4 Patient, Public and Staff Involvement Key stakeholder engagement is included in project work, at project team or workstream level, as appropriate.

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1 Report to Trust Board Date Tuesday 3 June 2008 Agenda Item O5 Title Continuous Improvement Programme /09 Sponsor Jac Kelly, Chief Executive Prepared by Emma Spouse, Programme Manager Presented by Andy Robinson, Director of Finance & Performance 1 Purpose and Key Issues To present the continuous improvement programme (CIP) for 2008/09 and the financial and non-financial benefits to be realised. 2 Equality and Diversity Implications The projects within the programme address equality and diversity issues appropriately. There are no adverse or positive impacts within the programme structure. 3 Legal Implications The Continuous Improvement Programme is assisting the Trust to meet its statutory duties. Specifically to: Break even on its income & expenditure account, taking one year with another Operate within it s external financing limit (EFL) Operation with a notified capital resource limit (CRL) 4 Patient, Public and Staff Involvement Key stakeholder engagement is included in project work, at project team or workstream level, as appropriate. 5 Controls and Assurances The Trust will continue to work with NHS South West Strategic Health Authority to ensure that the CIP remains on track through 2008/09 and into 2009/10. Project Managers will continue to submit fortnightly updates. Project progress will be monitored by the Programme Manager and senior finance staff with exception reports going to the weekly Executive Directors Group. Monthly reports will continue to be scrutinised by the Finance & Performance Committee. Project risks will be identified and discussed at monthly Project Managers meetings and risks placed on the Trust s risk register where appropriate. High risks on the risk register are discussed at the Risk Management Committee. Programme controls and progress are monitored by internal audit. 6 Cost Implications Cost of provision of Programme Office. 7 Potential risk to the organisation If programme project savings of 4.533m are not achieved the Trust would be at risk of not achieving its 7.9m surplus control total for 2008/09. 8 Recommendations The Trust Board to NOTE the Continuous Improvement Programme for 2008/09. Best Care, Highest Standards, Right Place

2 Strategic Objectives Ten strategic objectives were agreed by the Trust Board in May 2007 to support the Trust s mission statement Best Care, Highest Standards, Right Place. The strategic objectives have been developed to ensure there is a shared understanding and common purpose throughout the organisation about the Trust s strategic direction and what needs to be delivered. X Patient Safety Efficient & Effective Listening and responding to the needs of patients Deliver Care in the most appropriate setting High Quality Services Strategic Partnerships Modern and Effective Infrastructure Public Health Integrate Health and Social Care X Robust and Sustainable Standards for Better Health The Core and Developmental Standards for Better Health have been developed by the Healthcare Commission. Compliance with the Standards throughout the year form a part of the Trust s Annual Health Check. C1a Incident Reporting C7e Equality & Diversity C16 Patient Information C1b Safety Alerts C8a Whistle blowing X C17 Patient & Public Involvement C2 Child Protection C8b Personal Development Access to Services C18 Programmes Equality & Choice C3 NICE Interventional Access to Services C9 Records Management C19 procedures Emergency care C4a Infection Control C10a Employment Checks C20a Security and Health & Safety C4b Medical Devices C10b Professional Codes of Patient Privacy & C20b Conduct Confidentiality C4c Decontamination C11a Recruitment C21 Hospital Cleanliness C4d Medicine Management C11b Mandatory Training C22a C4e Waste Management C11c C5a C5b C5c NICE Technology appraisals Clinical Supervision & Leadership Clinical Professional Development C5d Clinical Audit C13c C6 Healthcare bodies cooperating together C7a Corporate Governance C14b X C7b Finance & Probity C14c Professional Development C22b C12 Research & Development C22c C13a Dignity & Respect C23 C13b Consent to treatment C24 Use of Confidential Information D1 C14a Complaints - Information X D2a Complaints Nondiscrimination Complaints Service improvements X D5b D13a C7c Clinical Governance C15a Patient Food Standards D13b X C7d Performance C15b Patient dietary requirements Public Health Health inequalities Public Health D of PH report Public Health - Working with partners Public Health Health promotion Major Incident Planning Patient Safety Risk reduction Clinical Effectiveness Best practice Continuous improvement of services Public Health Health inequalities Public Health National guidance Programme Office / Finance & Performance Page 2 of 11

