Strategy Committee Monday 25 September 2017 17.00 – 18.30 Seminar Room, Trust Education Centre, Royal Berkshire Hospital Item

Lead Time

1. Apologies for Absence

Graham Sims -

2. Minutes for Approval: 5 December 2016

Graham Sims 17.30

3. a) Clinical Services Strategy Update* b) Membership Engagement Questions*

Steve McManus/ Lindsey Barker Graham Sims

17.35 18.15

4. Date of Next Meeting: TBC

Graham Sims -

Agenda

*Presentation 1

Agenda Item 2

Council Strategy Committee Monday 5 December 2016 18.00 – 19.30 Seminar Room, Trust Education Centre, Royal Berkshire Hospital Present Mr. David Cooper (Public Governor, Reading) (Chair) Mr. Jon Andrews (Public Governor, Reading) Mrs. Shirley Anstis (Partner Governor, Alliance for Cohesion and Racial Equality) (up to minute 13/16) Ms. Wendy Bower (Partner Governor, West Berkshire Federation CCG’s) Mr. Jeremy Butler (Public Governor, East Berkshire) Mr. Ian Clay (Volunteer Governor) Ms. Jennie Ford (Partner Governor, East Berkshire Federation CCG’s) Mr. Paul Gupta (Public Governor, Wokingham) Mr. Spike Humphrey (Public Governor, East Berkshire) Mrs. Angelina Lewis (Public Governors, Wokingham) Mr. Tony Lloyd (Public Governor, Wokingham) Cllr. Gordon Lundie (Partner Governor, West Berkshire) (up to minute 13/16) Ms. Gwen Mason (Public Governor, West Berkshire) Dr. Charles McKenna (Staff Governor, Medical/ Dental) (up to minute 13/16) Ms. Deborah Sander (Public Governor, Reading) Mr. Steve Sellwood (Staff Governor, Admin/Management) Cllr. Bet Tickner (Partner Governor, Reading Borough Council) In attendance Mr. Craig Anderson (Director of Finance) (up to minute 13/16) Mr. Julian Dixon (Non-Executive Director) (up to minute 13/16) Mrs. Caroline Lynch (Trust Secretary) Miss. Emma Sampson (Deputy Trust Secretary) Mr. Graham Sims (Chairman of the Trust) Apologies Mr. Peter Dooley (Partner Governor, Berkshire Carers Service) 12/16 Minutes: 27 July 2016 and Matters Arising Schedule

The minutes of the meeting held on 27 July 2016 were agreed as correct record and signed by the Chair. A query was raised in respect of whether an update on the Clinical Services Strategy (CSS) could be provided to governors. The Chairman advised that a number of the sub-strategies, including the CSS were still in the draft stage. It was agreed that the Trust Secretary would liaise with the Medical Director to ascertain whether an update on the CSS could be provided to a future meeting of the Clinical Assurance Committee. Action: C Lynch

Minutes

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Council Strategy Committee 5 December 2016

The Committee discussed the Sustainability and Transformation Plan (STP) and Accountable Care System (ACS). The Chairman agreed that a detailed update would be provided to the January Council meeting. Action: G Sims

13/16 Draft Operating Plan 2017/18 and 2018/19

The Director of Finance introduced the draft Operating Plan for 2017/18 and 2018/19. The Trust was required to submit the final plan to NHS Improvement (NHSI) by 23 December 2016. NHSI had provided the Trust with revised control totals, and if the Trust signed up to these there would be additional sustainability funding available for 2017/18 and 2018/19. The Director of Finance advised that further information and Board discussions were required before the submission of the Operating Plan. Governor comments on the Operating Plan were sought and would be fed back to the Board and included in the final Operating Plan as appropriate. A query was raised in related to delayed transfers of care. The Chairman advised that the A&E Delivery Board were currently reviewing models in respect of delayed transfers of care used by the different local authorities. The Chairman requested that relevant partner governors consider whether they could assist with furthering the issue of delayed discharges with their local authority. A query was raised in respect of whether the Trust provided support to patients and carers who required care packages to be put in place prior to discharge. It was agreed that this would be added to the governor questions log. Action: C Lynch It was queried whether the priorities included in the Operating Plan could better reflect the aims of the STP specifically in relation to key priorities such as prevention and mental health. Action: C Anderson The Chairman advised that the Trust had been advised by NHS Improvement (NHSI) that it was no longer in breach of its licence and certificates of compliance would be issued for all non-financial undertakings.

