North NHS Trust Strategy 2016-2021

Contents

1 Executive summary 04 2 Introduction 06 3 Our values and vision 08 4 Strategic themes 10 5 Next steps and delivery plan 20 6 Conclusion 22 7 Appendix A: North Bristol NHS Trust today 24 8 Appendix B: The challenges we face 30 1 | Executive summary

North Bristol NHS Trust Achieving our vision to provide This strategy has been the high quality care that we developed for the period 2016 - is a provider of local aspire to within the resources 2021 to provide focus and clarity hospital services and available is an increasing of direction for our organisation complex specialist care challenge. By improving patient and its stakeholders. It takes flow, maximising productivity, into account detailed analysis for a large population using resources including our of the Trust, activity, quality, in the South West of workforce wisely, and sharing performance, outcomes, England. Employing over best practice across the Trust, opportunities and challenges, our finances will be sustainable and is informed by clinician, 8,000 highly skilled and and we will meet the national staff and patient views. caring staff, we aim to standards for operational The detail of this analysis is performance in the coming described in appendices A & B: deliver excellent clinical years. The aims described in The eight strategic themes that outcomes and a great this strategy are designed to will form the basis of our plans create an organisation in which experience for all service over the next five years are: the necessary savings and users: exceptional efficiencies are delivered to 1) Change how we deliver healthcare, personally enable us to do more with the services to generate delivered. resources already available. affordable capacity to meet the demands of the future We will take a leading We are one of the largest role and work with health 2) Be one of the safest trusts hospital trusts in the UK and and social care partners to in the UK treat some of the most difficult develop and implement 3) Treat patients as partners medical conditions, in an a Sustainability and in their care increasingly complex patient Transformation plan for the 4) Create an exceptional population. Bristol, North Somerset and workforce for the future We ended the 2015/16 financial area. 5) Devolve decision making and year with a £51.6m budget This will improve the lives of empower clinical staff to lead deficit, against a planned deficit residents by ensuring their of £26m. This adverse position healthcare needs are met as 6) Maximise the use of was mainly due to increased mandated in the NHS England technology so that the right use of temporary staff and Five Year Forward View. We information is available for lower than expected income, in will also work with specialist the key decisions part resulting from difficulties commissioners and networks of local providers to ensure 7) Enhance patient care through managing the amount of work research to do through our hospital high quality delivery of the beds. In 2016/17, and in the specialist services for which we 8) Play our part in delivering a years ahead, we aim to reduce have a wider responsibility to successful health and our deficit year on year and the population of the South care system return to a position of financial West of England stability.

4 We are committed to During 2016/17 the Trust maintaining a culture of will produce a set of enabling openness, transparency and supporting strategies and candour in all we do including Quality, Research, and especially in the way Information Management and we communicate with our Technology, Workforce, Estates patients and their families. In and Facilities, Communications consultation with staff, the and Stakeholder strategies. Trust developed a set of values These will provide more detail that represent what we stand and support delivery of the for and these will underpin overall strategy. the way we deliver the vision This strategy sets out a vision through our strategic themes. for the future and the themes Our values are: for work streams that will ensure the vision is realised. • Putting patients first Through this work: • Working well together • Striving for excellence • Recognising the person

The Board of Directors at North Bristol NHS Trust is committed “We will realise the to creating a strong, vibrant organisation which is at the great potential of our forefront of healthcare delivery in the West of England. The organisation by Trust Management Team is empowering our responsible for delivering the strategic vision. Each year, the skilled and caring Trust and Directorate business plans will detail actions that staff to deliver will specify how the strategic themes will be progressed. high-quality, financially Implementation of the business sustainable services in state-of-the-art plans is overseen by the Trust Management Team and the facilities. Clinical outcomes will Board. be excellent and with a spirit of Progress on implementation of the strategic themes will be openness and candour we will ensure an reported annually to the Board. outstanding experience for our patients.”

5 2 | Introduction

North Bristol NHS Trust This strategy has been We also provide high quality developed for the period 2016- specialist care for some of the is a centre of excellence 2021 to provide focus and clarity sickest patients in the region. for healthcare in the of direction for the organisation We work in partnership with South West and one and its stakeholders. It sets University Hospitals Bristol out a vision for the future and NHS Foundation Trust and of the largest hospital the strategic themes that will following a number of transfers trusts in the UK. The ensure that vision is realised. and mergers of clinical services The Trust strategy aims to between the two Trusts we environment and deliver a successful, sustainable both now provide coherent, context in which it and resilient organisation, high quality specialist services provides services is playing a full part in an at scale for the South West effective health and care region. We also work closely changing rapidly. This system. with other hospital providers strategy will ensure that in the delivery of networked we continue to provide The successful opening of care, for example hosting the the Brunel building on the Severn Network Major Trauma a high quality service site in May Centre, the South West Major to patients within an 2014 completed an important Arterial Centre, the South West phase of the long term Trust Burns Network and South West increasingly complex strategy. The new hospital Neuromuscular Network. environment whilst building has resulted in a Having worked hard to deliver transformative improvement also contributing to the a safe transfer in to the to infrastructure for services. new hospital infrastructure, health of the population Starting with two medium we recognise that the sized and separate hospitals in that we serve and the performance, quality and the north of Bristol and South wellbeing of our staff. financial sustainability of our Gloucestershire, the Bristol service delivery is not yet at the Health Services plan created a standard that we would expect. single Acute Trust, which has This was demonstrated in the merged the two hospitals on to reports of the Care Quality a single site. This has maximised Commission hospital inspections the opportunity for realising in 2014 and 2015 which the benefits of size and inter- assessed the Trust as ‘requires dependency of services. improvement’. North Bristol NHS Trust provides general hospital services for the local populations of South Gloucestershire, Bristol and North Somerset.

