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. As a system in Lewisham we are at the forefront of thinking nationally on Population Health and have invested in digital systems to support this. This reflects LGT’s commitment to tackling health and wider inequalities in our local communities. On this point we are mindful of the risk that in our desire to push towards digital we may marginalise some citizens for who tech-based solutions are not the right ones. To do this we aim to:

• Paperless workflows, digital the primary method of patient interaction with the Trust • Holistic view of patient from many discrete sources – digital support for full patient pathway • Agile adoption of new technologies and transformed services – e.g. outpatients 5. FINANCE

It is, however, encouraging that we have hit our financial targets for the last two years and we are clear from benchmarking that we have the opportunity to drive greater value for money while also improving the quality of our services.

In summary we are able to set out an exciting strategy for the next five years, having focused since April 2018 on the groundwork of culture, preparation and delivery. There will be many challenges but we have demonstrated our resilience throughout the Covid pandemic. Ultimately we aspire to:

• Deliver consistently high quality local services in hospital and in the community • Support our people to fulfil their potential • Provide our clinical and non-clinical services within a modern environment, digitally enabled where appropriate • Continue to build strong partnerships within South East London

Lewisham & Greenwich NHS Trust has a clear and exciting vision. We are clear on our own strategy and we will remain enthusiastic and proactive members of the Integrated Care System, Acute Provider Collaborative in South East London and Bart’s Health Care Pathology Partnership. Many challenges remain and more will emerge in the future but we are committed to driving further improvements for the people of Bexley, Greenwich and Lewisham. On this basis we look forward with confidence to the next five years.

Page 7

Page 159.9 of 159 H

2. INTRODUCTION

Lewisham and Greenwich NHS Trust (LGT) provides acute healthcare from two busy hospital sites and a range of community services. It was established in October 2013 following a period of intense controversy around the sustainability and configuration of acute services in South East London. This debate and uncertainty overshadowed the early years of the Trust’s existence during the course of which performance declined and politics dominated. These dynamics were largely outside LGT’s direct control, but they were compounded by a combination of inconsistent performance, weak governance and financial failings. Unsurprisingly morale was low and vacancy rates were among the highest in London. Cultural issues were endemic and rates of whistleblowing were high. At its lowest ebb the Trust was identified by its regulator, NHS Improvement, as one of the most challenged in England.

From April 2018 onwards the Trust embarked on its IMPROVEMENT JOURNEY. It has confronted its legacy and has been transparent and direct in the way it has addressed its issues. We are up front about the fact that we have more to do but are proud of the progress we have made through the efforts of our staff and with the invaluable support of our local communities. During 2020 the Trust, its staff and local people have been tested in a way that most of us have never been tested before. The response of our staff and the enormous goodwill of the people we serve have been inspiring.

Page 8

Page 159.10 of 159 H 3. STRATEGIC CONTEXT OUR VISION To work together to provide high-quality care for every patient, every day.

OUR VALUES OUR PRIORITIES • We treat everyone with respect and compassion Our five priorities are the things we care about • We work as a team to improve quality most and are central to achieving our vision. • We take responsibility for our actions Supporting our priorities we are proposing several • We work together for patients and colleagues ambitions which provide a bit more information on • We learn, develop and share knowledge the focus for each priority.

Page 9

Page 159.11 of 159 H ABOUT US Lewisham and Greenwich NHS Trust (LGT) was established on 1 October 2013 following the merger of Lewisham Healthcare NHS Trust and Queen Elizabeth Hospital (formerly part of South London Healthcare NHS Trust). We serve more than 800,000 people in the local communities of Lewisham, Greenwich, Bexley and other parts of South East London.

WE ARE RESPONSIBLE FOR:  Queen Elizabeth Hospital (QEH) in Woolwich  University Hospital Lewisham (UHL)  A range of adult and children and young people community health services for adults, children and young people in Lewisham, Bromley Stroke Rehabilitation service, hosting the GSTT Community Head and Neck Cancer Team (CHANT) service at the Waldron Health Centre.  Some outpatient services at Queen Mary’s Hospital in Sidcup.  Other services including Imaging at Eltham Community Hospital and Phlebotomy at Community Health centres, Eltham Community Hospital and Erith Hospital

We are proud to serve our communities with a comprehensive range of high quality, local hospital and community services and in turn we feel supported by our communities with over 94% saying they would recommend us to friends and family (Friends and Family Test 2018/19). The Care Quality Commission (CQC) inspected the Trust early in 2020 and published its report in July 2020. The Trust’s overall rating was “requires improvement”, but the CQC found many improvements since their previous inspection in March 2017, and rated our Community services as “outstanding”. They also commented on how caring they found our staff, with the Trust’s rating in the caring domain improving to “good”. While the CQC agreed with our assessment that there is more to do, they found positive signs that we are addressing the challenges we face. The report shows that we are moving in the right direction.