14/16 Review of Council Objectives 2016/17

The Trust Secretary introduced the report which set out progress made in respect of the Council’s objectives for 2016/17. Overall, good progress had been made.

The Committee recommended that the progress made in respect of the Council’s Objectives for 2016/17 be recommended to the Council. Action: C Lynch

15/16 Draft Council Objectives 2017/18

The Trust Secretary introduced the draft Council objectives for 2017/18 and advised that the membership section had been updated to reflect the focus on increasing the representativeness of the membership.

For the objective relating to striving to achieve a representative membership and meaningfully engage with all members; it was agreed that the methods section would be updated to state develop links with ‘local organisations’ as opposed to ‘the University of Reading and University of West London’. Action: C Lynch

2

Council Strategy Committee 5 December 2016

The Trust Secretary advised that an email would be circulated to governors requesting details of their involvement with local organisations so that key links could be drawn on in the development of the membership strategy. Action: C Lynch It was agreed that the updated objectives would be circulated to the Council for feedback and then submitted to the January Council for approval. Action: C Lynch

16/16 Governor Training and Development Programme Update

The Trust Secretary provided an update in respect of the governor training and development sessions for 2016/17. The Committee noted that training sessions were as follows:

• 25 January 2017: Structure of the NHS and the Commissioning Landscape • 29 March 2017: Quality & Quality Governance in the Trust • 31 May 2017: Patient Experience and Patient Leaders

17/16 Review of Committee’s Terms of Reference

The Trust Secretary introduced the terms of reference which had been submitted as part of the annual review cycle. It was agreed that the role of the Committee should be updated to state that the Committee will lead on the Council’s input into the Trust’s strategic plans ‘and plans relating to partnership working’. It was agreed that the revised terms of reference should be recommended to the Council for approval. Action: C Lynch

18/16 Date of Next Meeting

It was agreed that the next meeting would be held on Monday 20 February 2017, 5.30pm. SIGNED

DATE

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Strategy Committee Matters Arising and Outstanding Actions Schedule Agenda Item 2

Meeting Minute Ref

Subject

Matter Arising Owner Update

December 2016

12/16 Minutes: 27 July 2016 and Matters Arising Schedule

The Trust Secretary would liaise with the Medical Director to ascertain whether an update on the CSS could be provided to a future meeting of the Clinical Assurance Committee. The Committee discussed the Sustainability and Transformation Plan (STP) and Accountable Care System (ACS). The Chairman agreed that a detailed update would be provided to the January Council meeting.

C Lynch G Sims

An update on the Clinical Services Strategy will be provided at the Joint Board/Council meeting on 29 March 2017. This is scheduled for Joint Board/Council meeting in September 2017.

December 2016

13/16 Draft Operating Plan 2017/18 and 2018/19

A query was raised in respect of whether the Trust provided support to patients and carers who required care packages to be put in place prior to discharge. It was agreed that this would be added to the governor questions log. It was queried whether the priorities included in the Operating Plan could better reflect the aims of the STP specifically in relation to key priorities such as prevention and mental health

C Lynch C Anderson

Completed and response issued. Completed.

December 2016

14/16 Review of Council Objectives 2016/17

The Committee recommended that the progress made in respect of the Council’s Objectives for 2016/17 be recommended to the Council.

C Lynch

Completed.