6 This strategy and the Trust’s The NHS as a whole, including We will ensure that the views improvement work must North Bristol NHS Trust, is facing of key stakeholders, including address its financial position increasing pressure to deliver the local population inform and the delays in accessing its more with less. Our plans based the implementation plans to services, as well as continuing to on our strategic themes must enable delivery of the strategy. develop the highest standards deliver a sustainable, recurrent The Trust Board will monitor of patient care so that we financial surplus. Implementing and evaluate implementation deliver excellent outcomes and our strategy will ensure that we of the Trust strategy through a patient and carer experience make more efficient use of the the setting of objectives with that we can be proud of. The resources available to maximise key performance indicators and strategy has been developed benefit of our resources for outcome measures agreed on following detailed analysis of patient care and identify where an annual basis. The strategic the Trust taking into account cost savings can be made. themes will be reviewed each activity, quality, performance, year to ensure they reflect an outcomes, clinician, staff and The overarching strategy will appropriate direction of travel patient views. It takes a fresh be supported by enabling as the environment in which we look at our organisation, at and supporting strategies work and the population we the opportunities available, including Quality, Research serve continuously evolves. the challenges that can be and Development, Information foreseen, and at our strengths Management and Technology, and weaknesses. The detailed Workforce, Estates and analysis can be found in Facilities, Communications appendices A & B of this and Stakeholder strategies. document. The Trust strategy aims to deliver a successful, sustainable and resilient organisation, playing a full part in an effective health and care system.

7 3 | Our values and vision

3.1 Trust Values

During 2012, in consultation with staff, the Trust developed a description of our underlying values that represent what we stand for. We know that embedding these shared values in everything we do will increase staff engagement, improve outcomes and create a positive experience for patients. Our values are:

Putting Working Recognising Striving for patients well the person excellence first together

Understanding the Engaging with Making staff and Continuously impact of every role colleagues and patients feel valued reviewing what on patient care, even patients to and worth your time we do, to seek if you’re not in direct proactively resolve new ideas for contact issues Looking everyone improvement in the eye, Taking the time to Demonstrating acknowledging Demonstrating listen and care commitment to them, recognising commitment to shared objectives they are people continuous learning Protecting patient and development confidentiality, Including and Appreciating privacy and dignity consulting others differences and Celebrating efforts when making the strength that and successes Being open and decisions that affect diversity can bring transparent when them Recognising your things go wrong Helping the patient own limitations, Offering understand their using mistakes Intervening when encouragement and condition, involving as learning others have not, feedback to others them in decision opportunities and speaking up when making remaining resilient necessary Becoming trusted and when facing respected by staff Taking a holistic challenges Treating your patient and patients approach to care as you would expect a Going the extra mile loved one to be cared to make a difference for to patients and staff, even if this is indirectly

8 3.2 The vision for the future We will realise the great potential of our organisation by empowering our skilled and caring staff to deliver high-quality, financially sustainable services in state- of-the-art facilities. Clinical outcomes will be excellent and with a spirit of openness and candour we will ensure an outstanding experience for our patients.

We aim to provide best practice care and treatment with excellent clinical outcomes that are comparable to the best in the world. Care will be delivered safely ensuring every patient has an outstanding experience. We want to be part of a local system of healthcare that provides high quality care to patients with an efficient use of resources and understand that we need to continuously improve the care we offer so that we deliver in a more productive and efficient way. We want to be nationally recognised for our specialist services, leading regional provider networks and developing our services through a combination of clinical excellence, research and high quality training.

Exceptional healthcare, personally delivered.

9 4 | Strategic themes

To deliver our vision and strategic aims the Trust Board has chosen the following themes that will form the basis of our plans over the next five years:

Change how Be one of Treat patients 1we deliver 2 the safest 3 as partners services to trusts in the UK in their care generate affordable We will improve capacity to meet the We will develop delivery of care for our relationship demands of the future our patients by continuously with patients and Within our current portfolio working to increase the their families/ of clinical services, we will consistency and reliability carers so that they are more need to meet the challenges of our services, eliminating involved in making choices we face now and in to the variations in care provision about the planning and future by managing our that do not improve patient management of their care. For resources more efficiently and outcomes. We will become example, our ‘Ask 3 Questions’ changing the way we deliver proficient in working together campaign encourages patients care, particularly for frail and in teams to always provide the to ask three key questions elderly patients and those right care for every individual about their condition and with long term conditions. patient, in the right place. We treatment options. Knowing This will include using the will then be one of the safest what’s important to the expertise of hospital staff trusts in the UK, providing patient will help us to guide to increase care for patients outcomes that match the best them to the best decision. in community settings. We in the world. We will communicate in a will also need to respond transparent way and with to the development of candour if things go wrong. new technologies that will This will result in significant increasingly customise medical improvements in how patients interventions to individual experience the service we needs. offer. 4 Create an exceptional workforce for the future Our highly valued, caring staff are central to everything we do. We will develop a flexible and multi-skilled workforce that provides the staffing needed for the future. For example, we will continue to build on our nationally recognised apprenticeship and training programmes and develop our partnerships with the Universities. Our teams will be able to adapt to the changing needs of patients and work together to deliver the vision of the Trust. We will invest in our staff, nurture their talent and develop high performing teams. We will care for and respect our staff, prioritising their health and wellbeing to become an employer of choice.

10 Sections 4.1 to 4.8 describe the strategic themes in Devolve decision making and more detail, setting out our priorities for action during 5 empower frontline staff to lead 2016/17 and our ambitions for 2021 We will be a clinically led organisation, with frontline staff empowered to make decisions Maximise the use of technology so that the right and implement changes in their area of work, including clinical 6 information is available for the key decisions quality, operational We will innovate and transform our services through an performance and increasing use of technology, to drive better availability use of resources. of information to drive better outcomes for patients. This Together the will include information about individual patient directorate leaders care, which may be at a distance, as well as will take the data about the processes through which care organisation toward is delivered. Leaders and teams will then have the strategic vision. the information they need to ensure the Trust vision is realised.

Enhance patient care Play our part in delivering a 7 through research 8 successful health and care system Research active organisations We will act as leaders within our healthcare system, using like NBT deliver better outcomes our clinical knowledge and experience to ensure the most for patients. Also future effective care for patients. We will work with partners to improvements in care are ensure that our patients are treated in the right place, at dependent on development the right time and that of today’s research. We will the most appropriate organisation therefore build on our already provides the cost effective care that significant and growing research patients need. We will step up to play portfolio. We are one of the top a wider role in making the 30 research active trusts in the whole healthcare system UK and we aspire to become a successful both through the world leading research facility, BNSSG Sustainability and Transformation plan delivering high quality research and also through our leadership of specialist service of direct patient networks. benefit. Research will become an embedded component of clinical service delivery. 11 4.1 | Strategic theme 1 Change how we deliver services to generate affordable capacity to meet the demands of the future.

