Gateshead Health NHS Foundation Trust
OPERATIONAL PLAN 2015/16
(Summary for publication)
1.0 Introduction
In producing this Operational Plan for 2015/16, Gateshead Health NHS Foundation Trust has reviewed its progress against its 2014/15 Plan and has revisited the strategic context to highlight any significant changes with the potential to impact in 2015/16, year two of the Trust’s five year forward plan and beyond.
In this document we describe the outcome of this analysis and set out our plans to address the challenges and opportunities presented over the next twelve months.
We build on work undertaken last year and also take account of guidance contained in the following Monitor publications and planning documentation:
• Monitor guidance on the 2015/16 annual planning review for NHS;
• The Forward View into Action: Planning for 2015/16; and
• NHS Risk Assessment and Outcomes Frameworks
1.1 Our services
The Trust service portfolio is wide-ranging and includes those services associated with a district general hospital. Services are provided principally from the Queen Elizabeth Hospital, although we provide many services offsite at secondary care outpatient facilities including QE Metro Riverside, Blaydon Primary Care Centre, Bensham Hospital; in GP surgeries and in patients’ homes. Clinics also operate at other primary care settings across Gateshead as well as beyond the Gateshead boundary in Washington and South Tyneside. In addition to its DGH portfolio, The Trust provides a comprehensive older persons’ mental health service. It is a tertiary centre for gynaecology oncology and it is also a provider of specialist screening services, for breast, bowel and aortic aneurism. The screening services are offered to a wider range of populations including South of Tyne, Northumberland and Humberside, Cumbria and Lancashire.
1.2 Strategic context
1.1.2 Vision and themes
The Trust strategic themes were developed in 2014 upon a detailed analysis of external and internal factors likely to impact upon service delivery and sustainability for the following 5 year period. These are set out in Figure 1 below. We have reviewed the work undertaken to arrive at these themes and are of the view that they continue to provide a sound basis upon which we can deliver our objectives and plans for 2015/16. We have sought feedback from our local CCG, other partners on the Health and Wellbeing Board and local Systems Resilience Group, to seek assurance that they align with the local health and social care economy plans.
Fig 1: Strategic themes
2.1.2 Review of environmental context- has anything changed?
The outcome of the Trust’s planning review of the strategic context and environmental factors has confirmed that the former NHS ‘Call to Action’ challenges as set out in our strategic plan 2014 remain current:
· Demography:
o Ageing population - projections remain true for a stepped increase both in those aged over 65 years and significantly those aged 85 years and over, the section of the population with the greatest care needs. Gateshead population has a higher percentage of older people than the national average with 21% of people above state pensionable age compared with 19% nationally and 20% in the North East of England as a whole. The impact of an aging population is reinforced during winter months with the number of older patients admitted and an extended length of stay for this age group. This is reflected in activity and the measures required to ‘escalate’ service capacity to cope with the surge in demand (Figure 2);
o Poor health status - people in Gateshead continue to suffer more illness and early death than the national average and there are still marked variances in life expectancy and ill-health across the Borough (variance in life expectancy is 8.9 years for men and 9.4 for women across local authority wards);
o More than a quarter of Gateshead’s population has a long term condition (LTC) a significant number of whom have three or more LTCs;
o Deprivation and lifestyle choices continue to impact significantly upon health and demand upon health services.
Source: Gateshead Strategic plan 2014/15-2018/19 and Gateshead Joint Strategic Needs Assessment-Interim Report 2014).
Fig 2: Managing winter
· Austerity
The overall context of austerity and financial challenge facing our local health economy and the NHS nationally remains and continues to impact upon provision across all care sectors and interdependencies with high levels of demand increasing year on year, exacerbated by an aging population with complex needs.
The most significant issue facing the Trust in the next twelve months is to ensure in-year operational and financial resilience and sustainability, as we enter the most financially challenging period of our time as a foundation trust.
A comprehensive, staged approach is being put into place towards ensuring financial viability and sustainability going forward. This incorporates robust cost control by all clinical and non-clinical services; service redesign to modernise and streamline internally and across organisational boundaries; increasing and expanding the Trust’s portfolio of services, and working with local health and social care partners to look at new configurations of service in Gateshead and across the geographical area. The Trust will require sustained support and engagement from its key partners to enable timely implementation and achievement of this approach.
Fig 3: Ensuring future financial viability and sustainability: GHNFT staged approach
· Activity and demand
Pressure continues to be experienced within our services, and there is no evidence that activity is reducing. This is manifest in:
o High bed occupancy since quarter 2, 2013/14 rising towards 95% compared with best practice of 85%, which consequentially impacts upon bed availability for emergency admissions;
o Increasing non-elective admissions year on year (figure 4);
o Increased use of A&E services with subsequent pressure upon the four hour access target (figure 5);
o Consequential pressure upon capacity for planned care with the potential to impact on patient access, planned surgery and increased pressure upon achievement of access targets.
In developing our plans we have sought to understand the drivers of local issues and pressures more fully. Our intelligence would suggest that our services are experiencing both increased demand and worsening levels of patient acuity together with a range of other influencing factors that include:
· The local situation reflects national trends of increasing demand for urgent care services
(Figures 4 and 5)
Fig 4: Increasing emergency admissions
Fig 5: A&E Growth
Fig 6 Population estimates/projected admissions
o An increase in admissions associated with an ageing population who have greater care needs
o National policy requirements on improving efficencies and productivity in acute care have resulted in a manged reduction of beds over time whilst, to date there is currently a lack of viable alternatives to hospital admission with transformational care models being slow to impact;
o The Trust is working with commissioners on a range of processes to address this, include implementation of the Better Care Fund initiatives and the Vanguard initiative in primary care. Transformation of community services will also lead to better integrated services and care closer to home. It is essential that the pace and impact of these initiatives is monitored and assessed;
o Impact of austerity on the wider health and social care system imposes constraints upon local services that would otherwise enable effective patient flow in and out of hospital, and provide intermediate care and reablement to help avoid emergency re-admission;
o Impact of the latter on timely discharge reflected in increased length of stay for the frail elderly;
o Inappropriate use of hospital/A&E services potentially linked to public awareness and behaviours and some access issues in primary care.
