Bedford Hospital NHS Trust Annual Business Plan 2015/16

Transcription

1 Bedford Hospital NHS Trust Annual Business Plan 2015/16 1

2 Contents 1. Introduction 2. Strategic Context and Direction /16 Priorities and Objectives 4. Key Underpinning Plans a. Workforce b. Education & Training Appendices 1. Plan on a Page /16 Objectives 3. Summary Financial Plan 4. Summary Activity Plan 5. Key Risks 2

3 1. Introduction This document summarises the Trust s plans for 2015/16. In doing so it sets out our key priorities and objectives for the coming year, underpinned by more detailed financial, activity and workforce plans, that will enable the Trust to deliver its vision of providing excellent acute and integrated care for the people of Bedfordshire. Review of 2014/ /15 was a significant year for the Trust. The previous year had been particularly challenging for the organisation and for its staff and 2014/15 saw the impact of the responses to those challenges. Despite considerable operational pressures, especially during the winter period which included the closure of wards due to norovirus, the Trust achieved the key NHS Constitution waiting times standards for the year. It met national access targets including cancer and Referral to Treatment waiting times. It was one of a minority of Trusts in the east of England region to deliver the 95% A&E target and at regular times during the winter period was performing in the top 10% in the country. It met its targets for hospital acquired infection and made good progress in reducing incidents of harm (e.g. VTE, avoidable pressure ulcers) Following the 2013 CQC inspection report and follow up the Trust received an unannounced CQC inspection in August 2014 and as a result received confirmation that it was meeting all national core quality and safety standards, one of the few local providers to be doing so. Following a positive review by Health Education England East of England in October 14 paediatric junior doctors have returned to the Trust and the Trust now has a remodelled paediatric service providing excellent care. In addition the Trust achieved UNICEF baby friendly accreditation, one of the few in east of england to do so. In June 14 the trust published a clinical strategy that sets out a clear vision for the delivery of integrated primary, community and acute services and which strongly complements the vision for integrated care set out in the NHS 5yr Forward View (See Ch 2 below). In December 2014 the Trust received formal accreditation for its endoscopy unit. This was a key objective for the year and together with the associated capital redevelopment represents an important achievement for one of its core clinical services that will benefit many patients. It was evident therefore that the Trust s aim for 2014/15 of prioritising quality and safety was successful. This though meant considerable pressure on the Trust s financial position, resulting in a worsening of its overall deficit, and a clear priority for 2015/16 and beyond, set out in the objectives, is a return to ongoing financial viability, aligned to the development of new models of care and future organisational forms. 3

4 2. Strategic Context and Direction Bedford Hospital employs 2,500 staff (making it the largest local employer in Bedford) and has 360 beds. It provides the full range of acute hospital services including consultant-led A&E (66,500 attendances), obstetrics (3,100 births), oncology, critical care and neonatal special care unit. The trust is a member of a number of well-developed clinical networks across Bedfordshire, Hertfordshire and surrounding areas, including the East of England cancer, cardiac and stroke networks and East of England strategic clinical network for maternity, paediatrics and neonatal. It is an arterial hub for vascular services (commissioned by NHS England) and part of the Beds, Herts and Bucks Maxillofacial Network. In addition, there are strong existing clinical networks with Addenbrooke s (Cambridge University Hospitals NHS Foundation Trust) for cancer, paediatrics, neurology and otoneurology (ENT). These networks will be extended to haematology and interventional radiology in 2015/16. There are also network arrangements with the Luton & Dunstable Hospital NHS Foundation Trust for stroke, head and neck cancers and bowel cancer screening (Bedford is the hub for this service), with Northampton General Hospital for plastics and with Great Ormond Street Hospital. The trust s vision is; To provide excellent acute and integrated care serves to the people of Bedfordshire The clinical strategy published in June 2014 set out 4 Strategic aims in support of delivering this vision. Excellence in quality and safety Effective emergency & ambulatory models of care Horizontal integration via networks and partnerships Vertical integration of secondary, intermediate and primary care pathways Healthcare Review In 2014, the Bedfordshire and Milton Keynes health economies were subject to a strategic review commissioned by NHS England and the two national regulators Monitor and the Trust Development Authority (TDA), and involving the CCGs for Milton Keynes and Bedfordshire. In October 2014, the review published a progress report which set out the work undertaken during the review s study phase and made recommendations for developing robust options for local health services. Following a process of evaluation and elimination drawing on clinical expertise and public and patient feedback, two options emerged which focused on the creation of a major emergency centre and Integrated Care Centre on the two hospital sites. However the report noted that there still remained significant concerns about financial sustainability and accessibility of care within these two options The recommendations and next steps of the progress report were therefore to: Develop plans to offer more care closer to home via multi-disciplinary teams, involving primary care, community health services and social care. 4