Page 10

Page 159.12 of 159 H OUR SERVICES

WE HAVE TWO ACUTE HOSPITAL SITES:  Queen Elizabeth Hospital provides a wide range of inpatient and outpatient services, as well as emergency and planned care for people living in Greenwich, Bexley and other neighbouring boroughs.  University Hospital Lewisham provides both planned and emergency healthcare to residents of Lewisham and other local boroughs, including Greenwich, Bexley, Bromley and Southwark. COMMUNITY SERVICES

We provide community services in Lewisham for adults, children and young people offering a full range of services to support people in their homes, intervening early to avoid admissions and supporting early discharge for patients who are admitted. We work closely with other providers such as primary, social and mental health care. The Bromley Stroke rehabilitation team provides an intensive and rapid stroke rehabilitation service for patients in their own homes.

Our services for adults are provided by highly skilled professionals including community matrons and midwives, district nurses, the diabetes team, the home enteral nutrition team, the community head and neck team, podiatry and our sexual and reproductive health team. Services for children and young people include health visiting, occupational therapy, physiotherapy and speech and language services.

In Greenwich and Bexley community services are provided by Oxleas NHS Foundation Trust (www.oxleas.nhs.uk).

EDUCATION AND TRAINING

The Trust is a centre for the education and training of medical students enrolled with King’s College London’s GKT School of Medical Education. We are a training centre for nurses, midwives and allied health professionals and are pioneering new roles that will support the changing needs of our patients. In Lewisham, our health professionals also provide care to adults and children in a range of health centres, community clinics, and in patients’ own homes.

Page 11

Page 159.13 of 159 H THE POPULATION WE SERVE Our patients access our services from three main boroughs; Lewisham, Greenwich and Bexley with some patients accessing services from the wider South East London locality. There are distinct differences between the populations of Lewisham (who mainly attend UHL) and those of Greenwich and Bexley (who mainly attend QEH) and this creates different pressures and challenges for the services we provide across the boroughs.

OUR DEMOGRAPHIC

There are areas of affluence in each of the three boroughs we serve, but considerable variation and areas of significant deprivation. The table below sets out key characteristics of our three core communities (2015). Lewisham has the highest proportion of children (29.6%) and older people (25.7%) in economic deprivation in England. Lewisham Greenwich Bexley Deprivation (national rank out of 326 boroughs in 48th 78th 191st England) Life expectancy (women) 83.7 82.5 84.1 Life expectancy (men) 79 79 80 Healthy life expectancy (women) 64.3 61.0 63.9 Healthy life expectancy (men) 61.9 63.2 65.0 Ethnic diversity (national rank across local authorities) 24th 20th 43rd

POPULATION AGE PROFILE

Much of the growth in Lewisham is driven by births exceeding deaths and migration from EU and non-EU countries. The age profile between the boroughs is however significantly different.

In Lewisham, Greenwich and Bexley, the 2011 census found around a quarter of the population was aged 19 or under. Bexley also has a higher percentage of people aged over 65. According to the Office for National Statistics, 20% of Bexley’s population is expected to be over 65 by 2036, compared to 13% in Lewisham and 14% in Greenwich.

Page 12

Page 159.14 of 159 H OUR SYSTEM PARTNERS SOUTH EAST LONDON INTEGRATED CARE SYSTEM

The South East London partnership “Our Healthier SEL” was the first ICS in London and LGT has sought to be a proactive and positive partner. The ICS is organised on the basis of a ‘system of systems which recognises that integration happens at a number of levels, with partnerships established both within and across boroughs. The diagram to the right shows the health providers across the 6 boroughs. The organisations in SEL have a strong history of collaboration and together are committed to delivering a system ambition “to deliver a clinically and financially sustainable system for the future and address health inequalities in south east London” SEL ICSs priorities are entirely consistent with those of LGT: 1. Integrated community based care 2. Reduce pressure on urgent and emergency care 3. Improve planned care outcomes and performance 4. Deliver better outcomes for major health conditions 5. Deliver financial savings and achieve agreed financial targets SOUTH EAST LONDON CCG