December 2016

15/16 Draft Council Objectives 2017/18

For the objective relating to striving to achieve a representative membership and meaningfully engage with all members; it was agreed that the methods section would be updated to state develop links with ‘local organisations’ as opposed to ‘the University of Reading and University of West London’. The Trust Secretary advised that an email would be circulated to governors requesting details of their involvement with local organisations so that key links

C Lynch C Lynch

Completed. Completed. Email circulated to governors.

Strategy Committee Matters Arising and Outstanding Actions Schedule Agenda Item 2

could be drawn on in the development of the membership strategy. It was agreed that the updated objectives would be circulated to the Council for feedback and then submitted to the January Council for approval.

C Lynch

Completed and revised objectives approved by the Council.

December 2016

17/16 Review of Committee’s Terms of Reference

It was agreed that the role of the Committee should be updated to state that the Committee will lead on the Council’s input into the Trust’s strategic plans ‘and plans relating to partnership working’. It was agreed that the revised terms of reference should be recommended to the Council for approval.

C Lynch Completed.

Clinical Services Strategy

September 2017

1

Agenda Item 3a

The NHS nationally and locally is facing unprecedented challenge• The health and care system in the UK is

rightly held in high regard for its ability toprovide high quality, universalhealthcare at a low cost.

• Over the past two decades the NHS hasdelivered dramatic improvements inpatient outcomes, public satisfactionand reduced waiting times.

• Looking forward, however, acombination of pressures threatenthese achievements.

• We can see the early signs of thesepressures in the financial position ofthe NHS, and in the deterioration ofperformance against accessstandards.

• The Berkshire health system is nodifferent to the rest of England,maintaining a high quality servicerequires a step change in how we work

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Increasing demand due to changes in patients’ health needs:

Increasing possibilities due to changes in treatments, technologies and care delivery:

Increasing expectations due to changes in preferences and behaviours:

Increasing pressure due to changes in the growth of funding for health services:

①

②③

④

National and local drivers

The government has asked local NHS leaders to make progress in five areas

Wellness focused

•We must supportpeople to managetheir health better,reduce their risk ofdeveloping a longterm condition andenable those with along term conditionto manage it better

Learning and adopting

•The NHS must seekto learn fromsuccessful in healthsystems across theworld and to sharefindings andapproaches morequickly.

Productive and efficient

•Using the bestpractices identifiedin Lord Carter’srecent report,hospitals could save£5bn

Well-funded and resourced

•Sound financialmanagement andselective investmentin key resources(especially staff) areessential to asustainable healthand care system.

3

Truly integrated and system led

•Today’s care needsrequire amultidisciplinaryrather than anindividual approachto reduceduplication andenhanceeffectiveness.

Five focus areas in the NHS five year forward view

Locally we are looking to join up services and act as a single accountable care system

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In Berkshire West our programme is being driven by a collaboration between

• Berkshire West CCGs • Berkshire Health Foundation Trust • Royal Berkshire Foundation Trust

Together we are the “Berkshire West Accountable Care System” – and we have been recognised as one of 8 leading systems by NHS England

Currently the Trust provides four types of service to our patients At our core we are District General Hospital (DGH), providing acute medical and surgical services. We also provide a range of specialist services that are not typically found in a DGH

We think about the services we provide in four groups

5

Our clinical strategy drives our overall strategy and our approach to workforce, estate and IT Our strategy comprises of three different levels

1. Trust Strategy:Summarises the overalldirection for ourorganisation, setting outour values and prioritiesfor the years ahead

2. Clinical Strategy: Defineshow we will shape ourservices in order to providethe highest quality carepossible for our patients

3. Enabling Strategies: Setsout how we will shape ourresources in order todeliver on the clinicalservices strategy and theoverall trust strategy

Our vision values and priorities

Clinical services strategy

Quality strategy Workforce strategy IT strategy Estate strategy

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Trust strategy

Clinical strategy

Enabling Strategies

Our strategy

• The shape of the clinical services we offer is the cornerstone to ouroverall strategy as an NHS Trust.

