented April 2009 Review arrangements for Implement new robust June 2008 PM A sound information arrangements in light of any On-going governance and data findings from the review security

RESEARCH AND DEVELOPMENT – IRENE SCOTT / JONATHAN SHEFFIELD To procure a 3T MRI and To progress the Clinical Achieve formal planning consent December IS G MRI selection completed by University of Bristol. develop the Clinical Research Imaging Centre Finalise 3T MRI supplier 2008 Memorandum of understanding and business plan Research Imaging Centre development at St being developed. Planning Application submitted, at St Michael’s Hospital Michael’s Hospital with positive decision expected during January. with the University of the University of Bristol Bristol To refresh the Research & Increase spread of 90% of local Acute Trusts April 2009 JS G Formal launch of CLRN 25.9.08. All appropriate Development strategy, in comprehensive local involved posts now recruited. line with the Clinical Research Network Strategy review, and build Human Factor Training Programme for theatres on recent successes in funded. Programme now being developed. Programme Bids Achievement of two Two successful short listed bids April 2009 JS A One programme bid successful. Two further being further NHS Programme considered. bids Develop Board SMART indicators of research and October JS G Action completed. performance indicators development performance included 2008 for Research and in Board reporting framework Development

ORGANISATIONAL DEVELOPMENT – ROBERT WOOLLEY / LINDSEY SCOTT / JONATHAN SHEFFIELD / ALEX NESTOR To participate fully in the Deliver the access and Multiple Indicators and Targets April 2009 JS G Strategic framework launched 5th January. review by Lord Darzi of quality targets of the will be set out in the Strategic Plan the NHS, formulation of Strategic Plan the NHS South West Strategic framework and the further development of the Bristol Health Page 10 of 18 Objective Aim Performance Indicator Target date Lead RAG Progress/Next steps Status

Services plan Governance and Member Compliance with Core Core standard met and reported in Quarterly LAS G All arrangements were in place in time for ship: Standard 7a&c (relating quarterly assurance framework authorisation. The investment committee to working with local report. establishment as part of the Finance Committee was To establish governance health and local authority April 2009 agreed at Board on the 1st of July. arrangements appropriate organisations and working Compliance declaration at year end to Foundation Trust status together in local for Core Standard 7a&c. A range of patient experience and feedback sessions and, in particular, the partnerships) were held in August to inform the plan for patient and Board Meet Monitor Monitor performance reporting Quarterly LAS G public involvement. performance reporting requirements met. from To implement the requirements authorisatio Foundation Trust n membership plan for Deliver on actions in Membership and Governor plan in March 2009 LAS G 2008/09, which includes Membership Plan place for year 1. Ensure integration growing the membership, with wider 3 year PPI plan supporting the Representation improved Increased membership by end Mar March 2009 LAS G membership, achieving upon March 2008 position 09 addressing representative issues representation and establishing the members council

To agree the five year plan for patient and public involvement -this integrates work with the Trust’s membership. This will include the establishment of a patient panel. To agree and start work Carer Strategy Completed Agreed strategy in place April 2009 LAS G Work to start in the patient experience sessions that on the carer strategy will be held in August To achieve authorisation Achieve authorisation as a Authorisation Confirmed June 2008 RW G Trust authorised as University Hospitals Bristol NHS as a Foundation Trust Foundation Trust Foundation Trust on 2 June 2008 To enhance the positive Improved communication Programme of media training June 2008 RW New corporate communications strategy under reputation of the Trust capability in Divisions exercises in place for year G development for January 2009 which will generate through proactive Define Key Performance Agreed performance indicators July 2008 RW key performance indicators. Positive engagement communications and raise Indicators for subject to routine monitoring A with Divisions continues. Improved level of positive its profile in local and communications activities to negative coverage is confirmed by SHA media Page 11 of 18 Objective Aim Performance Indicator Target date Lead RAG Progress/Next steps Status national policy Improve the level of As demonstrated by agreed Ongoing RW monitoring. formulation positive media coverage performance indicators G To deliver the third year Evaluation of The third year of this programme is underway as of the corporate social achievements for 2007/08 Evaluation complete, Targets April A G planned, and includes additional area of work responsibility programme, set for 2008/09 2008 N ‘Pennies from Heaven’. focusing on key initiatives Energy Efficiency and with our local community Waste Reduction Action plan in place, March A G in Bristol and the wider completed and evaluated by 2009 N community, including year end internationally Health and wellbeing Action plan in place, completed programme and evaluated by year end March A G 2009 N Schools Ambassadors Action plan in place, completed programme and evaluated by year end March A G 2009 N To develop and implement a high quality intranet May 2008 AN New intranet successfully launched on 16th which significantly enhances the management and the High quality site which G September. governance of the Trust. attracts regular usage and good feedback To enhance customer service skills, particularly for March 2009 AN A Trainer has been appointed to lead customer front line staff. A services skills for ‘front line staff’. Three work shops Achieve target numbers set are planned for each month until year end with a for rollout target of 250 staff going through the workshop. 100 staff completed workshop.