5 Carry out further detailed work on the preferred options for the future provision of hospital services. Develop a detailed plan outlining the practical steps that need to be taken to prepare for public consultation. Keep clinical, public and patient engagement at the heart of the review, using the best practice tools and practices that the CCGs have developed. The Trust, Bedfordshire CCG, local GPs and partners obtained feedback from the public, patients and clinicians and have further assessed the scenarios for local applicability. This has been developed through the North Bedfordshire Primary and Acute Care Programme. This programme of work has focused on developing the following: A clear strategy and contractual framework for care closer to home, underpinned by quality standards and robust clinical pathways. A model for a vertically integrated hospital and community system, enabling local services to better support vulnerable people to be cared for outside hospital and deliver swifter assessment, diagnosis, treatment and discharge from hospital. Defining core hospital services and networking of hyperacute services to develop sustainable and modern district general hospital services that can meet the clinical standards of the future. National Policy Aligning with the next phase of local work described above, the NHS Five Year Forward View published in October 2014, sets out a shared view of how services need to change and what models of care will be required in the future. It differs from many other plans in arguing that England is too diverse for one size fits all solutions. It outlines a number of care models (set out in the Dalton Review) that might be adopted in different areas to put in place services fit for their local populations. One of the aims of creating the new models is to identify how the viability of smaller district general hospitals might be safeguarded. The Trust believes that the new models of care offer a number of potential opportunities for future sustainability when applied to the development of local integrated services and networks. This includes the primary and acute care system (PACS) and multi-specialty community provider (MCP) models. The Proof of Concept report following the next phase of the healthcare review is designed both to respond to the initial reports recommendations as well as complement the national thinking which had not been available when the first report was published. This in turn helps to set the objectives described below. 5

6 /16 Priorities and Objectives Our 2015/16 objectives therefore focus on how we will seek to deliver the annual components of our strategy. Given the national and local context described in Section 2, 2015/16 can therefore be seen as a transitional period for the Trust and for all of the NHS. The development of the next programme of work following the local healthcare review together with the emergence of national policy to address long term sustainability issues across the NHS mean that it will be a period of potential change and uncertainty. During this period the progress made in achieving national standards and targets will need to be maintained together with additional and significant steps made towards financial viability. The Trust will need to be flexible and dynamic as it responds to the changing environment and it will need to work outside of its natural boundaries and in greater collaboration with its partners to achieve sustainability across the local health and social care economy. As such the 2014/15 objectives can be summarised within 5 priority areas; 2015/16 Priority Summary Objectives 1. Quality Implementing the projects in support of continually reducing incidents of harm and preventing avoidable death; meeting CQC requirements. 2. Performance Maintaining and sustaining national standards and targets in line with the TDA accountability framework 3. Finance Returning the Trust to month on month achievement of its financial plans, statutory duties and deficit reduction 4. Service development Implementing the best practice models of care; for example urgent care, integrated children s services, and expanding ambulatory care 5. Enablers for the future Implementing those underpinning plans that will support a sustainable future model, for example IM&T, Workforce and Estates The 2015/16 strategic objectives, carried forward from 14/15 are; Develop a patient safety culture for harm free care Deliver seamless consistent high quality 7 day services Demonstrate a learning culture Define a sustainable clinical business model Display effective governance and leadership 6

7 The 2015/16 objectives supporting these are; Reduce incidents of avoidable harm Design & new models of Demonstrate patients and carers feedback results in service change Publish sustainable options for configuration Deliver the agreed financial plan Publish and Quality Strategy Transform inpatient flow and discharge education & training strategy Extend networks / partnerships for hyperacute services Deliver the workforce and recruitment plans Prevent avoidable deaths Implement integrated care for paediatrics Engage patients, staff and the community Begin integration with community services Develop and implement an IM&T strategy The detailed objectives, interventions and outcomes, mapped to our strategic objectives, are set out in Appendix 2. A summary of them (a Plan on a Page ) is shown at Appendix 1 7

8 4. Underpinning Plans Workforce The Trust has a workforce of 2,235 whole time equivalents. Staff engagement, satisfaction and feedback is good (NHS Staff Survey). A Workforce Strategy has been developed and the core components of aim; To make the Trust an employer of choice in the local community To develop an efficient, effective, skilled and adaptable workforce To engage and involve staff so that they feel able to contribute effectively To improve workforce productivity and reduce inefficiency Develop a culture that enables staff to deliver highest standards of performance Specific objectives will relate to significant reductions in Temporary staffing usage and costs. Workforce cost reductions will also be driven by Transformation for Excellence interventions. This will include: - A high focus on recruitment campaigns to significantly reduce the high use of agency staffing and costs and improving quality Greater use of lower cost posts to reduce pay bill and skills mix reviews. For instance use of Physician Assistants, Apprenticeships and new career pathways. A review of the Trust s approach to job planning and ensure clear links to productivity and activity. - There is a planned nursing establishment review every 6 months which is reported to Board. A sustained campaign to reduce sickness absence across the Trust and triangulate to temporary staffing use A review of back office and support services to explore outsourcing or shared services Education and Training Considerable time and resource has been invested in actions related to Medical Education and during the year the Trust will also focus on developing the centre for multi professional education and learning. Junior doctors began to return to Department of Paediatrics from August 2014 following a positive return visit by the GMC/Deanery in April 2014 and the action plan associated with this will continue to be implemented and tracked. A tracker system is in place to ensure actions from all visits are seen through. In addition the Trust has developed an Estates Strategy and is in the process of developing Quality, Workforce and IM&T Strategies. Together these provide the enablers to supporting the delivery of the vision for the sustainable clinical model The Modern District General Hospital. 8

