OPERATIONAL PLAN

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1 OPERATIONAL PLAN Our plans and priorities for the future This document presents a summary of Poole Hospital s key financial and operational plans for April 2014 to March 2016, and outlines we will continue to maintain the highest standards of patient care over the next two years.

2 OPERATIONAL PLAN INTRODUCTION: ABOUT POOLE HOSPITAL Poole Hospital NHS Foundation Trust is the designated trauma centre for the east of Dorset, serving a population of over 500,000 people, with a 24-hour major accident and emergency department. The trust provides general hospital services to the population of Poole, Purbeck and East Dorset, as well as a range of additional services such as maternity and neonatal care, paediatrics and neurology to the wider population in the eastern part of Dorset, including Bournemouth and Christchurch. In addition, the hospital s flagship Dorset Cancer Centre provides medical and clinical oncology services for the whole of Dorset, serving a total population of over 750,000. The hospital: has a track record for strong clinical performance, with a number of beacon clinical services achieving outcomes that are amongst the best internationally has a reputation for being open, friendly and patient-focused thanks to its unique philosophy of care, the Poole Approach has a reputation for efficiency and productivity, delivering high-quality services that provides excellent value to the taxpayer has a long-established history of collaborative working with commissioners and local partners is able to recruit, train and retain the very best people, committed to delivering safe, high quality, innovative patient care. LOOKING TO THE FUTURE: OUR KEY PRIORITIES In 2010, the board of directors at Poole Hospital agreed to pursue a merger with the Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust. However, following a detailed review, the Competition Commission made a decision to prohibit the merger in October Following the Competition Commission s decision, Poole Hospital s board of directors took timely and effective action to secure a sustainable future for the trust. An interim transformation director was appointed in November 2013 to lead the development of an improvement programme, and a new, experienced executive team were appointed following the resignations of four members of the existing board. The new team of executives, led by chief executive Debbie Fleming, took up post in April Page 1

3 The trust has redefined its strategy to maintain clinical and financial viability following the prohibition of the merger as follows: Stage / /16: rapid development and implementation of an internally focused transformation programme to deliver a significant reduction in costs over the next two years Stage /17 onwards: taking part in a clinical service review, led by Dorset Clinical Commissioning Group (CCG), across the whole Dorset health community resulting in major reconfiguration to deliver long-term clinical and financial sustainability for healthcare services in Dorset. This two-year operational plan focuses on the first of the above stages. The trust s key priorities over the period of this plan are as follows: develop a financial recovery plan to significantly reduce costs and protect the trust s liquidity over the next two years ensure the trust continues to provide safe, effective and high quality services to patients and is able to demonstrate this through completion of a successful Care Quality Commission Review address high risk back-log maintenance issues improve the resilience of emergency care services continue to achieve all operational standards and targets deliver the agreed IT strategy jointly with Royal Bournemouth (RBCH) develop a long term sustainable clinical and financial strategy for healthcare services to the population of Dorset in partnership with commissioners and other providers. The financial challenge Poole Hospital has an unusual case-mix with a relatively high proportion of non-elective activity. Under the current tariff structure it is difficult to achieve a financial surplus for the trust as a whole. Poole Hospital s financial sustainability over the next two years is dependent on: non-recurring transitional support from our main commissioners the delivery of transformational savings of at least 7% over the coming two years obtaining long terms loans (up to 20m) to support essential capital investment in the trust s infrastructure Page 2

4 the trust continuing to deliver the highest possible standard of patient-centred healthcare and achieving improved health outcomes for the local population employing and engaging a highly motivated, appropriately skilled workforce continuing to involve patients, the public and partners in developing patient-centred services continuing to manage all resources well so as to maintain financial viability. Financial plan summary 2014/15-15/16 At March 2014, Poole was in a balanced financial position with a small surplus, an acceptable liquidity position and no long-term debt. The deficits incurred in 2009/2010 and 2010/2011 have been addressed and the trust has achieved an operating surplus in each of the last three years. However, the 2013/14 operating surplus was supported by non-recurring and non-cash elements and had an underlying deficit of 4-5m. This underlying deficit meant cash balances had fallen from 15m at the start of the year to 10m at the end. The table below illustrates our position at the end of 2013/14, and our financial projections for the next two years: 2013/14 actuals 2014/15 forecast 2015/16 forecast m m m Income from activities Other operating income Donated income Total operating income Pay costs Drugs Non-pay costs Total operating expenditure EBITDA* Finance charges Surplus / (deficit) Cost improvement plans (CIP savings) Cash balance at 31 March Capital expenditure Funded by additional PDC Funded by long-term loans / leases * earnings before interest tax depreciation and amortisation Page 3

5 Our transformation programme Critical to Poole Hospital s clinical and financial viability is the need to achieve savings in the short term, whilst longer term plans are developed that will secure a sustainable future for healthcare services across the county. A key feature of this year will be the implementation of a detailed transformation programme, which is anticipated to deliver savings of 13.6m over the next two years. The development of the transformation programme has been led by the trust s interim transformation director, who has used internal and external resources to validate the trust s financial position and identify potential cost-improvement opportunities. The process is underpinned by robust governance to ensure compliance with key reporting controls, and maintain the quality and safety of care provided by the hospital. The programme will look at every aspect of our work to develop and implement effective and efficient models of care that are shaped around the needs of our patients. PATIENT-CENTRED CARE: A COMMITMENT TO QUALITY Improving the quality of care is at the centre of everything we do at Poole Hospital. Our commitment to quality is clearly articulated in the Poole Approach, which states that we will provide friendly, professional, patient-centred care with dignity and respect for all. The trust s quality report sets out how we will measure quality in key areas during the coming year. The report is available on our public website ( as part of our annual report for 2013/14. In reviewing patient care, patient safety, clinical effectiveness and patient experience the board has targeted five key areas for improvement in 2014/15: 1. Poole Approach culture and care We will continue to strengthen our commitment to the Poole Approach and further embed the Golden Rules, a set of guidelines which support the fundamentals of care 2. Bed occupancy We will aim to reduce the number of patients who are delayed in leaving hospital as well as our overall bed occupancy rates, working closely with partner agencies so that patients can get home sooner with the right support. 3. Clinical staffing Following a review of our nursing and midwifery staffing levels undertaken in autumn 2013, we will look at both the Page 4

6 changing needs of patients and our workforce to ensure we are providing the right levels of staffing. 4. Seeking patients views We will work to increase the number of opportunities for patients to provide feedback and comments on the services, care and treatment that they receive. 5. Mandatory training We will aim to increase our compliance against mandatory training requirements within the year, to ensure we are providing a safe, high-quality service to patients. OUR PLANS: OPERATIONAL PROJECTIONS The trust is not anticipating any significant change to patient activity during 2014/15. We have a track record of working closely with commissioners to manage service change, and financial budgets have been set to reflect the resources required to deliver anticipated activity levels and meet operational and quality targets. The trust saw a significant increase in GP referrals during 2013/14, and activity baselines have been agreed for 2014/15 which broadly reflect existing activity trends. However, if GP referrals continue to increase significantly, we will work with our commissioners to look at ways in which we might reduce unnecessary referrals. The trust has a permanent bed establishment of 575 beds. However, like many other acute hospitals, we have been very busy over the last 18 months, and the trust has made extended use of its 59 escalation beds. The trust has robust escalation plans in place which allow us to support increases in demand for hospital care at particular times, such as during the busy winter months. Poole Hospital has eight main theatres, three day-case theatres and two obstetric theatres. Budgets have been set for 2014/15 which provide the physical theatre and staffing resource to meet expected activity levels. The trust s theatre utilisation is broadly in-line with average NHS performance, but work is underway to review theatre usage and improve productivity further. To join Poole Hospital as a foundation trust member, call or visit Page 5