NHS Improvement: 2017/18 highlights collaboration trust respect innovation Annualcourage report 2017/18compassion highlights | 1 We support providers to give patients safe, high quality, compassionate care within local health systems that are financially sustainable.

Annual report 2017/18 highlights | 2 Introduction

NHS Improvement is “The NHS is a dynamic “The NHS faced continued responsible for overseeing institution that has constantly pressure from rising demand NHS foundation trusts, NHS evolved over the last 70 years. for its services in 2017/18, but trusts and independent If we continue to face the its staff met the challenge with providers. We offer the challenges the way the NHS’s dedication and resilience. The support these providers original founders did, we will proportion of trusts that the need to give patients succeed. NHS Improvement rated consistently safe, high quality, has a crucial part to perform as ‘good’ rose from 39% compassionate care within in this.” to 45%.” local health systems that are financially sustainable. By holding providers to account and, where necessary, intervening, we help the Baroness Ian Dalton NHS to meet its short-term Chair Chief Executive challenges and secure its future.

Annual report 2017/18 highlights | 3 This short report gives you an insight into what we have done The Single Oversight in 2017/18 towards achieving our 2020 objectives. Framework, introduced in It is organised around some of our main work programmes: 2016, identifies how we can quality improvement; financial control and turnaround; help trusts improve patient operational performance; provider productivity; strategic services. It is designed to change; workforce, leadership and improvement. Each is increase the number of equally important, and all are interconnected. trusts achieving ‘good’ or ‘outstanding’ Care Quality Read our full Annual report and accounts 2017/18 Commission (CQC) ratings, and is closely aligned with CQC’s approach. We With NHS England we published updated NHS planning guidance assign trusts to one of four in February 2018. This explained how the extra £1.6 billion revenue ‘segments’ depending on the funding for the NHS in the November 2017 Budget and the level of support they need. additional £540 million from the Department of Health and Social We updated the framework Care for core frontline services would be distributed. It reinforced in November 2017 based on our intention to move further towards system working through feedback and lessons from its sustainability and transformation partnerships in 2018/19. first year of operation.

Annual report 2017/18 highlights | 4 Quality improvement

With help from nine trusts, months, one ward had reduced We define quality in the NHS we created a national mental falls by 30%, while another in terms of patient safety, health improvement model. went 20 days without a fall; clinical effectiveness and We involved people who use previously it had only managed patient experience. Quality services, their families and six days. improvement and particularly carers throughout. the improvement of patient Our criteria-led discharge safety become ever more We set up a support team improvement collaborative important when pressure in with NHS England to help involved 13 trusts tackling delays the system increases as the local health systems eliminate in discharging patients who are NHS responds to growing inappropriate out-of-area well enough to leave hospital. demand. We provide clinical placements for acute mental Our national Stop the Pressure and managerial leadership health inpatient care by programme aims to eliminate and improvement expertise April 2021. avoidable pressure ulcers: 172 to support trusts’ care quality, We completed our falls trusts submitted improvement including patient safety. Much improvement collaborative plans to eliminate pressure ulcers. of what we achieve can only begun in early 2017, which be done in partnership with encouraged 19 trusts to reduce others. fall rates by 5%. After two

Annual report 2017/18 highlights | 5 Focusing on patient National maternal and • The percentage of trusts experience neonatal health safety rated ‘good’ by CQC rose collaborative from 39.1% to 44.8%, Our Board agreed a statement and the percentage rated of intent to embed the patient, Every maternity unit in England ‘outstanding’ rose from public and carer voice in our is taking part in our three-year 6.0% to 6.5%. work. We co-designed and collaborative, launched last commissioned a learning year, to reduce maternal deaths, • A total of 20 trusts network for heads of patient stillbirths and neonatal deaths improved from ‘inadequate’ experience, which 153 trusts and brain injuries by 20% by or ‘requires improvement’ joined. And we provided 2020 and 50% by 2030. to ‘good’ or ‘outstanding’, bespoke leadership development Trusts in the first wave against our own target focused on patient experience developed 176 improvement of 17. to 18 trusts. projects in areas such as smoke- • We published the first of free pregnancies, stabilising our patient safety review the very pre-term infant, and and response reports, six- recognising and managing monthly summaries of how deterioration in mother or baby. we reviewed and responded Learning will be shared through to issues reported to us. local learning systems that support local maternity systems.

Annual report 2017/18 highlights | 6 Financial control and turnaround

We introduced Use of The ongoing cost of private We are committed to Resources assessments finance initiative (PFI) schemes restoring trusts to financial in autumn 2017. They are is significant for many trusts. balance and improving designed to help providers, We therefore set up a working their use of resources national bodies and the public group to help ensure the NHS while delivering continuous understand how effectively gets the best possible value improvements in the quality trusts are using their resources. from PFI deals – for example, of patient care, as well as We developed them with CQC, by improving the way trusts securing long-term clinical which will combine our ratings manage PFI contracts. And we and financial sustainability. with its own in an overall trust- carried out a survey of how level quality rating. trusts manage these contracts. Spending on agency staff has continued to decrease since we introduced controls, falling by a third since 2015/16. Trusts spent £90 million less than planned in 2017/18 and £520 million less than last year.