9 Appendix 1 Plan on a Page Vision (1) Numbers in brackets = cross reference to 15/16 priority areas p6 of the plan safety To provide excellent acute and integrated care serves to the people of Bedfordshire Strategic Aims Excellence in quality and safety Effective emergency & ambulatory models of care Horizontal integration via networks and partnerships Vertical integration of secondary, intermediate and primary care pathways Strategic Objectives 15/16 Develop a patient safety culture for harm free care Deliver seamless consistent high quality 7 day services Demonstrate a learning culture Define a sustainable clinical business model Display effective governance and leadership Reduce incidents of avoidable harm 1 Design & new models of care 4 Publish and Quality Strategy 1 Publish sustainable options for configuration 4,5 Deliver the agreed financial plan 3 Operational Objectives 15/16 Prevent avoidable deaths 1 Transform inpatient flow and discharge 1, 2 education & training strategy 5 Extend networks / partnerships for hyperacute services 4 Deliver the workforce and recruitment plans 1, 3 Demonstrate patients and carers feedback results in service change 1 Implement integrated care for paediatrics 4 Engage patients, staff and the community Begin integration with community services 4 Develop and implement an IM&T strategy 5 Sources of Assurance CQC Inspection 2015 HEE / Prof body assessment Patient & Staff Surveys / FFT JHOSC TDA Accountability Framework CQC Domain Safe Effectiveness Caring Responsiveness Well Led 9

10 Appendix /16 Objectives Strategic Objective: Develop a patient safety culture for harm free care Operational Objective Interventions Outcome / KPI Lead Reduce incidents of avoidable harm (1, 2) Roll out the trust Patient Safety Programme projects: Care bundles, sepsis, kidney injury, handover, medication errors, VTE, falls, deteriorating patient, nutrition & hydration, learning from SIs, measurement and monitoring of quality Nurse Technology Fund 0 Never Events SIs <=14/15 outturn Project clinical outcomes: (reduced VTE, falls, sepsis etc) C Diff / MRSA trajectories met Reduced errors, complications and periarrests Medical Director / Nursing Prevent avoidable deaths (1, 2) Complete roll out of Night Systematically Review all deaths via mortality review group SHMI 100 Reduce mortality rate outliers per speciality Failure to rescue PAR audit 95% escalated Medical Director (1) Numbers in brackets = cross reference to 15/16 priority areas p6 of the plan safety culture for harm free 10

11 Strategic Objective: Deliver seamless consistent high quality 7 day services Operational Objective Interventions Outcome / KPI Lead Design & new models of care (4) integrated urgent care / service with partners. Develop business case for new ED as per model and Estates Strategy Recruit additional consultants and middle grades as per agreed business cases Develop Vascular/Interventional Radiology service Develop Joint PCI service with MKFHT 95% 4hr wait target Reduced medical outliers < length of stay (current / peer group) Vascular Intervention Centre status 18 weeks and cancer waiting targets Executive Directors / Divisional Medical Directors Transform inpatient flow and discharge (1,2) Confirm outcome of stroke business case Recruit acute geriatrician for AAU + community atres management system Undertake Surgical ward reconfiguration / streamline elective pathways Recruit additional consultants and middle grades as per agreed business cases Meeting 18 week and 2 week cancer standards 7 day / Flexible services at weekends < length of stay (current / peer group) Chief Operating Officer / Medical Director Implement integrated care for paediatrics (4) Agree and implement core integrated pathways for long term conditions Implement children s pathway for urgent care as per integrated A&E model < rates of admission for ACS < Length of stay < hospital follow up attendances Chief Operating Officer / Nursing 11