Within our current portfolio of Priorities for year one (2016/17) clinical services, we will need to meet the challenges we face • Minimise delays to inpatient • Develop and embed the Trust’s now and in to the future by care with timely discharge or service improvement and managing our resources more transfer when appropriate methodology efficiently and changing the way we deliver care, particularly • Improve the efficiency of • Begin work with GPs and for frail and elderly patients outpatients, theatres and bed community providers so and those with long term use to speed up access to care that patients with long term conditions. We will also need and maximise effective use of and complex conditions to respond to the development resources feel supported but hospital attendances are minimised of new technologies that will • Improve the quality of increasingly customise medical information available to leaders interventions to individual and management teams so needs. that service line reporting is We aim to develop a long developed to support service term culture of continuous line management improvement that will ensure every patient receives the best By 2021 we will: possible care on every occasion they need it. We will build an • Have achieved the highest • Have diagnostic services that organisational culture that level of rating from regulators support a growing number of providers to deliver prioritises patients and quality • Deliver services that meet all care above all else, with clear personalised care and ensure NHS constitution and national that patients receive the best values embedded through cancer minimum standards all aspects of organisational care, first time and in the most appropriate setting, away behaviour. We will deliver care • Deliver operational from hospital when possible in accordance with national performance standards to and local performance which other trusts aspire • Use service line costing so the targets; notably in relation to Trust understands how much • Deliver best practice emergency Emergency Department waiting each service costs and ensure care seven days a week times, referral to treatment costs do not exceed tariff times, transfers of care and • Have specialist services that income delivery against Care Quality meet best practice guidelines • Have eliminated the financial Commission hospital inspection for access to care recommendations. Our services deficit, offering a portfolio will be provided within the • In the best interest of the of services that deliver available financial, workforce patient, rapidly repatriate a financially sustainable and infrastructure resources. specialist patients to organisation referring hospitals and health • Lead networks of providers communities to deliver complex care that • Have maximised the use of is centralised where necessary the hospital infrastructure but close to home when efficiently across the week possible

12 4.2 | Strategic theme 2 Be one of the safest trusts in the UK

We will improve delivery of care high quality, safe care for restricted. Quality improvement for our patients by continuously every one of our patients, in is therefore a continuous and working to increase the every service every time it is long term requirement. consistency and reliability of our needed. We will continue to services. We will become experts work with partners to share We will maintain continued at working together in teams best practice and ensure that oversight of the outcomes to always provide the right care safe care is embedded within of care through contribution for individual patients. We will all pathways of care. We expect to national audit, national be one of the safest trusts in the rapid development of new registries and monitoring of UK, providing outcomes that technologies that will increase hospital episode statistics. match the best in the world. personalisation of medical We will measure and monitor treatment. Expectations of quality performance indicators We have a long standing patients will continue to and take action promptly when commitment to improving increase but available resources needed to ensure patients quality and safety in our will remain significantly always receive the quality of services. The aim is to provide care they need and expect. Priorities for year one (2016/17) • Ensure infection control • Ensure that at least 80% of • Meet all local contractual processes, including monitoring annual Commissioning for requirements for quality of and reporting are exemplary Quality Innovation (CQUIN) care programmes are delivered • Review learning from • Develop a suite of outcome every patient death and • Deliver the priorities of metrics relevant to all be transparent in our the annual quality account specialties investigations and Sign up to Safety commitments By 2021 we will:

• Have a reputation for to benchmarks and with • Have reduced complexity of excellence with outcomes messurably exceptional care in care by standardising according that match the best in the at least 10 specialties to patient pathways world • Deliver services that meet • Have developed team working • Have a culture of continuous patients’ needs seven days a that manages the complexity learning and transparent week of individual patient needs investigations that seek to and ensures that handover avoid patient harm as a result • Deliver care in an appropriate, between teams (inside and of errors in care well equipped and clean outside the Trust) promptly environment and reliably provides the • Reduce harm events to a • Offer rapid access to best necessary information enabling minimum level that is best in seamless care class amongst UK hospitals in class diagnostic services that meet all regulatory and • Publish quality and outcome • Have developed services professional standards measures to ensure relentless that are all providing good focus of the organisation on outcomes in care in comparison • Be a centre of excellence for quality improvement delivery of the Trust vision. methodologies 13 4.3 | Strategic theme 3 Treat patients as partners in their care

We will change our relationship Priorities for year one (2016/17) with patients and their families and carers so that they are in • Embed partnership working • Improve involvement of charge of making choices for the between the Trust and patients patients, their families and planning and management of by ensuring patient and public carers in discharge planning their own care. We will always involvement in an increasing and ongoing decisions communicate openly and number of our activities transparently when responding • Increase the number of patients to individual patient needs. • Improve timeliness, who receive end of life care in This will result in significant transparency and quality of their chosen location responses to complaints improvements in how patients • Use the ‘ask three questions’ experience the services we offer. • Act on information from CQUIN improvement model so The NHS Five Year Forward patient surveys including the that patients are empowered to View proposes that NHS Friends and Family Tests get the information they need organisations develop new relationships with patients and By 2021 we will: communities. We will support people to manage their own • Have expert service user • Have respect for patients’ health – staying healthy, involvement in all major knowledge of the needs making informed choices about change projects and service of their own long term care, managing conditions so developments conditions wherever they are cared for in the Trust their dependence on health • Patient held care plans will be care services is reduced. This in place, including self-care • Have tailored care to meet will decrease attendances for advice where relevant the needs of patients with urgent care and reduce the cognitive impairment, mental amount of time patients spend • Have clear written health issues or learning in hospital. Our services will information to support disabilities, maximising change so that patients have patient consent for all the opportunity for these rapid access when needed, and procedures individuals to understand and where possible, care and advice • Have end of life care provided contribute to decisions about within their own homes. in the setting of choice for their health patients and families with 24/7 • Have a patient experience access to expert support programme that listens to • Reduce follow up outpatient patients, carers and staff and appointments to those where learns from their experiences the only option for good care • Teams will develop the services is a face-to-face meeting in the they offer in response to what hospital patients tell them. Actively • Release outpatient capacity seeking patient feedback to provide rapid access for and responding promptly to patients who need it urgently complaints. • Have services that the people who use them rate highly and recommend to others

14 4.4 | Strategic theme 4 Create an exceptional workforce for the future

Our highly valued, caring staff and with clinicians working in the delivery of quality education are central to everything that we partnership with colleagues in for health care support workers. do. We will develop a flexible primary, community or social care. This is designed to support and multi-skilled workforce and progression within roles and into plan the staffing we need for Complex health care is delivered higher education, so that there the future. Our skilled teams will through teams who have the is a sustained pipeline of future be capable of adapting to the right knowledge, skills and workforce. changing needs of our patients approach to deliver for the needs and working together will deliver of today and to continually We want our staff to enjoy the Trust’s vision. We will invest in develop new approaches for working in the organisation and our staff, nurturing talent and high tomorrow. Our teams must work to feel valued and respected performing teams and ensuring together so that patient care in their roles. We will ensure time is available for appropriate is not compromised by barriers equality for all by implementing training. We will respect and care between teams. and supporting schemes such as for our staff, prioritising their the workforce race and equality We are a large teaching trust in standard, and we will embrace wellbeing so that we become an the South West with educational employer of choice. and support talent, providing partnerships with the regions opportunities for those who wish We will ensure safe and competent universities, colleges and a to progress their careers and staffing for our services now thriving schools and work achieve their potential. and into the future. We envisage experience programme. We a world where care could be have a National Skills Academy provided in different settings for Health Excellence Centre, for

Priorities for year one (2016/17) • Management skills • Workforce planning • All teams upholding development in place and capabilities are enhanced the highest professional impacting positively on delivery and rigorous standards • Appropriate management of • Minimise use of temporary • Deliver the staff wellbeing sickness and other absence staff CQUIN goals • Improve staff engagement, health and wellbeing By 2021 we will: • Have staff who are all • Create a culture of upholding • Have reliable staffing to full appropriately trained, the values and standards of establishment motivated and well led , with all behaviour of the Trust the skills required for safe care • Show that our staff are proud of • Have strong partnerships with the place they work and what • Give all staff the opportunity the universities and Deanery they achieve for a greater say in the future to support training of health of the organisation so they can care professionals fit for the effect and take responsibility future for making things happen

15 4.5 | Strategic theme 5 Devolve decision making and empower frontline staff to lead

Our organisation will be Priorities for year one (2016/17) clinically led, with directorates taking responsibility for and • Develop a detailed • Develop and enable clinical making decisions about implementation plan for leader capability addressing their area of work including clinically led, service line gaps in current skill sets clinical quality, operational management as agreed by the performance and use of • Align corporate functions Board. Actions to commence resources. to support and enhance within 2016/17 with clinical directorate success Clinical leadership, leads completion during 2017/18 to better solutions to the complex problems we face. Decisions will be taken closer By 2021 we will: to patient care and necesssary • Hold directorates accountable • Have clinical leaders who changes to culture will for delivery of quality care drive the future success of the happen more rapidly. Our and managing performance organisation as well as future Clinical Directorates are now within available resources performance led by a Clinical Director, through effective service line General Manager and Head management • Have management teams and of Nursing. These leaders will corporate functions skilled in be empowered to take the • Have clinicians with the time supporting clinical leaders to key decisions on behalf of the and skills required to lead be successful in their roles organisation. the organisation and develop succession plans for their roles • Have clinicians who are the There is more to be done to key decision makers, playing engage, enable and equip • Demonstrate seamless patient an integral role in shaping clinicians to take these leading care pathways through clinical services of the future roles and we are committed to directorates working together providing the support, time and training required. • Have clinical leaders focused on collectively delivering the strategic vision of the Trust as well as the success of their own area of responsibility

16 4.6 | Strategic theme 6 Maximise the use of technology so that the right information is available for the key decisions

We will innovate and transform convenient and this will also be of their lives. There are also our services through increasing applied to health provision. opportunities to use technology use of technology to drive better to provide services in different An important element of self-care outcomes and experience for ways such as through remote is enabling patients to understand patients. Our clinicians will have consultations. and monitor their own conditions. accurate and relevant information Access to their own data will be The new patient record system to support them to deliver care expanded as much as possible introduced in 2015, provides to patients. Our leaders and to enable self care by patients. a basis for future system teams will have the data they There are also opportunities to developments and will support need to measure the Trust’s use technology to deliver services the move to a full electronic improvements. Staff and patients in different ways, such as through patient record. We plan to be a are increasingly used to instant remote consultations. Enabling paperlight organisation by 2018. access to information in their patients to monitor their own This will include using technology everyday lives and they expect the conditions, is already available to support good decision making same when working or receiving in some services and should be such as rapid access to clinical care. Information Technology has expanded as much as possible guidelines. made many aspects of life more so that patients can take control

Priorities for year one (2016/17) • Stabilise the existing patient • Implement electronic reports and support staff to record system (Lorenzo) document management understand and interpret the data presented • Develop and implement • Agree and deliver a suite of service line reporting management information

By 2021 we will:

• Have electronic systems that • Use technology to support the • Routinely support demand and ensure all the information use of our clinical expertise capacity analysis and service line required for individual patient in caring for patients at a reporting care is always available to staff distance such as virtual clinic • Demonstrate that population in a format that supports their consultations and advice and data such as the Joint work flow guidance for GPs Strategic Needs Assessments is • Have sufficient hardware devices • Have systems that are accessible incorporated and resilient IT services in the to patients to help them into future planning clinical environment to support understand their own data and • Have data capture systems that use of the electronic patient support self-care support the service improvement record • Enable leaders to understand methodologies including rapid • Put in place systems that enable how the Trust functions, with cycle tests of change and key connectivity across the health real time information, business performance indicators community allowing rapid intelligence and large scale exchange of information to analysis to support future support care wherever patients development are located

17 4.7 | Strategic theme 7 Enhance patient care through research

Future improvements in care Priorities for year one (2016/17): are dependent on development of today’s research. We have • Broaden our research portfolio • Increase patient satisfaction a significant and growing to offer more of our patients with our research function research portfolio and are one the opportunity to participate • Make research more visible to of the top 30 research active in research patients and visitors trusts in the UK. Our research output will be expanded • Develop a five year research and further strengthened strategy for the Trust by actively supporting our • Invest in our research established research strengths workforce and facilities to in musculoskeletal, infection, increase our ability to deliver immunology, neurosciences the research of the future and urology. Diabetes and respiratory medicine will continue to be supported alongside emerging strengths in anaesthetics, obstetrics, By 2021 we will: vascular, surgery and stroke research. • Improve and integrate • Have research embedded research access across in clinical services delivering We aspire to become a world- the region providing our improvements in service leading research facility, that community with as many delivery and patient delivers high quality research of research opportunities as outcomes possible direct patient benefit and • Be leaders in research policy to embed a research culture • Increase the research income and process to improve in clinical service delivery. of the Trust research outcomes We have worked with our partner universities and NHS • Have patients who are integral Trusts in the region to form partners in designing and Bristol Health Partners. This directing our research partnership has established 20 • Demonstrate academic Health Integration Teams that excellence (publications and are aligned with the research, grant income) across our education and healthcare research strengths strengths in Bristol. We intend to further develop our systems for ensuring rapid introduction of new evidence based care for the benefit of our patients.