Annual report 2017/18 highlights | 7 Financial Improvement Programme We closely track trusts’ performance to help them Eighteen trusts volunteered for Wave 2 of our Financial address financial and Improvement Programme, which matches ambitious management operational issues. teams with external experts to enhance cost improvement programmes. It focuses on transferring skills and expertise to trust • 212 out of 234 trusts staff. Wave 2 built on the learning from Wave 1. accepted their financial control totals; almost 64% either met or exceeded them. Patient-level costing • Trusts closed the year with We made excellent progress towards the NHS being able to a deficit of £960 million, calculate precisely the cost of care for every single patient – not compared to £791 million in only drugs, tests and appliances but the time doctors and nurses 2016 /17. devote to their care and treatment. In 2017, 70 acute, mental health and ambulance trusts implemented patient-level costing • Despite this, the year-end and sent us data on £21 billion of costs. After consultation, we financial position represents decided that all acute trusts should record the costs of their continued progress by activity at a patient level from 2018/19. the trust sector towards financial sustainability.

Annual report 2017/18 highlights | 8 Operational performance

Throughout the year, the NHS To increase the use of criteria- Our aim is that NHS providers experienced rising demand and led discharge, our nursing maintain and improve high levels of bed occupancy. directorate published evidence- performance against the We therefore made planning based principles and ran standards in the NHS for winter – when these trends collaboratives involving 3,000 Constitution. We support reach a peak – a priority. For the patients, gaining international them to do so, to cope first time, formal winter planning interest. with increased demand – began in July. for instance, during winter Our emergency flow months – and to have In the 12 months to February improvement tool helps sustainable strategies to 2018, numbers attending trusts identify bottlenecks and maintain their performance. accident and emergency stress points. Since its launch in departments increased by September 2017, over 500 staff 1.8% and emergency hospital from 122 acute hospitals have admissions by 3.7%. The NHS used the tool. treated 160,000 more A&E patients within four hours over the winter compared to the previous year.

Annual report 2017/18 highlights | 9 Using technology to increase At the first pilot site, The Royal We took part in the national bed capacity Wolverhampton NHS Trust: response to several major incidents: A key part of our role is to help • patients were three times more trusts develop new ways of likely to be allocated to an • We advised trusts on action working to improve care and appropriate ward to combat the WannaCry meet demand. ransomware cyberattack. • operations cancelled due to Five trusts are piloting patient bed unavailability reduced by • After the Grenfell Tower flow system technology, which 60% fire, we ensured all trusts enables hospital staff to see real- identified any risks to time data on available beds so • length of stay fell by 11%. their buildings and took they can allocate patients to the necessary action. most appropriate ward first time. • When Carillion declared They can also locate equipment insolvency, we had already and housekeeping or portering drawn up plans to maintain staff available to clean a bed or patient services without transport a patient. interruption at the 14 trusts affected.

Annual report 2017/18 highlights | 10 Provider productivity

The Model Hospital is a digital Using the ‘top 10 medicines To help providers improve information service to help all list’ in the Model Hospital, trusts the quality of care and trusts identify opportunities to identified high cost branded meet financial objectives, improve their productivity. By medicines for which safe and we make sure they deploy the end of 2017/18 it had more equally effective biosimilar staff productively, manage than 8,000 registered users in and generic versions could be the NHS estate efficiently NHS provider organisations. prescribed instead. This saved and get the best deal on the NHS more than £324 million supplies. Lord Carter’s review We worked with 23 trusts in 2017/18. of NHS productivity in acute as part of our review of trusts found that reducing productivity and performance Our Nationally Contracted unwarranted variation could in mental health and Products Programme buys save the NHS at least £5 billion community health services, specific everyday hospital by 2020/21. Our provider collecting key data we will use products on behalf of the whole productivity programme is to develop an ‘optimal model’ NHS. From the first 20 products now supporting all trusts NHS community or mental in the programme, the NHS is on to reduce variation, make health trust. course to save £18 million a year. savings and efficiencies and improve services.

Annual report 2017/18 highlights | 11 Purchase price index and identifying and reducing • Bedford Hospital NHS Trust benchmarking tool unwarranted variations in used the Model Hospital service and practice. It found benchmarks for pathology By using our PPIB, Plymouth that implementing networks to negotiate an improved Hospitals NHS Trust negotiated of specialist vascular units deal with its pathology lower prices and now saves 13% could save 100 lives a year service provider, reducing a day on the products it buys. and save up to £16 million, costs by over £700,000. King’s College Hospital NHS Foundation Trust had ordered with a further £6.5 million • Our research found £1.9 million of goods direct with procurement savings. unwarranted variation suppliers, unaware that the GIRFT also found that if more among the NHS’s 105 same products were available at acute hospitals introduced pathology services, so we lower prices from NHS Supply consultant-led surgical are helping them form 29 Chain. By using PPIB, it assessments, the NHS could pathology networks. compared prices paid by other reduce unnecessary emergency • We provided corporate trusts and negotiated a cost admissions for general surgery services benchmarking reduction of 10%. by 30% – one of 20 ways to reports to all trust Getting It Right First Time improve patient outcomes that finance directors – an GIRFT – a partnership with the together could save £160 important tool for tackling Royal National Orthopaedic million a year. unwarranted variation. Hospital NHS Trust, and led by frontline clinicians – aims to improve care quality by