The CCG was established 1 April 2020, by merging Greenwich, Lewisham, Bexley, Bromley, Lambeth & Southwark CCGs. Each local area has a Borough Based Board and a local Director, responsible for local partnerships, with a number of supporting groups and committees. LGT is actively engaged in these groups for Lewisham, Greenwich and Bexley. PROVIDER COLLABORATIVES Along with our partners in Guy’s & St Thomas’ NHS Foundation Trust and King’s College Hospital NHS Foundation Trust we have established an Acute Provider Collaborative in South East London. This reflects the shift in national policy during recent years and the move away from the more competitive behaviours of the past. The focus increasingly is on ensuring that the local offer from the NHS is consistent across the whole of South East London. Alongside this we have moved to establish parallel arrangements separately with both Oxleas and South London & Maudsley NHS Foundation Trusts, to ensure that we retain a genuinely holistic focus on care and provider partnerships.

Page 13

Page 159.15 of 159 H 4. DRIVERS FOR CHANGE

NHS LONG TERM PLAN The Long Term Plan for the NHS (LTP) has set out clear requirements for how services will be delivered across the NHS by all providers. This strategy forms our response to the LTP and demonstrates the alignment of our plans to the national drivers for change. NHS PEOPLE PLAN The NHS People Plan for 2020/21 recognises the increasing pressures on our people and the need to look after them. In order to address this now, and for the future, the NHS needs more people, working differently, in a compassionate and inclusive culture. This plan sets out practical actions for employers and systems to take over the remainder of 2020/21. It focuses on: • Looking after our people particularly the actions we must all take to keep our people safe, healthy and well – both physically and psychologically. • Belonging in the NHS highlighting the support and action needed to create an organisational culture where everyone feels they belong. • New ways of working and delivering care emphasising that we need to make effective use of the full range of our people’s skills and experience to deliver the best possible patient care. • Growing for the future particularly the need to build on renewed interest in NHS careers, to expand and develop our workforce, as well as taking steps to retain colleagues for longer.

LONDON WORKFORCE RACE STRATEGY

London’s Workforce Race Strategy outlines the challenge and complexity involved in addressing race inequality, while recognising that this will require a long-term commitment. A series of 15 evidence-based recommendations set out how London’s NHS can make a significant and tangible difference to the experiences of its BME workforce.

Page 14

Page 159.16 of 159 LOCAL DRIVERS H

OUR HEALTHIER SOUTH EAST LONDON (OHSEL) We have aligned our strategy to maximise the utilisation and efficiency of our core estate, through collaborative working across all our Integrated Care System partners. This will involve integration with the wider public sector, collaborating on sharing and co-locating back office and other functions. We continue to maximise opportunities to enhance community-based care, to establish community ‘hubs’ for integrated, multidisciplinary working and to support care closer to home. We aim to maximise the opportunity through coordinated estate rationalisation to reinvest in the local estate and expand estate capacity to meet growing demand for planned care. LONDON DEVOLUTION INC LONDON ESTATES BOARD In August 2019, The London Estates Board (LEB) set out their vision for health property in the capital, titled ‘London’s Estate Matters: Health and Care Estates Strategy’. This is a partnership approach and the first time in the history of the NHS that a London-wide health and care estates strategy had been produced. The challenges of achieving this are acknowledged, such as the shortcomings within the existing estate; the report suggesting that up to one-third of the primary care estates needs to be replaced with superior facilities. The LEB aims to help deliver this £8 billion of investment, to support the release of around £2 billion of surplus land, and in turn to assist with the development of 12,500 new homes for London. ONE PUBLIC ESTATE (OPE) We are part of the One Public Estate (OPE), in Lewisham. Bexley Council have some small, non-health related projects and Greenwich Council are not part of the OPE, but the Trust will support them if they join in the future. The members of Lewisham OPE are, London Borough of Lewisham (LBL), Lewisham & Greenwich NHS Trust (LGT), Lewisham Borough Based Board, South London and Maudsley NHS Foundation Trust (SLaM and One Health Lewisham representing the Lewisham GP PCNs. The Lewisham OPE programme aims to make better use of public-sector sites, free up space for new homes and create jobs. It encourages the public sector to work more closely together by sharing sites and creating public-sector ‘hubs’ – where services are delivered in one place. OPE supports eight projects in Lewisham.