18 4.8 | Strategic theme 8 Play our part in delivering a successful health and care system

We will be leaders in our Priorities for year one (2016/17) health and care system, using our clinical knowledge and • Work with partners to • Prioritise improvements to experience to ensure the most develop and start to patient flow through our effective care for patients. implement the Bristol, hospitals, working with key We will work with partners North Somerset and South stakeholders and partners to ensure that patients are Gloucestershire Sustainability across the health and care treated in the right place at and Transformation Plan system to ensure patients are the right time and that the only admitted when necessary most appropriate organisation • Work with partners to design and are discharged as soon as provides the care that patients and implement plans that possible need. We will step up to play a ensure the sustainability of wider role in making the whole Weston General Hospital • Minimise delays in transfers of healthcare system successful. patients to other health care providers through building The NHS Five Year Forward effective provider networks View, states that the traditional divides between primary By 2021 we will: care, community services, hospitals, physical and mental • Be part of a successful • Have embraced opportunities health, are increasingly a and sustainable health to partner with other barrier to the personalised, and care system organisations to deliver care coordinated health services in more effective ways; be patients need. We acknowledge • Have developed networks they NHS, commercial that we need to build with other providers that or third sector constructive partnerships ensure patients are managed with commissioners and other in the right place at the right • Continuously develop providers to ensure that we time to meet their needs new ways to deliver services, are working together for the designed for and by the • Have built strong benefit of patients, wherever people who use them, relationships with all primary, they are in the health system. working with partners to community and secondary develop the whole health and For good outcomes, patients care providers to maximise care system need all parts of the system the effectiveness of care and to work seamlessly together. the patient experience Our vision is that we will take • Be working with partners to a strong leadership role in the ensure that rehabilitation, systems in which we work, with enablement and social care our clinicians driving changes in are accessed rapidly and in the how care is delivered. most appropriate location to meet patient need, including those with specialised needs

19 5 | Next steps and delivery plan In order to deliver our vision, we must implement the commitments set out in this strategy.

5.1 Governance

The Board of Directors at In the annual exercise of agreeing The Board will work closely North Bristol NHS Trust is the Trust and Directorate with the leaders of partner committed to delivering the business plans and in the setting organisations to ensure there vision described in this strategy, of budgets, the Board will ensure is a collaborative approach with the aim of creating a that appropriate resources are to whole system change and strong, vibrant organisation directed at achievement of that the Trust is making an which is at the forefront of the aims and ambitions within appropriate contribution healthcare delivery in the the strategy. to system success. West of England. The Board The Trust Management Team will agree the milestones for (TMT) is responsible for delivery of the strategy and the development and delivery of key performance indicators that the Trust strategy. Members will track progress. The strategy of TMT will work with the will be refreshed annually to Medical Director in developing, ensure that it continues to enabling, and supporting meet the evolving needs of strategies and workstreams. the population it serves and responds to technological and clinical advances.

20 5.2 Enabling and supporting strategies

The Trust strategy sets out • Clinical Services Strategy the direction of travel for To forecast future changes the organisation and the in the way clinical care is framework that will be used delivered so that accurate when developing detailed demand and capacity plans plans. Each directorate are developed and corporate area will develop their own Strategy • IM&T Strategy Implementation Plans setting To deliver reliable availability out specific actions for their of information for individual clinical areas and services. patient care and high quality This will result in relentless data for organisational focus on delivery of the Trust functioning strategy as a whole. • Research Strategy To build research capability The following have been and ensure rapid introduction identified as key enabling of new evidence based care strategies: for the benefit of our patients • Quality Strategy • Stakeholder Strategy To ensure high quality care To maintain open and across all specialties including effective relationships with delivery of safe and effective partners and other key care and excellent patient stakeholders experience • Communications Strategy • Estates and Facilities Strategy To ensure views are collated To ensure a high quality, and considered within flexible estate strategy implementation; • Workforce Strategy and tools developed to To ensure sufficient flexibility, ensure consistent narrative capacity and capability in and implementation of the the workforce including strategy throughout the Trust professional clinical staff and first class leadership and management skills

21 6 | Conclusion

North Bristol NHS Trust Providing the high quality care to which we all aspire, is a provider of complex within the resources available is and acute healthcare increasingly challenging and this for a large population situation is unlikely to change. This strategy is designed in the South West of to create an organisation England. We manage equipped to find the solutions to the problems we face and to some of the most difficult deliver sustainable success over medical conditions, in the long term. High quality, an increasingly complex motivated staff and teams that work effectively together to patient population with achieve the Trust’s vision are multiple comorbidities fundamental to our future and long term conditions. success. We are a component part We have the advantage of a complex health system. of having invested in a modern We provide services with estate and equipment, and the a significant and growing hospital building is designed demand. We have staff with to enable complex care to a the expertise that can support high quality and to provide an high quality care in different excellent experience for patients. settings. Working closely with partners in the system to ensure that the Trust is used where it adds most value to the population’s health will be critical to ensuring our vision for the future is realised.