Annual report 2017/18 highlights | 12 Strategic change

Throughout the year our We offer bespoke support to We want to ensure that national and regional teams trusts considering or proceeding every local area has health supported sustainability and with mergers, helping ensure and care services that are transformation partnerships clarity about the intended clinically, operationally and (STPs) as they moved from benefits. Where the Competition financially sustainable. We planning to implementation and and Markets Authority (CMA) support providers to design began to play a more prominent reviews a proposed transaction, and implement services that role in managing system-wide we support the trusts in best meet the needs of their efforts to improve services. developing their case and communities. With NHS England we set up advise the CMA about the a development programme for likely benefits for patients. the most mature STPs to evolve We worked on three high- into integrated care systems. profile mergers in Manchester, We envisage that all STPs will Birmingham and Derby that have evolve over time into integrated since been cleared by the CMA. care systems.

Annual report 2017/18 highlights | 13 • We used our Integrated How one STP is integrating services Support and Assurance Frimley STP’s North East Hampshire and Farnham vanguard Process, co-designed with brought together primary, community, acute, mental health and NHS England, to engage social care service teams. with 10 local health systems that were planning new Closer working stimulated new services and initiatives that help contracting arrangements. people manage their own health and care more effectively and receive more care and support in the community rather than • We worked with Greater hospital. For example, GP practices and other services created Manchester Health and ‘urgent care hubs’ offering same-day appointments with an Social Care Partnership to interdisciplinary team of GPs, nurse practitioners, orthopaedic identify a preferred long- practitioners, paramedic practitioners and other professionals. term solution for Pennine Acute Hospitals NHS Trust. GP practices are informed of all A&E attendances so they can direct appropriate information and advice to patients, helping • We published revised them access care more locally in future. Bringing together transaction guidance for resources has meant a better service for patients and a more trusts that included lessons efficient service that has reduced hospital admissions. learned from previous mergers and acquisitions.

Annual report 2017/18 highlights | 14 Workforce, leadership and improvement

We launched a major We launched Phase 2 of our We help providers workforce retention culture programme, take a strategic and programme. We provide developed with The King’s multiprofessional approach to targeted, clinically led support for Fund and three pilot trusts. safe staffing. We want trusts the trusts taking part to develop It is based on national and to build strong leadership and retention improvement plans. international evidence the capability to continuously identifying elements needed improve their services so The consultation document, for high quality care cultures. they are sustainable for the Facing the facts, shaping the future. We aim to improve future, which we helped shape, Staff from more than 46% the working environment for will lead to the first national of all NHS organisations NHS leaders and revitalise health and care workforce attended our demand and the systems of talent strategy for 25 years. capacity training. management and leadership With the Faculty of Medical development. Leadership and Management and NHS Providers, we identified eight actions all trusts could take quickly to improve junior doctors’ working environment and morale.

Annual report 2017/18 highlights | 15 Appointing chairs and non- We grew a talent database • Two cohorts of our aspiring executives of board-ready people across chief executive programme the country interested in non- graduated in 2017; 11 of the Our Provider Leadership executive roles in the NHS. 27 participants became chief Committee and subcommittees executives by the end made 320 NHS trust chair and NExT Director scheme non-executive appointments. of 2017/18. Our NExT Director scheme This included 115 new is designed to help find • We launched the aspiring appointments: 14 were chairs, and support a diverse next medical directors programme. and 205 were reappointments generation of talented people or extensions, of which 35 • We commissioned a survey to become non-executive were chairs. on current senior professional directors. Nearly 50 placements leadership for allied health Supporting chairs and have been taken up by women professionals (AHPs) to spotting talent and people from black, Asian show how AHP leadership We held 12 regional chair and minority ethnic communities arrangements affect quality networks led by executive across our London and Midlands and productivity. regional managing directors, and East regions. where provider chairs share best practice and discuss current challenges and regional issues.

Annual report 2017/18 highlights | 16 Our people

ELEVEN SITES CENTRAL TEAM ACROSS ENGLAND: AND FOUR REGIONAL TEAMS: Birmingham Cambridge London Coventry North Derby Midlands and East South - divided into Leicester South East and South Manchester West, and jointly Newcastle managed with NHS London (2) England Taunton

Annual report 2017/18 highlights | 17 Our people

1,369 EIGHT DIRECTORATES STAFF Medical Nursing Improvement Operational Productivity

Strategy Resources Regulation Communications

1,046 people responded to the annual staff survey 87% 83% 82% in November 2017 (83%) said “my line manager care about the future understand the aims treats me with respect” of NHS Improvement of NHS Improvement

Annual report 2017/18 highlights | 18 Contact us: NHS Improvement Wellington House 133-155 Waterloo Road London SE1 8UG 0300 123 2257 [email protected] improvement.nhs.uk

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