12 Strategic Objective: Demonstrate a learning culture Operational Objective Interventions Outcome / KPI Lead Demonstrate patients and carers feedback results in service change (4) Engage public, patients and carers in the range of 15/16 service developments e.g. integrated A&E, Paediatrics etc. Consult on changes to services where required in line with recommendations of the North Bedfordshire primary and acute care programme. Demonstrate learning from complaints, PALS, PHSO informs changes At least year on year improvement patient survey results NHS Choices / MyNHS feedback ratings Consultation outcomes Nursing training and education strategy (5) Deliver the action plans for HEEoE and college visits Develop MDT and skill mix across the Trust Secure training posts for.. revised governance arrangements for education and training Positive College/ School / Prof Body reviews Year on year improvement in GMC Survey results Upper quartile Staff Survey results Medical Director / Nursing Engage patients, staff and the community (5) Develop, consult and publish a Communications and Engagement Strategy Re-establish Patient Council with clear objectives and expected outcomes Review and rejuvenate staff engagement activities and mechanisms. Approved CE Strategy and plans At least Upper quartile staff survey results all key findings Nursing Publish and Quality Strategy (1) Develop, consult and publish a quality strategy. Refresh the governance structures to support delivery of the strategy Board approved strategy CBU level Delivery Plans Nursing 12

13 Strategic Objective: Define a sustainable clinical business model Operational Objective Interventions Outcome / KPI Lead Publish & implement sustainable options for future business model (4, 5) Deliver Proof of Concept report and modelling. Begin early implementation of models where full consultation not required. Engage and consult on the emerging models. Pursue opportunities through the NHS England new models of care programme Stakeholder supported viable models JHOSC approval Regulatory support Chief Executive Develop robust networks for hyperacute services (4) Extend joint appointments with Addenbrooke s to haematology, radiology Extend collaboration and networking with other trusts Demonstrate effective working with networks stroke, cancer, cardiac Consultants in post or under recruitment. Medical Director / Chief Operating Officer Begin integration with community services (4, 5) Develop detailed plans with CCG, primary care and SEPT to move to integrated models following N Beds acute and primary care programme recommendations Participate in community anti coag service Develop Community Respiratory Service Oncology + Hepatology department developments nurse led clinics /community clinics Service specifications agreed % integrated pathways in place Progress local plans for alliance contract Chief Operating Officer / Nursing 6 13

14 Strategic Objective: Display effective governance and leadership Operational Objective Interventions Outcome / KPI Lead Deliver the agreed 15/16 financial plan (3) Ensure Board approved CBU level budgets and plans incl contracted activity, business cases and workforce plans are in place. Ensure a detailed Recovery Plan and governance is in place Agree robust contracts with commissioners CBU Budgets Month on month achievement of plan Achievement of statutory financial duties TDA governance rating Finance / Chief Operating Officer workforce & recruitment plans (3, 1) Recruit, induct and mobilise additional nurses as per trajectory Additional nurses in post as per trajectory Nursing Develop and implement an IM&T strategy (5) Produce and publish IM&T Strategy Establish robust structure for implementation Project (s) delivery as per programme milestones Finance Director / Medical Director Demonstrate effective governance (2, 3) Review the effectiveness of Trust governance and supporting structures Maintain an effective Board Assurance Framework and robust systems for risk management Ensure the Trust meets its statutory duties for health & safety, Information governance CQC Inspection Report Annual Head of Internal Audit opinion Audit reports External Audit Governance Report TDA assessment Corporate Affairs 7 14

15 Appendix 3 Summary Financial Plan 2015/16 15

16 Appendix 4 Aggregate Activity Plan 2015/16 16

17 Appendix 5 Key Risks 2015/16 Annual Plan Key Risks Priority Areas Quality Performance Finance Service Development Enabling the Future Key Risks The Trust causes avoidable harm to patients. The Trust fails to meet national standards and The Trust fails to deliver its agreed financial plan. Urgent Care business case not developed / delays Mortality rates increase Poor patient Experience Causes Variance in clinical care (evenings / weekends) Staffing levels Lack of systematic patient involvement access targets. Available capacity does meet demand Failure of 15/16 admissions avoidance schemes Physical capacity constraints Insufficient skilled staff Ineffective management of financial risks Unrealistic CIP assumptions Insufficient management information to monitor plans Demand exceeds funded capacity Barriers to integration with community services CCG financial position Delays in agreement of models Contractual issues Proof of Concept document approval CCG intervention status The Trust is not able to respond to position itself to implement the recommendation of the N Beds Programme Ineffective or insufficient enabling plans eg IM&T and Estates CCG financial position Key Mitigations Patient Safety programme Hospital@Night Mortality Governance Quality Strategy Sources of Assurance CQC Inspection 15/16 Patient Surveys Divisional structure Consultant appts Workforce recruitment plans TDA Accountability Framework CQC Inspection Internal Audit Transforming for Excellence plans Recovery Plan Workforce Recruitment Plans Health Education England / Prof Bodies Patient & Staff Surveys Joint Programme Capacity Plan Extension of clinical networks Workforce Strategy Regulatory approval and consultation IM&T Strategy with external support Estates Strategy Internal & External Audit TDA Accountability Framework 17