22 23 7 | Appendix A: NBT today

7.1 Clinical Services

North Bristol NHS Trust is a services that serve a wider and Major Trauma centre supported provider of acute and specialist more regional population. by seven major trauma units health services and includes The general hospital services in other providers. The Trust services that reach into the require a range of skill sets provides the Major Arterial community such as maternity and infrastructure that can be Centre for the vascular network care and diagnostics. The found in most acute hospitals. which is delivered through Trust has 1,050 hospital beds The specialist services require a ‘lead provider’ model. This and employs over 8,000 staff. additional skills in areas includes 24/7 access to a In the financial year 2014/15 including diagnostics specialised multidisciplinary we received an income of and equipping. team which has access to a £552m. Income for patient care £1.5 million ‘hybrid operating was split 31.6% for specialist Our services have evolved to theatre’. services, commissioned by NHS meet the needs of patients and England and 63% from the commissioners. Working with The plastic surgery service Clinical Commissioning Groups University Hospitals Bristol NHS provides a highly specialised of South Gloucestershire, Foundation Trust a number team, experienced in the most Bristol and North Somerset. of significant transfers of complex cases in adults and services have been undertaken children (delivered at the Bristol In 2014/15 we treated over between the two major acute Children’s Hospital). The South 51,000 inpatients, including providers in Bristol that ensure West UK Burn Care Network is day patients, as well as caring care is provided in the most hosted by the Trust and covers for over 85,000 people in our appropriate setting. Where South and mid Wales, Devon, Emergency Departments. skills are in short supply, Cornwall, Somerset, Wiltshire, More than 6,000 babies were consolidation has taken place Hampshire, Scilly isles and born at Southmead, Cossham, to improve patient outcomes. South Gloucestershire. at home, or elsewhere in the The arrangements have community and we carried always given due regard to This grouping of specialist out approximately 295,000 the need for local provision surgical services including outpatient appointments. where possible, to ensure a neurosurgery has established good patient experience. As the Trust as an organisation that We provide general hospital a result of the changes made, treats the most complex surgical services to our local population we host the Severn Region emergency patients. and a range of specialist

24 ¡ Over 85,000 people cared for in our Emergency Department ¡ Over 6,000 babies born at Southmead, Cossham, at home or elsewhere in the community ¡ Over 56,000 inpatients treated, including day patients ¡ Over 7.9 million pathology tests conducted ¡ Approx. 295,000 outpatients seen

Consolidation of urology and Emergency care and cancer molecular biology expertise breast care services, in addition care have high demands for provides an opportunity to be to established skin cancer, diagnostic specialties from at the forefront of technological brain cancer and lower gastro- both pathology and radiology. changes that will deliver the intestinal services has resulted In recent years we’ve made personalised medicine expected in a centre of excellence for significant investments in two in the future. complex cancer surgery. We buildings to house pathology also provide diagnostic and services. The second of these Radiology underpins all of specialist components of upper opened in 2016. They are the Trust’s clinical services. We gastro-intestinal, lung and occupied by all of the Trust’s have continued to invest in gynaecology cancer care. We pathology services, together new technologies for both CT do not provide radiotherapy with a city wide consolidated and MRI scans and demand for or oncology services but service for histopathology these services continues to rise. work in partnership with and, in partnership with Working in partnership with University Hospitals Bristol NHS Public Health England, a Alliance Medical, we will house Foundation Trust to ensure microbiology service for Bristol a Positron Emission Tomography smooth pathways for patients and Bath. The Trust has a long (PET) scanner from 2016 who require these services standing genetics laboratory which will improve diagnostic following, or in conjunction with a national reputation. capability for cancer patients with, surgical intervention. The constellation of general in Bristol. Increasing amounts pathology services around of what was formerly surgical a continually developing work is now being undertaken by Interventional Radiology. It is expected that this trend will continue and because skilled radiologists are in short supply, it is likely that Interventional Radiology services will be relatively centralised in the health care system.

25 7 | Appendix A: NBT today

7.1 Clinical Services cont.

We need a strong Its academic strength and vascular services supporting interventional radiology service international reputation renal failure treatment and to deliver complex surgical for expertise in safe, team- kidney transplantation is work and are already taking based care. There is much another example of this patient referrals on a regional that the rest of the Trust as interdependent working. basis. well as other organisations can learn from its success. The Richard Bright Renal Unit In addition to the needs of the Associated with the maternity at Southmead Hospital is the Trust, diagnostics underpin services, the Trust provides largest of its kind in the West much of health provision in a specialist commissioned of England. It carries out primary and community care. level three neonatal intensive over 100 kidney transplants The requirement of earlier care unit which specialises in every year and has led the diagnosis, particularly for extremely premature babies, way with laparoscopic kidney patients with suspected cancer, working within a provider transplantation, spousal will increase demand for based neonatal intensive care donation and non-heart- diagnostic testing as well as the network. beating donor transplants. need for expert interpretation of results that supports decision The services we provide today Our Neurosciences department making in General Practice. create an interdependent is the regional centre for Ease of access to diagnostics whole. For example, trauma neurological services for the will be an important part of service provision requires West of England, including future provision. This represents complex orthopaedic services. Neurosurgery, Neurology a further opportunity for This makes Southmead hospital and Stroke, Neuropsychiatry, the Trust to make a positive the natural home for the Avon Neurophysiology, and contribution to the health Orthopaedic Centre, which Neuropathology. The needs of the local population. is one of the largest elective department also leads the orthopaedic services in the South West neuromuscular The Trust’s maternity service country providing regional, network. is a fundamental part of specialist complex elective The Interdependency of services our provision for the local care and services to the local population, along with suggests there is limited change population. Urology and to the portfolio that could be made without impacting on the performance of the Trust as a whole. The breadth of service delivery creates the Trust’s unique identity and as a result of this service delivery model the complexity of patients attending the Trust will continue to increase.

26 The Figure 1: NBT today interdependency of services suggests there Musculoskeletal Neuroscience is limited change Renal Local Hospital, Medical, Surgical to the portfolio and Maternity that could be services Trauma Centre made without Arterial Centre impacting on Emergency Cancer Surgery Surgery and care the performance Plastics/Burns of the Trust as a whole. The breadth of service delivery Diagnostics creates the Trust’s unique identity.