Page 15

Page 159.17 of 159 CHALLENGES AND OPPORTUNITIES H POPULATION GROWTH AND DEMOGRAPHICS The populations of both Lewisham and Greenwich are set to continue to grow by 11% over the next 10 years, with Bexley’s population set to grow by 10% over the same period. The growth in the northern wards of Bexley and Greenwich – those communities which will naturally look to Queen Elizabeth Hospital as their acute provider – is predicted to be as high as 25%. A high proportion of our patients live in areas that are amongst the most deprived in England, while a smaller proportion live in the most affluent areas. Lewisham and Greenwich both rank amongst the 15% most deprived local authority areas in the country and whilst Bexley is significantly less deprived overall there are pockets of deprivation in some wards. POPULATION HEALTH ADDRESSING INEQUALITIES Lewisham has an integrated data platform which provides dashboards and analytics to support a population health approach. Local multidisciplinary teams are beginning to use this to identify gaps in care and target interventions to those most in need. This allows a case-finding approach to be taken in priority areas such as diabetes and frailty. We can now identify patients who might previously have slipped through the net and optimise their care. It also allows us to track the impact of interventions on reducing variation and inequalities. This wider programme of work is in line with the LTP which has emphasised the importance of population health approaches (with an expectation that every ICS will have an integrated data set) and the need to address long standing inequalities. DEMAND AND CAPACITY The Trust must, first and foremost, strive to make best use of the facilities and resources which are currently available to it. We know that we currently have duplication and variation in the way we run our services and we will strive for upper quartile levels of productivity or better. The fact remains, however, that even having delivered that level of improvement the anticipated increases in population and the associated demand on our services is highly likely to result in a shortfall in capacity in our services over the next 5-10 years. Our emergency departments already care for over 1000 patients a day, in facilities designed for 300. QUALITY Overall our latest CQC report in 2020 rated us as Requires Improvement however our community adult services were rated as Good and our community services for children and young people were rated as Outstanding. We believe that through continuing to reduce variation and a commitment to clinical best practice we will provide consistently high quality care for local people.

Page 16

Page 159.18 of 159 5. OUR IMPROVEMENT JOURNEY H

Page 17

Page 159.19 of 159 OUR IMPROVEMENT JOURNEY H

Page 18

Page 159.20 of 159 WHERE WE ARE NOW H

Page 19

Page 159.21 of 159 H

Page 20

Page 159.22 of 159 H

WE WILL: . We will work towards achieving an overall CQC rating of Good, with some services, such as community adult services, moving from Good to Outstanding. . Make best use of diagnostic improvements to facilitate earlier treatment and based upon 7 day operating principles . Ensure that we maximise the use of evidence based clinical decision assessment tools such as Model Hospital data and Getting it Right First Time (GiRFT) and linking with improved clinical coding produced by the Trust for widespread Trust application across the clinical divisions. . Ensure a balanced provision of services are available for the population of the 3 boroughs we serve to ensure equality of access to services and reduce unwarranted variation. . Make best use of key resources and new technologies to ensure productive and locality based services with community engagement . Utilise our innovative Population Health Management system in Lewisham to identify where we have gaps in care, or where we are not meeting best practice standards so that we can target improvements. . Continue to implement effective digital systems across LGT building on the progress made through the development of ConnectCare and ensuring ever greater integration with other service providers’ systems. Our ambition is to enable increasingly real time secure access to patient data contained on GP, community provider and mental health systems. This will reduce duplication of administration, smoothing patient pathways and improving patient experience. . Continue the on-going programme to deploy ePrescribing and clinical documentation throughout the Trust – including Paediatrics and Outpatients. This will enhance the efficiency and safety of the medicines prescribing and administration processes in the Trust. . Reduction in the use of paper records will lead to enhanced record keeping, accuracy, and removal of inefficient operational processes. . Quality of care will be enhanced through focussing on removing inefficient processes, freeing up clinician time to spend with patients, enhancing quality of clinical interactions. . Provide an estate which supports our clinical services and is appropriate for the patients we see both in terms of capacity (availability of space) and suitability (meeting of modern standards and requirements). . Develop strategic outline case for the redevelopment of our hospital and community sites to address the quality, compliance and infrastructure issues to ensure we have a modern estate which is compliant, efficient and sustainable and fit for purpose the next 20-30 years. . Implement our site infrastructure plan to address the quality and compliance issues identified at the QEH. . Develop the options for addressing the CQC report, in particular relating to the ED and Critical Care departments at QEH. . Reduce the age profile to ensure we have modern “fit for purpose” facilities

