better good care Our Plans specialist safer value excellence performance respect dignity clinical

Transcription

1 safer good better value care Our Plans clinical specialist excellence performance respect dignity

2 safer good better value care Contents Foreword Our Vision, Values and Objectives Our Community How the NHS and healthcare is changing Our Services Our Commitment to Quality Performance and Achievements Commissioners and Partner Providers Clinical Strategy and Site Development Plans Our Team Financial Health and Capital Investment Education and Research Health Informatics Our Environment Governance Foundation Trust status Glossary Page 1

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4 safer good better value care Foreword - Our Journey and Our Plans At Royal Cornwall Hospitals NHS Trust (RCHT), we strive to serve the people of Cornwall and the Isles of Scilly so that local healthcare is continually improving. We are proud of our achievements and we are delighted to report that RCHT: is rated as a performing organisation by the Department of Health. This means that overall our services are considered of a good standard and we meet or exceed national targets and standards is unconditionally registered with the Care Quality Commission, verifying the quality and safety of our services has had no MRSA cases since late 2010, being confirmed one of the best records on MRSA infection rates in the country has improved performance across the range of key patient quality measures including waiting times, stroke care, treatment for a fractured hip and putting in place the gold standard procedure for patients who have had a heart attack has delivered improved financial performance moving from underlying deficits to surplus. Our Plans was the Trust s first five-year rolling strategic document, published in April It set out our strategy for developing the Trust, including our ambition to achieve Foundation Trust status by Our progress has been demonstrated by the fact that we are ahead of schedule on the ambition we set out then. We undertook our consultation on Foundation Trust status in autumn 2011 and are aiming to be a Foundation Trust, authorised by Monitor, during the financial year 2012/13. As part of our development towards Foundation Trust status, we have refreshed our strategy and set out a summary of Our Plans RCHT will: continue as the principal provider of acute and specialist healthcare to the people of Cornwall and the Isles of Scilly, from our three hospitals - Royal Cornwall Hospital (Treliske) in Truro, West Cornwall Hospital in Penzance and St Michael s Hospital in Hayle - as well as the numerous community locations across the county and the Isles of Scilly seek to develop our wider role as a provider of better integrated healthcare, focusing on services rather than sites Page 3

5 Foreword - Our Journey and Our Plans be robust to the challenges of increased competition among healthcare providers, providing the highest quality services to patients build partnerships and networks to develop an increased range of services and clearer pathways of care for the patients we serve. The Trust is resolutely focused on further improving the quality and effectiveness of the care and services provided to patients. The development of these services will be supported by the latest technology and leading edge design, with the Trust s Clinical Site Development Plan continuing to provide the blueprint for our site and service developments. RCHT s ambition is clear - to provide safer, better, good value care. Achieving Foundation Trust status is key to realising these ambitions and to harnessing the local passions and commitment of our partners in primary and community care, the voluntary sector, local authorities and others. Most of all it will represent the next step in engaging our public, partners and patients in developing quality services for the people of Cornwall and the Isles of Scilly. With the continuing support of our hugely talented and dedicated clinicians and supporting workforce, together with that of our stakeholders we are confident and excited for the future of our Trust. Martin Watts Chairman Lezli Boswell Chief Executive clinical specialist excellence performance respect dignity Page4

6 safer good better value care Our Vision, Values and Objectives The NHS Constitution enshrines in law what staff, patients and the public can expect of the NHS. It sets out a patient s rights regarding: access to health services the quality of care they receive the treatments and programmes available to them confidentiality, information and their right to complain. These rights are further strengthened by the Government s Health and Social Care Act 2012 which further places patients' rights at the centre of healthcare. RCHT is committed to upholding these rights and our vision, values and objectives reflect this. Our Vision By 2014, we will be a flourishing Foundation Trust recognised for the quality, safety, innovation and productivity of our services. We will provide safer, better, good value care and remain the preferred provider for our local people for their acute and specialist health care. We will build on this position over time to broaden the range of innovative community-based health services we offer. Our Values This vision is underpinned by RCHT s values: To work with So that we respect and dignity improve lives commitment to quality of care work together for patients compassion ensure everyone counts Our Strategic Objectives To support our Vision and our Values, the Trust has six strategic objectives. These were first set out in Our Plans but have now been refreshed and reordered to reflect the highest priority that we attach to quality and safety of care to: focus relentlessly on quality of care and patient safety remain the preferred provider of acute and specialist healthcare to the people of Cornwall and the Isles of Scilly work as a constructive partner in the community, promoting the integration of health and social care value and improve the working lives of our staff, promoting education, training and research work towards a sustainable, low carbon future deliver financial surplus annually. RCHT s Board is committed to public accountability and monitors performance against these objectives through its monthly Public Trust Board meetings and formally through its Annual Report. Page 5