• Equally it will shape our approach to workforce, IT and estate.

• As a result we have prioritised the development of the clinical servicesstrategy

Involvement of governors and members in shaping the CSS

1. Evidencegathering by the clinical team

2. Meetings withCEO and MD

3. Development ofservice strategies

4. Identification ofclinical priorities and transformation areas

5. Development andfinalisation of CSS documents

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Apr –Jul

Jun-Aug

Jul-Oct

Sep - Oct

Nov- Dec

September 2017: Questions to governors and members to help

us identify priorities

November 2017: Review of draft CSS ahead of its finalisation

by the board

The development of our CSS is being led by the clinical and operational leadership of our services

They have met with our medical director, chief executive and members of our strategy team to discuss:• The needs of patients• Our successes and challenges in delivering the services

we provide• Future pressures arising from changes in clinical practice

and regulation• Technological and clinical progress that may expand or

reshape the range of treatment possibleTo aid us in developing the CSS we are looking for your insight. This will take place at two key points

Emerging principles from our work on the CSS

CSS principles

The Trust will remain as the principle provider of hospital services for Berkshire West, and will provide and develop our specialist services where appropriate

Through the ACS, we will work with local partners, contributing our expertise to deliver care. This will involve working with GPs and community staff from the NHS and working with private providers to make best use of all healthcare assets in West Berkshire.

We will look to deliver care closer to home through our community hubs, through the delivery of selected services in GP surgeries and the use of digital and telephone services when it is safe to do so.

We will seek to drive high quality clinical care, improved patient experience and reduce variation in outcomes through application of evidence, data, and technology and standardised pathways.

We will look to strengthen our education and research portfolios to improve the quality of care to patients and develop our position as employer of choice.

We will continue to deliver improvements in efficiency and productivity so that we continue to be a financially sustainable and responsible organisation.

Discussions with clinical teams have helped us to identify six overarching principles that underpin the overall direction of travel for clinical services

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What do the principles mean for patients?

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More of our outpatient services will be delivered in GP

practices and our community hubs

Our services will be in the top 25% of NHS provided services in

England

We will invest to maintain local access to specialist Cancer,

Cardio, Stroke and Renal

We will look to bring additional specialist services to Reading

where it improves care and reduces cost

A&E and Maternity services will continue to be provided at RBH

Our staff will work in partnership with GPs and other NHS staff to

support your care

We will offer the choice of “skype”,

telephone or face to face appointments

You will have the opportunity to take part in pioneering

research or medical trials

Our services will be recognized externally

as providing outstanding care

Our patients will continue to

recommend our services

You will notice improvements in our

facilities

The process of discharge and transfer of care will be smother

Key questions for members and governors

We are looking to utilise the your insight to help us identify our priority areas and review the work being done by our clinical leaders

We have identified a number of questions that we would like to ask members through an on-line survey

We would like your view as governors as to:

� Whether the questions are appropriate for members?

� Whether there are additional questions we should be seeking views on?

� What you expect members will tell us?

Questions for members to help shape our CSS

1. To what extent do you agree with the CSS priorities(strongly agree, somewhat agree, neither agree or disagree, somewhat disagree, strongly disagree)

2. Are there additional priorities we should be applying as wedevelop the CSS? (Yes, No, - if yes free text answer)

3. Please could you rank the CSS priorities in order of priority toyou – 1 being highest? (Allows 1-7 to provide for other)

4. Which of the services provided by the Trust require the mostimprovement or investment? (list of specialities and services (e.g. OP, catering etc) anda free text answer)

5. Which aspects of areas of care outside of the hospital shouldRBFT be offering to support? (GP services, 111 services, Ambulance services,Community Hospitals, Mental Health, Specialist services, Social Care, Other –please state)

6. Is there anything else you would like us to consider as wedevelop the clinical services strategy? (free text)

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Agenda Item 3b