Page 21

Page 159.23 of 159 H

WE WILL: . Improve our performance against NHS Long Term Plan standards and metrics, national policy and college standards and guidance. . Consistently meet out NHS constitutional standards . Reduce unwarranted variation of care across the Trust. Our patients deserve consistency of care regardless of where they are treated and ensure that every patient experiences the best care. . Develop better ways to engage with patients, staff and local communities. . Work with our system partners to ensure that patients receive the most appropriate hospital care in the right setting at the right time. . Continue to build further integration through the Lewisham Health and Care Partnership, Healthier Greenwich Alliance and Bexley Local Care Partnership. . Improve our transition services for adolescents moving from children’s and young people services into adult services. This is already being supported through investment in transition nurses and adoption of programmes such as Ready, Steady, Go. . Increase the offer of in-reach and outreach services across the Trust to support reductions in readmission rates and length of stay and continue to develop relationships with GPs and locating clinics closer to home where appropriate. . Continue to support and develop our community and ambulatory care services. . Through continued investment we will improve the choice, effectiveness and timeliness of our communications with patients. . Outpatient clinics, where appropriate, to be virtual (e.g. via video or voice), saving patients travel and waiting time, and physical space in the hospitals. This will build on the work already undertaken during the Covid-19 pandemic. . Work towards a consistent and comprehensive digital patient portal to provide access to health records digitally. . Contribute to the Trust’s emergency departments through the application of electronic triage functionality, self-check in, and self- management apps. . Share data across providers, to ensure clinicians have a holistic view of the patient at the point of care. . Ensure our systems are secure, and meet the requirements of the NHS Data Protection and Security Toolkit, GDPR legislation and good cyber security practice. . Significantly reduce the area of non-patient space over the estate to a maximum of 35%.

Page 22

Page 159.24 of 159 H

WE WILL: . We will be a great place to work, with high levels of employee satisfaction and an efficient, effective and valued workforce. . Build on recruitment successes over the year and continue to attract people who share our values, and with the potential to provide the best quality service for our patients. We will leverage on our position as an anchor institution and work with partners and communities to provide career opportunities and entry through innovative options. . Prioritise the health and wellbeing of our staff and develop our ‘wellbeing offer’. We will work with our colleagues to embed our values and a culture that is open and transparent. . We will help staff feel safe and supported in workplaces that are free from aggression and abuse. . Support the development of our staff through their career with the trust using all the opportunities available including rotations, apprenticeships and training. We will build on our clinical academy to maximise the learning opportunities that we can provide for all. Recognising the impact of our leaders in increasingly complex times, we will improve leadership capability across all levels of the organisation. . Build a talent management and succession planning strategy that supports staff through their career lifecycle with the Trust. . Continue the development of a workforce that is increasingly agile and flexible and is able to respond to changing clinical needs, new ways of working and delivering care, and that is able to leverage the opportunities presented by new and improving technologies. . Develop and review all of our programmes whilst keeping in mind that our staff will feel a sense of belonging when they see their identities reflected in the workplace. We will work with our partners, networks and colleagues to deliver on an ambitious equality and inclusion plan that will seek to further improve representation of under-represented groups at senior levels within the Trust, and improve outcomes for staff in minority groups . Expect to continuously improve the quality and efficiency of our workforce processes and systems, ensuring that we consistently get the basics right, and support our clinical teams to deliver high quality care