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8 safer good better value care Our Community: Serving the people of Cornwall and the Isles of Scilly Cornwall and the Isles of Scilly have a rich and vibrant history, with a strong culture and sense of identity. It is a beautiful part of the British Isles in which to live, with an important tourist and holiday business. And, like any part of the country, it has its own distinct healthcare needs. There are 535,000 people living in Cornwall and the Isles of Scilly. The majority of them look to RCHT for their care. Among this population: Cornwall and the Isles of Scilly have a more elderly population than the rest of the country the local population is growing quickly, by around 5% from 2010 to 2016, with the most growth in groups over 65 years of age and the youngest age groups, reflecting high birth rates (where the number of births increased by 17% from 2001 to 2008) there are significant pockets of deprivation in the county, which bring their own healthcare needs and requirements, including issues concerning access to care Cornwall is a rural county with a widely dispersed population. In addition, the Isles of Scilly provide a further challenge in access to care. In addition, at the height of the tourist season, there can be around 300,000 extra people in the county and this can mean our Emergency Department faces high level of attendances in the summer months, especially in July and August, in addition to the usual winter demands experienced by all hospitals across the UK. This creates particular healthcare demands and delivery challenges. RCHT structures its current services and is planning future care on the basis of these challenges. For example, we provide services across a range of sites in the county harnessing our local community hospitals. In addition, we have developed care for elderly patients, for instance through improvements to the hip fracture pathway through the ortho-geriatrician and trauma coordinator services; and increased specialist care for stroke patients both within RCHT and across the community. Further, our future plans include the development of a birth centre at our main site in Truro to ensure we provide for the rising new births in the county. Page 7

9 How the NHS and healthcare is changing Over the life of this Plan, healthcare will continue to change. There will be demographic pressures on care. Patients will, quite rightly expect higher quality care from healthcare providers and new treatments and procedures. In addition, the Government s Health and Social Care Act 2012, sets out a number of changes in how the NHS and healthcare is organised and provided. In particular: new commissioning arrangements will be led by local clinical commissioning groups with Health and Wellbeing Boards being established within Cornwall and Isles of Scilly Councils determining strategic planning and commissioning for health and social care increased patient choice and competition for healthcare services with the introduction of Any Qualified Provider to provide services and improved information for patients to make informed choices. More widely, like the rest of the public sector, the NHS will experience a tighter financial environment over the lifetime of this plan. Part of the response across the country is the national QIPP (Quality Innovation Productivity Prevention) programme. This aims to improve the quality of care and ensure patients are cared for in the most cost effective setting. Locally, RCHT has engaged with Commissioners and partners to develop the programme and will respond to Commissioners intentions. In response, RCHT will ensure services respond flexibly to our Commissioners intentions and be ever more focussed on the needs of our patients and GP's. Part of our clinical strategy will see a focus on an increased range of services for patients to access, improving waiting times and the quality of care provided. clinical specialist excellence performance respect dignity Page8

10 safer good better value care Our Services RCHT serves the 535,000 people of Cornwall and the Isles of Scilly. Around 420,000 of them primarily look to RCHT for their secondary healthcare services. The local community s health needs, the dispersed Cornish population and the emphasis of our Commissioners on locally accessible services has shaped RCHT s provision of health services across a range of sites in the county. RCHT is committed to designing pathways of care around patients and moving services closer to where patients live. RCHT provides acute and specialist healthcare services as follows: Three key hospital sites: - Royal Cornwall Hospital in Truro. Treliske is the hot centre for our services providing a comprehensive acute emergency service for adults and children, as well as planned specialist care and maternity services. - West Cornwall Hospital in Penzance. The Hospital provides an acute diagnostic and surgical treatment centre, together with the newly developed 24 hour Urgent Care Centre, run in partnership with local GP's. - St Michael s Hospital in Hayle. The Hospital serves as an elective cold treatment centre specialising in orthopaedic and breast surgery. The site also includes Marie Therese House which provides a specialist neurology centre. Maternity services for the majority of the county, with a midwife led unit at Penrice, St Austell, a small birthing centre at Helston, as well as services from GP clinics and home births all supported by a consultant service at Treliske. Further, births are managed at St Mary s Hospital on the Isles of Scilly. X-ray, outpatient and other services across the county at the range of community hospital sites and at St Mary s Hospital on the Isles of Scilly. During 2011/12, across all the Trust s sites, RCHT provided around 485,000 outpatient appointments and procedures; carried out over 65,000 planned (or elective ) procedures; admitted around 46,000 emergency (or non-elective ) patients; and saw around 65,000 patients within its Emergency and Casualty Departments. Location of key healthcare sites in Cornwall STRATTON LAUNCESTON BODMIN NEWQUAY ST. BARNABAS FOWEY ST AUSTELL CAMBORNE/REDRUTH ROYAL CORNWALL HOSPITAL EDWARD HAIN ST. MICHAELS POLTAIR FALMOUTH WEST CORNWALL HELSTON LISKEARD Isles of Scilly ST MARYS COMMUNITY HOSPITALS RCHT HOSPITALS Page 9