3 A. BUSINESS PLAN Finance & Performance Committee 27 May /09 Continuous Improvement Programme The annual plan for 2008/09 will continue to focus on the Trust s financial and organisational recovery, specifically service redesign and continuous improvement, with the strategic service and estates plans continuing to be developed, refined and implemented. A methodical business planning cycle has been developed, which ensures clinical engagement and ownership of the Trust s strategic direction and 5 year strategic integrated business plans. Continuous improvement has been embedded across the organisation in 2007/08 and will continue into business plans for 2008/ Finance The Trust is required to deliver 4.533m savings through service redesign projects and directorate cost reduction efficiency savings in 2008/ Systems and Controls The Trust has defined Finance, Governance and Committee structures with clear lines of accountability to the Board. The Board receives detailed monthly reports on the Trust s performance, including key targets, workforce data, complaints, infection control, equality and diversity data and progress towards achievement of the Standards for Better Health. A performance based balanced scorecard is being developed for the Trust. The Trust has a well established Programme Office which supports, monitors and reports upon continuous improvement, service redesign projects and plans across the organisation as required. 3. Standards for Better Health Work continues to raise standards across the Trust and to ensure that sufficient evidence is available to assure compliance in those areas where standards were not met or not compliant. 4. Organisation development The Board continues to have regular information, briefing and development sessions. The Clinical Cabinet of Lead Clinicians meets regularly with the Medical Director. The service strategy Our Ambitions : Strategy into action 2008/09 - Service Strategy has been developed and presented to the Board in May Service and workforce plans are being developed and these form the bedrock of the 2008/09 Integrated Business Plan. A Leadership Development Programme, Free to Lead for 20 Clinical & Administration Managers took place in November A further cohort commenced in March Chief Executive bulletins highlighting key discussion points and decisions at meetings such as Executive Directors, Board and the Clinical Services Executive Committee are being circulated weekly to all staff in the organisation. 5. Workforce productivity Programme Office / Finance & Performance Page 3 of 11

4 The workforce performance information presented to Board is currently being reviewed and a new format implemented. The Trust s Human Resources Strategy is being developed and workforce plans are being aligned to the Trust s service based workforce plans. 6. Information technology R0 implementation is delayed pending resolution of a number of outstanding issues and the Trust is working closely with Fujitsu, Connecting for Health and operational staff to ensure safe implementation. Announcement of the go-live date will be communicated to the organisation on resolution of these and will give a 4 week notification period. 8. Procurement The procurement department is currently focussed on working with wards and departments to improve materials management in operational areas of the Trust. 9. Income generation This has been addressed specifically through the Clinical Coding project, which has proactively engaged clinicians in capturing activity across the organisation. A number of other income generating schemes have been and are being explored. 10. Estates rationalisation An outline planning application to develop the top end of the main NDDH site remains in discussion with the planners. Design will be progressing early 2008 for the development of new residential accommodation, with a view to vacating the existing accommodation in September The sale of the residences and surplus land is programmed for Prioritisation of plans to refurbish and redevelop elements of the existing NDDH and community sites, in line with the evolving service development strategy, is underway. This work will provide the basis for the Estate Strategy for the next 5 years. B. CONTINUOUS IMPROVEMENT PROJECTS Programme Office / Finance & Performance Page 4 of 11

5 Project number Project Status Workstreams / comments Target(s) Executive Lead Project Manager 1. PATIENT SAFETY & EXPERIENCE 31 Reducing Healthcare Acquired Infections Continue from 07/08 5 Medicines Management Continue from 07/08 Delivery of action plan (agreed with DH Nov 2007)) Additional actions from DH visit Antibiotic usage controls NPSA workstreams Clinisys e-prescribing Medical gases Savings target from 07/08 to be devolved to directorates 22 POCT Strategy New Agreement of POC strategy with stakeholders Implementation of POC team New workstream within existing Pathology Project Wider aspiration for community SS POCT from service strategy work not in Transfusions New To be defined Right patient, right blood to ED Haematology SLA with partner 38 Patient identification (documentation and record keeping) New organisations Patient ID 08/09 MRSA & C diff targets Andrew Kingsley NPSA targets e-prescribing system 100,000 directorates 79,000 CRES POCT in place Reduced incidents Bar coded name bands by (previously JG) Mike Roberts Paul Cooper John Bronze Kathleen Wedgewood Emma Spouse Continuation of documentation work commenced by LC-B Reduced incidents Standardised processes & documentation Senior Nurse Clinical Practice Programme Office / Finance & Performance Page 5 of 11