Page 159.25 of 159 H

WE WILL: . Have strong and effective relationships with our partner organisations within the South East London Integrated Care System seeking ever greater integration of services. . Work with our commissioners to ensure the right services are commissioned through the right provider to help deliver the right care in the right place at the right time for our local communities. . Work with our neighbours in GSTT and KCH to provide care for local people locally where possible and most appropriate, building on the work that is already underway in such services as urology, dermatology and elective orthopaedics . Work collaboratively with other providers as part of the Acute Provider Collaborative to ensure seamless care across our communities regardless of service provider. Work with providers, patients and voluntary sectors to manage care both in our hospitals and across our community services. . Work with our colleagues in Barts Health and Homerton Foundation Trust to establish a robust NHS Pathology network solution for south and east London. . Strengthen our relationships with local PCNs, supporting their development and collaborating on improving pathways. Maximise opportunities for primary and secondary care clinicians to work together. Jointly develop neighbourhood hubs in Lewisham focusing on anticipatory care alongside other sectors including voluntary, primary care and patient groups. . Build on the use of the Population Health Management system in Lewisham to better join up care between primary, community and acute services. Use a population health approach to identify gaps in care and jointly plan our response to these. . Work with the One Public Estate (OPE) programme to make better use of our community estate, free up space and create public- sector hubs, with services provided in one place. . We will improve utilisation and efficiency of our core estate, through collaborative working across all our Integrated Care System partners. In part this will involve integration with the wider public sector, collaborating on sharing and co-locating back office and other functions. . Through the OPE programme make better use of public-sector sites working more closely together by sharing sites and creating public-sector ‘hubs’ – where services are delivered in one place. . Expand estate capacity to meet growing demand for planned care

Page 25

Page 159.26 of 159 H

WE WILL: . Continue our work to look at how we provide our services across both of our sites and within the community (as well as with our system partners in SEL ICS), as efficiently and effectively as we can within the existing resources available to the Trust. . Increasingly this will mean we commit to different ways of aligning the financial incentives in the system, responding to national policy and exploring local opportunities. . Invest in a high quality estate, through our redevelopment programme, to ensure sustainable, modern facilities that create a welcoming environment for patients, staff and visitors. . Our plan over the next five years will be to ensure we deliver our indicative control totals as set out as part of the LTP and to ensure we improve our underlying deficit to make us a more sustainable organisation for the future. . Our clinical and financial sustainability are inextricably linked – we must find ways of providing care that is both high quality and productive if we are to achieve our strategic objectives. . We are committed to moving on from the competitive behaviours of the past and working collaboratively and transparently as part of the South East London system and within the three boroughs where we provide most of our services.

Page 26

Page 159.27 of 159 TIMELINE FOR IMPLEMENTATION H

YEARS 4 & 5 2023/24 – 2024/25

• Consistently deliver high quality local services • Reduce inequalities and variation of YEARS 2 & 3 – 2021/22 - 2022/23 services and improve outcomes. • Be a great place to work with all staff feeling supported. • Be firmly committed to partnership. strive for • Develop OBC/FBC’s for change, including consensus, mutual support and integration QEH whenever that is the right thing to do for YEAR 1 - 2020/21 • Improve our CQC rating patients. • Continued improvement in key • Able to demonstrate efficiency and value for performance indicators money across the range of our activities and return to financial balance.

• Getting the Basics- Right • Respond to covid-19 and develop plans to recover access to sertvices to return to BAU • Identify areas of inequality and- variation, and begin to develop plans to address these with our system partners • Start to develop robust Redevelopment, Digital and Transformation/Improvement plans

Page 27

Page 159.28 of 159 PLAN ON A PAGE H

Quality Patients People Partnership Money

Our Priorities

Be the first and foremost Be firmly committed to Be a great place to partnership. We will take a Deliver consistently a community provider of high quality local work. We have strong strong LGT perspective Be able to local and acute care. We values which all our services to the people into those partnerships but demonstrate efficiency are proud of the role we staff must live and will ultimately strive for and value for money of Bexley, Greenwich play and committed to breathe. All staff will consensus, mutual across the range of and Lewisham. contributing to the vitality feel supported and Lewisham heard. support and integration our activities.

What we will dowillWhatwe of local communities and whenever that is the right to reducing inequalities. thing to do for patients.

• An open and • Increased • Productive and • Improved outcomes inclusive culture collaboration efficient use of • Reduce inequality and variation • Engaged staff • Reduced resource • Early identification, diagnostic and • Agile and flexible duplication • Reduced backlog

intervention working responsive • Management of maintenance ourplans

The impact of Theimpact to patient needs flow • Financial balance

Page 28

Page 159.29 of 159 H

Appendices

• Projected Population Growth • Health Needs of our Communities • Estates Performance • Estates Profile

Page 159.30 of 159 H PROJECTED POPULATION GROWTH The populations of both Lewisham and Greenwich are set to continue to grow by 11% over the next 10 years, with Bexley’s population set to grow by 10% over the same period. The most significant growth, however, is to be seen in those wards within Greenwich and Bexley in particular which are most likely to look to QEH as their local hospital. Even with transformed ways of system working and upper decile levels of productivity this may well raise challenging questions around demand and capacity during the next 5-10 years.