11 Choosing RCHT for your care RCHT is committed to providing care for NHS patients free at the point of use and we are confident that patients will continue to choose RCHT for their care because we: offer high quality care in many places throughout Cornwall have an excellent infection control record with zero MRSA cases since 2010 meet the CQC s stringent quality and safety requirements with unconditional registration and a full range of critical care and other facilities to ensure patients are cared for in the safest environments are among the best NHS performers for short waiting times, with ever more pathways being developed to speed up access and ensure patients make the minimum number of visits to hospital ensure the utmost respect for patients dignity and privacy with same sex environments across our hospitals are developing cancer services that put us at the leading edge with the development of our True Beam Linear Accelerator. To deliver these services, the Trust is organised into clinical specialties and these are grouped into Divisions for management purposes. The Clinical Divisions are set out below together with their budgets in 2012/13 to provide an indication of relative size. Division Medicine and Emergency Department Surgery / Trauma and Orthopaedics Diagnostics, Therapeutics and Cancer Women, Children and Sexual Health Anaesthesia and Theatres Patient Facilities and Estates Corporate Support Financing, Depreciation and Reserves Sub-total Surplus Operating Budget ( m) % of Trust total clinical specialist excellence performance respect dignity Page10

12 safer good better value care Our Commitment to Quality Continuous quality improvement is central to RCHT s plans, as reflected in our top priority - to focus relentlessly on the improvement of quality and safety. We have demonstrated this through: unconditional registration with the Care Quality Commission since April % of patients responding to our local inpatient survey indicating that they would recommend the hospital to friends and relatives no MRSA infections for over a year, among the best performing Trusts in the country. Each year, the Trust consults with key stakeholders, such as Cornwall Council s Overview and Scrutiny Committees, Local Involvement Networks (LINks) and other members of the local health community, to agree its plans for improving quality of patient care. These are reflected in our annual Quality Accounts. For 2011/12, the Trust focused on: Patient Safety: Improving patient flow and safe discharge. Clinical Effectiveness: Delivering improvements in the stroke care pathway, including the NICE Quality Standard, and enhancing the care of patients with Dementia, including the Dementia Care Hospital Standards. Patient Experience: Improving the transition of children into adult services and improving end of life care. In 2012/13 and beyond our particular focus will be given to: Patient safety: - patient flow, including single point of access (and ambulance turnaround times) - Patient Safety Thermometer: reducing the avoidable harms that occur within wards - pressure ulcers, falls, infections and VTE - further improving safety and quality within operating theatres. Clinical effectiveness: - development and improvement of trauma services - improved pathway for Glaucoma patients - further improving the pathway for a fractured hip - improve medicine management through extending the use of electronic prescribing and electronic discharge - develop one stop shop through pre-op assessments at St Michael s Hospital - extend and develop laparoscopic services within theatres. Patient experience: - improve the patient experience of being discharged from hospital, and the associated quality of patient care given - improve the hospital environment through targeted investment in estates and facilities - reduce hospital readmissions (including emergency readmissions within 30 days) through improved hospital discharge planning and anticipatory care planning for ongoing care - early supported discharge for patients affected by stroke. RCHT will continue to focus on these key dimensions as we develop our services. Page 11

13 Performance and Achievements In recent years, RCHT has pursued a programme of sustained service and performance improvement. The Trust has moved from a weak / weak Healthcare Commission rating in 2006/07 to unconditional Care Quality Commission registration from April 2010, and has sustained DH performing status since Quarter 2 in 2009/10. This provides the basis for further improvements in care for our local population. Historic Healthcare Commission and DH Ratings 2007/ / / / /12 Quality Weak Weak Unconditional Unconditional Unconditional Resources Weak Fair Good n/a n/a DH Performing Status n/a n/a Q1 Q2 Q3 Q4 All quarters Q1 Q2 Q3 tbc Key improvements in performance for patient care include: - improvements in waiting times for treatment so that the Trust now meets all national target requirements for treatment within 18 weeks and meets all national waiting times targets - meeting infection control targets, with no cases of MRSA in over a year and Clostridium Difficile top quartile performance in infections in 2010/11 and meeting our targets in 2011/12 - emergency access targets met including less than four hour waiting times in Emergency Department - meeting all cancer access targets meaning that our patients receive treatment in line with national waiting times standards - major clinical improvements on both the stroke and hip fracture pathways. National standards in stroke are now met and the Trust is among the best performing organisations for best practice care for hip fractures. In addition, we have delivered some key achievements for our services, many of which were outlined in Our Plans These include: - developing new services such as rapid access to primary angioplasty, extensions to cancer screening programmes, stroke thrombolysis, Wet Aged Related Macular Degeneration services for ophthalmology patients; investment in Interventional Radiology and the newly formed Vascular Access team; and services for bariatric patients - providing innovative services such as our advice line to GP's on the management of renal patients; the establishment of a West Cornwall Hospital Treatment Centre meaning more procedures can be provided close to patients homes; accelerated access and one-stop services for orthopaedic patients at St Michael s Hospital; nurse-led diagnostics in areas such as urology; and the development of clinics using telehealth technology for young babies who need specialist input from tertiary centres - having our lowest obstetric mortality rates since records began and one of the lowest caesarean rates in the country. We will build on this strong base to provide consistently excellent performance and care, ever demanding of our performance as medical science evolves. clinical specialist excellence performance respect dignity Page12

