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Bedford Hospital NHS Trust
Annual Business Plan
2015/16
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Contents
1. Introduction
2. Strategic Context and Direction
3. 2015/16 Priorities and Objectives
4. Key Underpinning Plans
a. Workforce
b. Education & Training
Appendices
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 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
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.
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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
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.
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.
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
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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.
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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 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;
Deliver seamless consistent high quality 7 day services
Demonstrate a learning culture
Define a sustainable clinical business model
Display effective governance and leadership
Develop a patient safety culture for harm free care
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The 2015/16 objectives supporting these are;
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
Implement the education & training strategy
Deliver the workforce and recruitment plans
Prevent avoidable deaths
Extend networks / partnerships for hyperacute services
Implement integrated care for paediatrics
Engage patients, staff and the community
Begin integration with community services
Develop and implement an IM&T strategy
Reduce incidents of avoidable harm
Design & Implement the new models of
Demonstrate patients and carers feedback results in service change
Publish and Implement the Quality Strategy
Deliver the agreed financial plan
Publish sustainable options for configuration
Transform inpatient flow and discharge
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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.
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To provide excellent acute and integrated care serves to the people of Bedfordshire
Strategic Aims
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
Strategic Objectives 15/16
Deliver seamless consistent high quality 7 day services
Demonstrate a learning culture
Define a sustainable clinical business model
Display effective governance and leadership
Operational Objectives 15/16
Reduce incidents of avoidable harm 1
Design & Implement the new models of care 4
Demonstrate patients and carers feedback results in service change 1
Implement the education & training strategy 5
Deliver the workforce and recruitment plans 1, 3
Sources of Assurance
Publish and Implement the Quality Strategy 1
CQC Inspection 2015
TDA
Accountability Framework
HEE / Prof body assessment
Patient & Staff Surveys / FFT
Prevent avoidable deaths 1
JHOSC
Deliver the agreed financial plan 3
Publish sustainable options for configuration 4,5
Transform inpatient flow and discharge 1,2
Extend networks / partnerships for hyperacute services 4
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
CQC Domain Safe Effectiveness Caring Well Led
Develop a patient safety culture for harm free care
Responsiveness
Appendix 1 Plan on a Page (1) Numbers in brackets = cross reference to
15/16 priority areas p6 of the plan safety culture for harm free
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• 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
• Implement the Nurse Technology Fund
Interventions Outcome / KPI
• 0 Never Events
• SIs <=14/15 outturn• Project clinical outcomes:
(reduced VTE, falls, sepsis etc)
• C Diff / MRSA trajectories
met• Reduced errors,
complications and peri-arrests
Medical
Director / Director of
Nursing
Prevent
avoidable deaths (1, 2)
Medical
Director
• Complete roll out of Hospital @ Night
• Systematically Review all deaths via mortality review group
Strategic Objective:Develop a patient safety culture for harm free care
• SHMI ≤ 100
• Reduce mortality rate outliers per speciality
• Failure to rescue –PAR audit 95% escalated
Operational Objective
Lead
(1) Numbers in brackets = cross reference to 15/16 priority areas p6 of
the plan safety culture for harm free
Reduce
incidents of avoidable harm
(1, 2)
Appendix 2 2015/16 Objectives
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• Implement the 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
Operational Objective
Interventions Outcome / KPI Lead
• 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
• Confirm outcome of stroke business case
• Recruit acute geriatrician for AAU + community
• Implement theatres 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 /
Director of Nursing
• 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 /
Medical Director
Strategic Objective:Deliver seamless consistent high quality 7 day services
Design &
Implement the new models of
care (4)
Transform
inpatient flow and discharge
(1,2)
Implement
integrated care for paediatrics
(4)
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• Develop, consult and publish a quality
strategy.• Refresh the governance structures to
support delivery of the strategy
• Board approved strategy
• CBU level Delivery Plans
Director of
Nursing
• 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
Operational Objective
Interventions Outcome / KPI Lead
• At least year on year
improvement patient survey results
• NHS Choices / MyNHSfeedback ratings
• Consultation outcomes
Director of
Nursing
• Deliver the action plans for HEEoE and
college visits• Develop MDT and skill mix across the Trust
• Secure training posts for..• Implement the 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
Director of
Nursing
• 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
Medical
Director / Director of
Nursing
Demonstrate
patients and carers feedback
results in service change (4)
Implement the
training and education
strategy (5)
Engage patients,
staff and the community (5)
Publish and
Implement the Quality Strategy
(1)
Strategic Objective:Demonstrate a learning culture
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• 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
Operational Objective
Interventions Outcome / KPI Lead
• Stakeholder supported
viable models• JHOSC approval
• Regulatory support
Chief
Executive
• 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.
Chief
Operating Officer /
Director of Nursing
• 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
Medical
Director / Chief
Operating Officer
Publish &
implement sustainable
options for future business model (4, 5)
Develop robust
networks for hyperacute
services (4)
Begin
integration with
community services (4, 5)
Strategic Objective:Define a sustainable clinical business model
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• 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
Operational Objective
Interventions Outcome / KPI Lead
• CBU Budgets• Month on month
achievement of plan• Achievement of statutory
financial duties• TDA governance rating
Director of
Finance / Chief
Operating Officer
• Recruit, induct and mobilise additional
nurses as per trajectory
Additional nurses in post as
per trajectory
Director of
Corporate Affairs
• 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
Director of
Nursing
Deliver the
agreed 15/16 financial plan (3)
Implement the
workforce & recruitment
plans (3, 1)
Demonstrate
effective governance (2,
3)
Develop and implement an IM&T strategy (5)
Project (s) delivery as per
programme milestonesFinance Director / Medical Director
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Strategic Objective:Display effective governance and leadership
• Produce and publish IM&T Strategy
• Establish robust structure for implementation
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Appendix 3 Summary Financial Plan 2015/16
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Appendix 4 Aggregate Activity Plan 2015/16
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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.
Mortality rates increase
Poor patient Experience
The Trust fails to meet national standards and access targets.
Available capacity does meet demand
The Trust fails to deliver its agreed financial plan.
Ineffective management of financial risks
Urgent Care business case not developed / delays
Barriers to integration with community services
CCG financial position
The Trust is not able to respond to position itself to implement the recommendation of the N Beds Programme
Causes
Variance in clinical care (evenings / weekends)
Staffing levels
Lack of systematic patient involvement
Failure of 15/16 admissions avoidance schemes
Physical capacity constraints
Insufficient skilled staff
Unrealistic CIP assumptions
Insufficient management information to monitor plans
Demand exceeds funded capacity
Delays in agreement of models
Contractual issues
Proof of Concept document approval
CCG intervention status
Ineffective or insufficient enabling plans eg IM&T and Estates
CCG financial position
Key Mitigations Patient Safety programme
Hospital@Night
Mortality Governance
Quality Strategy
Divisional structure
Consultant appts
Workforce recruitment plans
Transforming for Excellence plans
Recovery Plan
Workforce Recruitment Plans
Joint Programme
Capacity Plan
Extension of clinical networks
Workforce Strategy
IM&T Strategy with external support
Estates Strategy
Sources of Assurance CQC Inspection 15/16 Patient Surveys
TDA Accountability Framework CQC Inspection Internal Audit
Health Education England / Prof Bodies Patient & Staff Surveys
Regulatory approval and consultation
Internal & External Audit TDA Accountability Framework
Appendix 5 Key Risks