27 7 | Appendix A: NBT today

7.2 Future demand 7.3 Market analysis and Other acute providers in context the region are Royal United As specialist services Hospitals, Bath, which consolidate within networks predominantly serves the The Trust operates in two population of Bath and North and with demographics main healthcare markets: indicating increased numbers East Somerset; and Weston of people living with more • Local acute services – Area Health, which serves the than one long term health predominantly for the population of North Somerset. condition, we can expect population of South Both trusts refer complex or increased demand for our Gloucestershire, Bristol specialist cases to North Bristol services. The activity projections and North Somerset NHS Trust. A significant review suggest that demand for of the models of care for elective work will continue to • Specialist services – primarily hospital services in Weston- increase for most specialties, in the South West of England Super-Mare is to be undertaken and particularly orthopaedics and in some cases, national. in 2016 with a view to ensuring sustainable, high quality which was expected to grow 5% We are one of two acute in 2015/16. Given the resource services for this population. trusts in the Bristol area. The review may impact the and capacity constraints in the Over recent years, there have health system, we will work share of care that is provided been a number of service by health organisations in with commissioners to deliver changes between the Trust and more care in the community Bristol, including North Bristol University Hospitals Bristol NHS NHS Trust. We do not expect and closer to Foundation Trust. No further home and also work with a change in patient flow with major changes are planned and respect to Bath. patients to enable self- it is therefore expected that the management. The aim is to market share will remain fairly The wider Bristol area also minimise increases in demand stable. hosts a number of private on hospital services. sector providers which all There are opportunities for us provide additional elective to grow some of our specialist capacity to the NHS. services if national drivers to improve cancer identification and treatment lead to more funding in this area. Other We play an important conditions such as stroke care may consolidate within tertiary centres. In order to role in developing the meet any additional demand, it is expected that networks within the region will improve, health care workforce ensuring that patients are repatriated closer to home as soon as they no longer require of the future. the necessary specialist care.

28 7.4 Workforce 7.5 Resea rc h

The Trust employs over 8,000 staff including: We have strong links with the Medical and Dental 853 and the University of the West of England (UWE). Admin and Estates 1,620 We have a significant and Healthcare and support staff 1,630 growing research portfolio with more than 280 researchers Nursing and Midwifery 2,210 delivering 450 research studies Scientific and Therapy 1,373 in the past year, including 48 commercial trials. Current Following the move to the We play an important role in research strengths include Brunel hospital building, developing the health care trauma, urology, MSK, staff turnover increased and workforce of the future. We obstetrics, neuroscience a number of individuals with provide education, teaching (including movement disorders, important skills and experience and training for undergraduate multiple sclerosis and have left the organisation. We and postgraduate doctors, Alzheimer’s disease), emergency will continue to concentrate nurses, midwives, allied health medicine, microbiology and on filling gaps in staffing with professionals and healthcare diabetes. We are growing permanent appointments scientists who work here, which in stroke, vascular surgery, to reduce dependence on is an established, respected dementia and plastics, we temporary staffing. There has centre for training healthcare have active research staff in also been a focus on developing students. every directorate and all of the necessary skilled staff in our regional specialities are areas such as theatres and Our Apprenticeship Centre is delivering research. intensive care. Understanding nationally recognised as an employer based education Research, and the associated and improving management of teaching and learning, sickness absence and all aspects programme with a Skills Funding Agency apprenticeship contract. supports delivery of care for of staff wellbeing are also areas approximately 5,000 patients requiring continued focus. The apprenticeship programme is seen as the start for many per year contributing to The staff survey in 2014/15 people who go on to fruitful staffing capacity. Research was taken after the hospital health care careers at all levels, trials give patients access to move and was a disappointing within the Trust and the wider novel treatments and the Trust result, with the Trust being health and social care economy. leads ground breaking research in the worst 20% for 10 of projects that are trialling new the 20 questions. Subsequent 2,157 new interventions and attracting information from the staff patients from across the UK. Friends and Family Tests, and employees joined Outcomes from Trust led the 2015/16 staff survey have the trust, including research in surgery, musculo- shown an improvement but skeletal services, microbiology the Trust Board acknowledge 1,609 clinical staff and obstetrics have been used that there is more to do, as to update national guidance, the performance and quality demonstrating translation of the services we provide into care improvements. are dependent upon a well- motivated and highly skilled workforce. 29 8 | Appendix B: The challenges we face

8.1 Population changes

The demand for healthcare continues to rise. Our populations are increasing, with steady growth in the number of older people and those living with one or more health conditions. There is an increasing amount of information available to people in need of health care. It is expected that increasingly informed patients will exercise their choices of where their care is provided. Patient voices and more consumerism within health will inevitably lead to changes in the way we interact with and respond to the needs of our patients. Some of the challenges for the future are set out below:

• An aging population with • Requirement to reduce • Population growth and the increasing numbers living variation in the quality of care need to address inequalities with dementia and in life expectancy long-term conditions • Greater emphasis on keeping people healthy and in charge • Growing numbers of patients • Greater public expectations of their own care with multi-morbidities – seven day access to care including cross-cutting clinical close to homes and a • Limited increase in real terms problems such as alcohol- coordinated approach budget for the NHS – the related conditions and to health and social care estimated gap between mental health conditions NHS spending and resources • Increasing complexity of available will rise to £22bn • Use of NHS funding for care required by individual over the next five years providing health care in patients to achieve best the community through outcomes • Commissioners and the Better Care Fund Local Authorities with • Increasing complexity of financial pressures and interdependent services competing demands within the Trust • Working with primary care £22bn and other services so that Trust services form part of integrated care • Innovating and cooperating across organisational boundaries both within and beyond the Trust £ £ £ £ 30 8.2 Efficient use of the Trust’s resources

The major immediate challenges we face include improving the flow of patients through the hospital by reducing bed occupancy, balancing capacity to deliver against the demand and achieving this within the financial resources available. Hospital beds should only be used for those patients who will gain the most value from what we offer. Too many frail and elderly patients are cared for in hospital beds when there are more appropriate, cost effective environments that would better meet their needs.

All of our services need to be Increased productivity must delivered to a high standard maintain our ability to care for of quality and efficiency increasingly complex patients to manage the anticipated as well as releasing more Mon demand into the future. capacity. To efficiently expand capacity it is likely that we To succeed, we must: will need to use more hospital Tues • Ensure that all planned resources over a longer working care is delivered at upper week (six to seven days) and decile productivity work in partnership with Wed other providers to share the • Focus on increasing workload. prevention and avoidance of Thur inappropriate admissions We must use our strength in diagnostic services to support • Make sure that patients clinicians in the Trust, in primary Fri are returned to referring care and community care to hospitals as soon as their define the health problems of needs can be met there patients and ensure they receive Sat the right care in the right place • Work with partners in the rapidly. health system to manage patients with rehabilitation Sun and re-enablement needs

The major immediate challenge we face is to improve the flow of patients through the hospital.