14 safer good better value care Commissioners and Partner Providers In order to deliver the very best healthcare to our local population we need to work closely with our partners both those who commission and pay for local healthcare, and those who provide services that our patients will use. At present, NHS provision in Cornwall and the Isles of Scilly is primarily funded and commissioned by NHS Cornwall and the Isles of Scilly (NHS CIOS). However, in line with the Government s NHS reforms, the responsibility for commissioning care will transition to a local clinically-led body - Kernow Clinical Commissioning Group - from October Kernow Clinical Commissioning Group (KCCG) is already a key partner for RCHT. We are working closely together to develop improved pathways of care for patients and to develop services. This includes the new Urgent Care Centre at West Cornwall Hospital which is a fantastic, new service for the people in the west of Cornwall, and also new ways of delivering outpatient services in partnership with GP s. RCHT has delivered its strategy as outlined in Our Plans in response to commissioner priorities. For example, A Healthy Future for All in 2008 set out the PCT s key priorities. The table provides highlights of how RCHT services respond. Page13

15 Commissioner priority Reducing teenage pregnancy Helping children achieve healthy weight Reductions in smoking rates Cancer prevention and treatment Reduce number and impact of stroke Mental health and wellbeing Dementia services End of life care Health inequalities Highlights of RCHT response Delivering sexual health and contraceptive services Supporting breast-feeding in hospital and families in early weeks of child s life through maternity services Dietetics services Supporting the Stop Smoking campaign and making RCHT smoke free accross all of our sites Implementing the Cancer Reform Strategy locally Screening programmes for breast, bowel, cervical and other cancers High profile skin cancer prevention work Investment in Linear Accelerator to ensure RCHT remains at the forefront of cancer and radiotherapy treatment Investment in stroke facilities and services as part of pathway Delivering Transient Ischemic Attack services Psychiatric liaison and health psychology services Integrating dementia care into inpatient services Palliative care partnership working with local hospices Locality eldercare leads working with local populations and hospices Improved stroke services with RCHT outreach to community sites; support to stop smoking and obesity prevention initiatives; improving sexual health services 1 NHS Cornwall and the Isles of Scilly (2008), A Healthy Future for All For the Isles of Scilly and the west and central areas of Cornwall, the acute and specialist services are currently primarily commissioned from RCHT, while in the east of the county GP's and patients look to Plymouth Hospitals NHS Trust and Northern Devon Healthcare NHS Trust. Our intention however, is to work with commissioners, to increase the range of services provided for the people east of the county, to improve quality, choice and access for patients. Further, specialist tertiary services, such as spinal surgery, cardiothoracic surgery and specialist paediatric services, are commissioned from key NHS centres in Plymouth and Bristol and RCHT develops networks of care and partnerships with these organisations to ensure the very best care for the patients we serve. A community interest company, Peninsula Community Health provides adult community health services in Cornwall, while Cornwall Partnership NHS Foundation Trust provides mental health and some children s community services to the county. In addition, there are other providers for planned care in the county. clinical specialist excellence performance respect dignity Page14

16 safer good better value care Clinical Strategy and Service Development Plans RCHT recognises the challenges it faces and the changing environment over the life of this Plan. To continue to improve services and quality, RCHT is taking a disciplined approach to deliver the operational changes required now, alongside the range of strategic initiatives over the coming years. At the centre of these developments is RCHT s Clinical Strategy, with each of its services identifying their direction of travel. These describe a Trust that will: focus on its duties as the key provider of emergency and acute care for the people of Cornwall and the Isles of Scilly, and as a key member of regional and local networks of care including in areas such as cancer and trauma care continue to improve and develop the range of services it provides to patients and GP's, including more options for referral into care and to manage care outside of an acute setting. This will include becoming a more integrated provider of care continue to play a key role in contributing to the wider health promotion and prevention agenda, consistent with its future as a healthcare provider, and will build on its existing community-focussed services such as in sexual health and maternity services; its work to promote smoking reduction; the development of liaison services to improve outcomes for patients with learning disabilities and mental health disorders; and the care RCHT provides for patients with long-term conditions, such as dementia. Page 15

