Trust Strategy 2015/20

Transcription

1 Trust Strategy 2015/20

2 Contents Introduction 3 Executive summary 4 Why does the present mode of care need to change? 5 Our vision, mission and vaues 6 Strategic objectives 7 Cinica strategy - our journey to date 8 Our approach to quaity 31 Our approach quaity improvement 33 Our approach to eadership and organisationa deveopment 39 Our approach to workforce 41 Our approach to information technoogy 43 Performance for patients 45 Future organisationa form 48 Our approach to research, deveopment and innovation 49 The estate and our capita programme 51 Financia strategy 57

3 Introduction Trust Strategy 2015/20 Introduction The Trust s 2015/20 Strategy sets out our pans and ambition to enhance and continuay improve the quaity of care and outcomes we provide to our patients. The potentia future deveopment of the Trust as a major emergency centre for residents iving in Dorset and west Hampshire aigns with the wider strategic reconfiguration of hospita and out-of-hospita care being ed by the Dorset Cinica Commissioning Group. The proposed future mode of care for Dorset residents is one that we have heped co-create with partner organisations and has been cinicay ed. In ooking forward we have taken account of the foowing key factors which have infuenced and shaped our proposas: the need to provide safe, compassionate, high quaity care to a of our patients the growing edery popuation with changing heath needs who pace greater and new demands on our services the importance of strengthening out-ofhours provision and offering consutant deivered care 24 hours a day, seven days a week - Sir Bruce Keogh the evident benefits of providing rapid access to care minimising waits for assessment, investigation, diagnosis and treatment and the importance of providing more integrated provision across hospita, primary and community services the pivota roe our staff pay as heathcare professionas and eaders and the direct impact they can have on quaity improvement, patient experience and outcomes. This is why a critica part of this strategy focuses on our work to deveop our eadership capacity and capabiity and further strengthen our organisationa heath the continued nationa shortage of some staff in some speciaist areas which combined with the financia constraints provide a vita impetus to reconfigure and centraise some services the wider financia chaenges, with demand for heathcare presenty outpacing increases in oca and nationa heath and socia care funding necessitating the creation of new modes of care which ensures that services are of high quaity, financiay sustainabe and viabe the need to consider new modes of care and organisationa form which sustain the continued viabiity of key services and underpin the drive to create centres of exceence in both emergency and panned care - Five Year Forward View finay, changes in technoogy and the importance of supporting and faciitating both oca innovation and the wider adoption of best practice to inform, shape and guide the deivery of safe, high quaity care to our patients. page 3

4 Executive su mmary Trust Strategy 2015/20 Executive summary This strategy describes a range of bod and exciting pans to strengthen and improve the care and services we provide to the residents of Dorset, west Hampshire and surrounding areas. We have set out our pans to deveop the Roya Bournemouth Hospita as the main emergency centre for Dorset. Christchurch Hospita wi operate as an extended community hub offering a wide range of community, diagnostic, outpatient, ambuatory, nursing home and primary care services for oca peope. The reconfiguration of cinica services proposed by the Dorset Cinica Commissioning Group (CCG) provides an opportunity to introduce new modes of care which we wecome and support. Our strategy directy addresses the need to adapt and change services. It is anticipated that the Cinica Services Review wi be fuy impemented in 2018/19 and our focus for the next three years, therefore, remains on strengthening the provision of existing services, working cosey with partners and continuing to meet the needs of our patients and doing so within the framework of increasing financia constraint. We wi expand our work on quaity improvement and extend the use of this methodoogy to drive down unwarranted variations in care and embed best practice approaches to meeting the needs of our patients. We wi encourage greater patient invovement in the design of our services and want to use the feedback from both patients and our staff to inform our work. Our vision is to be the most improved hospita by 2017 and within this strategy we describe how we wi achieve this. Our strategy sets out the work we are engaged in and wi continue with to deveop and embed a mode of coective eadership. This has at its heart a focus on deveoping a cuture which promotes greater staff engagement and ensures that a staff are abe to contribute to continuay improving patient care. The workforce chaenges we, and other organisations face need to be addressed through the adaptation of existing roes; the introduction of new roes and more innovative ways to recruit staff. It remains criticay important that we continue to focus on how we retain and deveop our staff so that everyone is abe to give of their best. In conjunction with oca commissioners we have set out pans to improve waiting times for access to a services and describe how we pan to improve patient care and generate improved efficiency in how we deiver that care through better use of information technoogy and IT systems enabing us to integrate information with partners in primary and secondary care. Our Estates Strategy sets out pans for the deveopment of the Roya Bournemouth Hospita as an emergency centre. It aso describes the redeveopment of Christchurch Hospita. These pans need to be taken forward within a financia context that means we wi need to adopt and embed an approach that offers vaue for money and seeks to drive out waste in order to ensure the funds aotted are used to support the ongoing provision of front-ine services. As part of this work we wi consider our future organisationa form and whether different forms are necessary going forward in order to protect and enhance the services we provide to our patients. page 4

5 Why does the present mode of care need to change? Trust Strategy 2015/20 Why does the present mode of care need to change? The chaenges expained above provide an important context for why services need to change. We have seen a dramatic improvement in the care we provide over the ast 10 years. Life expectancy has increased by 4% and patients have better outcomes foowing cancer and cardiac treatment/ intervention. Waiting times are consideraby shorter and patient satisfaction is higher. Conversey demand for care and treatment is rising exponentiay. The numbers of patients presenting at our Emergency Department rose by 7% ast year and the number of patients requiring emergency admission rose by 10%. The Trust, for the first time in its history, posted an operating deficit in 2014 of 5.2m and has set a deficit pan for 2015/16 of 12.9m. We pan to arrest this trend and ensure services are put on a sustainabe financia footing. These trends need to be set within a wider context where the heath system for Dorset as a whoe projects a funding shortfa of over 200m by 2021, if existing patterns of provision are maintained. In summary our focus is: continuing to improve the quaity of our care, patient experience, safety, and outcomes through an unreenting focus on quaity improvement heping reduce preventabe harm and mortaity estabishing new modes of care which strengthen emergency and panned provision and enabe Consutants to provide care 24 hours a day, seven days a week ensuring sufficient we-trained staff to support the deivery of enhanced modes of care promoting wider integration of service to ensure patients have a better experience, across the interface of primary, secondary, community and socia care ensuring our services are financiay sustainabe and affordabe to oca commissioners. reaising opportunities for oca innovation, deegated decision making and cear autonomy at a cinica eve This a means that we wi continue to evove, improve and deveop how services are provided. We describe within this strategy what changes are proposed and how they wi hep strengthen the ongoing care we wi provide to our patients. It is anticipated that the strategic reconfiguration of service wi be impemented in 2018/19. In the ead up to this our focus wi continue to be on how we improve the quaity of our care and doing so within the confines of the resources made avaiabe to the NHS. page 5

6 Our vision, mission and vaues Trust Strategy 2015/20 Our vision, mission and vaues Our vision Our vision and aspiration is to be the most improved hospita in the UK by Our mission Providing the exceent care we woud expect for our own famiies Our vaues The behaviours, cuture and ethos which guides our work and interaction with both patients and coeagues is underpinned by the foowing core vaues, a of which have been shaped by our staff. Our mission was deveoped by our staff and this means: Putting patients at the heart of everything we do Working together to improve care Being responsive to patients individua needs Communicate - say it, hear it, do it Improve - change it Teamwork - share it Pride - show it These vaues provide an important back-coth and underpin the organisationa deveopment work described on pages 39 and 40. page 6

7 Strategic objectives Trust Strategy 2015/20 Strategic objectives The key strategic objectives we have set are: to continue to improve the quaity of care we provide to our patients ensuring that it is safe, compassionate and effective, driving down reductions in the variations of care, ensuring that it is informed by and adheres to best practice and nationa guideines. Our priorities incudes the provision of harm-free care, reducing avoidabe mortaity ensuring patients are cared for in the correct setting and that our patient satisfaction eves are within the upper quartie or better for the NHS to continue to drive improvements in patient experience, outcomes and care across the whoe Trust. We wi use our QI methodoogy to support this work to support and deveop our staff so that they are abe to reaise their potentia and give of their best within a cuture that encourages engagement, wecomes feedback, is open and transparent deveoping our services as the main emergency care hospita for Dorset and west Hampshire residents ensuring patients have rapid access to a of our services focusing on the provision of timey diagnosis and treatment with waiting times exceeding nationa standards ensuring our services remain financiay sustainabe, services are provided within budget and resources are used wisey, cutting waste and thus aowing the maximum funding to fow to front-ine patient care page 7

8 Cinica strategy our journey to date Trust Strategy 2015/20 Cinica strategy - our journey to date We provide high quaity district genera hospita and tertiary services to a catchment popuation which ranges between 370,000 and 1.2m. The foowing inpatient services are provided to the conurbation of Bournemouth, Christchurch, east Dorset, west Hampshire, and the New Forest: Genera Surgery Breast Surgery Coorecta Surgery Upper GI Surgery Genera Medicine Gastroenteroogy Diabetes and Endocrinoogy Cinica Haematoogy Rehabiitation Speciaist Paiative Medicine Stroke Respiratory Medicine Rheumatoogy Dermatoogy Midwifery Birthing Centre Gynaecoogy A broader range of Outpatient Speciaties is shown in Annex A Additionay the foowing services are provided not ony to this catchment popuation, but aso to residents of Pooe and the surrounding areas: Uroogy Orthopaedics Ophthamoogy Compex GI Surgery We provide the foowing services to a arger conurbation encompassing Dorset, parts of Witshire and west Hampshire: Vascuar Surgery Eective care provided to the popuation of east Dorset, west Hampshire and the New Forest. Emergency care provided to the whoe of Dorset, Saisbury and southern Witshire Compex Upper GI Surgery For exampe, oesophagectomy procedures provided to the whoe of Dorset and west Hampshire Uroogy Provided to east Dorset, west Hampshire and the New Forest with compex robotic surgery offered to the whoe of Dorset Interventiona Cardioogy and Eectrophysioogy Eective services provided to east Dorset, outof-hours emergency intervention provided to the whoe of Dorset, compex EP provided for the whoe of Dorset Interventiona Radioogy Eective care provided to the popuation of east Dorset, west Hampshire and the New Forest. Emergency care provided to the whoe of Dorset, Saisbury and Southern Witshire Our Accident and Emergency service treated 86,748 patients in 2014/15. Of these over 70,000 patients attended the main Emergency Department and more than 15,000 patients attended the Eye Casuaty. There remains cose interpay between the services provided at the Roya Bournemouth Hospita (RBH) and those offered at Pooe Hospita with some consutants working on both site, enabing oca residents to have ready access to a broad range of outpatient services at their oca hospita. As an exampe, patients attending RBH can see an ora surgeon, ear, nose and throat surgeon, and a consutant page 8

9 Cinica strategy our journey to date Trust Strategy 2015/20 neuroogist, a of whom deiver inpatient care in Pooe Hospita. Visiting consutants aso attend from Southampton University Hospita Trust ensuring additiona specific input into mutidiscipinary team meetings to advise on the care of patients undergoing compex procedures. An extensive range of Radioogy services are avaiabe at RBH incuding word eading technoogy in CT and MR; a broad range of Pathoogy services are offered encompassing Haematoogy and Bood Sciences, Bood Transfusion, Microbioogy, Histopathoogy, Immunoogy, Ceuar Pathoogy and Phebotomy. Biochemistry services are provided via Pooe Hospita. The Roya Bournemouth Hospita is aso the site for the Dorset Prosthetic Limb Centre. The number of patients treated by the Trust has risen by 30% over the ast seven years. In 2014/15 we treated: 32,999 patients as emergency admissions 10,806 patients were admitted for inpatient eective treatments 59,265 patients received eective treatment as a day patient 9,085 patients received care as a day attendee 112,858 patients had a new outpatient consutation 254,913 patients had a foow up consutation In addition, there were in excess of 750,000 radioogica and pathoogica tests provided to patients. The roe of Christchurch Hospita is changing. Five years ago there were over 200 inpatient beds occupied by patients requiring ong-stay edery care and rehabiitation. As new approaches to care have heped reduce the time patients spend in hospita, and community and rehabiitation services have been enhanced and strengthened, so Christchurch Hospita has taken on a new roe. There are no onger any inpatients beds other than those providing speciaist paiative care. The hospita currenty provides a broad range of outpatient services, day hospita services, rehabiitation, NHS dentistry, phebotomy, X-ray and speciaist paiative care services. page 9

10 Cinica strategy our journey to date Trust Strategy 2015/20 Cinica Services Review The Cinica Service Review ed by Dorset CCG and invoving over 300 oca cinicians as we as members of the pubic has identified new modes of in-hospita and out-of-hospita care which the CCG wi consut on in eary The new modes of in-hospita provision centre on: the deveopment of a major panned care hospita with an urgent care centre the creation of a major emergency hospita a panned care and emergency hospita ocated in west Dorset A broad outine of each of the three modes is shown beow. The concentration of emergency services for east Dorset at a singe ocation Monday-Friday in hours, and for the whoe of Dorset out-of-hours, addresses directy the need to strengthen these services through the provision of consutant-deivered care, 24 hours a day seven days a week. It aso responds directy to Sir Bruce Keogh s review: Transforming Urgent and Emergency Services in Engand, pubished in Out-of-hospita care. A major reconfiguration of out-of-hospita care is aso proposed with the deveopment of two arge hubs in the east of Dorset, one at the major panned care hospita site and the other at a community hospita ocation. Given the deveopment underway at Christchurch Hospita and the arge geographic popuation it serves, it is ideay paced to deveop as one of the arger hubs offering a range of primary care, outpatient and community services. Within the west, five to seven oca hubs are to be deveoped, based around existing community hospitas with one such hub potentiay ocated on the acute site in west Dorset. The smaer hubs wi serve a popuation of 60,000 and the arger hub a catchment popuation of 125,000. A oca hub wi typicay provide primary care services to a catchment popuation of 30,000 and the arger hub these services to 40,000 peope. page 10

11 Cinica strategy our journey to date Trust Strategy 2015/20 page 11

12 Cinica strategy our journey to date Trust Strategy 2015/20 The proposas in outine are shown beow. page 12

13 Cinica strategy our journey to date Trust Strategy 2015/20 The future roe of the Roya Bournemouth and Christchurch hospitas The benefits for patients These changes wi enabe ongoing improvements in the services we and the wider heath community offer. Broady the benefits for patients incude: better outcomes for patients by reducing morbidity and the number of preventabe deaths enhancing the patient experience whie in hospita and subsequenty when receiving community and/or socia care improving access to services by offering both primary and secondary care services 24 hours a day, seven days a week reducing the number of patients that need to be admitted to hospita for their care, with greater emphasis on education and sef care increasing the focus on prevention bringing skis and expertise together to create centres of exceence for both panned and eective care improving opportunities for innovation and enhancing research and deveopment contributions cosing the projected financia gap of over 200m for the heath community and ensuring oca Trust services are financiay sustainabe The Cinica Services Review signas two possibe future roes for the Roya Bournemouth Hospita (RBH) as we move towards impementation of its key recommendations. We wi either deveop as a panned care site in which case there wi be a significant contraction in faciities and services at RBH or we wi deveop as the main emergency centre for Dorset and west Hampshire residents. In considering these options from a patient perspective, we beieve that the interests of the residents of Dorset and west Hampshire are best served through RBH deveoping as the main emergency hospita. The reasons for this are mutifod. The importance of concentrating vita emergency and non-eective services cose to the argest popuation centres. The Bournemouth and Christchurch ocaities comprise 237,600 residents. In contrast the Pooe ocaity comprises 149,010 residents. This is underscored by the fact that the hospita presenty serves the highest concentration of residents (Christchurch, New Miton and Highciffe) aged over 85 in Engand. Christchurch, for exampe, has 31% of residents aged over 65; this compares with 21.6% in Pooe. Detaied time trave anaysis shows that access to care for the majority of the popuation is best served by the ocation of district genera hospita emergency services at RBH. Criticay, those patients that require out-of-hours emergency care transferred from west Dorset are readiy abe to access RBH within 60 minutes. Indeed, the most acutey unwe patients treated within Dorset aready receive emergency care for acute conditions (heart attack and emergency aneurysm) at RBH. The estabished track record of providing high quaity emergency care; for exampe the mortaity rates and cardiac outcomes are aready among the best in the country. page 13

14 Cinica strategy our journey to date Trust Strategy 2015/20 Bournemouth, as a ocation, is important in maintaining wider network services with heath systems outside of Dorset. As an exampe the Vascuar Network with an emergency hub based at RBH works effectivey because of its ocation and a shift in ocation is ikey to resut in break-up of the service. Vaue to the taxpayer is important. It is ceary evident that deveoping RBH as the emergency centre wi be the most cost-effective option for the Dorset heath system both in terms of ongoing revenue costs and the capita spend required to estabish up to 1,100 beds necessary to support the deveopment of the emergency centre. How quicky the proposed changes can be impemented wi be critica to securing important benefits for patients. The modern design of the RBH site aows for rapid expansion ensuring that the new faciities can be put in pace quicky. In tandem with this, the Trust is working cosey with Bournemouth Borough Counci and Dorset County Counci to support further improvements to the road network that wi open up new direct inks between the hospita and the A338 and a further expansion of the A338. Criticay the deveopment of RBH as the main emergency centre wi aow Pooe Hospita to deveop both as a speciaist centre continuing to provide radiotherapy and as a panned care centre. What changes are panned to support the deveopment of RBH as a major emergency centre? The redeveopment of RBH as the main emergency site for Dorset wi necessitate the reocation of the foowing inpatient services to the Roya Bournemouth site: obstetrics and neonatoogy to be reocated from Pooe (3) inpatient paediatrics reocated from Pooe (4) trauma services oncoogy a sma range of cancer, major head and neck and ora/maxio-facia surgery (3) It is anticipated that up to 300 high-risk women from west Dorset wi give birth in the Obstetric Unit on the main emergency site. (4) Out-of-hours emergency admissions for the whoe of Dorset wi occur at this site. In addition a range of existing services based on the RBH site wi need to be expanded to serve the whoe of the east Dorset popuation and, where shown, the whoe of Dorset and west Hampshire, out-of-hours. These are: Accident and Emergency Department services with a substantia enhancement of the existing service to offer 24/7 consutantdeivered care emergency admission for medica and edery care patients incuding stroke emergency surgica patients incuding out-of-hours with provision to serve the whoe of Dorset compex ow voume eective surgery inpatient haematoogy critica care Whie the focus of the main emergency site is orientated towards provision of emergency and non-eective care there are a range of eective services that wi need to be co-ocated with these services. These incude: a inpatient uroogy a inpatient vascuar surgery a eective Cardioogy procedures compex eective genera surgery and gynaecoogy The reason for this is it is not ogisticay practica to spit these services and offer them on the main panned care site. page 14

15 Cinica strategy our journey to date Trust Strategy 2015/20 In order to provide reasonabe access to patients in west Hampshire, Christchurch and Bournemouth, it is further proposed that services such as day-case haematoogy, oncoogy, paediatric ophthamoogy, and a sma range of other day-case surgery is maintained on the main emergency site. Simiary it wi be important to provide a range of one-stop outpatient services on this site compementary to the broader range of emergency care. A substantia radioogy presence wi be critica and as a minimum a hot ab. Work is currenty underway with Pooe Hospita and Saisbury Hospita to consider further options for the provision of pathoogy services. This work wi concude in eary Under this scenario the foowing inpatient and day-case services woud be reocated from RBH to Pooe Hospita: Eective Orthopaedics Eective Ophthamoogy Eective Genera Surgery Day-case Uroogy Day-case Vascuar Surgery Diagnostic Endoscopy (some endoscopy provision wi be retained on the emergency site which wi offer an emergency beeding rota 24 hours a day, seven days a week) Rheumatoogy and Dermatoogy day-case provision Dorset Prosthetic Limb service wi aso reocate to Pooe Hospita Interventiona Radioogy Eective and Emergency PCI Eectrophysioogy and Compex Pacing The Midwife run Deivery Unit Compex Gastroenteroogy 90% of medica emergency admissions and genera medica edery care patients Inpatient Haematoogy Acute Stroke services Critica Care In tota, more than 40,000 patients requiring emergency and compex eective intervention/ treatment woud need to be transferred to receive their care at Pooe Hospita. What services woud be offered at RBH as a panned care site? High-voume ow compex surgery incuding day-case surgery, eective orthopaedics, ophthamoogy and 10% of the acute medica take which wi be managed on an ambuatory basis wi remain on the RBH site. A new urgent care centre wi be created, run by GPs offering 24/7 urgent care services. High-voume, ow compex genera surgery, ENT, and gynaecoogy wi be transferred from Pooe Hospita. It is anticipated that rheumatoogy and dermatoogy services wi be centred on the panned care site. It is anticipated that these changes, subject to consutation, wi be impemented from 2018/19 onwards. RBH as a panned care site Shoud Dorset CCG, NHS Engand and West Hampshire CCG determine that it wishes to see RBH deveop as the panned care site, this wi create a very different roe for the Trust going forward. The foowing services woud be reocated from RBH to Pooe Hospita: Accident and Emergency services Major and emergency Genera Surgery Eective inpatient and non-eective Uroogy Inpatient and emergency Vascuar Surgery page 15

16 Cinica strategy our journey to date Trust Strategy 2015/20 Additionay, the Trust anticipates the reocation of some inpatient community hospita beds to hep deveop a fraity unit, step-up and step-down faciities and ongoing rehabiitation. This bed base is ikey to be between 60 and 80 beds in size with additiona outpatient faciities. Under this scenario we woud anticipate shrinking the tota bed base by, in the order of, 450 beds. It is aso envisaged that the panned care site wi be used to deveop out-of-hours primary care services and, under this scenario, discussions wi take pace with oca GPs about the potentia to deveop a primary and acute care system (PACS) approach. Future roe of Christchurch Hospita There is an ongoing cose correation between the future roe of RBH and that of Christchurch Hospita, shoud RBH deveop as the main emergency site. Through deveopment of a joint venture with Quantum, construction work is underway to redeveop Christchurch Hospita as a community hub providing an extended range of services to the popuation of Christchurch, Highciffe, New Miton and the wider conurbation. New faciities and services incude the deveopment of a 60-bed nursing home faciity, the construction of 78 units of assisted iving accommodation, the provision of a oca pharmacy, and the estabishment of a GP surgery on site with purpose buit faciities. The Trust aso proposes in 2017/18 to repace the existing Speciaist Paiative Care Unit with a new expanded faciity supported by McMian Caring Locay. A new Day Hospita and outpatient faciities are aso being deveoped. The tota investment in Christchurch Hospita is over 30m and the work wi be competed in 2016/17. Shoud RBH deveop as a panned care site, it is anticipated that the range of outpatient and diagnostic services ocated at Christchurch Hospita wi reduce; with a focus on primary and community service provision. Future changes to existing cinica services provided by the Trust Here we summarise some of the panned and potentia changes to existing services, infuenced by changes in technoogy, demand and new ways of working. Whie some of these wi occur prior to the fu impementation of page 16

17 Cinica strategy our journey to date Trust Strategy 2015/20 the Cinica Services Review (CSR) proposas, others describe how services wi evove in the ead up to and impementation of the CSR. Medica Directorate The Medica Directorate encompasses the medica speciaties of gastroenteroogy, respiratory medicine, acute medicine, diabetes and endocrinoogy as we as the Emergency Department (ED). A recent focus of our work has been the strengthening of services at the front door of the hospita with an expansion in medica and nursing input to these areas. This has enabed and supported the deveopment of new pathways of care, more ambuatory provision, and new modes of assessment such as the Bournemouth Rapid Evauation and Treatment Hub (BREATHE). In turn this has ed to more patients being managed effectivey without recourse to admission and the reease of resources esewhere within the Trust to care for the most acutey i. The creation of an emergency hospita for Dorset offers the opportunity to deveop further speciaist medica care and treatment. Specificay we envisage the emergency site being deveoped to cohort high acuity medica speciaty patients in gastroenteroogy, respiratory medicine, diabetes and endocrinoogy in order to deiver speciaised 24/7 consutant-deivered services. This woud dovetai we with the deveopment of services for acutey unwe patients who require compex and emergency endoscopic and interventiona radioogy procedures aso necessitating the continuing presence of acute surgery on site. We aready offer the most speciaised services in Dorset for gastroenteroogy, diabetes and endocrinoogy and have estabished inks with other speciaised centres nationay. We anticipate this being deveoped further through an operationa network that woud aow us to deveop shared pathways across sites to optimise the use of coective resources across the county and reduce the variations in care. The concentration of expertise on one site naturay aows the rapid avaiabiity of speciaists to care for other patients within the hospita and is a mode which is now being deveoped within our gastroenteroogy service. Ambuatory care wi continue to be deveoped as the optima future mode for most patients, apart from the very acutey unwe, with speciaised input to the front door and page 17

18 Cinica strategy our journey to date Trust Strategy 2015/20 speciaist advice, rapid access to consutantdeivered care with high quaity patient care promoted through the use of ambuatory medicine. The expansion of acute medicine through combining existing teams across the two sites wi faciitate the estabishment of 24/7 cover by acute medicine for the medica take. This woud aow the expertise that acute medicine can deiver to offer patients the highest quaity, readiy accessibe, speciaised care on admission. Speciaty in-reach within 24/7 woud aow patients access to a speciaist expert opinion within the shortest of timeframes. In tandem with this we are aso seeking to improve further community working, especiay across the speciaties of respiratory medicine and diabetes, with a view to promoting further admission avoidance, care coser to home and more integrated care as we as 24/7 advice to primary care as we as inpatients. Fu impementation of the CSR proposas wi necessitate a significant expansion of the bed base for medicine within the main emergency hospita. It is anticipated that the existing RBH bed compement wi need to increase by approximatey 85%. The integration of speciaist teams wi be a critica feature of deveoping an outstanding speciaty based service for west Hampshire and Dorset residents offering some speciaist care across the whoe of Dorset whie serving the popuation of east Dorset and west Hampshire seven days a week. It is anticipated that approximatey 10% of the existing medica take wi continue to occur in the panned care centre with the principa focus being on the deivery of ambuatory care with the more acutey unwe patients being admitted to the main emergency site for east Dorset. The creation of an emergency hospita aows for a significant strengthening of the Emergency Department services across east Dorset. The aim is to provide consutantdeivered care 24 hours a day, seven days a week. This wi, however, require a further expansion in the consutant workforce. The department wi continue to provide network support to the urgent care centre to be run by primary care cinicians on the panned care site. It is anticipated that approximatey 30% of patients that currenty attend Emergency Departments wi sti be seen and treated appropriatey on the panned care site. A arger, more modern Emergency Department wi need to be deveoped to act as a hub for pre-hospita care with the emphasis on estabishing a framework for the trauma service to become the major trauma unit. This wi incude estabishing a paediatric emergency service as part of the main acute Emergency Department. Our focus wi aso be to deveop even stronger inks with primary care and other aied heath services to ensure patients are in the right pace for their care and the appropriate management of their condition. The deveopment of nurse practitioners caring for those patients with minor injuries as we as more major cases wi hep faciitate an efficient, rapid turn-around, nurse-ed minor injuries unit. This is intended to ensure that we maximise the use of resources for the criticay i and injured patients. It is envisaged that the estabishment of a new Accident and Emergency Unit wi occur during 2018/19. In the ead up to this time we wi continue to focus on providing high quaity care to our patients seven days a week. Cardioogy Our previous strategy paved the way for a significant expansion in the range of cardioogy service provided to RBH. Patient outcomes from a range of interventiona procedures incuding percutaneous coronary intervention are among the best in the UK with the unit continuing to improve a aspects of a comprehensive cardioogy service. We anticipate as a consequence of the impementation of the CSR, the rapid integration of cardioogy services particuary in the east of Dorset prior to the deveopment of a singe main emergency site. This wi mean the centraisation of invasive cardioogy on a singe site in the east, and is anticipated as eary as 2016/17. Within this context a number of important and exciting deveopments in cardioogica provision are proposed and described in greater detai beow. page 18

19 Cinica strategy our journey to date Trust Strategy 2015/20 PCI and PPCI Continued improvement in the primary PCI service incuding the deveopment of patient pathways in conjunction with South West Ambuance Service (SWAST) eading to a reduction in the time between the ca from the ambuance service that a patient is en route to the hospita and the insertion of a baoon to aow the opening up of arteries. The consoidation of the on-ca service for consutants providing PCI service across Dorset securing contributions from Saisbury and Dorset County hospitas in offering a county-wide out-of-hours PPCI service. A natura extension of the working day and the deveopment of seven day working eading to extended PCI provision resuting in more fexibe working and reduction in ength of stay particuary for non-eective patients. The improvement and consoidation of the cinica data systems supporting anaysis and provision of eective PCI services. Front door service for 7/7 We pan to improve access to cardioogy opinion and for ambuatory care options for cardioogica conditions. In conjunction with this, access wi aso be improved to outpatients tests, CTCA and stress imaging. To aid the rapid assessment and treatment of patients, cardiac nurse practitioners and speciaists nurses wi work in more generic roes within the Emergency Department and work is underway that wi ead to further integration of the Rapid Access Chest Pain Cinic with other front-door accident and emergency services providing a comprehensive seven day service. For those patients admitted to our wards, we wi continue our work to improve discharge panning and extend the use of nurses and pharmacists to aow muti-professiona criteria ed discharge pathways to be fuy estabished. Imaging In conjunction with oca commissioners, we pan to extend the existing imaging capacity for ECHO, trans-oesophagea ECHOs, CTCA and cardiac MRI. The panned integration of services between Bournemouth and Pooe wi hep extend the range of expertise avaiabe to support this. In addition, proposas are currenty being considered for the acquisition of a dspect stress nucear imaging faciity. The imaging service aso pans to achieve BSE reaccreditation status in 2016/17. page 19

20 Cinica strategy our journey to date Trust Strategy 2015/20 Heart faiure Recent appointments in heart faiure, incuding the expansion of consutant and speciaist nurse input, enabes the Trust to secure some vita improvements to the heart faiure service with better integration with community services incuding the provision of open access ECHO. Ongoing work to deveop an integrated service wi be a major feature of the Trust s work during the period Arrhythmia service We pan to estabish a 24/7 arrhythmia service. Recent consutant appointments aied to the proposed integration with the Pooe-based service and physioogists wi hep estabish this. However it wi need to be provided on a network based approach which wi ikey resut in a arge network being estabished with partners outside of Dorset. Other priorities within cardioogy incude further deveopment of the cinica and commercia research opportunities, creating a Dorset-wide information system to support cardioogy incuding access between primary and secondary care, further refining the number of catheter aboratories and the beds required to provide for emergency services, securing and supporting the deveopment of the cardioogy workforce incuding medica nursing and cardiac physioogy staff and reaising the opportunities for improved procurement to hep underpin the provision of services. Proposas are aso being considered to expand and deveop the suite of private patient services avaiabe, to compement NHS provision. This incudes the potentia to deveop in coaboration with an externa partner dedicated private patient faciities. Surgica services Our surgica services incorporate the deivery of eective and emergency care for subspeciaist areas of Upper Gastrointestina (Upper GI), Surgery, Coorecta Surgery, Vascuar Surgery, Uroogica Surgery, Breast and Endocrine Surgery and Gynaecoogica Surgery. The Upper GI/Coorecta Surgery services are responsibe for eective care and for the management of emergency surgica (acute) patients. Sir Bruce Keogh s report in 2013 reinforced the importance of emergency surgica care being deivered by appropriatey skied consutant medica staff 24/7. A consutant-deivered emergency care service has been provided at RBH since September Further consutant appointments within the next six months wi add resiience to this service and, importanty, wi aso enabe the eve of ambuatory emergency care to be enhanced above the current 20% threshod by ensuring rapid access to consutant opinion. We aso aim to reocate the Ambuatory Emergency Care adjacent to the Surgica Admissions Unit to improve the fow of patients within the hospita and as a consequence improve their page 20

21 Cinica strategy our journey to date Trust Strategy 2015/20 experience whie in hospita. The additiona appointments aso enabe improved efficiency of theatre utiisation with more fexibe scheduing and provide a greater opportunity to back-fi ists thus enabing the continuing reduction in the waiting time for eective surgica procedures. For vascuar surgery, RBH acts as the hub for emergency and more compex care working in conjunction with consutant coeagues from Saisbury and Dorset County hospitas which serves the whoe of Dorset, west Hampshire and the southern Saisbury popuation. Foowing the consoidation of emergency vascuar services in ine with the nationa strategy our next step is to focus on the further deveopment of major eective care within the hub operating as the centre for a major eective vascuar aneurysm repairs, working in cose coaboration with the vascuar services on the spoke sites which wi focus on outpatient and more ambuatory day care treatment. Foowing impementation of the CSR it is proposed to introduce new hybrid vascuar theatres. Additionay, we propose the deveopment a one-stop ambuatory therapeutic intervention for the management of varicose veins with the majority of venous endotherapy being provided on an outpatient basis. We aso propose to drive forward further vertica integration of venous ucer therapies with pathways now being deveoped for the management of these patients within the community and this service wi deveop during 2016/17. Our uroogy service serves the popuation of Pooe, Bournemouth, Christchurch and west Hampshire with the most compex surgery aso performed on site for patients who ive throughout Dorset. There has been considerabe technoogica advances within uroogica surgery and robotic-assisted prostatic surgery is now we embedded with concomitant reductions in morbidity and ength of stay. We need to further deveop our roe as the Uroogica Cancer Centre for Dorset by streamining pre-operative pathways, progressing the enhanced recovery programme and mapping capacity to demand. Further emphasis is being paced on the reduction of ength of stay for patients particuary those awaiting prosthetic surgery who wi benefit from the recent introduction of tempate biopsy cinics. The consutant workforce is being expanded to both reduce further waiting time for eective procedures, and aso ensure that a comprehensive and robust 24/7 consutant-deivered uroogica emergency service can be provided for patients. We wi simiary expand our private patient provision offering patients a choice; income generated wi go towards underpinning the continued provision of NHS services. The deveopment of women s heath services at RBH wi be aided through the transfer of services to the new Jigsaw Buiding which wi be open from September These new faciities wi aid panned changes in the deivery of both breast and gynaecoogy services. In particuar, faciities wi aow the fu estabishment of one-stop diagnostic breast cinics providing cinica and radioogica assessment during one visit. The Breast Team wi aso be expanded. A breast physician is to be appointed to ensure that we provide women with timey access to diagnosis and treatment. These changes wi provide a greater resiience both to the breast service and to the meanoma service. Within gynaecoogy it is simiary panned to estabish more one-stop cinics with cinica and diagnostic services being provided at the same visit. There wi be a further migration of some existing day case procedures to outpatients procedures particuary in areas of interventiona coposcopy and hysteroscopy. There wi be a continued fusion of services between Pooe Hospita and RBH with emphasis on 24/7 consutant-deivered care within the Eary Pregnancy Unit at the vanguard of providing cinics at the weekends. An equay important strand of our work is the focus on retention and recruitment of surgica nursing staff and the deveopment of we ed medica, nursing and business management to the directorate. Fu impementation of the CSR proposas wi hep further consoidate the provision of outof-hours acute surgica care across the whoe of Dorset. Cose working and coaboration aready exists with surgica coeagues in Pooe and west Dorset with regard to Upper GI surgery and the deveopment of a singe page 21

22 Cinica strategy our journey to date Trust Strategy 2015/20 site for emergency genera surgery wi enabe sub-speciaist consutant care to be provided 24 hours a day, seven days a week. Orthopaedics The need to deveop further the orthopaedic revision knee and hip arthropasty service in ieu of the needs within the community, buiding on recent additiona appointments. The strengthening of discharge arrangements and coser working with both socia care and the oder peope s service to enabe appropriate review of patients whie in hospita. An unreenting focus on quaity improvement, management of pathways, sub-speciaty working and outcome measures. This work wi be combined with a further focus on theatre efficiency and continued improvements in productivity. Ongoing improvements in communication with patients, other hospita teams, GPs, incuding a strengthening of the consent process. Our eective orthopaedic service is the fifth argest in Engand. It has an exceent reputation for providing high quaity care and offers a comprehensive range of eective orthopaedic interventions. The consutant medica staff who provide this service are aso responsibe for the trauma service at Pooe Hospita. Eective orthopaedic services post impementation of the CSR wi be ocated on the panned care site. The key priorities outined beow therefore focus on the continued provision of orthopaedic services at RBH unti impementation of CSR. Further strengthening of the interface between the orthopaedic service and primary care through the deveopment of sub-speciaty groups to hep advise GPs, strengthen communication and deveop improved referra patterns. This work incudes the orthopaedic management service. The importance of considering how orthopaedic capacity is ring-fenced within the hospita and the further use of the Derwent as a dedicated faciity for orthopaedic care. Finay, there is a need to review and improve the outpatient accommodation avaiabe to orthopaedic patients recognising the high voumes of patients being seen in the department. Ophthamoogy We offer an exceent, comprehensive ophthamic service provided by a dedicated team of highy skied professionas operating from purpose-buit faciities. The chaenges the ophthamic service face incude: increasing demand due to the rising edery popuation and higher birth rates the high voume of patients with ong term conditions associated with od age particuary gaucoma and macuar degeneration (AMD) page 22

23 Cinica strategy our journey to date Trust Strategy 2015/20 medica workforce chaenges which wi necessitate different approaches to providing the workforce going forwards the acceerated introduction of compex and/or expensive new drug treatments eg amear keratopasty, gaucoma surgery and injectabe drugs for AMD In response to these and other chaenges we have identified some important actions necessary to underpin the continued provision of high-quaity ophthamic service: i Innovate: we want to find new ways to deiver care through virtua cinics, IT soutions, optometry and nurse-ed shared care. Care provided by consutant-ed mutidiscipinary teams. Continuing to be at the forefront of new technoogy and treatments, for exampe new drugs for dry AMD, new scanning techniques, new aser technoogy supported by our generous charity The Friends of the Eye Unit. ii Integrate: we want greater integration (not competition) with primary care providers by eading training and governance of GPs and optometrists, to provide increased ow compexity ophthamoogy care in the community. iii Educate: continuing to exce in the provision of training to Wessex junior doctors, expanding the roe of advanced nurse practitioners in nurse-ed injection cinics, ocuopastics and emergency care. Surgica skis courses with our state-of-theart simuator. iv Coaboration: increasing our support and roe in cross-speciaty research, for exampe haematoogy/oncoogy trias; providing community optometrists with support for prescriber s certification; joint paediatric consutant appointment with Dorchester; providing out-of-hours emergency care Dorset wide. preventabe sight oss and we pan to be abe to respond to these chaenges in conjunction with oca commissioners and this wi require a further increase in the medica workforce as we as the deveopment of new roes. Finay, we pan to extend the number of sites at which patients can receive ophthamoogy treatment offering surgery at the emergency and panned care sites, with outpatient provision at community hub ocations. Haematoogy Haematoogy can be categorised into cinica and aboratory provision. For cinica haematoogy the anticipated outcome of the Dorset CSR is the deveopment of a singe east Dorset inpatient haematoogy unit and autoogous transpant unit. This wi resut in a the estabishment of a new joint faciity with Pooe and Bournemouth medica and nursing teams amagamating to provide this singe east Dorset service. There wi be a singe junior doctor and consutant on ca haematoogy service deveoped as a resut reinforcing a consistent approach to patient care and management. In addition we wi need to ensure the arger joint transpant unit gains JACIE accreditation. We aso wish to consider ambuatory care for autoogous transpant patients. At RBH the new Jigsaw haematoogy/oncoogy day unit opens in September This wi aow expansion of speciaist haematoogy cinics and increased cinica tria work. The newy refurbished Aseptic Pharmacy Unit wi aso enabe increased cinica tria work in haematoogy. We are aso panning to expand The potentia for treatment of dry AMD within the next five years wi be the greatest ogistica chaenge and wi dwarf the introduction of treatment for wet AMD in 2007, which has seen outpatient numbers in the macua service rise exponentiay. Cataract surgery demand wi continue to rise putting constant pressure on the RTT target. Patient expectation wi righty increase in this era of page 23

24 Cinica strategy our journey to date Trust Strategy 2015/20 the homecare deivery of drugs programme and initiate a haemato-oncoogy drugs review programme to make cost savings and ensure patients continue to get the best possibe and current anti-cancer medications. These changes wi occur during 2016/17. Increasing homecare and community chemotherapy provision are aso a priority within our five year strategy as piot studies have shown these to be very popuar with patients and reduce the need to attend hospita and therefore the risks of infection. Patient driven outpatient foow up for some haematoogica conditions (e.g. ymphoma) are being pioted around the region and this is aso something we pan to deveop to obviate the need for unnecessary journeys to hospita and improve patients quaity of ife/ survivorship. In addition we wi commence a piot outreach transpant cinic at Dorset County Hospita in 2015 to simiary reduce unnecessary trave for our transpant patients and improve the quaity of their ife. In the next five years the Haematoogy Department wi have embraced pathoogy integration. This is an exciting opportunity to gain efficiencies through coaborative work for an innovative and stream ined service. It wi chaenge the way pathoogy is currenty deivered but wi modernise the service and provide for greater efficiencies. We anticipate the proposed joint venture with Pooe and Saisbury hospitas to be fuy operationa within three years. Within this project, the Speciaist Integrated Haematoogy Maignancy Diagnostic Service (SIHMDS) wi deiver fuy integrated reports for the diagnosis of a haematoogy cancers incuding ymphoma. The SIHMDS wi incorporate state-of-theart moecuar diagnostics both in house and with coaboration with the nationa genomic centres. In addition, it wi continue to have a research arm and comprehensive quaity programme. Pathoogy service The provision of pathoogy services wi as signaed earier change radicay over the next five years. Increased technoogy through the introduction of resut requesting and reporting, near patient testing and the fundamenta redesign of the pathoogy service are a important priorities. Hospitas require responsive hot aboratories, other testing can be provided on a more remote basis. The joint venture work with partner organisations underway now wi enabe an integrated service to be provided by 2017/18. End of ife care We provide an outstanding speciaist paiative care service. Our pans incude the repacement of the current Speciaist Paiative Care Unit with a new enarged faciity taken forward jointy with Macmian Caring Locay. The new speciaist faciity wi be ocated at Christchurch Hospita and is schedued to be deveoped in 2017/18. page 24

25 Cinica strategy our journey to date Trust Strategy 2015/20 Our pans incude further work with partner organisations to fuy integrate the hospita and out-of-hospita paiative care services. Presenty too many patients experience imited or itte choice as to where they spend their fina weeks and days. More patients want to spend their fina days at home with their famiy or in a supported externa setting, away from the hospita. Working with Dorset Heathcare Foundation Trust and Dorset CCG we want to secure an expansion in the range of support avaiabe to aow patients this choice. Midwifery services continue to have a choice as to whether they birth at home, in a midwife unit, or in an obstetric unit. Oder peope s medicine The midwifery birthing service has recenty been reocated to new purpose-buit faciities in a secuded part of the RBH site. This transfer has proved immensey popuar with both women attending the deivery unit, their spouses, staff and midwives working in the unit. Increasingy midwifery services need to be considered and managed as a singe integrated entity across east Dorset. Despite providing no obstetric care, we are responsibe for over haf of a antenata and postnata care provided to women across the east Dorset conurbation. Locay, consutants empoyed by RBH provide vita input to the Obstetric Unit at Pooe Hospita and it is panned that this continues. More emphasis is aso now being paced on supporting more women to give birth at home. Fu impementation of the CSR proposas wi see midwifery birthing faciities being co-ocated within east Dorset with the main obstetric service thereby minimising transfer times shoud women who choose to birth in the midwife deivery unit need to be transferred for obstetric intervention. A women wi, however, Our oder peope s services have changed radicay over the ast two years with the focus on deveoping a centre of exceence for the care and management of oder peope with a mutipicity of heath needs. The aspiration of the team is to provide an inspirationa pace to work, to deveop and deiver a first cass nationay and ocay respected service through expertise in treatment, care and rehabiitation, coaborative working, demonstrating compassion in working together with patients, famiies, carers and community services. Our ambitions To further expand our medica workforce and deveop enhanced nurse and therapist roes to support the strengthening of the muti-professiona approach to the care of oder peope. To sustainaby deiver a high quaity best practice stroke service at Sentine Stroke Nationa Audit Programme eve with a SSNAP domains at eve B or better. Short term this incudes fu impementation during 2015 of the stroke out-reach service to ensure a stroke patients have the necessary best practice assessments and treatments in the required time scaes incuding CT scan, water swaow, screen, thromboysis, and ensure the eariest possibe transfer to the Stroke Unit. Embedding the five daiy actions to improve patient fow within the hospita and ensure that patients are in the correct wards for their speciaist needs, care and page 25

26 Cinica strategy our journey to date Trust Strategy 2015/20 treatment. These five daiy actions are eary decisions on discharge; timey provision of discharge medication; senior review of patients to enabe discharge; the transfer to speciaty bedded wards from the Acute Medica Unit and a focus on appropriate ength of stay. To redesign our discharge service to ensure a fuy pro-active approach to panning not just the care, but the aftercare of patients and their discharge To continue our work with Socia Service coeagues, GPs, and Dorset Heathcare Foundation Trust to support the embedding of discharge to assess and enabe the redesign of the frai edery pathways. This work incudes fuy embedding the Discharge to Assess mode and the trusted assessor roe, coaborative working with oca GPs to deveop and impement hospita based ocaity iaison eads and coser working with Pooe Hospita to agree standardised pathways and modes of care for the frai edery. The input of patients and carers in constanty providing feedback about the care received is essentia. We want to deveop further our patient engagement work to ensure that patients are fuy invoved in the evauation, redesign and improvements that wi aid their care. We wi continue and extend our work with Bournemouth University to provide specific academic earning opportunities aigned to best practice and nationa guideines for oder peope s care; we are working to deveop further opportunities to promote research and to transate that into the care we provide on a daiy basis to our patients. reduce the reiance on nursing and care home provision. In tandem with Dorset CCG and oca authority partners we aim to expore and then impement greater provision of step-up and step-down faciities to minimise the time patients have to spend in hospita once their acute heath needs are met. Recruitment into oder peope s services continues to pose chaenges both ocay and nationay. Our work centres on the deveopment of new roes and the deveopment of reevant competency frameworks to support and incentivise more nurses working in the edery care environment. We aso wish to deveop coser inks with nursing homes and support the maintenance of patients in their homes by creating coser inks between primary and secondary care to support rapid intervention and minimise the need for patients to be brought into hospita. As the CSR gains traction so we woud wish to consider the expanded use of Christchurch Hospita as a hub for speciaist muscuoskeeta services. Oder peope s services wi continue to be provided on both the panned care and main emergency sites into the future. Speciaist services Our speciaist services encompass orthodontics, Dorset Prosthetics Centre, dermatoogy, rheumatoogy, Sexua Heath Department, environmenta contros and pharmacy. These services operate within a cinica directorate structure committed to One facet of the deveopment of oder peope s services is the roe that speciaist nurses and therapists pay in providing mutidiscipinary care. We pan to introduce new oder peope s nurse practitioner and nurse speciaist roes to ensure ongoing provision of high quaity robust and sustainabe seven day services. Further work is required with oca authorities to consider the deveopment of more support within the community to aid the rehabiitation of patients once they eave hospita and so page 26

27 Cinica strategy our journey to date Trust Strategy 2015/20 providing professiona exceence, integrity of iving, earning and practising with the highest ethica and cinica standards. Our primary focus for each of these cinica areas is the deveopment of new cinica pathways, and the impementation of NICE recommendations. The future of the sexua heath service wi be determined by the outcome of the tendering process currenty underway for sexua heath services run by Dorset County Counci. The Trust has combined with oca NHS and third sector partners to offer a range of new and different services compementing existing sexua heath services and await the outcome of the tender process in the Autumn of The new contract wi be operationa from January 2016 and if we are not successfu we wi need to work with oca commissioning partners to secure the continued provision of HIV services for the Dorset popuation. Tendering of services aso impacts on the Dorset Prosthetics Centre. The Steepers tender for the provision of prosthetic components is due for renewa in December 2016 and interna bid wi be produced to compete for this service. Within dermatoogy, cinica work is underway to engineer different pathways and roes with more of the dermatoogy service being provided in future through speciaist nurse roes and in partnership with oca GPs. Work is underway to deveop a cuture of open communications that fosters a sense of community with the federation of oca genera medica practices. This incudes deveoping new ways of integrating services in an outpatient setting in reation to dermatoogy and rheumatoogy with the aid of new technoogy, for exampe photographic patient triage. As CSR work deveops we anticipate transitioning to managed cinica networks which wi aow greater integration of services, hep reduce variation and approach, and further drive up standards. It aso has the potentia to create a ead provider mode for services across Dorset. It is anticipated that orthodontics, the Dorset Prosthetic Centre, dermatoogy, and if we retain the Department of Sexua Heath wi primariy be ocated within the panned care centre to operate on a hub and spoke basis. There is a continuing commitment to advance services through coser integration of education, research and coaboration. Strengthening innovation by increasing research portfoios through trias particuary in rheumatoogy and the Department of Sexua Heath is aso a key feature of our work in 2016/17 and 2017/18. The introduction of both eectronic prescribing and order communications wi have a profound impact on pharmacy services by streamining existing processes and aowing consoidation of pharmacy support within areas incuding the Fraity Unit where the pharmacists roe as an independent prescriber working cosey with mutidiscipinary teams has been critica to expediting the eary discharge of patients. Pharmacy services wi continue to evove and the outsourcing of outpatient prescribing and the deveopment of homecare provision wi be key features of the changing nature of the pharmacy service. Radioogy Our radioogy service is a centre of exceence and is centra to so much of the care we provide. This is refected in the recent significant expansion in radioogica investigation, intervention and scanning faciities. Deveopments in both cancer and cardiac care mean that radioogy is a critica service in providing diagnosis and treatment to these and many other patients. We currenty have some of the most advanced CT technoogy in the word. Some rationaisation of radioogica provision has aready taken pace; the vast majority of interventiona radioogy is undertaken ocay in Bournemouth where there is aso specific expertise for cardiac imaging. In contrast Pooe Hospita is the soe provider of nucear medicine and PET and provides the vast majority of the paediatric radioogica service. Shoud RBH deveop as the main emergency site for Dorset we wi need to ensure a fu paediatric radioogy service is avaiabe. One of the benefits of providing this service ocay is the ready and quick access to Southampton where paediatric surgery is required. Given the current extensive range of acute care provided at RBH, we are we paced to deveop our faciities as the main emergency hospita going forward. page 27

28 Cinica strategy our journey to date Trust Strategy 2015/20 Conversey, shoud RBH be identified as the panned care site there wi be a need to reocate a range of services to Pooe as the main emergency site and the corresponding shift of the Breast Screening Unit in expanded form to RBH. In this scenario, interventiona radioogy woud predominanty be provided at Pooe Hospita but with some eective services to be provided ocay. In the short term an additiona CT scanner wi be estabished within the Emergency Department to hep support the management of patients with conditions such as stroke, to ensure ready access to imaging, onward treatment and admission to the Stroke Unit. We are keen to work with primary care and community coeagues to hep advise on and input to the deveopment of new imaging faciities within the community. We envisage community hospitas and hubs performing X-rays and utrasound scans operating within a centra communication system in iaison with the Trust to ensure integrated provision of imaging services. With the deveopment of the panned care site we envisage the provision of direct access for CT and MR. More generay the imaging faciities in Dorset end themseves to the deveopment of a network or pan-dorset imaging service with joint picture archiving, order communications, unified pathways and governance structures. We are keen to work with partner organisations to secure this. This in turn woud enabe the accreditation of a sites compying with the Imaging Services Accreditation standard. An increased network wi aso aow us to use reporting resource effectivey to cover eave, sickness and deveop sub-speciaty expertise incuding joint working to secure appropriate out-of-hours support for the emergency site. There is a cear need to deveop an Interventiona Radioogy (IR) network to mirror the vascuar network now in pace. The estabishment of the network invoving organisations in Dorchester and Saisbury wi pave the way for an expansion of the working day. The aim is to achieve this in The roe of IR wi continue to expand in a number of ways: there is increased demand in CT for CT angiography, CT guided IR procedures e.g. (RFA) more biopsy/drainages performed by IR page 28

29 Cinica strategy our journey to date Trust Strategy 2015/20 increased demand for MSK intervention eg furo/ct guided pain bocks, vertebropasty hybrid CT for IR procedures - vascuar and uroogica interventions in a theatre environment, cryobation/tace treatments There is aso a need in the medium term to introduce the foowing: emergency IR avaiabiity at Pooe to incude postpartum haemorrhage, GI beeding, coonic stenting, trauma-reated beeding (a dependent to some extent on acute services review but improved cover wi be required at Pooe irrespective of any fina decision re geography) eective IR provision, particuary for cancer-reated procedures, eg insertion of ong-ines, paiative stenting, and peuroperitonea shunts neuro/stroke imaging - access to 3T scanner, on the site of acute stroke unit. Impications of cot retrieva in acute stroke = urgent CT cerebra angiography and transfer to University Hospitas of Southampton These deveopments need to be supported by oca commissioners. The diagram beow describes how services at both RBH and Pooe Hospita wi evove in impementing the CSR. RBH Green Paediatrics (equipment/faciities/reporting) Obstetrics (faciities/jigsaw aready buit) NeuroRadioogy - acute TIA/stroke IR (in pace - current BC for extended day) Cardiac MR/CT (in pace) ED capacity (in pace - shoud be!) Endoscopic US/ERCP (in pace) 24/7 CT (in pace) Pooe Purpe IR suite (x one - Oncoogy/emergency Obstetric) PET-CT (in pace) Radiotherapy panning (in pace) Paediatrics (in pace) Obstetrics (in pace) Breast Screening Unit (in pace) 24/7 CT (in pace) Pooe Green IR suites (two+ suites - emergency and oncoogy ) Cardiac MR/CT capacity/optimisation CT capacity - third CT (emergency and oncoogy) Endoscopic US/ERCP NeuroRadioogy - acute TIA/stroke Paeds (in pace) Obstetrics (in pace) 24/7 CT (in pace RBH Purpe Breast screening unit expansion IR eective (in pace) OP/eective scanning capacity (third CT) 24/7 CT (in pace) page 29

30 Cinica strategy our journey to date Trust Strategy 2015/20 Anaesthesia Directorate Our Anaesthesia Directorate is responsibe for anaesthesia, theatre services, critica care, pre-assessment, the management of a 36 hour stay ward, acute pain services and sterie suppy services. The short term goa is to provide a more suitabe theatre environment to cope with the increased capacity and ski set required to deiver a fu range of surgica services. This has, and wi require the ongoing recruitment of non-medica theatre staff (scrub and anaesthesia) and the training of these staff to meet our patient s needs. An ongoing programme of recruitment wi aso be supported to boster our medica workforce in responding to anticipated retirements and to ensure that the medica manpower is sufficient that we can continue to deiver services safey and maintain an important training roe for junior doctors. There is a pressing need to simpify our over-compicated theatre tempate; this wi entai moving to a standard four and eight hour theatre ist and these changes wi be co-ordinated with systems to improve the utiisation and efficiency of our operating theatre suites. It is panned that these changes wi be introduced in the eary part of The provision of consutant-deivered services seven days a week has ong been a feature of the operation of critica care services; simiary our emergency CPOD theatre aready runs on a 24 hour/seven day week basis. One of the chaenges we aim to address is how we best pan and organise our acute pain service in order to extend the hours it operates recognising that patients need these services seven days a week. Our sterie suppy service operates from purpose-buit factorybased faciities at Aderney Hospita. It has the capacity with further investment to provide services to other oca hospitas and this is one option currenty being considered aongside others incuding the reocation of the service to the RBH site. A decision on the future ocation of this service wi be made during 2016/17. Fu impementation of the CSR wi signa significant changes for the anaesthesia and critica care services in particuar. A arger critica care unit wi need to be deveoped on the emergency site and this wi be assisted through the integration of existing teams working at Pooe Hospita and RBH. Shoud the CCG decide to site the main emergency centre at RBH, investment wi need to take pace to expand our faciities for the management of paediatric surgica emergencies, and the current out-of-hours provision wi need to be strengthened to meet the increased acute work that wi fow to the emergency centre. RBH aso remains we paced to provide a fu range of eective surgica services shoud it be deveoped as the panned care site. page 30

31 Our approach to quaity Trust Strategy 2015/20 Our approach to quaity Our Quaity Strategy has as its guiding principes the need to ensure patients are safe, that their care is cinicay effective and their experience is the best it can be. The work to deiver this ambition is described in outine beow. Each of our primary areas of focus - safety, effectiveness and experience is underpinned by a detaied programme of activity described in further detai within our Quaity Strategy. The governance framework which supports our quaity work is overseen by the Trust s Quaity and Risk Committee and the Heathcare Assurance Committee which gain assurance through detaied reviewing of a series of ward, departmenta and patient experience metrics. We wi reentessy strive to ensure everyone can SEE quaity in everything we do. The Trust Quaity Strategy Quaity Strategy Strategic Aim To deiver exceent QUALITY heathcare Primary Drivers 1. To keep patients safe 2. To ensure patients receive cinicay effective heathcare 3. To provide the optimum experience for patients and their carers 1.1 Reduce Avoidabe Harm 2.1 To maintain effective cinica governance processes 3.1 To provide effective Board to Ward eadership 1.2 To provide an environment for continua earning 2.2 To impement cinicay effective heathcare 3.2 To deiver high quaity patient communication and to optimise first impressions Secondary Drivers 1.3 To ensure an open and honest cuture for patient safety 3.3 To optimise dignity in care 1.4 To embed quaity improvement methodoogy across the organisation 3.4 To optimise ethica and spiritua care 1.5 To support eadership for safety at a eves of the organisation 3.5 To ensure effective care of vunerabe peope page 31

32 Our approach to quaity Trust Strategy 2015/20 We have deveoped a Sign Up to Safety Pan to hep give effect to our strategy, and in so doing our work is focused on deivery five important pedges. Put safety first. Commit to reduce avoidabe harm in the NHS by haf and make pubic goas and pans deveoped ocay. Continuay earn. Make our organisation more resiient to risks, by acting on the feedback from patients and by constanty measuring and monitoring how safe our services are. Honesty. Be transparent with peope about their progress to tacke patient safety issues and support staff to be candid with patients and their famiies if something goes wrong. Coaborate. Take a eading roe in supporting oca coaborative earning, so that improvements are made across a of the oca services that patients use. Support. Hep peope understand why things go wrong and how to put them right. Give staff the time and support to improve and ceebrate the progress. Our pedges have been deivered through carefu evauation of quaitative and quantitative reference data, feedback from staff, patients and our governors. The work underpinning this is shown beow: Sign up to Safety Pan SIGN UP TO SAFETY DRIVER DIAGRAM To reduce avoidabe harm To provide an environment for continua earning To ensure an open and honest cuture for patient safety Embed Quaity improvement across the organisation To support eadership for patient safety across a eves of the organisation Reduce inpatient fas Reduce hospita acquired pressure ucers Improve the eary recognition and treatment of sepsis Embed safety checkist compiance across the Trust Impement Datix web to maximise reporting and earning Continue with Interna and Externa Peer review programme Embed e-mortaity reviews across a speciaities and further deveop shared earning processes Enhance Ward to Board Patient Safety Reports, Pubish Quaity Dashboards internay and externay Deveop and embed Trust Vision and Vaues (Pride, Teamwork, Communicate and Improve) working with staff and patients Deveop a standard approach and methodoogy for Quaity Improvement across the Trust Impement a Trust Quaity Improvement Training Programme Utiise QI for improvement in cinica pathways for Unschedued Care Impement eadership programme for a cinica staff Further deveop change eaders programme Promote our Thank You recognition initiative Support the interna PRIDE Awards initiative Ensure nursing risk assessments are competed accuratey and in a timey manner Embed new Care Group governance structures Enhance documentation and communication during transitions of care within the Trust and with externa agencies page 32

33 Our approach quaity improvement Trust Strategy 2015/20 Our approach to quaity improvement Our Quaity Improvement Programme has been deveoped to engender a cuture of continuous improvement and earning within the organisation - empowering staff and encouraging the deveopment of cinica eaders. I It is recognised that the future needs to ook and fee different and we are about to embark upon a significant period of cinica and organisationa change prompted through the Cinica Services Review. We therefore need a sustainabe programme of quaity improvement that drives up standards and maintains them. A programme approach wi be adopted, with a proven methodoogy, ed by the Executive Team and incuding cear senior cinica eadership and engagement. This wi provide grip and assurance ensuring our intentions are being deivered. We commenced our QI programme in May 2014 and this has deveoped rapidy to a centra programme of work to improve care, reduce variation, embed best practice and wi increasingy focus on the effective and efficient depoyment of resources heping shape our savings and reinvestment work to underpin services. We are doing this by: deivering transformationa change and quaity improvement projects that resut in a safer and more caring hospita for patients changing the way we do things so that quaity improvements are part of everything we do, every day creating an environment where a staff have a shared sense of ownership and responsibiity and fee enabed to make our hospitas among the best using the energy and enthusiasm of our staff and take the best ideas to improve quaity and safety for our patients ensuring as many as possibe are invoved in our improvement projects being in a position where our patients are rating our hospita as one of the best in the UK for safety, experience and effectiveness engaging and empowering staff to deiver and sustain the changes needed in their workpace deveoping the taent of our staff at every eve of the organisation providing our staff with the improvement and change expertise and skis enabing as many as possibe to be invoved in our improvement projects achieving a consistent message that improving quaity eiminates waste, reduces variation and improves efficiency page 33

34 Our approach quaity improvement Trust Strategy 2015/20 Outcomes: What wi success ook ike? 1 Better patient experience and feedback. Patients fee confident about our services. Patients fee more invoved and know what is happening to them. 2 Better working environment for staff. Staff are ess stressed and not under constant pressure. They are working within more ordered processes and protocos, with care based around interna professiona standards and evidence based best practice. Our staff fee centra to everything we are going - empowered, with the right skis and competencies to do their job effectivey. In addition, they are cear about their accountabiities and responsibiities and fee vaued for the contributions they are making to the organisation. 3 Performance and outcome metrics are improving. We are inquisitive and interested in what we can do better, achieving upper quartie performance and benchmarking we across a range of outcome measures. We are viewed as an acute hospita capabe of deivering significant improvements. 4 Deivering a cost effective and vaue for money service. We are deivering our 2015/16 and 2016/17 efficiency and productivity pan. We are investing our resources wisey and in the most effective way. 5 Our heath system is more integrated. We are seen as a catayst for change and activey supporting better partnership working across Dorset and with our oca partners. We have successfuy buit reationships and are moving together in a coaborative way. We adopted a standard improvement approach for quaity improvement based on the Institute for Heathcare Improvement (IHI) mode for improvement. This is shown beow RBCH Mode for Improvement FORM A TEAM SET AN AIM ESTABLISH MEASURES IDENTIFY CHANGES TEST CHANGES IMPLEMENT CHANGES SPREAD CHANGES IMPLEMENT CHANGES What are we trying to accompish? How wi we know that a change is an improvement? What changes can we make that wi resut in improvement? This methodoogy gives ski, empowers, and encourages staff to continuousy improve offering compassionate care at every eve and doing what is best for patients. A of our QI projects use appropriate quaity improvement methods, incuding ean toos. Underpinning our approach is a change mode (adapted from John P Kotter) to highight the importance of: increased urgency with a strong vision and case for change buiding the guiding team with the right peope, emotiona commitment and right mix of skis to inspire peope to move creating short term wins with aims that are easy to achieve and in bite-size chunks communicating for buy-in and empowering action by simpifying the message and removing obstaces to making the change happen and ensuring it sticks Act Study Pan Do We have introduced an academy for continuous quaity improvement to hep us identifying current change eaders, skis and expertise within the organisation. page 34

35 Our approach quaity improvement Trust Strategy 2015/20 The RBCH Improvement Academy is: providing short course programmes in QI toos and techniques removing the barriers and bocks that inhibit their efforts buiding on what is good and promote the message that improving quaity eiminates waste and improves efficiency heping staff test out new ideas for improving the quaity of heathcare growing from within and hep spread earning heping embed core vaues for RBCH We have run staff training modues in introduction to improvement and what is LEAN? Three of our doctors in training have received Wessex Quaity Improvement Feowships focusing on hospita fow (geriatrician support to surgica teams and best practice board and ward rounds) and fast track cancer referras. In addition, seven of our doctors are currenty participating in the Wessex SAS doctors Quaity Improvement Programme. In 2015/16 we are further deveoping our roing programme of QI mode for improvement earning and deveopment for staff, incuding junior doctors. This wi hep us spot high potentias and encourage mentoring and coaching to grow our own eadership capabiity. We are deivering rea benefits for patients via priority QI projects. These projects are cinicay ed and co-created with patients, focusing on achievement of nationa standards and where appropriate the deveopment of new modes of care. Each work stream has been acceerated with achievement of quick wins to signa the pace of change. Last year our key priority was unschedued care. We focused on the redesign of our front door to a) increase cinica expertise b) provide more comprehensive ambuatory emergency care and c) ensure a frai oder peope are reviewed by a geriatrician within hours of referra. We deivered the foowing benefits for patients: remova of AMU escaation beds a comprehensive ambuatory care service to increase access to same day emergency care and reduced admissions to traditiona hospita bed base dedicated nurses to take GP cas and coordinate fow introduction of reguar board rounds to more direct pu for oder peope and surgica ambuatory from ED increased medica cover at weekends and out of hours senior decision maker at front door with consutant avaiabe to take the ca from the GP and ED (in hours) strengthened consutant input to the hospita at weekends with consutant ward rounds for care of edery, AMU, gastroenteroogy, cardioogy, surgica wards now in pace 7/7 to reduce variation in week-end discharges strengthened physician input to patient care in the evenings by doubing the number of SPRs on duty unti 11pm, increasing consutant physician input unti 7pm and extending acute physician input into the Acute Medica Unit to 9pm appointment of GPs to work in AEC cinic (incuding weekends) to support winter resiience deveopment of a short-stay ward (supported by designated socia workers, discharge panning key workers and experienced therapists from the OPAL team) to faciitate discharges and ensure admission for up to five days ength of stay is maintained introduction of interface geriatricians. Front door service for edery care patients deveoped and supported by MFE consutant and the OPAL team, to ensure comprehensive geriatric assessment is received at the eariest opportunity and patients are treated on the correct edery care pathway, commensurate with their needs a cear focus on patient fow, embedding daiy whiteboard rounds in MFE, anticipated discharge dates and cear cinica criteria for discharge and admission into the right ward setting to deiver significant reductions in ength of stay page 35

36 Our approach quaity improvement Trust Strategy 2015/20 impementation of a transitiona care ward for oder peope for patients waiting for pacement, community hospita transfer for ongoing rehabiitation or patients waiting for intermediate care capacity Tabe 1 Tabe 1 demonstrates our efficiency and productivity gain as a resut of this quaity improvement project. In summary, 0.96 overa reduction in our non-eective ength of stay and associated reduction of 26,547 bed days. Medicine for the Edery non-eective average ength of stay reduced from 15 days (December 2013) to 12 days (December 2014). Tabe 2 Tabe 2 highights our improvements in discharging genera medicine non eective inpatients with a ength of stay of two midnights or ess (target 65%). page 36

37 Our approach quaity improvement Trust Strategy 2015/20 Tabe 3 Tabe 3 highights the percentage of patients with ambuatory care conditions seen in ambuatory care services. In 2013, our baseine was 12% against the nationa target of 25%. Our conversion rate to ambuatory care is now 35% (215 patients per week) excuding foow ups. We are panning a conversion rate of 45% as a stretch target for 2015/16 This year we have chosen to focus on a suite of five quaity improvement projects: Sepsis Aim: To deiver the sepsis six to a patients with severe sepsis and / or septic shock within one hour by December Hospita Fow Aim: To improve patient fow throughout the hospita by impementing interna professiona standards by March 2016, this incudes discharge panning and impementation of the five daiy actions: eary discharge focus on preparation of medications senior review by medica staff reducing ength of stay and ensuring eary access to our wards from the admissions area GI Cancer (two week waits) Aim: To estabish safe systems to deiver at east 93% compiance on two week waits for GI patients by March 2016, without detriment to other GI patients. Checkists Aim: To standardise and embed safe checkist practice and cuture across a areas undertaking interventiona and / or surgica procedures by September Safe Emergency Laparotomy Aim: To reduce mortaity rate from emergency aparotomy surgery from 11.4% to 9% by March During 2015/16 we are aso committed to the Wessex Patient Safety Coaborative (Breakthrough Series) with teams participating in two strands of work - sepsis and transfers of care. As we progress this work we wi continue our focus on reducing avoidabe mortaity and reducing variations in practice. The QI methodoogy wi be used to underpin improvements in processes to create both greater efficiency in how we care for patients as we as focus on improving the quaity of care - recognising the cose correation between the two. page 37

38 Our approach quaity improvement Trust Strategy 2015/20 The new priorities we have therefore set for the Trust focus on: Strengthening our substantive workforce, improving recruitment and retention and reducing our reiance on agency staff and the associated spend. Improving the responsiveness of our front door services to ensure as a minimum we reguary meet the 95% standard for patients to be treated within the Emergency Department or admitted Ensuring timey access for patients requiring inpatient cardioogy care, by reducing the current ength of stay and drawing patients through to the correct cardioogy wards from esewhere in the hospita Ensuring the timey discharge of patients from critica care eradicating deays in patients returning to speciaty-based wards Improving the fow and throughput of patients within theatre, to ensure optima efficiency Redesign of eective pathways to aid rapid access to panned care, incuding the provision of speciaist advice to primary care page 38

39 Our approach to eadership and organisationa deveopment Trust Strategy 2015/20 Our approach to eadership and organisationa deveopment The RBCH eadership chaenge is to become the most improved hospita in the UK by 2017 and we wi achieve this by being a we ed organisation that deivers safe, high quaity patient care that is cinicay and financiay sustainabe. There is compeing evidence that heath care organisations secure better outcomes for patients where there is a coective approach to eadership. Coective Leadership A staff take responsibiity for the success of the organisation in deivering continuay improving, high quaity and compassionate care Deveoping Coective Leadership for Heathcare, The King s Fund 2014 The evidence further affirms: eadership is the most important infuence on cuture staff engagement is one of the most important infuencers of patient outcomes and experiences of being cared for - patients receive better care when staff are engaged, motivated and we ed quaity improves when a staff are focused on continuay improving patient care and forever reducing harm cuture change wi not happen by accident, a strategic approach is critica to success In summary our aim is to estabish a coective vaues-based eadership approach where a staff take responsibiity for the success of the organisation in deivering continuay improving, high quaity and compassionate care. Coective, vaues-based eadership behaviours - A eaders: Promote engagement, participation and invovement as their core eadership approach Promote appropriate staff autonomy and accountabiity Ensure staff and patient voices are encouraged, heard and acted on Encourage staff to be responsiby proactive and innovative Avoid domination, command and contro except in crisis Dea effectivey with poor behaviour, performance and variation in standards Mode compassion in deaing with patients and staff Invest in peope management and eadership Encourage high eves of genuine team working and co-operation across boundaries page 39

40 Our approach to eadership and organisationa deveopment Trust Strategy 2015/20 Coective Leadership - a eadership mode for RBCH? Leadership of a, by a and together with a Leadership the responsibiity of a - anyone with expertise taking responsibiity when appropriate Interdependent, coaborative eadership - working together to ensure high quaity heath and socia care Leaders and teams working together across boundaries within and across organisations to ensure system success Leaders prioritise success of patient care across the organisation/system at east equay with their own area of operation Creating a coective, vaues based eadership cuture Deveoping a eadership strategy How wi we achieve this? We wi deveop an approach that wi estabish and embed coective eadership within the organisation to enabe us to deiver our strategy and secure the necessary cuture change. We wi: Deveop a ong term vision and strategy for cuture change Engage with our staff to define the cuture we want to create Design a sustainabe and strategic approach to changing cuture through our eadership mode of coective eadership Deveop our eaders to hep them create and sustain that new cuture ensuring they are skied, competent and confident to meet our eadership chaenge A sustainabe programme wi be in pace by December 2017 with a cuture of coective eadership and continua improvement embedded in the way we do things here. 0-6 months Discover (compete Apri 2016) 6-12 months Design (compete Sept 2016) What are the gaps between what we have and what we need to deiver? Mission, vision, vaues Needed vs existing capabiities - number of eaders, quaities, diversity, medica/cinica Review against CQC cuture measures A cear and unique Leadership Strategy to deiver priorities for the next three to five years to improve patient care, performance and finances Taent, organisation design, eadership cuture and deveopment months Taent management Deiver Leadership deveopment - programmes and interventions Organisation deveopment - cuture, teams, boundary spanning, coaboration page 40

41 Our approach to workforce Trust Strategy 2015/20 Our approach to workforce Here we set out our approach to: the current and future workforce chaenges the importance of maintaining organisationa resiience how we educate and deveop our staff The workforce chaenge We have a number of workforce chaenges. Some are across the wider NHS and encompass the suppy of appropriatey trained cinica, medica and support staff whie others impact more specificay on this organisation. Our work is principay focused on ensuring we have a highy motivated workforce with the right ski mix to deiver the care and treatment required. This necessitates deveoping new and different competencies as we adapt existing roes in response to anticipated shortages and rationaisation of suppy incuding the aocation of junior doctors to work in hospitas and the shortfa of professionas in areas such as histopathoogy, oder peope s medicine and accident and emergency services. The work wi be informed by a detaied workforce modeing. We wi underpin the deveopment of new and existing roes by a compementary focus on innovative recruitment, deveopment and retention, exercising our abiity to work coaborativey with heath care partners and higher educationa providers. Critica to our future success wi be the work we do to strengthen our approach to retaining and deveoping our existing staff. This is a key strand of work which wi be deveoped further in tandem with our approach to coective eadership. We propose to work cosey with oca heathcare providers in a co-ordinated approach incuding the recruitment of potentia staff from overseas and the deveopment and provision of careers and work experience opportunities for younger peope. We are currenty experiencing difficuties in recruiting to the foowing areas, a of which are nationa priorities for recruitment: emergency medicine oder peope s services and stroke theatre practitioners and ODPs histopathoogy page 41

42 Our approach to workforce Trust Strategy 2015/20 A range of approaches are being pursued to strengthen recruitment in these areas together with deveopment of extended roes and the deveopment of new roes incuding pharmacists abe to prescribe and physician assistants. We are aso working cosey with Heath Education Wessex and deveoping supporting programmes and piots such as the work aready undertaken on the piot of the heathcare support worker. A more comprehensive workforce strategy wi be deveoped in the autumn considering the potentia needs of the organisation within the context of the deveopment of a singe main emergency site for Dorset and the provision of the panned care site in east Dorset. Notwithstanding this, it is criticay important in terms of both recruiting and retaining staff that we maintain a strong reputation as a good empoyer and have the right organisationa cuture. Critica to this is the need for the heath and webeing of our staff to be appropriatey supported. Services that support this incude occupationa heath, effective peope management and good management practices. We train our managers to recognise work-reated stress and wi continue to activey support activities that hep staff deveop and sustain a heathy work/ ife baance. Enabers for this incude fexibe working arrangements, fostering an open and supportive work environment, working in partnership with Trade Unions and the ro out and deveopment of the new behavioura based appraisa framework. We work cosey and coaborativey with a range of education, training and deveopment partners incuding Heath Education Wessex, Bournemouth University and Bournemouth and Pooe Coege. We vaue the importance of education and training as a too to deveop our existing and future workforce and to support the deivery of high quaity care on a sustainabe basis. The work wi continue and be acceerated. To support these aims our new Bended Education and Training Department - BEAT - was estabished in September 2014 and provides support and deveopment to staff within the Trust. BEAT pay a crucia part in deveoping and retaining a high-quaity and motivated workforce, ensuring staff are fit and safe to practice, are as effective as possibe in their roes, and are up to date with the atest earning and best practice. Sustainabe and safe staffing and workforce productivity To support the overa Quaity Improvement Programme we are reviewing the arrangements for the use of temporary and agency staff. We need to reduce our reiance on agency staff, strengthening the quaity of our services and improving our use of pubic funds. A sustainabe approach to the use of bank and agency staff is being deveoped incuding the upgrading of the Trust e rostering soution provided through the Coud that providing a better system with enhanced connectivity and fexibiity. In addition we are reviewing the use of medica and other ocum/interim usage in the Trust and ensuring that appropriate checks and baances exist. Some other workstreams incude: ensuring a greater suppy of NHS nurses through the deveopment of the RAN programme (Return to Acute Nursing) and the nationa Return to Practice programme deveoping inks for the recruitment of overseas nurses to fi hard to recruit gaps sharing and deveoping internay best practice actions on staff retention and providing rotations and education opportunities and deveopment supporting efforts to provide our staff with more fexibe working incuding ooking at shift patterns and deveoping better career paths for staff reducing staff sickness rates and the resutant need for agency staff by improving the heath of our staff and providing effective support for the management of sickness absence page 42

43 Our approach to information technoogy Trust Strategy 2015/20 Our approach to Information Technoogy We have deveoped a joint strategy in concert with our partners at Pooe Hospita NHS Foundation Trust founded and deveoped on 27 projects to underpin: safe patient care greater efficiency in our processes improvements to the working ives of our staff by using modern informatics A centrepiece of this is the drive to achieve paperess patient journeys by the deveopment, procurement and impementation of inked cinica computer systems, presenting a appropriate cinica information and functionaity at the point of care seamessy integrating with primary care systems. Additionay, we are impementing digita channes to hep patients and carers fee more connected with the hospitas, take ess effort in their heathcare transactions, respond to their concerns and improve their contro of their persona care options. The agreed architecture to support this is based on a cinica porta with best of breed systems. The tabe beow summarises current and future intended progress: Progress and headines of next deiverabes Aready achieved Interim Eectronic Patient Record (EPR) jointy with Pooe Eectronic Nationa Eary Warning System E-Mortaity forms Singe Informatics Service deivering to PHFT via an SLA Singe Radioogy systems between Pooe and RBCH enabing seamess image sharing Eectronic Document Management: Depoyed to a speciaties Within the next two years Further embedding EDM Eectronic Nurse Assessments (from Nov 2014) Order Communications for Primary Care and Acute Eectronic Prescribing and Medicines Administration Eectronic etters emaied to patients Migrating to a modern EPR shared with PHFT to provide seamess access to a PHFT and RBCH cinica data Dorset Wide Heath and Socia Care Record page 43

44 Our approach to information technoogy Trust Strategy 2015/20 The benefits of this approach, which is fuy provided for within our capita programme, centres on our aim to: ensure information about the patient s current situation and reevant history is coected eectronicay at each point aong the journey and made avaiabe instanty 24/7 to a appropriate cinica professionas to maximise safety and cinica quaity deveop the potentia use of IT system inteigence in supporting and guiding cinica decisions according to best evidence, practice and safety expoit the opportunities to improve inks between organisations to enabe the vision of shared care between primary/secondary/ tertiary and socia care settings to be reaised engage patients, carers and current/ future commissioners of care by adding vaue through informatics innovations to make the trusts their first choice provider of acute care hep patients and carers make an informed choice about their care options by providing information about the scope, quaity and outcomes of our services enabe service improvements particuary to improve the Trust s efficiency achieve the commissioners intentions and patient quaity improvements described in the Commissioning for Quaity and Innovation (CQUIN) contract causes and supporting our approach to providing more and rapid access to speciaist advice for primary care page 44

45 Performance for patients Trust Strategy 2015/20 Performance for patients Urgent and emergency care access Among the most important considerations for our patients is the abiity to rapidy access care when it is required. Here we describe our work and commitment to improving access incuding: waiting times for our Emergency Department referra to treatment (RTT) times for outpatients, diagnostics and procedures cancer diagnosis and treatment times These are part of the NHS Constitution, our reguatory and contractua requirements and core quaity standard patients shoud expect. Each year sees significant growth in demand, as we as deveoping best practice. This chapter sets out our five year approach to meeting these chaenges in each of these three areas. Taking a whoe system approach incuding GP primary and community care, menta heath and socia care, is criticay important. The Better Together Programme for Dorset provides the framework for greater integration of socia and heath. The Cinica Service Review (CSR) sets out an out of hospita mode of expanded primary care hubs and integrated ocaities, better abe to manage edery and chronic conditions. Sir Bruce Keogh s Urgent Care Review findings, especiay the need for integrated urgent and emergency care in a ocaity, are centra to our strategy. This in particuar means we wi work over the next five years to: deveop a singe, integrated network spanning GP out of hours and extended hours services, aowing patients a simpe to access urgent care service deveop a GP practice on the RBH site and singe front door approach for ED wak ins, and GP extended and out of hours support integrated heath and socia care ocaities, with a priority for Christchurch s edery popuation have a singe Dorset heath record, aowing cinicians rea time access to key information, incuding anticipatory care pans deveoped by oca GPs for high risk patients join up the support for oca nursing and residentia homes, so the hospita and other parties are supporting residents far better, eading to better care and reduced inappropriate emergency admissions within the hospita we wi continue to buid upon our improved emergency care pathways described on pages 14 and 15 by: expanding further ambuatory (day case) emergency care (AEC), providing diagnosis and treatment, without an overnight stay. AEC wi be moving to seven days and increasing the range of conditions seen. page 45

46 Performance for patients Trust Strategy 2015/20 embedding good practice, such as the five daiy actions for inpatient ward care, to ensure fow with the right patient in the right pace at the right time strengthening the front door by expanding ED and acute physician consutant numbers, immediate access to CT scanner, and cinica pathways improvement to aow quicker and more accurate decision making continuing to move forward a seven day service, buiding upon the exceent progress of the ast two years, so medica, therapy, diagnostics and other services are fuy functiona regardess of the day of week. Specific focus on community seven day services and discharge wi have the argest benefit to deveop a nationay recognised centre of exceence in oder peope s care, both embedding best practice and innovating to remain at the forefront. Significant progress has been made over the past two years, in strengthening stroke services, and measuraby improving the quaity of inpatient oder person s care. As we as continuing this progress we wi further deveop our research and deveopment, teaching, and give a high priority to community based geriatrician support to GPs and others Taken together these strands of work wi aow us to use the current resources to better effect, so as to improve quaity and outcomes, and meet the rising demand from an aging popuation, and a growing popuation with more ong-term conditions. We wi as part of this, be active in vertica integration, combining with community and primary care to provide a seamess service. If fuy successfu this aows a shift from inpatient to community care, which is better for patients, and underpins the three to five year CSR strategy for out of hospita care. Waiting times for outpatient cinics, diagnostics and treatments (referra to treatment) At any one time there are over 20,000 patients at RBCH on referra to treatment pathways, progressing through to their diagnosis and treatment. Ensuring a of these patients have timey and effective outcomes is centra to our strategy. In ine with the NHS Medica Director s guidance we wi be focusing on patients on these pathways (cocks sti running) and their individua stages of care e.g. to first cinic, to diagnostics, to operation if required etc. Our strategy is focused around the foowing key initiatives. Improving our theatre, outpatients and diagnostics productivity, such that we can absorb growing demand within existing workforce and faciities, is the centra, most important aspect. This fits we with our quaity and financia improvement pans, as we can improve productivity at the same time as improve cost and quaity by reducing deays, dupications and wastage. This wi hep our hardworking staff fufi their fu potentia, because the systems and procedures can be made more effective. Key aspects of this work incude: better capacity and demand panning and management, stopping backogs buiding and high cost catch up work page 46

47 Performance for patients Trust Strategy 2015/20 better and more standardised pathways, using ean processes to reduce deays and wastage improved IT for booking cinics, diagnostics and procedures improved coding and information coection to ensure we have accurate data for panning and biing new modes of care, incuding patient education and empowerment, reducing the need for foow ups and improving patient outcomes greater joint working with GPs and others to support advice and guidance and simpe diagnostics in the community to ensure quaity and integrated care, without the need for hospita trips muti-skiing to aow different staff groups to undertake tasks and improve vaue for money In years three to five, the CSR wi change the ayout of services particuary at the very speciaist and emergency eve. Over the next three years our focus remains therefore on improving existing services. Cancer services The third key area of nationa and oca expectation for prompt, high quaity care is for cancer services. The cinica strategies chapter sets out how, through the CSR we can improve inpatient haematoogy, and by having a singe east Dorset centre for compex, consutant ed services, we can improve cancer outcomes, such as for cancer surgery. The trend for the ast 15 years has been towards greater networks of care, sharing scarce expertise and resources to ensure exceent cancer care. This resuts in improved outcomes and saved ives. Looking ahead to the next five years, we wi deveop our cancer strategy, incuding improving our access times for each stage of care. For fast track GP referras we wi pan for increased numbers, especiay GI and skin patients and we are redesigning pathways and processes to achieve this. We wi deveop more direct to test referras pathways, to aow GPs faster access to resuts for the patients, to more quicky rue out or diagnose cancer. Our CT deveopment is key to this, aong with deveoping endoscopy capacity. The Jigsaw Buiding for day case oncoogy and haematoogy, and women s heath, wi aow more one-stop cinics, in far better surroundings, to improve the effectiveness and experience for patients. Supporting both prevention and secondary prevention (for those who have beaten cancer) to remain heathy is a core part of our work. We wi do this with partners, especiay in pubic heath and councis, GPs and vountary organisations. The expansion of screening wi be supported, especiay for bowe cancer. This requires us to expand our endoscopy services, and improve our processes, work which is underway. We wi engage in the Wessex five year cancer strategy deveopment over 2015/16, and the work on the Dorset Cancer Aiance, so as to ensure we are maximising the joint effort of partners, and using the best evidence to make decisions. Research and deveopment wi continue to be a key part of our work to improve care, but aso aow patients the option of cutting edge treatments. The deveopment of person centred drugs, targeted to maximise their effectiveness, is an area we are we paced to deveop over the next five years. These specific priorities, aong with the cinica strategies, and supported by workforce, IT, estates and capita and finances, form the backbone of our approach to the next five years. As the NHS Forward View deveops, so we wi adapt for the oca popuation we serve. We wi aso remain active in deivery of the core expectation around emergency, eective and cancer care services. page 47

48 Future organisationa form Trust Strategy 2015/20 Future Organisationa Form There are a number of factors which wi infuence the future organisationa form that underpins the deivery of services from the Roya Bournemouth and Christchurch hospitas. The increasing financia chaenge for this and other neighbouring trusts highights a cear potentia that absent of a significant reshaping of the present modes of care, the current organisationa form is not sustainabe into the medium term (three to five years). The fundamenta redesign of services driven by the Cinica Services Review (CSR) wi create the need to reshape organisationa form. Within east Dorset, services on one site wi expand by up to 50% and on the other shrink by at east 50%. The creation of a main emergency site, and the interdependence it wi have on staff from other organisations wi ead to further consideration of a number of exciting options. These incude: the potentia to create a singe acute organisation for Dorset, or the possibiity of extending this further to a singe consoidated acute and community trust the scope to deveop both muti-speciaty community providers and/or primary and acute care systems principay inked to the panned care site the potentia to integrate hospita, community and socia care We recognise that our organisationa form is unikey to be sustainabe. Work has therefore begun with other oca providers in Dorset to expore the potentia to deveop an acute vanguard project designed to identify organisation forms that wi enabe the ongoing provision of high quaity financiay sustainabe services. This work wi incude detaied examination of the potentia to create a joint venture vehice to aow future ongoing provision of cinica, non-cinica and support services. Those cinica services that coud be incuded in such a venture incude Emergency Department provision, cardioogy, genera surgery, stroke, vascuar surgery, interventiona radioogy, obstetrics, gynaecoogy and paediatrics. The cinica support services coud incude pathoogy where work is aready underway, pharmacy and imaging. Non-cinica services coud incude most back office functions. Any potentia new organisationa form woud need to fuy support impementation of the CSR proposas and safeguard the continued provision of high quaity care. Longer term, there remains the potentia, subject to the requirements of the Competition and Marketing Authority, to create a singe provider of secondary and community heath care services in Dorset and this coud represent the optima soution for viabe provision of services in Dorset. The vanguard appication wi be pursued in Autumn page 48

49 Our approach to research, deveopment and innovation Trust Strategy 2015/20 Our approach to Research, Deveopment and Innovation The Roya Bournemouth and Christchurch Hospitas FT is the highest performing cinica research unit in Dorset with a dedicated infrastructure and team to support, oversee and faciitate research activity within the Trust. Prerequisites for cinica research incude good cinica practice, we-trained and motivated teams and a strong underying hospita infrastructure. The reativey high voume of cinica research activity is a cear marker of the presence and stabiity of these prerequisites. Cinica tria activity predominanty focuses on adopted trias from the Nationa Institute of Heath Research (NIHR) portfoio. There is aso significant commercia tria activity sponsored by pharmaceutica companies and industry. Both groups of activity represent an additiona income to the Trust representing a combined turnover of circa 2.5m. Going forward we aim to continue the trend of expanding our research activity and seek to take advantage of the emphasis being paced on more commercia tria activity. During the ast two years the cinica tria recruitment activity has increased, by way of exampe in 2013/14 a tota of 1200 patients were recruited to NIHR portfoio studies and this increased in 2014/15 to 1776 patients. The Trust wishes to work more cosey with the Wessex NIHR to ensure an appropriate fow of funds to support the ongoing panned expansion in research activity. The strong and we estabished research and innovation infrastructure provides a firm patform on which to deveop future activity. This is underpinned by cear and signaed support for the deveopment of research through key areas of activity incuding Haematoogy, Cardioogy, Orthopaedics, and Gastroenteroogy. It is, however, recognised that the uncertainty created by the Cinica Service Review and the future deveopment of sites incuding the Roya Bournemouth Hospita wi create some uncertainty for the industry support in research. Nevertheess, it is important that we continue to work together with other oca Trusts to deveop research. The future pattern of research activity wi broady refect the future configuration of services, for exampe the deveopment of the Roya Bournemouth Hospita as an Emergency Centre woud ensure that the Trust retains and deveops further its Cardioogy, Haematoogy and Stroke reated activity. Conversey if the Trust deveops as a Panned Care Centre it is ikey to deveop further research activity in speciaties such as Rheumatoogy, Dermatoogy, Dementia and Neurodegenerative diseases. The Trust is aso keen to evauate and consider how it can deveop a cinica trias unit creating the abiity to undertake further eary phase pharmaceutica trias which incude extensive pharmacokinetic studies. Christchurch Hospita and its deveopment as a hub in coaboration with Genera Practice aso provides the opportunity for more verticay integrated cinica services and therefore potentiay a nove venue for research work. During the ead up to impementation of the CSR we wi continue to foster and deveop reationships and cinica projects with partner organisations and externa stakehoders incuding Bournemouth University Cinica Research Unit, the Wessex Academic Heath Sciences Network and the NIHR Coaboration for Leadership in Appied Heath Research and Care (CLAHRC) Wessex and Quinties. We are aso deveoping a cinica innovation framework to hep improve cinica productivity and support; a widespread adoption of new approaches to improving strengthening of care and cinica outcomes. There wi be a specific focus on ceary defined repetitive systems for page 49

50 Our approach to research, deveopment and innovation Trust Strategy 2015/20 specific cinica presentations mapped against quantified cinica outcome measures which enabe: Improvement in the consistency of heathcare Anaysis of the cinica worth of the interventions and treatments provided The easier embedding of new determined best practice, heath technoogy, appraisas, NICE guideines and research findings Easier embedding of cinica research of uncertain components of care Cost anaysis of components of care pathways Exporation of potentiay more efficient modes of care or determining the processes are, in fact, optima page 50

51 The estate and our capita programme Trust Strategy 2015/20 The estate and our capita programme Our estate portfoio is required to be fexibe in its scae, scope and utiisation to support the evoving patient and cinica service requirements. In order to achieve this we have continued to invest in ways that optimise the efficiency and quaity of the estate whie simutaneousy responding changes in demography and technoogica advances, a of which drive our strategy. The purpose of the estate strategy is therefore to enabe the impementation of our strategic objectives. Two significant capita schemes have been in recent deveopment at the Roya Bournemouth Hospita (RBH) which wi enabe improved service deivery in purpose-designed faciities, and which wi aso have the coatera benefit of generating space capacity, and thereby faciitating spatia reconfiguration, in the main hospita buiding. The Jigsaw Buiding is due for competion in September Additiona space is aso being freed up through the impact of the Eectronic Document Management project in reducing space currenty used for medica record storage, retrieva and archive. There is then scope for the further deveopment of cinica capacity at RBH through both strategic reconfiguration and further new buid deveopment, as iustrated beow: NEW MULTI-STOREY CAR PARK? DERWENT EXTENSION NEW PATHOLOGY? The new Bournemouth Birth Centre opened in November JIGSAW (SEPT 2015) NEW SSD? MAIN FRONTAGE EXTENSION (MATERNITY?) ED EXTENSION NEW WARD BLOCK (REPLACES DPC) page 51 KEY

52 The estate and our capita programme Trust Strategy 2015/20 Dorset Cinica Services Review (CSR) CSR background The Dorset CSR wi be expected to define the Estate Strategy direction and priorities for the next 25 years, with the Roya Bournemouth Hospita becoming either the Dorset major emergency centre or a panned care centre. Major emergency site scenario Under the RBH major emergency site scenario, the foowing services coud be moved from the main hospita buiding to off-site ocations (i.e. to the panned care site or esewhere in the community), or to sateite ocations on site, in order to create capacity in the main hospita buiding for the deveopment of emergency services: Vacated (to purpe site, community, or esewhere on site) Eective Orthopaedics Eective Day Surgery Pathoogy Ward 8 (TIU) Ante Nata Rena Orthodontics Sexua Heath Rehabiitation Dorset Prosthetic Centre Overnight Stay Ward Women s Heath Thoracic Outpatients Ward 10 (Day case oncoogy) Various Administrative Functions Using the capacity created, the services beow woud enabe the major emergency cinica mode: New Expanded Integrated support functions Trauma Paediatrics Maternity (inc. NICU) Additiona acute medicine and surgery Expanded Bed Base Expanded ED Expanded Critica Care (ITU/HDU) More Main Theatres Capacity More Diagnostics Capacity Pathoogy? Sterie Services Department? page 52

53 The estate and our capita programme Trust Strategy 2015/20 Panned care site scenario Under the RBH panned care site scenario, the foowing services woud move from the RBH site to Pooe Hospita as the major emergency site: Vacated (to green site) Emergency Department AMU/AAU Critica Care (ITU/HDU) Stroke Cardioogy Inpatient Haematoogy Main Surgica Speciaties: Vascuar Uroogy Gynaecoogy Coorecta Upper GI Surgica Admissions? Pathoogy? Sterie Services Department Under this scenario, there woud be a significant reduction in the RBH bed base and reduced acuity of the cinica activity taking pace on site, eading to substantia vacant space: New Reduced Expanded Urgent Care Centre (in pace of ED) Significanty Reduced Bed Base Reduced Main Theatres Reduced Diagnostics? Day Surgery Eective Procedures page 53

54 Singe bed 19.0sq m (19) Singe bed 19.0sq m (19) Singe bed Singe bed 19.0sq m 19.0sq m (19) (19) En Suite 5.3sq m (5.0 ) Singe bed 19.0sq m (19) Singe bed 19.0sq m (19) En Suite 5.0sq m (5.0 ) 5.0sq m Singe bed 19.0sq m (19) Canopy over En Suite 5.0sq m (5.0 ) En Suite 5.0sq m (5.0 ) Quiet Room 14.9sq m En Suite (5.0 ) Manifod 10.0sq m Disp Hod Curtain En Suite 5.0sq m (5.0 ) 8.2sq m 4 Bed Ward 76.0sq m (76) (6.0) Bath 14.0sq m (14) Bath En Suite 14.1sq m (14) 4 Bed Ward 75.9sq m (76) Dirty Utiity 9.3sq m (8.0) Eectrics Nurse St'n 5.3sq m 3.9sq m (5.0 ) Suice WC Curtain 2.3sqm (1.8) En Suite 8.2sq m (5.0 ) Body Store (20) 20.2sq m En Suite Curtain En Suite 6.9sqm 6.3sq m (5.0 ) (6.9) (1.8) WC 2.3sqm C Utiity 16.1sq m (16.0) En Suite 5.0sq m (5.0 ) En Suite 6.9sqm (6.9) Curtain Singe bed 24.8sq m Kitchen Store Linen 9.0sq m (9.0) Singe bed 19.0sq m (19) En Suite En Suite 5.0sq m 5.0sq m (5.0 ) (5.0 ) Singe bed 19.1sq m (19) Nurse Base 25.5sq m (25) Kitchen (12) 12.1sq m 12.1sq m (12) (19) Singe bed 19.0sq m (19) Waste Store 14.7sq m (10) Troey Lift Quiet Room 8.6sq m Pant Room 26.9sq m (20) Patients Utiity Sisters' Office 10.6sq m (10.5) Singe bed 19.0sq m (19) Curtain / Laundry 10.9sq m (11.5) Store Ceaners 9.9sq m (7.5) Kin 8.1sq m (5.0) Community Dis Equipment Store 20.4sq m (20) Equipment Store 18.5sq m (12) 7.0sq m 5.1sq m 6.8sq m (12) Doctors' Office 19.4sq m (20) Day dining room 44.9sq m (40) COURT YARD Sitting / Pay area (12+15) 31.0sq m Dis WC WC WC (4.5) sq m sq m 3.6 SCREEN Beverage Room (8.0) (7.0) 8.0sq m Office 8.3sq m WC 3.9 Dis WC Quiet Room 10.0sq m (2 x 4sq m) 15.1sqm Office Reception 9.5sq m Therapy Store 12.0sq m (12) Gym 25.0sq m (25) Muti Purpose Room 15.0sq m (15) DISPLAY Fem WC Dis WC Compementary Therapy Aromatherapy 15.0sq m (15) Activities Area 34.8sq m (24) Cafe Dining Room 34.2sq m (30) Sitting Room 40.1sq m (36) Wheechair store 7.3sq m (15) Entrance Area 103.2sq m Mae WC Baby change 4.0sq m Entrance Lobby 11.1sq m Servery 13.0sq m Store 3.2sq m P by JCG checked SH Tites and shading added P by JCG checked SH Scheme reduced in size P by JCG checked SH First issue The estate and our capita programme Trust Strategy 2015/20 Christchurch Hospita The continuing deveopment of the Christchurch Hospita site remains a key component of our estate strategy. Optiona Deveopment and (Variant Bid) Assisted Living (Quantum) Nursing Home (Quantum) Residentia deveopment New Macmian Unit Eectrica cpd Materias & Equipment Store New GP Surgery & refurbished Outpatients PRELIMINARY The Roya Bournemouth and NH Christchurch Hospitas NHS Foundation Trust Togate Estates, Stanbridge Ears, Romsey SO51 t: f: admin@studiofourarchitects-romsey.c cient The Roya Bournemouth and Christchurch Hospitas NHS Trust project Christchurch Hospita Rationaisation studio fou architects tite Preiminary site pan showing new Macmian, fats & housing date scae Apri :500 paper drawn che A1 JCG SA job no. dwg. no. rev SK S01 P3 fie 34143_SKS01_P3 S4 whoe site pan 09 June 2 Phase one is progressing and wi deiver: new GP practice, pharmacy and X-ray department, and refurbished outpatients and other areas. nursing home and senior iving deveopments (via joint venture with Quantum) An OJEU notice has now been issued in respect of a Phase two deveopment, which wi deiver: new Macmian Unit residentia deveopment (incorporating key worker housing) other commercia deveopment (subject to bid approva) other potentia cinica deveopments (variant bid) Compiance, refurbishment and infrastructure Aongside, and compementary to, the strategic deveopment of the Trust estate portfoio, it remains a key priority to ensure ongoing backog maintenance, refurbishment and adaptation of the buiding stock and associated infrastructure with a view to ensuring safety, compiance and fitness-for-purpose. Annua aowance wi continue to be made in the capita pan for such essentia works. page 54

55 The estate and our capita programme Trust Strategy 2015/20 Sustainabiity As a part of the NHS, pubic heath and the socia care system, it is our duty to contribute towards the eve of ambition set in 2014 of reducing the carbon footprint of the NHS, pubic heath and socia care system by the equivaent of a 28% from a 2013 baseine, by These represent ambitious goas to reduce carbon emissions in the heathcare sector, and in doing so protect the heath and webeing of the UK popuation. It is our aim to meet these targets. We are committed to continuay improve on minimising the impact of its activities on the environment, and in doing so reinforcing its commitments to both the Good Corporate Citizenship Mode and cost improvement. In order to meet these targets we are working in a number of areas to invest in ow-carbon technoogies and practices. The key areas for action now and over the next five years are: energy, water and carbon management (incuding invest to save schemes) sustainabe procurement, incuding of food ow carbon trave, transport and access, waste reduction and recycing deveoping green spaces staff engagement and communication buidings and site design organisationa and workforce deveopment partnership and networks governance, IT and finance to underpin the above. We reguary reviews and report on progress against the Good Corporate Citizenship (GCC) Assessment Mode and key actions within an accompanying Sustainabiity Management Action Pan. Monitoring, reviewing and reporting of energy and carbon management are carried out quartery via the Carbon Management Group. We have been progressing with energy and carbon management in a number of areas over the ast coupe of years. In 2014 this was formay recognised through two nationa awards for our work: NHS Sustainabiity Day Behaviour Change Award Winner NHS Sustainabiity Day Waste Award Winner We have aso been recognised ocay with regards to the work that has been carried out around promoting active trave to staff by receiving the foowing award: Bournemouth, Pooe and Christchurch Business Trave Network - Trave Action Pan, Initiative of the Year 2015 Medica equipment strategy We have invested heaviy in medica equipment over the years, especiay in radioogy, cardioogy, theatres and endoscopy. As a resut we have cutting edge scanners, a theatre robot and many other exampes of state of the art equipment. The asset register is used, aongside the operationa department s knowedge of ikey repacement timings, to forward pan. This combined with horizon scanning of deveopments in technoogy sets a two year forward ook. Over the next five years maintaining being at the forefront wi become more difficut, as funding remains static, kit needs repacing and new equipment becomes more expensive. As equipment becomes more sophisticated so the inks with the IT systems become more crucia e.g. sharing resuts with eectronic document management, and with test ordering (order comms). page 55

56 The estate and our capita programme Trust Strategy 2015/20 To baance these demands the capita strategy has a three part response: increasing of the medica equipment budget from 1m to 1.5m; the charity fundraising strategy focusing more on equipment (which has the added benefit of saving on VAT, increasing the spending power by 20%); thirdy the Trust wi aso consider managed equipment services. These ink operationa and equipment needs with speciaist suppiers, foowing a procurement process, which can be better vaue for money. There wi be severa high capita cost items invoving equipment in the next few years, which wi be required regardess of the CSR. These incude: deveoping the third CT scanner in our Emergency Department, transforming the speed of diagnostics, and creating much needed extra scanning capacity refurbishing the four cardiac abs at RBH upgrading the Derwent theatres Other capita decisions, incuding the fifth cardiac ab pans and a wider theatres upgrade, wi be reviewed in the ight of CSR decisions. Transport inks Five Year Capita Programme Years one to two of this strategy wi be about minimising spend for two reasons. Firsty major commitments without a CSR decision are unikey to be appropriate, uness they are future proofed for either option (which is why CT3 is progressing now). Secondy the need to reduce draws upon capita reserves, as our financia pan requires us to maintain iquidity. For these reasons the 2016/17 capita pan wi therefore be reviewed downwards. The CSR decision, foowed by Treasury approva of any major capita enabing works, wi be the argest factors affecting the future capita programme from years two to five. The pans for the panned care centre option wi be minima, as in effect this wi aow de-commissioning of faciities on the RBH site. A draft Five Year Capita Programme, based on RBH as the major emergency site, has been deveoped. This utiises the many advantages of the site to fex and expand. In addition the Trust is working with Bournemouth Borough Counci to deveop a viabe pan for a major road junction onto the site, which aready has part funding from centra Government. Access to and from the RBH site is a major issue, as peak time traffic combining with minor events such as roadworks, can create severe congestion. Minor works such as improved signaing, pus strenuous efforts to manage traffic demand and hep staff with trave aternatives is maintaining a workabe situation. However staff being unabe to access work easiy is a recruitment and retention concern. The strategic soution is an on/off junction from the Wessex Way. Some 6m of government funding is committed to this for 2018/19, but it requires at east match funding, via deveopment of the unused and to the north of the hospita. We wi work with the counci and the and owners to deveop a viabe proposa. Improved road access, and staff parking are key outcomes we are ooking to achieve from this partnership. page 56

57 F inancia strategy Trust Strategy 2015/20 Financia strategy Cinica Commissioning Group (CCG) aocation/ resources CCG aocation growth is predicted to average between 1.5% and 2% during the period of this strategy. Locay, our commissioners the Dorset CCG experienced growth of 2.5% during the ast financia year, and remains 2% distance from target. Tariff reform and efficiency Consistent with the nationa foundation trust picture, during 2014/15 we experienced significant operationa and financia pressures for the first time since we were icensed as an foundation trust. These incuded considerabe demand pressures - a 10% increase in emergency admissions, doubing the number of deayed discharges, and a nationa shortage of medica and nursing professionas resuting in a significant premium cost spend. As a resut, we did not meet our panned deficit of 1.9m and ended the year incurring a deficit of 5.2m. Non-recurrent item adjustments resuted in this deteriorating further to an underying deficit of 6.5m. The financia strategy focuses on how we manage future performance buiding on our historic successes. Strong financia performance is fundamenta to the Trust s service aspirations so our pans are grounded on a strong business mode. The financia strategy is set in context and covers the period from 2015/16 to 2017/18, being the period up to the point at which the commissioner-ed Dorset Cinica Services Review (CSR) is anticipated to commence impementation of the agreed mode of care. The current and predicted tariff continues the need for the NHS and in particuar, the provider sector to continue with reentess and significant efficiency savings. The requirement is 3.5% in 2015/16 and indications are for a simiar position thereafter. The newy eected government has confirmed that 8bn wi be made avaiabe to the NHS by 2020, however this is conditiona on deivery of 22bn of further recurrent (CIP) efficiencies, hence the trust must pan to deiver above the minimum requirement to reduce the current eve of deficit. The nationa expectation is that respective oca heath economies wi determine the detais of how productivity opportunities wi be reaised. The more significant cost improvement is assumed to be reeased from 2017/18 through the impementation of the CSR however in the medium term, we are obiged to stabiise the financia position internay through various areas of priority focus: use of shared services in back office functions improvements in the use of the estate more efficient care through better coordination with partners. prioritising the most effective treatments and reducing errors and waste enhanced cinica productivity better use of resources workforce ski mix review page 57