The London Healthy Urban Development (HUDU) population projections (May 2018) provide a further overview of population changes in our Boroughs. Significant growth are projected for Bexley, in particular in North Bexley across Thamesmead and Belvedere; and in Greenwich in the Peninsula and Woolwich Riverside. The Diagrams below show projected 10 year growth for Bexley and Greenwich.

BEXLEY GREENWICH LEWISHAM

Source: GLA 2016 Round Projections HUDU 2018 ©

Page 159.31 of 159 H HEALTH NEEDS OF OUR COMMUNITIES

A high proportion of our patients live in areas that are amongst the most deprived in England, while a smaller proportion live in the most affluent areas. Lewisham and Greenwich both rank amongst the 15% most deprived local authority areas in the country and whilst Bexley is significantly less deprived overall there are pockets of deprivation in some wards. Although the health of our populations has improved significantly over the last 5 years challenges still remain;

 We have a vibrant, diverse and mobile population with extremes of deprivation and wealth.

 Between 24% and 26% of children are classified as living in poverty depending on borough.

 75% of over 55s have at least one Long Term Condition (LTC) although in Lewisham the prevalence of LTCs is reduced, mainly due to the younger age profile of this community.

 58% of adults and 32% of children are overweight or obese.

 Premature death and differences in life expectancy are significant issues. Lewisham, for men in particular, is performing below the national average for premature deaths and overall within Lewisham the trend of improvements in life expectancy appears to have stalled for both men and women.

 Our populations are diverse with 38% of BME heritage in Greenwich, 46% in Lewisham (with this forecast to increase to 50% by 2028) and 29% in Bexley. These populations are at greater risk from conditions such as diabetes, hypertension and stroke.

 The main causes of death across our three populations are cancer, circulatory disease and respiratory disease although in terms of reducing inequalities in life expectancy circulatory disease is a greater contributor for men and women.

 15% of the Lewisham population smoke, more than the national average, 12% of Bexley and 18% of Greenwich

Page 159.32 of 159 H ESTATES

ESTATES PROFILE – KEY FACTS:

• LGT comprises two acute sites and run community • Other Organisations occupy 14% of our site space and support services from circa 20 properties, • 1025 inpatient beds and 21 theatres across two acute located in the 3 boroughs. 177,000 sqm GIA across sites freehold and leasehold interests • Following acquisition of community services in 2012 • Two acute sites account for 90% of estate by area LGT now provides community and acute services in over • 40% is income generating core clinical space 15 freehold and leasehold sites (excluding residential) • 56% of estate by area is PFI which is very significant across Lewisham, Greenwich & Bexley but mostly in • 55% of estate by area is over 30 years old Lewisham. The acute and complex healthcare is provided from LGT’s two large sites at UHL and QEH.

Carter review The Model Hospital Functional Suitability • The non-patient areas on the QEH and • The Model Hospital review • Investment is required to ensure all acute and UHL sites accounts for 104,000 sqm or brought to light several key community estate is functionally suitable and in line with 59% of the total space availability, areas for our Trust to make modern standards. compared with the Lord Carter improvement: o Estates and Facilities Costs • Significant improvement is required in the following recommendation for all Trust to operate 66% more than the Model areas: with a maximum of 35% of non-clinical Hospital (69% at QEH and o Poorly configured ED and Critical Care at QEH space. 58.5% at UHL) o IPC requirements following Covid-19 – flow o Hard FM Costs 20% larger issues/green and blue pathways (ward configuration) than the Model Hospital Emergency Care pathway impact on Paediatric ED at (34% at QEH and 12% at UHL UHL) o Fragmented outpatient accommodation in pockets of o Estates and Property inflexible speciality specific space and in particular, Maintenance Costs 108% more than that of the Model poor quality and configuration for dermatology and Hospital (113% at QEH and cardiology. 73% at UHL) o Split location of theatres at UHL which impairs streamlined surgical patient pathways leading to a poor patient experience o Endoscopy capacity issues across South East London at UHL.

