Hospital Group Operational Plan 2019 Contents Introduction .............................................................................................................................2 Our Population .........................................................................................................................3 Reform and Transformation ......................................................................................................4 Quality and Safety ....................................................................................................................6 Health and Social Care Delivery .................................................................................................8 Unscheduled Care ....................................................................................................................... 8 Scheduled Care ......................................................................................................................... 10 Specialist Services ..................................................................................................................... 12 Women and Children’s Services ............................................................................................... 12 Cancer Services ......................................................................................................................... 13 Finance ................................................................................................................................... 14 Workforce / HR ....................................................................................................................... 17 Appendices Appendix 1: Quality Assurance Key Performance Metrics: ...................................................... 20 Appendix 2: RCSI Hospital Group Activity: .............................................................................. 103 Appendix 3: RCSI Hospital Group Organisational Structure: .................................................. 104 Appendix 4: 2019 WTE & Agency budgets by staff / hospital site .......................................... 105 Appendix 5: RCSI Hospital Group Capital Infrastructure: ....................................................... 106 Introduction Introduction RCSI Hospital Group established in 2015 comprises the following hospitals: - Beaumont - Connolly - Cavan - Monaghan - Our Lady of Lourdes, Drogheda - Louth County - Rotunda Academic Partner: - Royal College Surgeons Ireland RCSI Overall Statement of Vision and Key Strategic Objectives Statement of RCSI Hospital Group Vision: To provide world class care, exceptional clinical services with respect and compassion. Key Strategic Objectives Within the context of the patient being the core focus for all endeavours, the RCSI Hospital Group is pursuing 8 thematic objectives, each with related critical success factors necessary for successful advancement: 1 Improve Access Performance. - emergency care diagnosis, treatment and management. - elective care diagnosis, treatment and management. 2 Deliver relevant services that are planned and organised to meet designated population health needs, achieve desired health outcomes in a manner consistent with evidenced based best practise with particular focus on efficiency, effectiveness and quality. Recognising also the need for continuous improvement and innovation. 3 Do no preventable patient harm. 4 Deliver services equitably on the basis of need, governed by the principles of Fairness, Honesty, Respect and assigned Accountability. 5 Develop and generally advance an integrated delivery model. - a single delivery model across the 7 operational sites. - successful integration with Community Services, particularly with regard to Chronic Disease Management. - cognisant of the need to operate in a complex environment of vertical and lateral collaboration and the participation in service and academic health networks both nationally and internationally. 6 Fiscal Prudency with regard to resource utilisation and investment. 7 Develop Education and Research capacity and capability with designated academic partner in a manner that supports and generally enhances direct service delivery. 8 Ensure Staff enabled, supported, trained, developed and accountable. 2 Our Population Our Population Population Health The RCSI Hospital Group serves populations in five counties – North Dublin, Meath, Louth, Cavan and Monaghan. The area stretches from the north banks of the River Liffey in Dublin City Centre, north to the border with Northern Ireland, and west to the border with County Donegal. It comprises urban, rural and commuter belt areas, and covers approximately 6,817 square kilometres in total. There is considerable variation in population density from a low of 39 persons per square kilometre in Cavan to a high of 4,139 persons per square kilometre in north Dublin city. Residents of neighbouring areas such as South Dublin and Kildare also access hospitals for secondary care and maternity services. Beaumont Hospital, which is the largest hospital in the group, in addition to providing emergency and acute Secondary Care services to the local community is also a designated Cancer Centre, the Regional Treatment Centre for Ear, Nose and Throat and Gastroenterology and also the National Referral Centre for Neurosurgery and Neurology, Renal Transplantation, and Cochlear Implantation - as such treating patients from all parts of the country. The RCSI catchment area has experienced rapid population expansion in recent years, growing from approximately 640,000 in 2002 to 817,522 in 2011. This population growth is projected to continue, reaching almost 875,000 by 2021. Provisional preliminary data from Census 2016 suggests that the population in the catchment area has now reached approximately 864,000. The catchment covers a large area, including urban, rural and commuter areas, each presenting different challenges for service delivery. The population in our catchment area is relatively young. Fingal has the youngest and fastest growing population in the Country. Per Census 2016 average age is 34.3 (3 years lower than the average) and the growth rate between 2011 and 2016 was 8 per cent more the twice that for the country as a whole. However while 10% of the population is aged 65 and over, compared with 11.7% nationally, some areas within the catchment include higher proportions of older people. In particular, in the area around Beaumont hospital (Dublin North Outer City), 15.4% of the population are aged 65 and over, while Cavan and Monaghan each have approximately 12% of the population aged 65+. While in the 5 counties (Fingal, Meath, Louth, Cavan and Monaghan) there were 5872 people over 85 and 21938 between 75 and 85 per Census 2016. Older people in the RCSI catchment area were less likely to be living alone, relative to other catchment areas. However, almost a third of older adults in Dublin City live alone, compared with less than a quarter in Meath and Fingal. Levels of deprivation in the area were low relative to other Hospital Group catchment areas, with 37% of the population living in areas which are classified in the top 3 deciles of deprivation. This compares with the most deprived catchment area, West/North West, where 49% of the population live in areas in the top 3 deciles of deprivation. However, there were sharp contrasts in deprivation across areas. In Louth, 68% of the population live in areas classified as being in the top 3 deciles of deprivation, compared with only 22% of the population in Fingal. Levels of good or very good self-rated health among the total population, and older people, varied across the catchment, with better health reported in Fingal and Meath, and worse health in Dublin City, Louth and Monaghan. GP provision is low in the RCSI catchment area, particularly in Meath, Cavan and Monaghan. This may lead to increased hospital activity which would be more appropriately carried out in a community setting and increased numbers of hospitalisations which could have been avoided with higher primary care provision. A wide range of emergency, diagnostic, treatment and rehabilitation services are provided across these, supported by a workforce of 9,200WTE staff (December 2018 census). Our aim is to provide high quality and safe care underpinned by the development of a single effective corporate and clinical governance structure. 3 Reform and Transformation Reform and Transformation Focus in developing operational plan has encompassed: - Having patients at its centre. - Being informed by the latest best practice. - Striving to integrate all present services – insourcing and maximising usage of all available capacity with available capability. - Development of appropriate patient pathways and clinical networks in and across hospitals in the Group. - Promotion of integrated service provision with community services through working with the four CHOs associated with the population served by the RCSI Hospital group, by promoting a modernised and streamlined service model in line with Sláintecare. This can be delivered through outreach services, telemedicine, virtual health clinics, integrated assessment services and cross-sector working, which will all support independence and choice for patients. - Ensuring alignment of service developments in both acute and community service areas where there is an opportunity to build upon existing pathways of care (e.g. frail intervention therapy teams and older persons’ services) which