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    Bedford Hospital NHS Trust

    Annual Business Plan


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    1. Introduction

    2. Strategic Context and Direction

    3. 2015/16 Priorities and Objectives

    4. Key Underpinning Plans

    a. Workforce

    b. Education & Training


    1. Plan on a Page

    2. 2015/16 Objectives

    3. Summary Financial Plan

    4. Summary Activity Plan

    5. Key Risks

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    1. Introduction

    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.

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    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


    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

    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


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    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

    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


    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.

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    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


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