Page 159.33 of 159 BACKLOG MAINTENANCE H

QEH/UHL 5 YEAR BACK LOG SPEND/RISK PROFILE

ALMOST CERTAIN LIKELY POSSIBLE UNLIKELY TOTAL

LGH RETAINED ESTATE £ 7,153,710.43 £ 4,683,725.74 £ 9,504,201.25 £ - £ 21,341,637.43

LGH NON RETAINED ESTATE £ 896,328.22 £ 4,586,984.21 £ 4,229,836.34 £ 418,315.54 £ 10,131,464.30

QEH RETAINED ESTATE £ 666,092.88 £ 947,727.14 £ 658,823.04 £ - £ 2,272,643.06

TOTAL £ 8,050,038.65 £ 9,270,709.95 £ 13,734,037.60 £ 418,315.54 £33,745,744.80

QEH INFRASTRUCTURE UPGRADE In addition to the above QEH backlog spend required on the non PFI Buildings, there is significant investment required on the QEH adding services infrastructure. The total project costs of the services infrastructure works has been valued at £62.6m. COMMUNITY 5 YEAR BACK LOG SPEND/RISK PROFILE ALMOST LIKELY POSSIBLE UNLIKELY TOTAL CERTAIN FREEHOLD £31,697.60 £1,821,801.15 £1,116,079.81 £0 £2,969,578.55 LEASEHOLD £184,213.44 £273,743.42 £873,275.04 £0 £1,331,231.90 TOTAL £215,911.04 £2,095,544.57 £1,989,354.85 £0 £4,300,810.45

Page 159.34 of 159 EXISTING PROFILE - UHL H

KEY FACTS

 Annual PFI Costs are 17.5m per annum  74,858 sqm of accommodation of which  £8.5m Availability and Hard FM  21,000 sqm is in Riverside PFI building  £9m Soft FM  518 beds and 11 theatres incl. obstetrics + 1 vanguard theatre  Site area of 5.8 hectares  50% of buildings predate 1980, more than 30 years old  59% of the accommodation is non-patient area

UHL DISTRIBUTION OF SPACE

The latest ERIC returns have shown that on the Lewisham Site the distribution of space was:

Area Area Lewisham: Clinical, Non Gross Internal Floor Area 74,858 m² Non-Clinical 18,559 m² Clinical and Other Space Occupied Floor Area 74,089 m² Non-Clinical/ Total Clinical Area 21%

Area Total NHS Estate Occupied 99.00 % Floor Area 31% Clinical m² Clinical 55,263 m² 50% Non-Clinical m² Site Heated Volume 200,040 m³ 10% Non-Clinical 18,559 m² 9% Other m² Land Area (Owned) 5.80 Total Area Other 16,280 m² Hectares

Land Area (Not - Hectares Delivering)

Page 159.35 of 159 UHL SERVICES SITE MAP H

Northern end of site to be considered for disposal

Page 159.36 of 159 UHL AGE PROFILE H

Significant estate pre-dates 1975 and will be a key contributor to the estate backlog maintenance and compliance. This part of the estate lends itself to the redevelopment opportunities.

Page 159.37 of 159 H EXISTING PROFILE - QEH

• The QEH is a refurbishment of a 1970s military hospital serving patients from the Royal Borough of Greenwich and the London Borough of Bexley and is a Private Finance Initiative.

• There are long‐standing estates quality issues were identified when the we took over the site from the South London Healthcare Trust (SLHT) merger following legal due diligence during the merger October 2013. The Transaction Agreement relating to the merger identified large investment requirements however these have continued to increase and currently stand at £62.2 million.

• The west end of the site houses Oxleas Mental Health inpatients under a leasehold arrangement together with a range of administrative support and education services and is in poor condition. The former residential block (S Block) has been empty since the military vacated the site in 1995. The strategy therefore is to redevelop this proportion of the site.

• A range of general secondary services including: o One of the busiest Emergency Departments in London o Maternity service with over 4,000 births o Paediatric inpatient services including oncology unit

KEY FACTS

 Annual PFI Costs - £28m  546 beds and 9 theatres (7 main and 2-day theatres)  Site area of 18 hectares  65% of buildings by age predate 1985  78,000 sqm of accommodation  Significant proportion of the South site is empty  56% is non-patient facing services

Page 159.38 of 159 QEH – POTENTIAL DEVELOPMENT AREAS H

The highlighted “blue” areas are the potential areas for development which will be considered as part of the options that are developed for the strategic outline case for the QEH site.

Potential development areas/ opportunities

Page 159.39 of 159 AGE PROFILE - QEH H

As with UHL the area of the estate highlighted in orange pre-dates 1970 and lends itself to redevelopment or disposal as part of the strategic outline case for QEH

Page 159.40 of 159