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Lewisham and Greenwich Nhs Trust Trust Strategy, 2021

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Lewisham and Greenwich Nhs Trust Trust Strategy, 2021 H LEWISHAM AND GREENWICH NHS TRUST TRUST STRATEGY, 2021-2026 CARING FOR OUR COMMUNITIES Page 159.3 of 159 H Content Page 1. Executive Summary 3 2. Introduction 8 3. Strategic Context 9 • About us • Our Services • Population we serve • Our System Partners 4. Drivers for Change 14 • National Policy, Internal and External drivers • Health needs of our population 5. Our improvement Journey 17 6. Our Strategy 20 1. Quality 2. Patients 3. People 4. Partnerships 5. Money 7. How we get there 26 Appendices 28 Page 159.4 of 159 1. EXECUTIVE SUMMARY H LEWISHAM AND GREENWICH NHS TRUST WAS FORMED IN OCTOBER 2013 The organisation faced early challenges and period of instability. Initial uncertainty about services – the future of some of our key services were unclear – national decision was taken to overturn radical plans for reconfiguration Issues with our workforce – illustrated through high vacancy rates Some progress in service redesign and cross-site working, but this was not consistent Financial instability – we missed our financial targets These factors meant that we faced real challenges progressing our plans for the future. IT WAS CLEAR WE NEEDED TO STABILISE THE TRUST AND SERVICES LGT entered 2018 facing challenges on every front – workforce, quality, performance and finance. This meant that we were compelled to put some of our more ambitious plans, for example for the redevelopment of our sites, on hold while we concentrated on some of the basics. WE HAVE MADE SUBSTANTIAL PROGRESS DURING THE LAST TWO AND A HALF YEARS Three years ago our vacancy rates were among the highest in London (17%), today they are among the lowest (below 9%) • While our overall CQC rating remains Requires Improvement, we have made demonstrable improvement across all areas of our quality dashboard and are now rated good for well led. • Despite running some of the busiest emergency services in London in facilities which require substantial investment, our performance throughout 2020 has been among the strongest in London • We have delivered our financial targets for the last two years and are cautiously optimistic regarding our outturn position for 2020/21 We believe the time is right now to be clear both on our clinical strategy and on some of the enablers and supporting investment we consider essential to its delivery. We have set out the risks to delivery in our Board Assurance Framework so we position our strategy not only about our evolution but also a necessity in order to best solve the key challenges we are facing. Page 3 Page 159.5 of 159 H THE PROGRESS OF THE LAST TWO YEARS SHOW WE ARE RIGHT TO BE AMBITIOUS Achieving our vision will mean: Quality – we will deliver consistently high quality local services to the people of Bexley, Greenwich and Lewisham Patients – we are first and foremost a community provider of local and acute care. We are proud of the role we play and are committed to contributing to the vitality of local communities and to reducing inequalities. People – LGT will be a great place to work. We have strong values which all our staff must live and breathe. All staff will feel supported. Partnership – We have moved on from the negative, competitive behaviours of the past and are firmly committed to partnership. We will ensure that we take a strong LGT perspective into those partnerships but will ultimately strive for consensus and mutual support on the basis that this will ultimately be in the best interests of patients. Money – we will be able to demonstrate efficiency and value for money across all of our activities. WE HAVE DEVELOPED OUR 5 YEAR TRUST STRATEGY This strategy provides the strategic certainty which was so elusive during LGT’s early years. Much remains to be done, not least in our efforts to reduce variation and develop consistent models and standards of care across all our services. We recognise there will be a series of challenges to deliver our strategy, not least the forecast growth in our population, but a demographic that has considerable variation and areas of significant deprivation. We will now embark on a rolling development programme to take that next phase forward. Our strategy has 5 key threads which are: 1. CLINICAL STRATEGY Driving all our thinking on the future is our Clinical Strategy. This area has been contentious since the mid-2000s but we have now achieved consensus with our provider partners, commissioners and the South East London Integrated Care System (ICS) on key areas of potential debate; We will continue to run 24/7 emergency services on both our acute sites, at Queen Elizabeth Hospital (QEH) in Woolwich and at University Hospital Lewisham (UHL), QEH will retain a central role in South East London as one of the busiest emergency centres in the capital and will require substantial capital investment on that basis Page 4 Page 159.6 of 159 H We will provide integrated community care for adults and children, working closely with our partners in primary care, mental health, social care and in the voluntary sector Full consultant-led maternity services will continue to be provided from both UHL and QEH, whilst services are also extended into the community to support mothers closer to home We will work with other hospitals in South East London to redesign our provision of elective care, developing our thinking around the future of UHL as an easily accessible hub for planned care in the heart of South East London We will transform outpatient services, capturing and building on the rapid progress made during the Covid Pandemic while ensuring that services are designed in the most appropriate way for the individual patient and clinical team Cancer pathways will remain a priority, again with increasing consolidation at UHL In tandem we have developed the essential enabling strategies for Workforce, Digital, Estates and Finance. These come together to form our overarching Trust Strategy. 2. WORKFORCE STRATEGY We have made clear our commitment to making LGT a great place to work for all. We are equally clear that this has not always been the case in the past. We believe the recent improvements in our vacancy rates demonstrate that we are making good progress. Crucially we believe we will deliver our objectives by: • Recruiting staff who share our values • Caring for the health and well-being of all our staff • Developing and retaining a workforce that is fit for the future • Creating inclusive workplaces Our priorities for the next few years are wellbeing, inclusion and talent management with access to support in career development. We will make policies clear and simple and work in partnership with other public sector organisations in South East London. Our strategy is consistent with both the NHS People Plan and the London Workforce Race Strategy. Page 5 Page 159.7 of 159 H 3. ESTATE STRATEGY We have equally ambitious and necessary plans for our estate. While the new QEH first opened 20 years ago, the core infrastructure dates back to the early 1970s. The clinical space was not designed to meet the requirements of a busy DGH and certainly not to deal with the demands placed on it by a rapidly growing population. The space challenges have only been compounded during Covid, with Infection Prevention and Control a persistent challenge. While we have previously secured central funding to the tune of £48m to invest in the infrastructure at QEH, we believe further substantial investment will be necessary to make the hospital fit for the next 20-30 years and to right size it for the future. With this in mind and in partnership with the ICS we have commenced work on a Strategic Outline Case (SOC) for the substantial redevelopment of the QEH site, focusing first and foremost on those areas with the greatest need for investment – namely the Emergency Department, Critical Care and Imaging. This SOC will be complete by the spring of 2021. At the same time we are developing our plans for both the UHL site – focusing on our emergency pathway, the development of a hub for planned care and the reprovision of South London & Maudsley’s NHS Foundation Trust’s inpatient psychiatric service (from the current Ladywell Unit) – and for our community estate. Our ambition is to move with pace to a position where we are able to provide both our clinical and corporate services in a modern and appropriate environment, digitally-enabled to support flexible working. • Make better use of space utilisation, functional suitability, quality, adaptability and environmental management. • Substantially reduce our backlog maintenance liability and have efficient “fit for purpose modern facilities”. • Have a green and sustainable approach 4. DIGITAL STRATEGY The digital agenda is crucial for the NHS and again we have made strong progress. We have a single Electronic Patient Record (EPR) system to support our acute services across both sites. We successfully deployed the functionality to support electronic prescribing and clinical documentation during the summer of 2019 across most of our services. This process will be completed during 2021 as we go live in Outpatients and Paediatrics. We are replacing obsolete systems for Picture Archiving and Radiology and have procured Trust-wide solutions. Again these will go live during 2021. In the community in Lewisham we have the well-established RiO system, consistent with the system used by our community partners in Oxleas NHS Foundation Trust in Greenwich and Bexley. Page 6 Page 159.8 of 159 H While LGT is increasingly digitally mature we do retain a number of more bespoke legacy systems. We are working hard to ensure that we have clear plans in place to ensure that the way in which these systems are integrated with Cerner is consistent and that we have a robust programme for updating and, where appropriate, replacing them over time.
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