17 Clinical Strategy and Service Development Plans RCHT will also contribute to a range of exciting developments across Cornwall, being championed by the public and private sectors and strengthened by the creation of a unitary authority, Cornwall Council. This includes the multi-partner, European-funded new Innovation Centre being developed on the Royal Cornwall Hospital campus as part of our health, education and research provision; the developing strategic partnership between health providers and Cornwall Council; and the opportunities which will arise from super-fast broadband in the county, including for telehealth. RCHT will: be a central part of an integrated care system and transform from solely an acute hospital trust to an innovative healthcare provider throughout Cornwall have lower levels of traditional outpatient and emergency activity. Planned services will grow a little, but traditional outpatient activity levels will be lower, with a larger proportion of follow up work done in the community, in primary care or by telephone and through virtual clinics. This will include using telehealth, new technologies and skills in the community to develop out of hospital and preventative services, improving long term conditions management and reducing emergency admissions provide services that will be even more productive with our staff working in new and different ways reflecting the needs of our patients. RCHT will employ fewer staff based in an acute hospital setting and more providing services in the community. However, the hospital work will be based on leading edge technology; buildings and facilities; and developing research and development opportunities ensure its focus on quality of care, clinical development and service innovation is underpinned by clinical networks, education, research and comprehensive staff development programmes develop an estate of higher quality but smaller in size, with increased shared use and the potential for joint ventures with other health and social care organisations have harnessed new ventures, networks and creative partnerships for a variety of clinical and non-clinical services. clinical The Strategy will be supported by a move to Service Line Management. This will allow individual clinical services greater autonomy and responsibility for developing their services, while ensuring the services work together to provide essential care to our local population. specialist excellence performance respect dignity Page16

18 safer good better value care Clinical Strategy and Service Development Plans The work of individual Specialties has led to a strategic direction for services over the coming years and a set of Service Developments. These include: Acute care - Developing our emergency services as part of the national trauma networks, with RCHT becoming a designated Major Trauma Unit with specialist services in pelvic reconstruction and vascular interventions. - Integrating unplanned care to support emergency demand management by working with the highest referring GP Practices and Nursing Homes; developing the potential of telehealth; and working with Early Intervention Hubs to manage patients in non-acute settings. - Working with our partners in Peninsula Community Health to develop the facilities in community and other hospitals away from our hot centre at Royal Cornwall Hospital. The development of an Urgent Care Centre at West Cornwall Hospital represents a first step, with RCHT working in partnership with local GP's to develop a new range of services for patients. - Creating alternatives to traditional management of unplanned care, including hot clinics in areas such as gastroenterology to allow patients to be booked into urgent consultations rather than being admitted and increasing the level of support and advice via telephone and . - Fully deliver our new Level 2 and 3 critical care facility, improving patient flow and enhancing recovery. Planned care - Developing a range of outpatient services such as telephone advice lines, virtual clinics and one-stop clinics in areas such as urology, gastrointestinal surgery, ophthalmology, therapies and ENT. This will include building on our good practice in renal services, which has been well received by local GP's and patients. - Simplifying our patient pathways and improving access. We have already established improved booking and management arrangements for our new accelerated pathways in orthopaedics at St Michael s Hospital and will seek to extend the areas where we can reduce the number of visits to hospital such as in oral surgery and orthodontics. In addition we will improve working with partners in order to develop and extend complex pathways for patients, including with the newly developed Dental School as part of our orthodontic care. - Integrating planned care through RCHT clinicians engaging with local GP's and the Referral Management Service to agree pathways of care enabling clinical advice to be given outside of acute hospital settings and through other routes, such as virtual clinics or advice lines. As part of this work, we are also seeking to streamline patient pathways to reduce the need for follow-up outpatient appointments. - Improving diagnostic services in areas such as nurse cystoscopy and building on new technologies such as the digitisation of imaging. - Provide more planned services in the community, developing new centres in areas such as dermatology and new pathways for patients using our pain service. This will include maximising the benefits of the new Treatment Centre at West Cornwall Hospital. Page 17