31 8 | Appendix B: The challenges we face

8.3 Commissioner priorities

National priorities In South Gloucestershire In Bristol • Securing additional years of • The size of the population • Tackling the stark health life for the people of England of South Gloucestershire inequalities between affluent with treatable mental and is increasing and deprived areas physical health conditions • There is a steady growth in • Addressing the health needs of • Improving the health related the number of older residents a rapidly growing, young and quality of life of the 15 and those living with one ethnically diverse population million+ people with one or or more health condition more long-term conditions, • Improving the health of including mental health • The financial environment children in care and of conditions is challenging which means disadvantaged children that more must be achieved • Reducing the amount of with the resources that are • Tackling premature death time people spend avoidably available caused by cancer, which in hospital through better remains the biggest killer and more integrated care in • Local people need to be of people aged under 75 the community, outside of supported to achieve and in the city (38%) hospital maintain good health and wellbeing • Addressing the health needs • Increasing the proportion of those who are living of older people living • More people are living longer and with long-term independently at home with heart disease, diabetes, conditions such as dementia, following discharge from hypertension, dementia especially those aged over hospital and obesity 75 who are living alone • Increasing the number of • A key objective is to drive • Improving partnerships people with mental and integration of out-of-hospital between GPs, community physical health conditions care so that patients are health and social care workers having a positive experience better managed in the community • Improving pathways for long- of hospital care term conditions, especially • Increasing the number of diabetes people with mental and • Improving health services for physical health conditions patients with conditions caused having a positive experience by obesity, smoking and rising of care outside hospital, in rates of alcohol consumption general practice and in the community • Commissioning health promotion services to reduce • Making significant progress these problems in the future towards eliminating avoidable deaths in our hospitals caused • Working closely with the by problems in care voluntary and community sectors

32 The NHS Five Year Forward Specialised Commissioning challenges – Bristol, North View and NHS Planning Somerset, Somerset and South Gloucestershire (BNSSSG) Guidance (2016/17) will guide local commissioner plans and • A diverse population spread • Reducing the above national the Trust’s priorities over the across urban and rural average incidence of next five years. Place based settings with variations in malignant melanoma health planning for populations levels of ethnicity, inequality in the South West requires specification of and access a local Sustainability and • Managing specialist Transformation Plan and leaders • A higher proportion of commissioning within in this locality have decided that population aged 65 or over a challenging financial the population for planning compared to the rest of the UK environment purposes will be Bristol, • A need to improve rates of North Somerset and South premature mortality from Gloucestershire (BNSSG). liver disease Since a significant proportion • A need to reduce incidents of of the work we deliver is for suicide and self-poisoning a wider population in the region, we will also engage • Managing the likely increases with specialist commissioners in incidence of cardiovascular and organisations in provider disease due to smoking, networks to determine high alcohol consumption sustainable plans for these and obesity services.

33 8 | Appendix B: The challenges we face

8.5 Operational 8.4 Financial performance performance

Our financial position is not sustainable and we must become Both before and after moving adept at doing more with the funds available by using our services to Southmead, we resources more efficiently, as well as maximising income. Our faced challenges in balancing Long Term Financial Model sets out the financial plan to 2020/21. capacity and demand. Particular To return to a sustainable position, we have set out to achieve a concerns relate to: £150m transformation programme to be delivered over the next five years. The recovery of our financial position is now likely to be • Emergency pathways extended in light of the 2015/16 out turn position. Re-working of demonstrated by poor the financial model will be an annual event to take into account performance against the in-year position and progress with implementing the strategy. the four hour standard over a prolonged period • Orthopaedic, neuroscience and urology elective and cancer capacity, demonstrated by performance on the Referral To Treatment and cancer standards • 52 week waits for spinal surgery

20,000 elective operations and 5,000 emergency operations

34 8.6 Quality and Safety of patient care

The Trust Board is committed The priorities for safe care difficulties for patients caused to providing a high quality identified in the last four years’ by the disruption of the move of service to patients and to Quality Accounts are: and these were reflected in a transparency of information decline in patient experience about quality. An Account of • Infection control in the subsequent months. the Quality of our services is • Preventing deterioration of A number of actions have been published annually and contains acutely ill patients including taken to improve the experience a review of the year and sepsis and acute kidney injury of care including: the roll out of identification of the priorities televisions to the single rooms, for quality improvement. • Reducing pressure ulcer increased parking and ongoing incidence support from the volunteers. The Hospital Standardised Mortality Ratio and Summary • Reducing mislabelling The priorities for patient Hospital Mortality Indicator of blood tests experience identified in the have steadily improved since the • Safe systems of care Trust Quality Accounts over the move into the Brunel building past four years have been: and continue to be below the in operating theatres national average. There has • Improving nutrition • Providing patients with clear been significant improvement assessments information about their care in the mortality statistics for patients admitted at weekends • Ensuring medical records • Improving the experience and these are now no different and bedside patient of cancer patients to those for weekday admission. documentation are in place • Increasing response rates and learning from the Friends and Through our Clinical Audit • Improving planning, quality Family Tests Committee and Quality and timeliness of discharge Surveillance group, systems are information • Improving care for patients in place for monitoring clinical with Dementia outcomes. As described in 8.7 Patient experience the Quality Accounts we give 8.8 Conclusion particular priority We asses the experience of to contributions to National patients through the annual Through service change and Audit and National Registries. national patient surveys, transition to the new hospital This allows clinical teams to including the cancer experience our patients and staff have compare the outcomes of our survey, the monthly Friends experienced disruption. This care with those in other trusts. And Family Tests and through has resulted in the challenges investigation of complaints. described in the appendix, in The safety programme is Performance in the patient and focusing on developing a addition to those experienced staff surveys demonstrates areas by the NHS as a whole. The culture of ensuring that for improvement, particularly in patients always receive all of themes described in the Trust relation to customer care and strategy are the mechanisms by the evidence based care that staff engagement. they need and that there is which these challenges will be met over the next five years. an ongoing commitment to Although many patients were eliminating errors impacting complimentary about the new patient outcomes. environment in the Brunel building there were also

35