6 7 SS41 Child protection New Implementation of ContactPoint Network of provision 39 Community Hospital medical cover New Implementation of appropriate levels of medical cover 2. EFFECTIVE & EFFICIENT 8 Non-Pay procurement Radiology ( 11K) Alliance ( 83K) Facilities ( 54K) equipment hire ContactPoint implementation Established network Medical cover 83K Alliance? 20K department CRES Alison Diamond Iain Roy Janet Phipps Nikki Kennelly Tricia Hawson 17 Specialist staffing reviews Radiology ICU Community hospitals staffing 25 Nurse staffing New NHS Professionals (based on 07/08 agency spends) E-rostering (based on 0.75 wte reduction per ward) 3. LISTENING & RESPONDING TO NEEDS OF PATIENTS 40 No Waits New IT systems (Neil Schofield) Booking processes (Naomi Hooker) OP scheduling (Caroline Raby) Theatre scheduling (Heather Brazier) Redesign of pathways (with defined start & stop points) Pathway co-ordinator roles 4. DELIVER CARE IN THE MOST APPROPRIATE SETTING 11 Maternity Services Review Skill mix review & commissioning Day assessment unit Impact review (high / low risk) C-section rates CNST Improve breast feeding rates SS17 Midwifery led clinics in SureStart SS18 facilities SS20 Assurance that teams are fit for purpose 654, ,000 Stephanie Chambers 8 weeks RTT Sharon Gillbard DAU BC to support 35:1 midwifery staffing ratios Reduced C- section rates Julia Drury Programme Office / Finance & Performance Page 6 of 11

7 SS21 Midwifery on-call teams SW maternity network 16 Long term conditions Stroke Bideford BC &SS94 # Neck of Femur SS16 Development of care pathways for vulnerable groups 24 Impact Implementation of Jonah software Benefits realisation of implementation 5. INTEGRATED HEALTH & SOCIAL CARE 29 e-sap Implementation of e-sap SS119 Benefits realisation 32 R0 Fujitsu Cerner Millenium Implementation of Trustwide electronic patient record (NPfIT) Benefits realisation 41 Complex Care Teams New Development and SS118 (My Life, My Choice) implementation of complex care teams following appointment of cluster managers 6. HIGH QUALITY SERVICES 7 100,000 Nikki Kennelly Yvonne Langer May % bed occupancy June ,000 TBC Established complex care teams Paediatric Review Delivery of Children s Review action plan (largely reliant on build in 08/09) 17,000 SS35 Transitional care SS32 Paed surgery flying hours Links to Estates work in 8. SS31 Modern & Effective intrastructure Neonatal leadership 23 Radiology Radiology OOH working Benefits realisation of PACS 35,000 New Absence management Will support delivery of 42 Workforce development Various workforce projects in SS work: SS9,10,12,23,51,55,65,107,111, 131,146d,167,173,193,205,212,217 Job planning Leadership & management development ESR financial targets in project 25 Nikki Kennelly Andy Robinson Director of Health & Social Care Catherine Oliver Katherine Biggs Yvonne Langer Martin Scrace North Devon Cluster managers Janet Phipps Neil Schofield Catherine Oliver Mike Roberts Maureen Bignell ESR Manager Programme Office / Finance & Performance Page 7 of 11

8 7. STRATEGIC PARTNERSHIPS 43 Emergency planning & business continuity 8. MODERN & EFFECTIVE INFRASTRUCTURE 34 Outpatients SS215 GP1 Major incident plan in place Business continuity plans (by systems) New Estates programme Benefits realisation of move into new dept CAB / R0 implications (ongoing) Links to NO WAITS project Plans in place & tested Rowena Green New OP department at NDDH Op Manager - Caroline Raby 35 SS220 GP6 15 GP2 27 SS197 SS SS51 GP10 44 SS112 SS2 GP3 7 GP4 Day Surgery Estates programme Links to NO WAITS project BC for Day surgery unit Healthcare Records Sexual Health New facility at BHC Development of community facilities Pathology Emergency Hub incl. Chemotherapy Hub Chemo Paediatrics SS community estate in 09/10 New New New Estates programme Strategy Records scanning Benefits realisation of move into new department Estates programme (build) Benefits realisation of GUM & FP teams merger onto one site Managed networks (see 9. public health) Estates programme Development of operating policy Outline business case Pathology OOH working POCT implementation Estates programme Development of operating policy Outline business case A&E / MIU workstream DTU workstream Estates programme Development of operating policy Outline business case 33 Decontamination Estates programme BC for HCR department 49,000 Sexual Health service based at Barnstaple Health Centre BC for Pathology department 100,000 (pye) POCT in place BC for Emergency Hub & Chemo suite BC for reconfigured paediatric accommodation Janet Phipps Jac Kelly Mike Roberts Janet Phipps Op Manager - Heather Brazier Sharon Gillbard Kate Ogilvie Op Lead - John Bronze Op Lead - Rowena Green Programme Office / Finance & Performance Page 8 of 11

