bedford hospital nhs trust annual business plan ?· dunstable hospital nhs foundation trust for...
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Bedford Hospital NHS Trust
Annual Business Plan
2. Strategic Context and Direction
3. 2015/16 Priorities and Objectives
4. Key Underpinning Plans
b. Education & Training
1. Plan on a Page
2. 2015/16 Objectives
3. Summary Financial Plan
4. Summary Activity Plan
5. Key Risks
This document summarises the Trusts 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
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 Trusts aim for 2014/15 of prioritising quality and safety was
successful. This though meant considerable pressure on the Trusts 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.
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
Addenbrookes (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 trusts 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
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
reviews study phase and made recommendations for developing robust options for local health
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.
Excellence in quality and safety
Effective emergency & ambulatory models of
Horizontal integration via networks and
Vertical integration of secondary, intermediate
and primary care
Carry out further detailed work on the preferred options for the future provision of hospital
Develop a detailed plan outlining the practical steps that need to be taken to prepare for
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
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.
3. 2015/16 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