19 Planned care Clinical Strategy and Service Development Plans - Adopting new technologies to ensure new clinical services are provided in Cornwall as soon as possible, for example with the development of our new laparoscopic theatres including at West Cornwall Hospital. Maternity and newborn - Maintain RCHT s status as a local neonatal unit, minimising the number of babies that need to be cared for out of county, and developing our transitional facilities for babies who need special care so that their length of stay in hospital can be reduced. - Develop a birthing centre at Royal Cornwall Hospital and continue to provide our maternity services from GP to hospital to after birth care across the county. Children s health - Developing our general acute and specialist paediatric provision, including pathways in areas such as children s respiratory conditions. - Develop dedicated theatre time for paediatric only lists and a paediatric theatre. - Improve pathways for children with complex care needs, so that there are clearer routes into our Community Paediatric services. clinical specialist excellence performance respect dignity Page18

20 safer good better value care Staying healthy Clinical Strategy and Service Development Plans - We will seek to develop more preventative services for example using our vascular and diabetes service to develop a foot service to reduce Cornwall s amputation rates. - Continuing to develop our cancer services, including responding to the increasing complexity of services in areas such as chemotherapy, radiotherapy and haematology. Further we will continue our key role within the South West Cancer and Screening Networks and our centre of excellence for breast cancer care at St Michael s Hospital and our partnership with Plymouth Hospitals NHS Trust to provide gynaecological cancer care. - Further develop our county-wide sexual health services, integrating our genito-urinary medicine and contraceptive services to meet unmet demand. Mental health - Continue to work closely with partners to develop the appropriate psychiatric liaison and psychological support to our patients. - Meet the Government s expectations of improved care for patients with dementia, an increasingly important issue for our patient population. Long-term conditions - Focus on reducing admissions in areas such as cardiology, eldercare, respiratory and general medicine. We will achieve this by working more closely with community services, such as heart failure and respiratory nurses, and our clinicians working across the full pathway and supporting out of hospital care. We will also support wider initiatives such as the development of telehealth and the acute GP services. - Ensuring appropriate pathways for patients and support to primary care. This will mean supporting the potential for community management for rheumatology patients with stable conditions; developing appropriate pathways for neurology patients; and ensuring patients with a clear diagnosis of chronic fatigue syndrome / ME receive the appropriate clinical specialist care more quickly. End of life care - Support end of life care out of hospital settings to reduce unnecessary admissions and support people dying in the setting of their choice. - Develop a more generalist palliative care service working closely with local hospices and Macmillan services. Page 19

21 Clinical Strategy and Service Development Plans Clinical Site Development Plan To deliver many of these changes, we will ensure our accommodation is continually improved to meet modern standards. To achieve this, RCHT has developed an Estate Strategy and Clinical Site Development Plan, which sets out plans to ensure that clinical services are located in the right place in modern fit for purpose facilities. Its focus is on developing high quality facilities for patients, while ensuring the right clinical adjacencies. This underpins the movement to a hot hub at Royal Cornwall Hospital bringing together the Emergency Department, Critical Care, diagnostics, acute medical patients and the most complex surgery. In particular, the plan will improve quality and safety by co-locating hot services; improving patient flows and modernising equipment and facilities. Key progress to date includes being one of the first Trusts in the UK to install the latest medical technology including: Gamma Camera with a CT scanner to improve diagnostics, the creation of an Interventional Radiology Suite, and the True-Beam Linear Accelerator providing leading edge radiotherapy treatment for cancer. In 2012 we have completed the upgrade at Medical Ward 2 and the Laparoscopic Theatre Installation at West Cornwall Hospital; the installation of the Laparoscopic Theatre Programme at Royal Cornwall Hospital, Treliske. Further developments taking place are the re-configuration of Trelawny Wing Theatres and Surgical Floor; re-provision of Ophthalmology; Phase 1 of the Emergency Department Single Point of Access and re-provision of Residential Accommodation for staff and medical students. Early plans for 2013/14 aim to re-provide the gynaecology ward; develop Phase 2 of Emergency Department Single Point of Access; development of a midwife-led birthing centre; re-provision of the Neonatal Unit; reprovision of Endoscopy; and commencement of Stroke / Neurology re-provision. From 2014/15 onwards, RCHT will develop a paediatric theatre and surgical unit; complete the Trelawny Medical Floor; re-provide Lowen Ward and the Haematology Department; re-provide outpatients at West Cornwall Hospital; and improve Cardiology facilities. In addition, RCHT will develop its surgical services to provide more care to all of Cornwall, including the east of the county, and provide more integrated, community based care for patients outside of hospital settings. These service developments will be supported by RCHT s key services providing theatre support, pharmacy, instrument sterilisation, pathology tests and healthcare technologies. As a result, in five years time RCHT will look very different to how it is today. It will be a clinical healthcare provider offering a wider range of innovative and preventative services, focused on providing safer, better, good value care. specialist excellence performance respect dignity Page20

22 safer good better value care Our Team RCHT s staff are its greatest asset. They are integral to delivering the Strategy. We employ around 4,800 whole time equivalent staff across clinical and non-clinical services and are the second largest employer in the Cornish economy. We recognise that there are significant workforce challenges, particularly in terms of staff engagement and perceptions of RCHT as a good employer. These have been highlighted in NHS National Staff Survey results in recent years. The Trust will focus relentlessly on these challenges and ensure our organisational values are reflected in our behaviours and the tone of communication throughout the organisation. We will ensure that a constant dialogue with our staff is developed and maintained where real, tangible differences in our service provision and the way we manage them are a direct result of the feedback that we receive in these conversations. We will develop and empower our staff to be the best they can be, supported by excellent leaders that are equipped with the skills to motivate, inspire and to deliver excellent patient care and to feel proud of the organisation for which they work. In 2010, RCHT launched the Extra Mile Excellence and Innovation Annual Awards to recognise and celebrate the work of our staff and volunteers. The winners are nominated by both patients and staff and provide an opportunity to recognise those who provide outstanding patient care and services. RCHT is committed to delivering its Workforce Strategy which sets out how we will develop as an employer and commits to delivering: patient focus - a workforce organised around the needs of patients clinical excellence - a workforce with a reputation for clinical excellence Page 21

23 a great place to work - an organisation generally recognised as an employer of choice for the health care sector and for Cornwall performance and innovation - an organisation which drives great performance and fosters innovation, empowerment and social entrepreneurship NHS values-based - an organisation where the NHS values act as the compass for all that every employee does flexibility and value for money - delivering health care in the most cost effective ways and breaking down barriers to flexibility and agility. Our Volunteers, Friends and Charitable Funds RCHT is proud of and extremely grateful to its volunteer workforce, who work alongside our staff. Currently there are approximately 400 volunteers who freely give of their time to support work for the Trust in a number of departments. These volunteers significantly support the running of the hospital and contribute to the raising of funds that improve our ability to offer high quality services to patients. Allied to the volunteer team, are the League of Friends for each of our three hospitals. These provide a valuable partner for the Hospitals, helping raise funds and determine appropriate projects to provide valuable patient amenities. At Royal Cornwall Hospital, the volunteer workforce has now entered into an agreement that allows them to automatically become Friends of the Hospital. RCHT is also supported by the Royal Cornwall Hospitals NHS Trust Charitable Fund. This was established in 1996 to benefit the patients and staff of RCHT. It works closely with the Friends and helps provide additional equipment for patients and to support other activities such as specialist training for staff. While healthcare provision at RCHT s three sites is funded by the NHS, voluntary donations help to provide the extras that can help to brighten the lives of patients and staff and aid future diagnosis and treatment. Charitable Funds are currently leading RCHT s Phoenix Stroke Appeal, working in partnership with BBC Radio Cornwall. This was launched in 2011/12 and aims to raise 500,000 to improve stroke services for the people of Cornwall, ensuring they have instant access to rehabilitation aids and novel rehabilitation methods. To date, the appeal has raised over 250,000, including a donation of 36,000 from the Friends of Royal Cornwall Hospital. clinical specialist excellence performance respect dignity Page22

24 safer good better value care Financial Health and Capital Investment RCHT has followed a rigorous approach to financial management, leading to improved financial results. Following a number of years of financial underperformance, RCHT had a debt of 46m in 2008/9. Concerted improvements in financial results now mean the Trust is delivering surpluses, with a 4.4m surplus in 2011/12. This has allowed us to reduce the outstanding debt to below 23m. Our future financial plans have been developed to underpin the delivery of our Strategy, and are based on the local Commissioners Quality Innovation Productivity and Prevention intentions. Delivery of surpluses over the life of this plan will allow us to continue to repay our loan as well as allow funds for capital investment. Capital Investment RCHT is pursuing a programme of capital investment in buildings, equipment and technology, the centre of which is the Clinical Site Development Plan (CSDP), published in The CSDP is clinically led providing a long-term strategic plan, which covers the three Hospital sites. It aims to keep RCHT services, sites and facilities at the cutting-edge of technology developments and innovation. Phase 1 of the CSDP consists of 52 projects, and started in late The Trust has made a very good start - to date, 29 of the 52 Phase 1 projects have been completed with total investment of over 28m. Some of the key projects completed during 2010/11 and 2011/12 include: Sexual Health Hub, Headland Unit, Gamma Camera, Digital Mammography, Sunrise CT Scanner, Trelawny Front Entrance, Patient Monitors Programme, Theatre Direct Admissions, Pre-Operative Assessment, Paediatric Oral Surgery, West Cornwall Renal Unit, West Cornwall Treatment Centre, Infection Control Ward Upgrade, St Michael s Digital Upgrade, Re-configuration of Day Case Theatres, Interventional Radiology, Re-provision of Therapies, Critical Care and West Cornwall Laparoscopic Theatre. Whilst levels of capital funding are likely to be lower than in previous years, the Plan will continue to be prioritised and overseen by the Programme Board with clinical representation from across the Trust. We will also seek to use our financial freedoms as a Foundation Trust to enter into new ventures and partnerships to generate further investment in patient services. Page 23

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26 safer good better value care Education and Research As a provider of acute and specialist care RCHT has significant amounts of education and research activity. They underpin our clinical services by providing highly trained staff and ensuring that our care remains at the cutting edge of developments. There are significant opportunities to further develop by working with partner organisations. This will raise the profile of the RCHT and secure the benefits seen in patient care in organisations that have a strong culture of supporting education and research. Our partners include: National Institute of Health Research of the NHS through Peninsula Comprehensive Local Research Network and Topic Research Networks Exeter University Plymouth University Cornwall County Council NHS research and development Quintiles and other contract research and pharmaceutical companies for commercial research The European Centre for Environment and Human Health (ECEHH) The Health and Well Being Innovation Centre The SW Postgraduate Deanery Learning and Education Training Board Academic Health Science Network Research and Innovation RCHT will be an active partner in the new Academic Health Science Network which will provide a systematic delivery system to transform the identification, adoption and spread of innovations and best practice. We will continue to increase our work with the Peninsula clinical research networks. This will mean that we will set out an ambitious strategy and implementation plan to increase the amount of research activity at RCHT. We will see more patients enrolled in NHS and commercial trials bringing benefits to their care.we will continue to develop the infrastructure to allow RCHT build on our current successes to compete in the market to provide rapid, flexible responses when we identify suitable research opportunities. We will build on the existing partnership through the University of Exeter with the ECEHH to increase the academic activity on the RCH campus. We will support the development of the Health and Well Being Innovation centre which opens in 2013 by encouraging clinicians to think innovatively about how they care for their patients. This will result in the generation of ideas for improved care or new medical equipment that can be developed leading to the generation of new businesses and jobs in Cornwall. Education Having a highly skilled workforce is fundamental to being able to deliver excellent outcomes for the people we care for. This means they receive the best possible clinical care and that our customer service is exemplary. To achieve this we will continue to build on our reputation as an educational organisation. We will develop our staff training programmes to equip our staff with the skills they need. Page 25

27 Education and Research In addition we will work with our partners to realise the opportunities to have new employees with the clinical and leadership skills necessary to continue developing our services. We will maximise the use of our education facilities in the Knowledge Spa and open the new residences on the RCHT campus in RCHT hosts over 400 undergraduate students and 250 postgraduate doctors receiving specialist training. Medical We will develop our partnership with the new Exeter Medical School to deliver the highest standard of undergraduate medical education. We will work with them to increase the number of clinical academic posts within RCHT that provide both education and research capacity and excellence. We will work with the Learning and Education Training Board to provide high calibre postgraduate medical education. Nursing and Allied Health Professions With our partner Plymouth University we will introduce the new degree level undergraduate nursing course. This will strengthen the recruitment opportunities to the course and increase the capability of the graduates. We will support the career progression of the newly qualified nursing graduates. We will work with Plymouth University to develop further undergraduate and postgraduate health and social care related courses. Dental The Peninsula Dental School will be run by Plymouth University and we will develop our dental undergraduate training capacity. It is a graduate entry programme and is community focussed. We will continue to provide the medicine in dentistry course where the students learn about relevant medical conditions to their practice. clinical specialist excellence performance respect dignity Page26

28 safer good better value care Health Informatics RCHT recognises that modern information technology is a fundamental enabler to the delivery of safer, better, good value care. Just as in all other walks of life the proper application of information technology can transform the way services are delivered. Our Health Informatics Strategy will ensure clinicians and support teams have convenient access to the most advanced technology and innovative equipment, and to the right information at the right time at the right place. We will replace traditional hospital case notes and paper based forms with electronic records accessed at the bedside or clinic with portable computers. Technology will transform care and diagnostics services. Key parts of our strategy therefore include: development of an electronic patient record that will enable the care and treatment of new patients to be provided largely using electronic systems providing access to the electronic record with wireless computers as well as increased use of electronic white board increased use of telehealth technology to support care closer to people s home, including making use of the superfast broadband in Cornwall working with partners to deliver an integrated care record to support integrated care across the care system. RCHT will also ensure that information technology supports the cost effective delivery of corporate or what are called back office services. Our strategy will also replace many paper based processes with electronic forms that integrate with RCHT s Electronic Staff Record and Finance Systems. This will release savings that will be reinvested in front line clinical services. RCHT has recently endorsed a Business and Clinical Intelligence Strategy that will provide real time as well as periodic intelligence to support operational and clinical management. This includes the further development of patient level costing that will underpin RCHT s ambition to achieve upper quartile performance across all of its clinical services. Page 27