9 9. PUBLIC HEALTH 45 Public Health a. Working well b. Patient health promotion c. Public health information Various projects in service strategy: SS45,86,96,97,104,125,126,154, ,198,199,200,208 Development of BC for NDHT inclusion in Super Centre Management of change process for affected staff New To be defined Raise PH agenda locally Partnership working FBC to Trust Board Improvement indicators to be determined 27 Sexual Health New Managed networks OOH and A/L cover 10. ROBUST & SUSTAINABLE 36 FT Application New Progression of FT application supported by : FT application Integrated business Plan submission by Long term financial model June 2009 Governance arrangements (TBC) Communications plan and public consultation Organisation & Board development plan 46 Service Line Reporting New Development of service level costing models to support FT application Phlebotomy services 08/09 Key: GP = Estates Strategy programme of work IS = Informatics and information technology strategy programme of work SS = Service Strategy programme of work WS = Workforce Strategy programme of work Speciality & procedure specific costs Iain Roy Maureen Bignell Kate Maynard Brian Sherwin Andy Robinson Op Lead - Bob Lowe Janet Phipps Jac Kelly Andy Robinson Juliet Cross Katherine Smith Maureen Bignell Colin Dart Programme Office / Finance & Performance Page 9 of 11

10 Continuous Improvement Programme Report 2008/2009 The Committee received an end of year update and lessons learned from the 2007/08 programme in April List of all CIP projects to date Project No. Project Name Year Status Commenced 08/09 1 Bed Reconfiguration 06/07 Closed 2 Elective Care Redesign 06/07 Closed 3 Outpatients Skill Mix Review 06/07 Closed 4 Admin & Clerical Review 06/07 Closed 5 Medicines Management 07/08 Open 6 Estates Efficiency 06/07 Closed 7 Paediatric Services Review 06/07 Open 8 Non-Pay Procurement 06/07 Open 9 Clinical Coding 06/07 Closed Weeks RTT 07/08 Closed 11 Maternity Services Review 07/08 Open 12 Physical Therapies Review 07/08 Open 13 District Nursing Review 07/08 Closed 14 Learning & Development 07/08 Closed 15 Healthcare Records and A&C 07/08 Open 16 Long Term Conditions & Rehab 07/08 Open 17 Speciality Staffing Reviews 07/08 Open 18 Community Hospitals & MIUs 06/07 Closed 19 Productivity (job planning) 07/08 Closed 20 Emergency Care Redesign 07/08 Closed 21 Transport 07/08 Closed 22 Pathology 07/08 Open 23 Radiology 07/08 Open 24 Impact 07/08 Open 26 Payroll & ESR 07/08 Closed 25 Nurse Staffing (NHSP in 07/08) 07/08 Open 27 Sexual Health 07/08 Open 28 Contact Portal (telephones) 07/08 Closed 29 e-sap Implementation 07/08 Open 30 Occupational Health 07/08 Closed 31 Reducing HCAIs 07/08 Open 32 R0 Fujitsu Cerner Millenium 07/08 Open 33 Decontamination 07/08 Open 34 Outpatients 07/08 Open 35 Day Surgery 07/08 Open 36 FT Application 07/08 Open POCT strategy into Project 22 08/09 New 37 Transfusions 08/09 New 38 Patient ID, documents, records 08/09 New Child Protection into Project 7 08/09 New 39 Community Hospital Medical Cover 08/09 New 40 No Waits 08/09 New 41 Complex Care Teams 08/09 New 42 Workforce Development 08/09 New 43 Emergency Planning & Business Cont 08/09 New 44 Emergency Hub inc. Chemotherapy 08/09 New 45 Public Health 08/09 New 46 Service Line Reporting 08/09 New Programme Office / Finance & Performance Page 10 of 11

11 Continuous Improvement Programme Report 2008/2009 C. PROJECT MONITORING MEETINGS The Programme Manager and Deputy Director of Finance meet regularly with Project Managers and Finance Managers, on a project by project basis, to provide challenge, ensure benchmarking, close monitoring of progress and saving achievements. D. MONITORING OF CONTINUOUS IMPROVEMENT PROGRAMME Projects are mapped into Microsoft Project 2003 software / Excel to scope and track the service redesign and efficiency projects. Project managers have been reporting on a fortnightly basis against the tasks, milestones and completion dates detailed in these plans. Internal audit reviewed programme and project processes and documentation in July 2007, and more detailed project audits took place in January Project monitoring will be monthly in 2008/2009. A meeting is arranged with the Director of Finance on 23 May and a verbal update will be given. E. FINANCIAL SAVINGS The 2008/09 Budget was approved by in March The financial savings were presented and are attached as Appendix 1. Due to the financial year end work required in April, it was agreed that a formal finance report would not be presented to this meeting. The Director of Finance will present a verbal update on the pay position for April together with an update on the financial savings target. E. RECOMMENDATIONS To NOTE the Continuous Improvement Programme for 2008/09. Programme Office / Finance & Performance Page 11 of 11

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