CAPITAL DEVELOPMENT – IRENE SCOTT / ROBERT WOOLLEY To continue to invest in New primary electrical Power capacities achieved February IS G On programme. the Trust’s estate, sub-station 2009 particularly in the patient “BHOC Refresh” Improved patient areas in BHOC Dec 2009 IS G Detailed work to finalise design and increase cost environment, and to certainty completed. Specialised Services Division to improve physical access Jan 2010 make application for charitable funding for majority to services through of scheme January 2009. development of additional BRI Queens Building Improved external appearance. tba IS G Governors’ advice is not to undertake the ‘do on site parking for frontage minimum’ option and to include this in BRI patients and visitors. Redevelopment Plans. Concrete repair works being costed. To complete the planned Refurbishment of theatre Good staff facility and infection Mar 2009 IS G Capital funding prioritised. Work commenced and

of 18 Objective Aim Performance Indicator Target date Lead RAG Progress/Next steps Status centralisation of sexual changing rooms at risks reduced. due for completion on programme. health services at the Heygroves and St Central Health Clinic Michael’s Hospital Works to achieve Compliance not inhibited by estate August IS G Complete compliance in reasons 2008 Histopathology in the BRI Queens Building. IM&T relocation project Successful transfer of operations January IS A Contract proceeding on programme for completion from Terrell Street to Southwell 2009 April 2009. IM&T Dept to transfer post completion Street to fit in with BHI commissioning programme.

Clinical Research Centre Building works complete to time / December IS G Capital funding prioritised. Procurement of work (CRIC) budget 2009 commenced.

Bid to the Wolfson Bid meets Wolfson criteria September IS A Wolfson bid unsuccessful. New smaller feasibility Foundation for a Clinical 2008 study being undertaken for SH&N Division to expand Research facility in the Lucentis service (will require capital funding). Eye Hospital. December Development of a 5-year 2008 Feasibility study under way for SH&N Division to space use plan achieve paediatric Healthcare Commission December compliance in the Eye Hospital. (Capital bid for 2008 2009/10)

Replacement and upgrade Clinical risks identified. Solution October IS G Capital prioritised for 2008/09. Contractor appointed, of pneumatic tube system to eradicate agreed and 2009 user group reconvened, final details being agreed for implemented commencement in January 09. Further rationalisation of Provision of training facilities on March 2009 IS G Awaiting outcome of review of Education Centre. training facilities within time and to agreed specification. the Education Centre to make provision for IM&T. Trust Boardroom suite Trust Boardroom completed on March 2009 IS G Phase 1 work complete January 2009. Phase 2 time and to specified standard. follows on. Risk Management Absence of adverse incidence / March 2009 IS G Planned and reactive works being progressed. No Programme: prosecutions. adverse indications at this time. DDA compliance Fire Safety Backlog maintenance Page 13 of 18 Objective Aim Performance Indicator Target date Lead RAG Progress/Next steps Status

Health and Safety Lease obligations. Integration of Sexual Building functional in accordance July 2008 IS G Project complete. Health Services in Bristol with divisional operational Plan / Business Case Patient Environment Demonstrable change in the quality March 2009 IS A Bathroom and toilets improvement programme in improvements of facilities in chosen areas as per place. Scope of works increased by £100K to add two specification. additional cubicles on Ward 11. The need to avoid bed closures has delayed the programme. Programme has now been reviewed and re-scheduled between January and September 2009. Ward 26A annexe has now been converted to a Cohort Ward. Patient environment works prioritised by TOG September 2008 and being delivered. To establish robust plans Establish work Formal work plan and steering April 2008 IS G SBCH Steering Group in place to direct activity with for the transfer of services programme for transfer of group in place detailed action plans. to the South Bristol services to SBCH and Community Hospital and internal steering group the closure of the Bristol Agree specifications for Service specifications agreed with May 2008 IS G SBCH Steering Group in place to direct activity with General Hospital. service provision at Bristol PCT detailed action plans. SBCH To progress construction Complete construction of Building completed and Feb 2009 RW G Scheme on programme to complete in February 2009 of the new Bristol Heart the Bristol Heart Institute commissioned with services operational by May 2009. Institute and develop full Preparation for the Key Full Business Case sections March 2009 RW G On programme to deliver Full Business Case in 2009. business cases for transfer of specialist complete redevelopment of the children’s services from Bristol Royal Infirmary Frenchay Hospital to the and the centralisation of Bristol Royal Hospital for specialist children’s Children services at the Bristol Preparation for the Key Full Business Case sections March 2009 RW G On programme to deliver Full Business Case in 2009. Royal Hospital for redevelopment of the complete Children. Bristol Royal Infirmary

TEACHING AND LEARNING – ALEX NESTOR To continue to develop and deliver a comprehensive Focus leadership development in Ongoing AN G Leadership programme leadership programme at all levels of the organisation, particular on skills required to established for 2008/2009 and published. Currently in reflecting our values and vision, including business support Foundation Trust status roll-out. Page 14 of 18 Objective Aim Performance Indicator Target date Lead RAG Progress/Next steps Status acumen, innovation, partnership working and social Assessment of annual training plan March 2009 The focus this year has been the development of a responsibility to ensure it is fit for purpose management programme due for roll-out in January 09. To evaluate and increase the impact of the trust in Implement regular reporting on AN Proposed Teaching Metrics being presented to Trust providing high quality teaching, training and placement metrics regarding teaching and May G Executive Group in July, and requires further opportunities training. 2008 refinement. Teaching Metrics to be devised upon the development of the Teaching and Learning Strategy group with assigned leads. Implement new e-learning AN E-Learning lead has been appointed and the range of  To extend the packages on leadership skills. June G materials has been increased. range and quality of Uptake and Evaluation of materials 2008 All materials need to go through the e-learning group electronic and blended for quality assurance. learning Coverage and Accuracy Audit AN OLM is now in place for corporate training. A roll-  To use the To assess accuracy of information Septe G out plan is being scoped out for the trust. electronic Oracle Learning held on the Oracle system and use mber Management system to to assess skill levels and training 2008 enhance analysis of existing requirements, especially at level 1, workforce skills and provide 2 and 3 skills a focussed approach for future skills development To enhance the provision of development opportunities Specific analysis of level 2 AN There is now a new integrated approach to SFL and around skills for life and Level 2 skills (approximately learning amongst ancillary and G NVQs – a summary to go to the Board. equivalent to 5 GCSE’s at A – C grade) and skills for administrative and clerical staff, life. Progression towards Leitch ‘pledge’ for 2010 and production of development Awareness raising for Managers is planned as part of plan post analysis the HR Roadshows in January and February 2009. 4. Administrative and clerical Awareness raising for staff will follow with a number Staff of promotional events.  Ancillary Staff

July 2008 Sept 2008

of 18 Objective Aim Performance Indicator Target date Lead RAG Progress/Next steps Status

WORKFORCE – ALEX NESTOR  To continue to To continue to attract and Support Chief Nurse in reducing AN On-going. After a period of increased vacancies, attract and retain high retain high calibre staff nurse vacancy levels, particularly Febru G vacancy levels reduced. However, during the last calibre staff at Bands 2, 3 and 5. Have detailed ary to three months there has been a slight increase in strategies for posts perceived as July vacancies.  To provide hard to recruit for 2008/09 2008 sustainable succession Specific initiatives continue in order to address and career planning shortages at Band 5 however, with a national shortage strategies in the Trust at this level, winter pressures and ward openings,  To continue to Trajectory in place for 6 vacancies have seen an increase over the last couple move towards the trust months to monitor reduction of months. Recruitment continues for Nurse vision of the in nurse vacancy levels Assistants seeing a small improvement in vacancies workforce and skill at this level. mix for the future, To provide sustainable Performance against plan. Plan AN including establishing succession and career currently being devised. A A review of the Management and Leadership the Assistant planning strategies within programme is currently being undertaken and Practitioner the Trust the plan is for these programmes to reflect a programme and clear career pathway. A Talent Management Nursing Assistant Programme is currently being scoped in framework, and Women’s and Children’s. developing a five year To continue to move Train 20 Assistant Practitioners. AN workforce and skill towards the trust vision of Recommence NVQ 2 training and Traini G 20 more Associate Practitioners planned for mix plan for the Allied the workforce and skill new NVQ 3 training cohort. ng March 2010. Associate Practitioner facilitator Health Professionals mix for the future, comm to start in January 2009. 3 NVQ Co-ordinators and Healthcare including increasing Achievement of planned numbers ences appointed August 2009, 1 to be appointed Scientists. numbers at higher of staff trained. March January 2009. NVQ Assessor support to be National Vocational 08 provided, further workshop for AHPs and  To deliver robust Qualification (NVQ) Healthcare Scientists to support skill mix plan, workforce strategies to levels and assistance produced November 2009. NVQ registrations support the Full practitioners. are on track with the plan. Business Cases for the To deliver robust To support Divisions in the AN BRI Workforce Plan to support business plan to BRI and Specialist workforce strategies to production of workforce plans to As G commence when options for service provision and Paediatrics, the Trust support the Full Business underpin the business cases. deter configuration have been defined, work on reviewing preferred provider role Cases for the BRI, Agreement of business cases mined the OBC workforce plan to commence in January for the South Bristol Specialist Paediatrics, and underpinned by workforce by 2009. Community Hospital, service changes/transfers. strategies Projec and service t Page 16 of 18 Objective Aim Performance Indicator Target date Lead RAG Progress/Next steps Status

changes/transfers Group  To continue to s focus on increasing To continue to focus on Embed supporting attendance September AN G Supporting Attendance policy in place, training for service improvement increasing service across all divisions, and through 2008 line managers completed. HRM’s monitoring and productivity, using improvements and this support Divisions to achieve monthly sickness absence and following up long term the involvement and productivity, using the targets for sickness reductions sick records / frequent short term absences with line expertise of staff to involvement and expertise managers. Review of sickness-related CRES plans support this at all of staff to support these at Continue to reduce ‘time away December due October 2009. stages all stages. from work’ due to efficient 2008 training methodologies. January 2009 reviewing policy to take on board Line Managers feedback. Re-launch policy in conjunction with staff side February 09. To develop and For Human Resources function implement a high quality specifically, implement Staff Map End of A G Staff Map launched on 16th September. Health intranet which and health and wellbeing site. Add May N & Wellbeing achieved. HR Zone to be significantly enhances the Human Resources Zone to HR 2008 integrated into workspace. management and the Web. governance of the trust. Maintain a high quality site which attracts regular use and positive feedback – ongoing monitoring Ongoing

To enhance customer Annual Training Plan Evaluation services skills, Continue detailed rollout March A G Divisional meetings and review Training Plan particularly for front line programme across divisions – 2009 N all on target. staff. further targets to be set post evaluation Maintain progress in Action programme in place to relation to Staff Attitude respond to staff attitude survey Contin A G Action plan updates reported to TOG quarterly. Survey results results, including aspects of staff uous N (comparative national health and well-being results to be known in April 2008) Continue development of Recruitment strategy in place recruitment strategy, with Contin A A Action plan being developed particular reference to uous N schools and college leavers in Bristol and Page 17 of 18 Objective Aim Performance Indicator Target date Lead RAG Progress/Next steps Status

surrounding areas.