These issues will be compounded given poor health status/deprivation in some parts of the Borough and pressure within the health and social care system as a whole.
2.1.3 Achievements and ongoing improvement
Within the context described above the Trust has seen completion to plan of significant developments to improve services for Gateshead residents. These included:
· New Emergency Care Centre (ECC) which opened to plan in February of this year providing one front entrance for all medical, surgical and paediatric emergencies, short stay, frailty assessment, integrated back-of-house services and walk-in services. This represents a significant improvement in services for the local population supported by state of the art technology and designed using lean principles;
· Pathology Centre of Excellence: re-configuration of pathology services for South of Tyne and relocation onto the QEH site was completed alongside the opening of the Trust’s £12m Pathology Centre of Excellence. The new hub is enhancing diagnostic and screening services for the local population and presents significant growth and market development potential for the Trust;
· Establishment of QE Facilities (QEF) a wholly-owned subsidiary of the Trust that creates an exciting framework in 2015/16 and beyond to further develop Trust service support functions whilst achieving efficiencies and income generation.
In addition, the Trust continues to demonstrate its commitment to and reputation in, providing high quality services. This is core to its values and has been repeatedly recognised by the Care Quality Commission (CQC) with its rating of Band 6 for quality and safety.
2.1.5 Transformational care models
Service redesign and transformation and the delivery of new service models remain high on the Trust agenda, in line with national policy. Two significant ongoing issues include the redesign of musculoskeletal pathways (MSK) working in partnership with Gateshead CCG and existing providers, and transforming community-based services. The Trust is engaged in work with the local GP federation (CBC), local authority and other providers, on the latter, to develop an innovative approach to local service delivery.
Cross-boundary collaboration on service transformation and delivery will form an essential element of the strategy for delivery of good affordable health and social care into the future.
2.1.6 Better Care Fund
As referenced above, progress is being made to implement and recruit staff to support plans established during 2014/15 and this work will continue in collaboration with our commissioners. However, the potential to reduce pressure upon Trust services in real terms remains to be tested, given the overall pace of demand for hospital services from the ageing population. This has been the subject of detailed dialogue with commissioners as part of the 2015/16 contracting round and will be closely monitored throughout the year.
3.0 Delivering the strategy
3.1 Our plans for 2015/16
Our strategic themes and corporate objectives are aligned to national policy and planning guidance. As referenced in section 1.0 of this document. They will ensure that we continue to meet the Terms of our NHS Provider Licence and the Public and patients’ rights under the NHS Constitution. They take account of our commissioners’ and Local Health Economy priorities and reflect our knowledge and understanding of the local context with regard to need, preferences and patient flow.
A summary of our objectives for 2015/15 is contained in the table below. These are mapped to our strategic priorities and are supported by detailed service-level plans and measureable milestones. Achievement will be closely monitored throughout the year.
8
Strategic theme / Objectives for 2015-16 /1.0 Patient-centred, co-ordinated care / We will deliver services that are clinically evidenced and that represent best practice and parity of esteem.
We will ensure all services provided comply with the CQC standards of quality and safety and that CQC registration is maintained
We will achieve all national compliance and local clinical quality performance targets (including CQUIN)
We will ensure services are safe, clinically effective and provide excellent patient experience
We will deliver a programme of service transformation to provide clinical pathways that are “joined up” and provide a high quality experience for patients
We will underpin the delivery of high quality care with a programme to ensure all staff, both clinical and non-clinical are aware of our strategic vision and understand how their work supports delivery of high quality care
2.0 Ensuring clinical and
financial sustainability / We will develop financial recovery plans during 2015-16 to minimise the planned in-year operational deficit and scope the extent of the opportunities over the medium and longer term to determine whether the trust can become financially resilient and sustainable in its current form (section 2.1 and financial commentary)
We will deliver services that are clinically sustainable through:
· Ensuring critical mass to sustain quality of clinical expertise
· Workforce planning built on rigorous capacity and demand plans for all services
· Engaging in strong clinical networks and building alliances to underpin local services
We will ensure operational resilience during 2015-16 and beyond
We will commit to continuous service improvement to ensure that the services we provide are effective and efficient
3.0 Integration and
Innovation / We will explore further opportunities for service and structural integration in line with the strategic service review.
We will seek to provide community health and elements of social care to Gateshead residents
We will work in collaboration with other agencies to develop new and innovative service models of care that deliver integrated health and social care to Gateshead residents within the financial envelope available
We will develop a range of business partnerships and alliances across service sectors to provide an innovative range of services to our catchment populations.
We will undertake a further review of the Estates Strategy to reflect the current context as described in the 2015/16 plan.
4.0 Provider of choice / We will be the provider of choice to patients and commissioners for a portfolio of commercially viable services
5.0 Expanding our portfolio / We will develop our portfolio through new service models and new markets that are:
· Commercially viable
· Clinically sustainable
· In line with our core values
· Build upon areas of expertise and reputation
8
3.2 Key elements of our plans
3.2.1 Operational and financial resilience
Within the current strategic and financial context and, given the size and nature of the services (largely acute) that GHNT FT delivers, ensuring operational and financial resilience and future sustainability is a necessity and will be a focus of plans for the next twelve months and into the longer term. This is especially important given the increasing pressures being placed upon services, experiences of demand in previous months and also the new rules for funding capacity to manage winter surge. Work includes: