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Bridgewater Community Healthcare NHS Trust

Summary Integrated Business Plan 2012-2017


Contents

Chairman’s and Chief Executive’s Introduction

Page 4

About Us

5

Mission, Vision and Values

6

Key Facts

8

Health Profiles of our Communities

9

Our Services

13

NHS Foundation Trust status

17

Market Assessment

18

Building the Bridgewater Strategy

20

The Bridgewater Offer

22

Service Developments

23

Performance

29

Financial Performance

34

Risk

36

Cost Improvements and Quality of Care

39

Workforce and Leadership

43

Our Board

45

Bridgewater Summary Integrated Business Plan 2012-2017

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Chairman and Chief Executive’s Introduction We are delighted to present our Summary Integrated Business Plan (IBP) which sets out the key elements of our five year business plan for the Trust, including future plans for services as we develop as a successful NHS Foundation Trust. The Trust provides community health services to the residents of Ashton, Leigh and Wigan; Halton; St Helens; Trafford and Warrington. We also provide specialist community dental services in these areas plus Bolton, Tameside, Glossop, Stockport and western Cheshire. Bridgewater Community Healthcare NHS Trust (Bridgewater) was established in April 2011 as a result of the transfer of community services from four local boroughs into Ashton, Leigh and Wigan Community Healthcare NHS Trust. To recognise this significant change in the geographical area the Trust was renamed as Bridgewater. Our five year business plan sets out a clear vision and strategy to develop as a Foundation Trust that is well managed, has sound governance, is financially viable and will be legally constituted. We have a focus on patient safety and put the patient at the centre of everything we do. As a Foundation Trust we will be giving our patients, staff, members and stakeholders a strong voice in our future so that they can influence our development and growth as an organisation and as a provider of choice. We hope you find this document a useful and informative summary of our business plan and an aid to understanding our strategy for bringing high quality, integrated care close to home in the communities we serve. If you have any comments on our plans please contact us using the details at the end of this document.

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Harry Holden

Dr Kate Fallon

Chairman

Chief Executive

Bridgewater Summary Integrated Business Plan 2012-2017


About Us Bridgewater was originally developed as a platform for change in the health and social care delivery system. The majority of our services are delivered in patients’ homes or at locations close to where they live, such as clinics, health centres, GP practices, community centres and schools. As a provider of both mainstream and specialist care, our role is to focus on providing cost effective NHS care, keeping people out of hospital and supporting vulnerable people throughout their lives. As a dedicated provider of community services, our strategy is to bring more care closer to home. This means providing a wider range of services in community settings to keep people healthier for longer and developing more specialist services to support people to live independently at home.

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Our Mission, Vision and Values Our mission is: To improve local health and promote wellbeing in the communities we serve Our vision is: To work closely with local people and partners to promote good health and to be a leading provider of excellent community healthcare services in the North West The Board consulted with staff, patients and commissioners to review and reaffirm our mission, vision and values throughout 2011/12. The values are listed in Figure 1 below.

Figure 1- Bridgewater’s Values

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Value

What this means

Patient Centred

Patient care is our priority

Encouraging Innovation

We encourage and embrace new ideas to deliver improvements in patient care

Open and Honest

We communicate clearly to develop relationships based on mutual trust and respect

Professional

We provide a quality service for patients by investing in our staff, recognising and valuing their contribution

Locally Led

We will continually develop our knowledge of the communities we serve so that we can be responsive to local need

Efficient

We will use our resources wisely to ensure quality patient care and value for money

Bridgewater Summary Integrated Business Plan 2012-2017


Figure 2 - Bridgewater’s Strategic Focus, Aims and Goals

Strategic Focus

Strategic Aim

Strategic Goal

Patients

We will provide excellent, timely and personal healthcare close to patients homes, ensuring that we tailor our services to meet their individual patient need.

We will continue to demonstrate improvement in the delivery of high quality, safe, excellent and effective personal community healthcare for our patients.

We will work with our local communities and strategic partners to ensure that we design and implement integrated services which improve access, reduce health inequalities and promote health and wellbeing.

We will continue to work with local communities to improve services that support their health and wellbeing, establishing targets that will demonstrate that we are achieving this.

We will ensure that our organisation has longterm financial viability and sustainability, is well governed and is accountable to the communities we serve for the services we deliver.

We will continue to deliver value for money by ensuring efficiency in all our activity and processes in local health economies.

Community

Organisation

We will make it easier for patients/carers to access our services where and when they need them.

We will continue to engage with stakeholders and the local community to ensure that we develop a community organisation that is recognised as contributing positively to the lives of the local population.

We will achieve Foundation Trust status by 2013 and be assessed as the leading provider of community healthcare in the North West by 2015. We will continue to be financially secure and accountable across our entire organisation.

People

We will invest in the development of our staff to ensure that they have the skills required to deliver high quality and safe services to the communities we serve.

We will develop world class skills, competencies and experience, to deliver high quality care through our workforce planning, organisational development and education and to be seen as the employer of choice. We will continue to engage with our staff, fostering talent and developing leaders, to deliver change, innovation and improvement.

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Key Facts The table below provides a summary of key facts about Bridgewater. Figure 3 - Key facts about Bridgewater

Area Covered

266 square miles across five boroughs

Population Served

1,015,370 ONS (2010) 1,779,300 including dental service (ONS 2009/10)

Headcount (as at April 2012)

4,035 (3365 wte)

Labour Turnover

12.37% as at April 2012

Number of Inpatient Beds

29 (Newton Community Hospital)

Number of Properties

210

Reference Cost Index (by division 2010/11)

ALW HSH Trafford Warrington

Overall Income

£167.9m split into the following (£m) ALW £43.3 Dental £6.73 HSH £51.03 Trafford £23.65 Warrington £27.23 Others* £16.0

*Other income includes Local Authority (£6.21m), Trusts/Foundation Trusts(£3.43m), Other non-protected income includes Road Traffic Accidents (RTA) (£1.78m), Service Increment for Teaching (SIFT) (£0.15m), Non-Medical Education and Training (NMET) (£0.76m), Healthcare Libraries (£1.50m), Other (£0.69m), Non-patient services to other bodies (£0.96m), other revenue (£0.52m)

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103 101 77 71

PCT Localities

•NHS Ashton, Leigh & Wigan •NHS Halton & St Helens •NHS Trafford •NHS Warrington

Clinical Commissioning Groups

•Halton •St Helens •Trafford •Warrington •Wigan

Lead Commissioner for Community Dental Services

NHS Halton & St Helens

PCT Clusters

•Greater Manchester •Merseyside •Cheshire

Local Authorities

•Halton •St Helens •Trafford •Warrington •Bolton •Tameside •Stockport •Cheshire West & Chester •Wigan •High Peak

Bridgewater Summary Integrated Business Plan 2012-2017


Health Profiles of our Communities The Trust operates across a large, complex, health and social care footprint, addressing the needs of populations. The geography of Bridgewater includes some of the most deprived communities in England with the associated health and lifestyle challenges. This means there are significant variations in morbidity and mortality between the most affluent and deprived communities served by the Trust. The population is ageing, so demand on our services will continue to grow during a period of unprecedented financial pressures. Across our local health economies, this necessitates a new model for the delivery of more care out of hospital, in partnership with General Practitioner (GP) colleagues and other stakeholders, to ensure patients receive a seamless service. The health profiles of each of our boroughs is summarised as follows: -

Wigan Health Profile • The health of the people in the borough of Wigan is generally worse than the England average. Deprivation is higher than average and about 12,100 children live in poverty. Life expectancy for both men and women is lower than the England average. • Life expectancy is 11.1 years lower for men and 8.0 years lower for women in the most deprived areas of Wigan than in the least deprived areas. • Over the last 10 years, all-cause mortality rates have fallen. Early death rates from heart disease and stroke have fallen, but remain worse than the England average. • 19.3% of Year Six children are classified as obese. Levels of teenage pregnancy, breast feeding initiation and smoking in pregnancy are worse than the England average. • Estimated levels of adult “healthy eating”, smoking and obesity are worse than the England average. Rates of hip fractures, smoking-related deaths and hospital stays for alcohol-related harm are higher than average. Rates of sexually transmitted infections and road injuries and deaths are better than the national average. • Priorities in the borough include reducing avoidable premature deaths from cardiovascular disease (CVD) and cancer and reducing teenage pregnancy rates.

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Halton Health Profile • The health of people in Halton is generally worse than the England average. Deprivation is higher than average and about 7,000 children live in poverty. Life expectancy for both men and women is lower than the England average. • Life expectancy is 11.1 years lower for men and 10.8 years lower for women in the most deprived areas of Halton than in the least deprived areas. • Over the last 10 years, all-cause mortality rates have fallen. The early death rates from heart disease and stroke have fallen, but remain worse than the England average. • 23.8% of Year 6 children are classified as obese, higher than the average for England. Levels of teenage pregnancy, breast feeding initiation and smoking in pregnancy are worse than the England average. • Estimated levels of adult “healthy eating” and smoking are worse than the England average. Rates of sexually transmitted infections, smoking related deaths and hospital stays for alcohol related harm are worse than the England average. The rate of statutory homelessness is lower than average. • Priorities for Halton include smoking, alcohol, mental health, obesity and breastfeeding.

St Helens Health Profile • The health of the people in St Helens is generally worse than the England average. Deprivation is higher than average and about 8,600 children live in poverty. Life expectancy for both men and women is lower than the England average. • Life expectancy is 11.5 years lower for men and 8.4 years lower for women in the most deprived areas of St Helens than in the least deprived areas. • Over the last 10 years, all-cause mortality rates have fallen. Early death rates from cancer and from heart disease and stroke have fallen, but remain worse than the England average. • 21.9% of Year Six children are classified as obese, higher than the average for England. Levels of teenage pregnancy, General Certificate of Secondary Education (GCSE) attainment, alcohol-specific hospital stays among those under 18, breast feeding initiation and smoking in pregnancy are worse than the England average. • The estimated levels of adult “healthy eating” and smoking are worse than the England average. Rates of sexually transmitted infections, smoking related deaths and hospital stays for alcohol related harm are worse than the England average. The rate of violent crime is lower than average. • Priorities for St Helens include smoking, alcohol and mental health, obesity and breastfeeding.

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Bridgewater Summary Integrated Business Plan 2012-2017


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Trafford Health Profile • The health of the people in Trafford is generally better than the England average. Deprivation is lower than average, however about 6,900 children live in poverty. Life expectancy for women is higher than the England average. • Life expectancy is 10.6 years lower for men and 5.7 years lower for women in the most deprived areas of Trafford than in the least deprived areas. • Over the last 10 years, all-cause mortality rates have fallen. Early death rates from cancer and from heart disease and stroke have fallen and are similar to the England average. • 16.4% of Year Six children are classified as obese, lower than the England average. Level of teenage pregnancy, GCSE attainment, breast feeding initiation and smoking in pregnancy are better than the England average. • The estimated level of adult obesity is better than the England average. The rate of hospital stays for alcohol related harm is worse than the England average. Rates of hip fracture, sexually transmitted infections and road injuries and deaths are better than the England average. • Priorities for Trafford include tobacco and smoking, alcohol, obesity and active lifestyle.

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Warrington Health Profile • The health of the people in Warrington is mixed compared to the England average. Deprivation is lower than average, however about 5,700 children live in poverty. Life expectancy for both men and women is lower than the England average. • Life expectancy is 9.7 years lower for men and 7.0 years lower for women in the most deprived areas of Warrington compared to the least deprived areas • Over the last 10 years, all-cause mortality rates have fallen. Early death rates from cancer and from heart disease and stroke have fallen, but the latter remains worse than the England average. • 17.5% of Year Six children are classified as obese. Levels of alcohol-specific hospital stays among those under 18 and breast feeding initiation are worse than the England average. The level of GCSE attainment is better than the England average. • An estimated 19.0% of adults smoke and 22.9% are obese. Rates of road injuries and deaths, smoking-related deaths and hospital stays for alcohol-related harm are worse than the England average. The rate of sexually transmitted infections is better than the England average • Priorities in Warrington include tackling health inequalities, reducing levels of CVD and reducing harm caused by alcohol. It is clear from the information above that the major health issues associated with deprivation, unhealthy behaviours and lifestyle choices are prevalent within each of our boroughs. The impact of these problems is different in each locality, each neighbourhood or each household. As a provider whose staff are in contact with people within their own communities on a day-to-day basis, our services must understand the local issues and respond to these health needs at each level.

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Bridgewater Summary Integrated Business Plan 2012-2017


Our Services

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Bridgewater provides approximately 136 different clinical services across its core footprint (there is some overlap between divisions that will be resolved). The largest are general services, such as district nursing, health visiting, physiotherapy, podiatry, speech and language therapy. We have an increasing workforce providing healthy living and lifestyle advice services. We manage three walk-in centres, provide health care in three prisons and our specialist dental services care for some of the most vulnerable people in our communities. We have one state of the art community hospital at Newton-le-Willows. The nature of community services is that they are patient-focused, looking at the needs of the individual and family or carers, not just at one single condition or pathology. We deliver holistic care, often working in partnership with other agencies in health and social care to provide a seamless service.

Figure 4 - Services provided by Bridgewater

Warrington

Trafford

Health & Wellbeing

Long Term Conditions Acquired Brain Injury

Adult Learning Disability Service

Adult Learning Disability Service

Adult Mental Health Improvement

Adult Speech and Language Therapy

Adult Weight Management Service

Cardiac Rehabilitation

Alcohol

Catheter Care

Brief Interventions

Community Matrons

Cancer Collaborative

Continence Service

Children & Young People

Diabetes Service

Community Nutritional Support Services

Echo Technician & Consultant

Counselling Service

Heart Failure Nurses

DAT Service

Bridgewater Summary Integrated Business Plan 2012-2017

Halton & St Helens

Services

ALW

Provided to:

Warrington

Trafford

Halton & St Helens

Services

ALW

Provided to:

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Figure 4 - Services provided by Bridgewater (cont.)

Neurological Rehabilitation Service

Early Years Assessment

Orthoptics

Food & Nutrition

Occupational Therapy One Stop Resource Centre

Graduate Mental Health Trainees

Physiotherapy

Health Service in Schools

Podiatry

Health Trainer Service

Pulmonary Rehabilitation

Homeless & Vulnerable Persons' Team

Respiratory

Older People's Services

Stroke Team

Open Mind Service

Warrington

Psychological Therapies

Audiology

Sexual & Reproductive Health

CAMHS

Smoking Cessation

Child Development Centre

Wellbeing Services

Child Health Services

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Trafford

Health & Wellbeing

Long Term Conditions

Child Health

Halton & St Helens

Services

ALW

Provided to:

Warrington

Trafford

Halton & St Helens

Services

ALW

Provided to:

Specialist Services

Children SLT

Adult SLT

Children's Community LD Nursing

Cancer & Palliative Service

Children's Community Nursing Team

Cancer Support Service

Children's Community Therapy Service

Chronic Pain Management Service

Children's Cystic Fibrosis Team

Dermatology

Children's Respiratory Service

Dietetics

Continence Children

Ear Care Service

Continuing Care

Falls Prevention Service

Dietetics

GPSI for ENT

Bridgewater Summary Integrated Business Plan 2012-2017


Figure 4 - Services provided by Bridgewater (cont.)

Child Health

Warrington

Trafford

Halton & St Helens

Services

ALW

Provided to:

Warrington

Trafford

Halton & St Helens

Services

ALW

Provided to:

Specialist Services

Eating Disorder CAMH's Service

Infection Control (including TB services)

Family Nurse Partnership

Infection Control Nurse

Health Visiting

Lymphoedema Service

HPV Service

MacMillan Community Palliative Care

Looked After Children's Health Service

Marie Curie Nurse Service

Midwifery Halton

MSK Physiotherapy Service

Minor Illness Prevention Service

Orthopaedic & musculoskeletal services

Neighbourhood Mums

Palliative Care Clinical Nurse Specialists

Orthoptics (children)

SPB Counselling Specialist Palliative Care and Bereavement

Paediatric Community Medical Service

Specialist Palliative Care Team

Paediatric Liaison

TB (Tuberculosis Service)

Physio & OT (children)

Tissue Viability Service)

Safeguarding

Wheelchair & Specialist Seating Service

School Nurses

Wheelchair Service

Sure Start T.E.D.S.Trafford Early Development Service

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Figure 4 - Services provided by Bridgewater (cont.)

Urgent Care

Urgent Care Alexandra Court & Richmond House

St. Helens RARS)

Care Home Support Team

Stoma Care

Care Home Support Service

Transport Services

Community Phlebotomy

Treatment Rooms

Community Rehabilitation Therapies

Walk In Centres

Continuing Healthcare Assessment

Discharge Facilitation

Offender Health Risley

District Nursing

Prison Healthcare Services

ICES (Integrated Community Equipment Service) Intermediate Care Beds Intermediate Care Medical Cover

Stockport

Bolton

Special Care Dentisty Paediatric Dentistry Out of Hours Dentistry

IV Therapy

Minor Oral Surgery

Newton Hospital

Oral Health Promotion

Nursing out-of-hours

Dentistry in Prisons*

One Stop Resource Centre

Warrington

ICAT Intermediate Care & Therapy

Trafford

Dental

ALW

GP Out-of-hours Service

Halton & St Helens

Early Supported Discharge Team

Western Cheshire

Offender Health Thorn Cross

Tameside & Glossop

Offender Health

Dental Call Handling Service in and out of hours

Halton RARS

Warrington

Trafford

ALW

Services

Halton & St Helens

Provided to:

Warrington

Trafford

ALW

Services

Halton & St Helens

Provided to:

* Also in Prestwich Hospital, North Manchester

POPPS Partnership for older people's project Single Point of Access

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Bridgewater Summary Integrated Business Plan 2012-2017


Clinical Networks In order to support service development and delivery, we have established Clinical Networks to allow healthcare professionals working in the same discipline but in different localities to work together for mutual patient and professional benefit. The focus of these groups is developing clinical leadership, service improvements and pathway redesign which ensures the skills and experiences available across the Trust are maximised. The six clinical networks that have been established are: Urgent Care, Children’s Services, Specialist Services, Offender Health, Long Term Conditions and Health and Wellbeing (including dental).

NHS Foundation Trust Status Bridgewater aims to become a Foundation Trust during 2013 and our ambitions are underpinned by a commitment to engage and involve patients, staff and partners in our plans for the future. As part of our application to become a Foundation Trust we carried out a full public consultation in early 2012. The results of this confirmed support for our Foundation Trust plans. The Foundation Trust model, with a wide local membership and a Council of Governors, provides an obvious strategic fit with the culture of a community trust. Achieving Foundation Trust status will provide the following benefits: • Local decision making as opposed to decisions dictated by central government. • We will have members (patients, local people and staff) who will be informed about developments within the Trust and have the opportunity to influence decisions about services and the direction of the Trust. • Public and staff members will elect fellow members to serve on the Council of Governors, who will represent their views at a senior level within the Trust. • The Council of Governors will consist of 33 governors – 17 governors elected by public members (patients and local people); nine governors elected by staff and seven partner appointed governors. • The Council of Governors will hold the Board of Directors to account on behalf of the community that the Trust serves and is responsible for the appointment of the Chairman and Non-Executive Directors. In addition, the Council of Governors approves the appointment of the Chief Executive.

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• Through our Foundation Trust members and governors, we will ensure that we are more accountable to our local communities and our staff. We will engage our members and governors in service redesign, performance reviews and on-going service development and challenge sessions. • As a Foundation Trust we will ensure that we reinvest surpluses in the design and implementation of new and innovative services which ensure that patients are cared for in a safe way in a community setting. • We will be independently regulated by Monitor. Achievement of Foundation Trust status will enhance our status within our local community and we will use this to recruit and retain high quality staff. We will use our financial freedoms to ensure that we reinvest in service development, organisational and staff development. We will ensure that we use our brand as an NHS Foundation Trust to develop strategic service delivery partnerships locally. We will build upon our brand to support our commercial strategy of organic service growth as a premier provider of local community services. The rigour of the Monitor compliance framework is welcomed by the Board and staff who are keen to demonstrate the improved health outcomes and service experience our patients receive, as well as the efficiency and value for money we provide for commissioners.

Market Assessment Bridgewater operates in a complex health and social care market where many of our partners are also our competitors. This is equally applicable across secondary care, primary care, mental health services and some elements of social care provision. The commissioner landscape is changing rapidly, with the relationship between the roles of the Clinical Commissioning Groups (CCGs), National Commissioning Board and local authority commissioning arrangements still to be fully established. Working as we do across five local Boroughs (plus the additional five areas covered by the dental network), our assessment of the market takes into account the intentions and plans of five main CCGs, three primary care trust (PCT) clusters and five local authorities, each of which is functioning in the context of its own Joint Strategic Needs Assessment (JSNA). Our commissioners’ intentions are summarised in the diagram opposite:-

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Bridgewater Summary Integrated Business Plan 2012-2017


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Figure 5 - Summary of Commissioning Strategies Commissioners’ Golden Thread Service Principles

Commissioning Intentions

Quality

Innovation

Productivity

Prevention

Care Outside Hospital

Patient-Centred Care

Integrated Service Delivery

National Policy Drivers

WIGAN

WARRINGTON

HALTON

ST HELENS

TRAFFORD

DENTAL

Urgent Care Reform

Urgent Care Reform

Urgent Care Reform

Urgent Care Reform

Urgent Care Reform

Specialist Dentistry

LTC Management

Integrated Community Nursing

Integrated Community Nursing

Integrated Community Nursing

Cancer

Specialist Paediatric Dentistry

End of Life Care

COPD & CHD Pathways

COPD & CHD Pathways

COPD & CHD Pathways

HV Expansion

Community OPD

Community OPD

Community OPD

IAPT

Risk Stratification

Risk Stratification

Risk Stratification

Stroke Care

Teenage Pregnancy

Teenage Pregnancy

Teenage Pregnancy

Community Cardiology

Alcohol

Minor Oral Surgery

Cancer

Bridgewater is leading the way on integration, with social care and prevention services being best placed within communities to form the “glue” between hospital and social care. Engagement with stakeholders such as each of our main local authorities, GPs, voluntary agencies and housing agencies has enabled us to further develop our model for integrated working within our health and social care economies and to embed this within communities.

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Building the Bridgewater Strategy The following diagram illustrates how Bridgewater has arrived at our strategy for meeting the health needs of our local populations in each of the areas we service and delivering on our commissioners’ intentions within the current regulatory and economic environment. Figure 6 - Building the Bridgewater Strategy

Population Characteristics • High levels of deprivation • Poor lifestyle choices • Growing elderly population • Growing younger population

JSNAs

Health Consequences

Commissioner Response:

• High levels of long-term conditions • Often multiple long-term conditions • People living longer with them

• Deliver QIPP • Reduce hospital spend • Reduce hospital capacity • Care closer to home • Better management of longterm conditions • Intergrated delivery

Financial context: Flattening of NHS revenues Demand projected to keep rising Significant growth in hospital spend QIPP Evidence of value for money

Current Service Response

Quality & Outcomes: • Performance Framework • Quality Impact Assessments

• Extensive hospital interventions • High rates of emergency admission • Hospital diagnosis • High use of outpatient services • High rates of planned admissions

THE BRIDGEWATER OFFER: COMMUNITY SERVICES AS A PLATFORM FOR SUSTAINABLE REFORM

QIPP: Intergrated Delivery. Personalisation. Care closer to home. Patient centred care Effective relationships. Productive Community Services. Telehealth. Service Line Management. Redesigned pathways Urgent care. Early diagnosis. End of life care. LTC Management. Diagnostics. Children & Families Prevention. Health Improvement

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Bridgewater Summary Integrated Business Plan 2012-2017


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To ensure that our key stakeholders are informed, involved and engaged with our development and direction, we have developed and implemented an engagement framework. As part of this, all key stakeholders have been involved in discussions about the development of the IBP, the development of our organisation and our future plans to meet the needs of our local communities. These discussions have been supportive of our plans but have also led to amendments to the IBP following stakeholder feedback. In addition to the changing commissioner relationships at a local level, the national imperatives of the Health and Social Care Act (2012) open up the NHS provider market for community services. The ‘Any Qualified Provider’ (AQP) initiative is both an imminent challenge and an opportunity. It requires a step change in our approach to service delivery and to our ability to accurately assess our cost base and understand our current models of provision. Understanding the impact of AQP initiatives on whole services is critical in order to determine service viability where AQP initiatives remove key pathway steps which in turn may compromise profitability of the pathway.

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The Bridgewater Offer Community trusts are uniquely placed to support the reduction in avoidable attendance and admission to hospital, working as we do at the population level within local areas, in partnership with patients, families and general practices. In this way community trusts support local quality, innovation, productivity and prevention (QIPP) challenges by freeing up acute trusts to reduce their footprint and remain viable within an overall shrinking NHS resource envelope. Bridgewater is increasingly delivering and facilitating the provision of integrated care pathways with hospitals and local authority partners, recognising the need for risk sharing and true partnership working. We expect this approach to grow as demand rises due to the ageing population and the rising incidence of long-term conditions. We intend to stimulate discussion between Bridgewater and our commissioners, local authorities, Health and Wellbeing Boards, GPs, NHS providers and other partners which will result in us collectively realising the dividend that community services can bring to the NHS in these challenging times. Much work is taking place within the boroughs that Bridgewater operates.

Figure 7 - The Bridgewater Offer

Specialist Care for Vulnerable Minorities

Cost benefit of large population base

Personal Care for Long Term Conditions

Working in partnerships, avoiding admissions

Universal Services Early Years to End of Life

0-19 yrs, frail elderly, dementia

Self-Care and Wellbeing Services for Whole Populations

Public health related long-term demand

We can anticipate that competition and choice will be broadened out over the coming years and our challenge as a newly formed organisation is to flex our service offer to respond to the choice agenda within an overall reduction in resources.

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Bridgewater Summary Integrated Business Plan 2012-2017


Service Developments

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Bridgewater’s service developments link directly with its strategic objectives and the commissioning intentions of our local CCGs, local councils and Health & Wellbeing Boards. They are developed with a view of the market and economic situation in which we operate and are refined in consultation with partners. The key strands of the service development plans in Bridgewater are around the following areas: • Building on the strong foundations of services that we already provide, we will shape the local agenda, delivering holistic, innovative and integrated models of care by working in partnership with patients, carers and their families. • Working in partnership to deliver a platform of integrated care with partner organisations to meet the growing health needs of our communities. • Improving the delivery of care in community settings, bringing care out of hospital and developing services closer to people’s homes. • Improving access to services: educating, informing and empowering people, to maximise their ability to use them. Removing barriers that prevent access by minority groups. • Improving people’s health, aiming to help them stay healthier for longer and using all our staff to focus on ill health prevention. • Educating and enabling citizens to manage their own long-term conditions, as well as their wellbeing and quality of life, promoting self-care and maximising their potential wherever possible. • Providing universal services, that fully meet the health and social care needs of individuals within whole populations, from birth to death. • Utilising innovative and cost effective approaches, including technology, to deliver community healthcare and provide more immediate communication and monitoring, with easier access for patients. The Trust is developing business cases to generate new or changed services that support improved service efficiency and improved quality and effectiveness to support the delivery of long-term financial viability of the organisation. In addition, bringing Bridgewater together has created opportunities for development and re-organisation of services. The following developments do not require investment from commissioners and are largely within our gift to make happen.

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Figure 8 - Service Initiatives

Description of Initiative

Commissioning Drivers

Integrated Care Teams (All Divisions) Neighbourhood, locality and borough-wide teams of multi-disciplinary and multi-organisational professionals will offer care ‘wrapped around’ GP practice lists supporting the needs of risk stratified patient groups, supporting the management of long term conditions, offering tailored care and support and drawing down more specialist community-based services where necessary and reducing demand for expensive hospital intervention.

• Care closer to home • Management of long term conditions • Reform of urgent care • Improving access

We will work with partners across sectors to identify groups or populations that may not be engaged or registered with GPs.

• QIPP

As well as delivering a reformed model of care within, or closer to patients’ homes, this model of delivery will incorporate a number of other service developments.

Redesign of Offender Healthcare (ALW and Warrington) A review of the three custodial establishments across Bridgewater has identified significant improvements in service delivery which may be available by streamlining the provision of GP, advanced nurse practitioners and pharmacy services. The Merseyside Cluster are involved in a project around improving offender health and their care records, taking into account the higher incidence of offenders with learning difficulties. By working together with colleagues across offender health, benefits of support and sharing best practice will develop the service.

• Management of long term conditions • Avoidance of hospital admission • Reform of urgent care • QIPP

The considerable expertise around offender healthcare provision could develop into new business in further establishments, custody suites etc.

Wheelchair Services Hub and Spoke It has been recognised that the wheelchair services across the organisation deliver high volume, low cost, low complexity services alongside low volume, high cost, and high complexity services. In all cases the current services have challenges to address and each strand of the service requires a different solution. Recognising the scarcity of expertise, a hub and spoke model is proposed for wheelchair assessments, delivery of products and maintenance.

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• Care closer to home • Management of long term conditions • QIPP

Bridgewater Summary Integrated Business Plan 2012-2017


Figure 8 - Service Initiatives cont.

Description of Initiative

Commissioning Drivers

Specialist Services Redesign One of Bridgewater’s key strengths is the availability of highly specialised community based services. By their very nature, these tend to be small services so there are opportunities of scale and efficiencies of management structures by reviewing across the whole organisation that will increase the resilience of these services and hence increase their ability to reach some of our most vulnerable patients.

Redesign of Out of Hours Services (ALW and Warrington) A review of out of hours services across the Bridgewater footprint to look at opportunities to improve the use of scarce resources, particularly there are opportunities to review call handling, triage and clinical advice.

• Care closer to home • Avoidance of hospital admission • Reform of urgent care • QIPP

• Care closer to home • Avoidance of hospital admission • Reform of urgent care • QIPP

Customer Centre of Excellence Bridgewater’s opportunity to bring together the functionality and accessibility of a Call Centre will deliver a single point of access to our services for the public and professionals. Its potential has yet to be fully explored but it is envisaged that it will be a key hub for our engagement with the public and access to patient services support where required.

• Care closer to home • Management of long term conditions • Reform of urgent care • QIPP

Walk-In Centres (ALW and HSH)

• Care closer to home

In common with other services, there are opportunities of scale and sharing expertise.

• Reform of urgent care • QIPP

Our Business Plan also details our intentions for innovative and effective service developments which will meet the needs of local people without having to rely on hospital based services. These will require investment from commissioners or reinvestment of efficiency savings in order to happen.

Bridgewater Summary Integrated Business Plan 2012-2017

25


Figure 9 - Service Developments

Description of Initiative

Commissioning Drivers

Telehealth This development supports the work of the Integrated Care Teams and is a key enabler supporting more effective management of long-term conditions in the community. It allows patients with long-term conditions to monitor and manage their health and supports self-care. A viable opportunity to increase efficiency and effectiveness for services such as COPD could be addressed within current work streams with the Advancing Quality Alliance (AQUA).

• Avoidance of hospital admission • Self-management of longterm conditions • QIPP

Community IV Therapy This development will increase the provision of home IV therapy services for patients with a defined diagnosis of infection or other conditions requiring IV therapy. It provides a safe alternative to hospital admission. It is also proposed to extend the service to further reduce hospital admissions by offering blood transfusions and chemotherapy in the community.

• Care closer to home • Management of long term conditions • QIPP

Every Contact Counts Developing self-care initiatives to provide information, services and advice to people to assist them to manage their own health for longer will be the key to managing future demand for services. Ensuring that every contact made by a community health practitioner also has an element of health promotion and ill health prevention will assist with this delivery.

• Care closer to home • QIPP

Enhanced Diagnostic Support To support the work of the integrated delivery teams and to manage demand for hospital referral and outpatient appointment, the Trust would build upon existing community diagnostic services such as; • • • •

26

Community Cardiac Physiology Ultrasound Plain Film X-Ray Scoping

• Care closer to home • QIPP • Reform of urgent care

Bridgewater Summary Integrated Business Plan 2012-2017


Figure 9 - Service Developments cont.

Description of Initiative

Commissioning Drivers

Home DVT Assessment (Wigan)

• Care closer to home

Within the integrated delivery teams, capacity would be created to enable home deep vein thrombosis (DVT) assessment within a patient’s home or community setting thereby preventing the need for hospital referral.

• Reform of urgent care

Family Nurse Partnership (All Divisions) A specialised service offering direct support to our most vulnerable families.

• DVT assessment • QIPP • Family Nurse Practitioner (FNP) research • National Every Child Matters and parenting strategies

Call to Action Expansion of our health visitor workforce. In line with the national ‘Call to Action’ programme, the Trust is expanding its health visitor workforce in partnership with our commissioners across all localities.

• National ‘Call to Action’ policy

Pain Management An extension to our existing MSK services would enable management of chronic pain including the delivery of joint injections to take place in less expensive community settings.

• Care closer to home • QIPP

Dysfunctional-Uterine Bleeding Service Bridgewater will provide a community based service for the management of dysfunctional uterine bleeding. This will include assessment, investigation and treatment when appropriate by the insertion of Mirena intra-uterine device. This will mean that women presenting with the condition will be effectively managed and followed up within a community setting.

Bridgewater Summary Integrated Business Plan 2012-2017

• Care closer to home • QIPP

27


Figure 9 - Service Developments cont.

Description of Initiative

Commissioning Drivers

Family Planning Intra-Uterine Device (coil) Insertion Service (IUCD) Coil insertion is the preferred method of contraception for many women but access to family planning clinics at the appropriate time can be difficult to achieve. Bridgewater will provide family planning clinics specialising in coil insertion across the divisions aligned to complement existing primary care based family planning services.

• Care closer to home • QIPP

Early Diagnosis of Dementia

• Care closer to home

Bridgewater staff, particularly district nurses, health visitors and community matrons, are being educated to assess patients for dementia and to refer on to the most appropriate clinician.

• Dementia components of CCG strategies

Integrated Sexual Health / GUM Service This development will provide a fully integrated service with a hub and spoke “one stop shop” model. This will reduce duplication and provide a more efficient and effective service to clients who will receive appropriate advice and/or treatment at the point of access.

• Care closer to home • QIPP • National Policy

Offender Healthcare – Styal Prison Bridgewater is currently bidding for the tender to provide a comprehensive, integrated healthcare system across the prison community. The service will reduce the number of healthcare visits outside of prison and improve the health outcomes for offenders and reduce health inequalities. This will add to our current portfolio of three prison healthcare services.

28

• QIPP • Improving access • Avoidance of hospital admission • Care closer to home

Bridgewater Summary Integrated Business Plan 2012-2017


Performance

2

The development of a robust quality and performance management framework is a major priority for the Trust if we are to enhance our ability to demonstrate high quality delivery, efficiency and improved productivity. Work is advancing within the Trust and at a national level, therefore we are adopting relevant national “general” indicators, working to agreed community specific indicators with the Department of Health (DoH) and our peer trusts and consulting locally with our commissioners to ensure that our metrics are fit for purpose. Since April 2011, Bridgewater has been responsible for the performance of its four geographical divisions and the dental network, reporting to Trust Board and national bodies (situation reports (SITrep), referral to treatment times (RTT), accident and emergency (A&E), out of hours, prison health, units of dental activity (UDAs)) using nationally mandated standards. In addition, as contracts for Bridgewater services are broadly still based on a PCT footprint, each division reports to its lead commissioner on activity within the commissioner footprint. This arrangement will be superseded in 201314 with contract reporting directly to CCGs. Further information that describes the Trust’s current and future commissioning arrangements is detailed in Figure 10 below: Figure 10 - Commissioning and Performance Arrangements

Division

National Current Performance Commissioner Management

Board Performance Management

ALW PCT/CCG

Via NHS Greater Manchester (ends 1/4/13)

Halton & St Helens

Halton & St Helens PCT/ CCGs

Via NHS Merseyside (ends 1/4/13)

Warrington Division

Warrington PCT/CCG

Via NHS Cheshire (ends 1/4/13)

Trafford Division

Trafford PCT /CCG

Via NHS Greater Manchester (ends 1/4/13)

Activity, performance, contracts and Finance

Dental Division

Within each PCT / CCG area

Via national dental reporting arrangements

Clinical effectiveness and clinical outcomes

Ashton Leigh & Wigan

Board receives a comprehensive integrated performance report covering all aspects of Quality, safety & governance Human resources (HR), organisational development (OD) & improvement

The Board is supported by the Performance Sub-Committee to review appropriate performance issues in detail

Bridgewater Summary Integrated Business Plan 2012-2017

29


In 2011/12 the Trust met all of its quality targets and slightly over-performed on contracted activity, delivering over 2.6million patient contacts. The Trust manages performance within 4 domains : 1) Quality, safety, governance and risk 2) HR, organisational development and improvement, 3) Activity, performance, contracts and finance 4) Clinical effectiveness and clinical performance Comparative performance within relevant areas for Bridgewater provided services is outlined below in Figure 11. Our data shows that patients treated in Bridgewater services receive their care in a more timely way, to a high standard and in the majority of areas to a higher standard than both national expectation and regional averages. In all areas where lower than expected standards are seen, improvements are evident and underperformance is marginal. Bridgewater clinical services perform well above average, deliver high quality and safe care in a timely and patient friendly way. This places the Trust in a strong position to retain business, attract new business and assure commissioners and patients that patients and patient care is safe in our hands.

Figure 11 - Comparative Performance within Relevant Areas for Bridgewater

Domain

Quality,

Measure

Target

Patient

90%

Experience

Satisfaction

Prison Health

100%

standards

Compliance

2012-13 performance year to date (to July 12)

Regional average where available

Improvement or deterioration from last year

n/a

n/a

BWT Perf 97.5

Governance

and Wigan

Halton & CQUIN

St Helens

Compliance

Trafford

BWT Perf 100%

n/a

On target

n/a

Report

Target

July 12

Achieve

BWT Perf

Compliance /

On target

n/a

Report

Target

July 12

Achieve

BWT Perf

compliance /

On target

n/a

compliance / Target

Report July 12 BWT Perf

Achieve

30

Report

BWT Perf

Target

Warrington

Improved

July 12

Achieve Compliance /

Report July 12

Safety and

Ashton, Leigh

Source/ Date

On target

n/a

Report July 12

Bridgewater Summary Integrated Business Plan 2012-2017


Figure 11 - Comparative Performance within Relevant Areas for Bridgewater Cont.

Domain

Measure

Target

NHS Safety

Compliance

Thermometer

With Plan

2012-13 performance year to date (to July 12)

Regional average where available

Improvement or deterioration from last year

Source/ Date

BWT Perf Compliant

Report

n/a

July 12

CQUIN Compliance

SHA A&E Indicators

Compliance

Met

Met

Same

July 12 Report BWT Perf

Sickness Absence

4.70%

3.30%

n/a

Improved

Mandatory Training HR, OD and Improvement

Report July 12 BWT Perf

100%

91.36%

n/a

Improved

Report

Compliance

July 12

Safeguarding

BWT Perf

Training

100%

91% +

n/a

Improved

Report July 12

Compliance

BWT Perf PDR rates

100%

79.70%

n/a

Improved

Report July 12

Meeting Contracts

SHA

Activity

Met

n/a

Improved

Targets

July 12 Report

Activity, Performance,

A&E 4 Hour

Contracts &

Target

95%

99.83%

96.10%

Improved

to AUG 12

Finance RTT 18 Weeks Performance

SHA 95%

Above 99%

97.70%

Improved

Non Admitted

Report

Non Admitted 95th

July 12

SHA 18.3 Weeks

14 Weeks

Percentile

Bridgewater Summary Integrated Business Plan 2012-2017

15.5 Weeks

Same

July 12 Report

31


Figure 11 - Comparative Performance within Relevant Areas for Bridgewater Cont.

Domain

Measure

OOH (Carson Standards)

Target

2012-13 performance year to date (to July 12)

Compliant

NonCompliant on 2 Standards

Regional average where available

Improvement or deterioration from last year

Source/ Date

Improved

July 12

SHA Report SHA

Cancer 2 Weeks Waits

95%

100%

July 12 Report

Cancer 31 Activity,

Days to

Performance,

Treatment

SHA 94%

100%

96%

Improved

Report

Contracts & Finance

SHA

Cancer 62 days to

85-90%

100%

85%

Improved

July 12 Report

Treatment

SHA

Meeting GP Referral

July 12

Meet Plan

Met

Met

Same

July 12 Report

Targets Submit IAPT

Standard

Met

Met

n/a

Data Set

BWT TFA

Finance Surplus

Data Submission

Surplus Met

Met

Improved

Return July 12

FRR

3

BWT TFA 3

Same

Return July 12

EDITDA Finance

Margin

EBITDA Achieved

BWT TFA 1

1.8

Improved

Return July 12 BWT TFA

100%

105.7

Improved

Return July 12 BWT TFA

I&E Surplus

1%

1.60%

Improved

Return July 12

32

Bridgewater Summary Integrated Business Plan 2012-2017


Figure 11 - Comparative Performance within Relevant Areas for Bridgewater Cont.

Domain

Measure

Target

2012-13 performance year to date (to July 12)

Regional average where available

Improvement or deterioration from last year

BWT TFA

Debtor Days >90 days,

Source/ Date

Met

Improved

Not Met

Return July 12

5% Tolerance Finance Prior Year Contracts

BWT TFA Met

Same

Met

Closed

C Difficile Infections Clinical

SHA None

July 12

Met

Report

Mixed Sex

Efectiveness

Accd’n

and Clinical

Breaches

Return July 12

SHA 0

0

2

Same

July 12 Report

Performance Vaccination and

Met

Exceeded

Immunisation Targets

Bridgewater Summary Integrated Business Plan 2012-2017

BWT TFA Same

Return July 12

33


Financial Performance Our financial plans What are we trying to achieve? • Delivering surpluses to allow for a significant capital investment to improve the quality of our I.T. systems and buildings to support service modernisation. • Delivering increased efficiencies whilst maintaining and improving the quality of our services. • Managing changes in service delivery and care pathways in partnership with our stakeholders. • Ensuring workforce changes are managed effectively. • Delivering short, medium and long-term financial viability whilst contributing to the overall financial sustainability of the health economies in which we operate. What are we going to deliver? Our financial plans are to: • Put aside on average £1.6m (approximately 1% of turnover) each year in order to make the planned improvements to our I.T. systems and buildings and to create a small financial cushion to help us to manage future risks. • Spend £11.8m on IM & T, estates and medical equipment to improve the quality of our services provided to patients. • Deliver £46.3m of savings by being more efficient, innovative and productive. • Get the balance right so that we achieve financial stability whilst at the same time improving the quality of our services.

34

Bridgewater Summary Integrated Business Plan 2012-2017


Key Financial Figures 2012 - 2018 Figure 12 - Income and Expenditure Projection Summary 2012/13 £m

2013/14 £m

2014/15 £m

2015/16 £m

2016/17 £m

2017/18 £m

163.3

160.7

157.8

156.1

154.4

152.7

4.6

4.5

4.4

4.3

4.3

4.2

Total income

167.9

165.2

162.2

160.4

158.6

156.9

Pay Expenses

(116.3)

(114.6)

(112.2)

(109.9)

(107.6)

(105.4)

Non-pay Expenses

(49.4)

(46.9)

(46.2)

(46.5)

(46.9)

(47.3)

(165.7)

(161.5)

(158.4)

(156.4)

(154.5)

(152.7)

2.2

3.6

3.8

4.0

4.1

4.2

EBITDA Margin

1.3%

2.2%

2.3%

2.5%

2.6%

2.7%

Non-operational Expenses

(0.5)

(1.8)

(2.1)

(2.5)

(2.6)

(2.4)

Surplus

1.7

1.8

1.6

1.5

1.5

1.7

1.0%

1.1%

1.0%

1.0%

1.0%

1.1%

Domain Clinical Income Other Operating Income

Total expenses EBITDA

Net Margin

Figure 13 - Productivity Impact (excluding any service developments) 2012/13 Domain Activity Increase

2013/14

2014/15

2015/16

2016/17

2017/18

1.96%

1.81%

2.20%

2.10%

1.83%

Contacts (000)

3,176

3,238

3,297

3,370

3,440

3,503

Clinical Staff (wte)

2,375

2,317

2,254

2,166

2,082

2,001

Contact/Week

31.8

33.3

34.8

37.0

39.3

41.7

Contacts/day

6.4

6.7

7.0

7.4

7.9

8.3

Bridgewater Summary Integrated Business Plan 2012-2017

35


Risk Bridgewater has established a robust governance assurance process in order to assess the viability of the Trust’s CIP both from a financial stand point and a quality impact perspective. The governance arrangements that the Trust has adopted have benefited from the recommendations within the joint Monitor and Audit Commission good practice guide entitled ‘Delivering Sustainable Cost Improvement Programmes’. Bridgewater has a strong track record in delivering a significant level of CIPs and the forward targets are felt to be realistic and achievable. Detailed plans exist for 2013/14 and 2014/15 with outline themes and high level plans for the remaining three years of the planning period. The staffing impact in respect of estimated headcount reductions and impact on productivity has been estimated for all five years.

Key Risks The major risks facing the organisation with the financial impact have been identified as follows: • CIP Shortfall – Where our CIP performance falls short by 15% in year one then 10% in each year thereafter and resolved in the subsequent year. • Financial Pressure – Monitor routinely imposes an additional 0.5% cost pressure (per year) to applicant’s base cases. This could represent regulatory changes, price competition, inflationary increases, etc. • Activity Growth – It is assumed that there is activity growth of 1.2% per year with no income growth. Associated costs (clinical staff costs, drugs, clinical supplies) rise proportionately. • AQP – The assumption is that in year two, the Trust loses approximately 4% income, but is only able to lose 50% of the associated costs. • Price Competition (whether through local QIPP targets or other) – this causes a fall in income of 1% each year in years three to five. Although the Board has identified mitigation for each of these risks, these sensitivities have been combined to form a downside, and the table overleaf summarises the financial impact of the downside as follows:

36

Bridgewater Summary Integrated Business Plan 2012-2017


Figure 14 – Income and Expenditure (I&E) Impact of Downside Scenario Sensitivity Domain

Explanation

CIP Shortfall

Underachievement by 15% in Year 1, 10% in Years 2-5, 50% recovered in one year, 100% recovered in two years

Monitor

Additional Financial Pressure Equivalent to 0.5% Reduction in Income/Year

FY14

FY15

ÂŁm FY16

(1.1)

(1.5)

(1.3)

(1.3)

(1.3)

(0.7)

(1.5)

(2.2)

(3.0)

(3.8)

(1.0)

(2.1)

(3.3)

(4.5)

(5.7)

FY17

FY18

Activity Increase of 1.2%/Year,

Activity Growth increase in associated costs of 1.2%, no additional income

AQP

Loss of 4% Income FY15, 50% of AQP Services Covered by TUPE

0.0

(3.0)

(0.8)

(0.7)

(0.7)

Price Competition

Income to Fall by 1% FY16FY18, No Effect on Activity

0.0

0.0

(1.4)

(2.8)

(4.3)

Total Effect

(2.8)

(8.1)

(9.0)

(12.3)

(15.8)

Surplus Domain Base Case

FY14

FY15

FY16

FY17

FY18

1.8

1.6

1.5

1.5

1.7

Downside

(1.0)

(6.5)

(7.5)

(10.8)

(14.1)

Cash Domain Base Case

FY14

FY15

FY16

FY17

FY18

4.5

6.2

7.8

9.4

10.9

Downside

1.6

(4.8)

(11.9)

(22.5)

(36.7)

2

1

1

1

1

Financial Risk Rating Domain

In order to mitigate against the downside, a series of actions and financial estimates have been worked up and these are summarised overleaf together with the financial impact from mitigation.

Bridgewater Summary Integrated Business Plan 2012-2017

37


Figure 15 - Mitigating Actions FY14

FY15

ÂŁm FY16

Pay Freeze/Review of Terms & Conditions

0.2

1.0

1.8

2.6

3.5

Exploit Income Opportunities

0.0

0.5

0.8

1.7

1.9

Manage Activity to Avoid Excessive Cost Growth

1.0

2.1

3.3

4.5

5.7

Control Non-Critical Spend

0.7

1.1

1.2

1.2

1.4

Increase Efficiencies

0.0

0.5

1.1

1.4

1.8

Other

1.8

1.4

1.1

1.1

1.0

Total Effect

3.7

6.6

9.3

12.5

15.3

Surplus Domain Base Case

FY14

FY15

FY16

FY17

FY18

1.8

1.6

1.5

1.5

1.7

Downside

(1.0)

(6.5)

(7.5)

(10.8)

(14.1)

2.7

0.3

1.8

1.7

1.2

FY14

FY15

FY16

FY17

FY18

Domain Base Case

4.5

6.2

7.8

9.4

10.9

Downside

1.6

(4.8)

(11.9)

(22.5)

(36.7)

Mitigated Downside

5.6

6.0

7.5

9.3

10.3

3

3

3

3

3

Sensitivity

Explanation

Domain

Mitigated Downside Cash

Financial Risk Rating Domain

38

FY17

FY18

Bridgewater Summary Integrated Business Plan 2012-2017


Cost Improvements and Quality of Care Given the need to make significant savings through recurrent productivity and redesign programmes, the Board ensures that quality impact assessments are undertaken by the Medical Director and the Executive Nurse on all CIP proposals, since safety and effectiveness must not be compromised in any circumstances. Where appropriate, we are rolling out the uptake of new technologies to deliver patient care in innovative ways to improve the patient experience.

Clinical Quality Strategy The Trust has in place an Integrated Clinical Quality Strategy whose components are illustrated below: Figure 16 – Quality Services Target Learning Culture Audit / R&D New Technologies

Inequalities / Public Health

Promotion / Marketing

Quality & Safety (Clinical Governance)

Sustainability

Stakeholders

Public & Patient Engagement

Financial Balance / VFM Workforce Clinical Engagement

Bridgewater Summary Integrated Business Plan 2012-2017

39


The Trust has developed and is embedding a “Quality Dashboard” that allows services, divisions and the Trust Board to monitor, review and target key quality indicators. The Trust has agreed with commissioners, and is leading nationally, on a programme to implement an outcomes framework in the next contracting round. This will ensure that services are commissioned and provided based on clinical value, patient and population outcomes and quality of service. The Quality Strategy underpins our commitment to excellence by setting up four key domains; 1. 2. 3. 4.

Patient experience and involvement Clinical effectiveness Patient safety Governance

Each of these domains has clear objectives, well defined targets and trajectories and clear monitoring and success criteria so that the Board can track our progress and drive the quality agenda forward within Bridgewater. Patient Experience and Involvement • Develop a Bridgewater patient charter. • Ascertain patient’s views regarding the quality of our services on a regular basis ensuring that patients. ➢ ➢ ➢ ➢

Are treated with respect and dignity Are provided with appropriate information or advice Have confidence and trust in health professional(s) Receive the care that mattered to me

• Conduct staff Surveys within Bridgewater on a regular basis, in addition to the National Staff Survey, to ensure staff are: ➢ ➢

Listened to and involved in shaping our decisions and strategic approaches Motivated to provide the best patient experience

• Ensure lessons learnt from complaints/PALS are identified, acted upon and shared across the organisation. • The Trust will continue the implementation of the “Important Choice‟ agenda (End of Life Care Pathway) supporting patients to be cared for in the place of their choice. • The Trust will implement the new model for health visiting –“A Call to Action Health Visitor Implementation Plan‟.

40

Bridgewater Summary Integrated Business Plan 2012-2017


2

All Divisions will develop alternative methods of seeking service feedback including for example: ➢ ➢ ➢

SMS texting Family Echo Care Cards

• The Trust will engage Members and Governors in ensuring the Board receives timely patient experience feedback via: ➢ ➢ ➢

Council of Governors Regular Involvement Activities Annual Member Survey

Ascertain Members and Governors views regarding the quality of our services and areas for quality improvement. Clinical Effectiveness • Clinical Network forum to drive forward continuous improvement of services for patients, and their carers/families through clinical engagement. • To focus on the development of care pathways (map of medicine) specifically for end of life, dementia, cancer, and early diagnosis, and other long term conditions managed through Urgent Care and Specialist Services networks. • To maximise the potential for an integrated approach to providing effective and efficient care patient care across the health and social care economy. • Bridgewater will put in place a communication technology (telehealth/telecare) and resource programme to support self-care and increase health literacy within its patient and carer population. Whilst delivering efficiency gains by supporting patients to manage their care and live more independently. • Review Bridgewater offender health provision to reduce inappropriate variation and maximise quality of services provided. • To improve life chances for children aged 0-5 by improving the level of access and support to families with children from 0-5 in line with the DoH Health Child Programme (2009). • Development of a range of clinical effectiveness and performance indicators.

Bridgewater Summary Integrated Business Plan 2012-2017

41


Patient Safety • Increase patient safety incident reporting and reducing actual harm levels. • Reduce or contribute to the reduction of:➢ ➢ ➢ ➢

Community developed or deteriorating pressure ulcers Residential home and acute trust developed or deteriorating pressure ulcers Catheter acquired infections in the community Falls in inpatient and intermediate care facilities

• Maintain adherence to the requirements of Hygiene Code of Practice. • Establish a culture of “no avoidable infections. • Implement a comprehensive, consistent, and patient centred approach to risk management across the Trust. • Establish and maintain safe and clean community premises which are fit for purpose.

Governance • Reconfigure a governance structure that reflects the needs of the new organisation. • Ensure effective monitoring of Clinical Quality Strategy to ensure key aims and objectives are realised. • Ensure compliance with the Monitor Quality Governance Framework (July 2010.) • Ensure Bridgewater learns the lessons from all relevant national reports and enquiries. • Implement an integrated business intelligence reporting framework (SLR/SLM) across all service lines to ensure heads of service, divisional directors can monitor and report on their performance from service line to board. • Implement a programme of ‘walk-rounds’ to monitor the environmental standards within clinics, led by Executive and Non-Executive Directors. • Ensure Bridgewater quality impact assessment tool (QIAT) is completed for all cost improvement plans (CIPS) and service redesigns. • Maintain CQC registration without conditions for all regulated activities.

42

Bridgewater Summary Integrated Business Plan 2012-2017


Workforce & Leadership

2 2

Our Five Year Workforce Plan It is recognised that our workforce is our most valuable resource and that the staff are ambassadors for our mission and vision and also for creating our reputation of a highly performing and responsive organisation. Our workforce’s support of our development and growth is matched by a commitment from the organisation to their future learning and development needs, which supports their personal ambitions for the future, an improved patient experience and the organisation’s need to be flexible to meet the future demands of the evolving NHS. We know that having access to high quality training and development is vital to our professional staff and is a key factor in recruiting and retaining a high quality team. Our patients tell us that knowing our staff have the right skills to meet their needs is very important to them. We identify specific clinical learning needs to respond to short and long term service needs ensuring staff are provided with ongoing skills development to support service improvement and redesign. In order to ensure the high quality leadership and people management that are crucial if we are to meet the new agenda and the expectations of people who use our services, we have developed a leadership model to support the continued development of leaders at all levels of the organisation. To continue to deliver the scale of change required and to respond to the challenges, Bridgewater will continue to work to ensure we have a robust, integrated workforce plan. The following assumptions have been made in planning for our future workforce: • Funded vacancies will need to be included in our staffing baseline. • Where posts have been offset against a CIP these posts will be removed from the funded establishment figure/baseline. • Our health visitor staffing levels will increase year on year in line with our trajectory, with a commitment to training and supporting students on the widening access programme. • Administrative and clerical staffing levels will not increase, but staff will be deployed to effectively support clinicians. • Our Health Improvement team staffing levels will remain static as discussion on public health provision is concluded with our local authority colleagues.

Bridgewater Summary Integrated Business Plan 2012-2017

43


• There will be a rationalisation of ‘back office’ functions. • Consultant medical input will not decrease; however, effective partnerships with specialist providers will be explored. • Sickness levels will decrease. • There will be a reduction in the use of bank and agency staff. • There will be a more agile workforce, working in different ways, utilising technological advancements that will impact on our estate requirements. • The support worker roles will be developed. • There will be a need to reduce or remove some roles within the Trust via voluntary or compulsive redundancy or mutually agreed resignation terms.

Senior Leadership of the Trust To realise the ambitions of the IBP, we demonstrate strong and effective leadership at every level of the organisation and engender a shared commitment to the realisation of our objectives. The Board consists of five Executive Directors from within the organisation plus a Chairman and seven Non Executive Directors. The Executive Directors are: the Chief Executive Officer (CEO); the Director of Finance; the Director of Operations; the Executive Nurse / Director of Governance; who is responsible for quality, safety and standards; and the Medical Director. The Director of Human Resources and Organisational Development attends Board but is a non-voting member. The Senior Management Team also includes a Director of Clinical Performance whose remit is to develop our corporate performance framework and service line management systems. This Director is not a Board Member, but is directly accountable to the CEO. Similarly, there is a Director of Corporate Development who reports to the CEO and is responsible for communication, strategic relationship management and new developments. Board members have a broad range of skills and experience. We have initiated a Board Development Programme and are committed to its full implementation. The Board has in place an extensive Assurance Framework which is reviewed on a quarterly basis, with the implementation of the framework being carried out and monitored by the Senior Management Team. The Board pays particular attention to quality and safety, inviting patients to tell their stories and undertaking “walkabouts”.

44

Bridgewater Summary Integrated Business Plan 2012-2017


Our Board

Harry Holden

Dr Kate Fallon

Chairman

Chief Executive

Karen Bliss

Steve Cash

Baron Frankal

Non Executive Director and Chair of Audit Committee

Non Executive Director

Non Executive Director

Sue Musson

Bob Saunders

Colin Scales

Non-Executive Director/ Designate Senior Independent Director

Non Executive Director and Chair of Quality and Safety Committee

Executive Director of Operations

Bridgewater Summary Integrated Business Plan 2012-2017

Bridgewater Integrated Business Plan 2012-2017 45


Mike Treharne

Dr Steve Ward

Dorothy Whitaker

Executive Director of Finance, Information and Performance / Deputy Chief Executive

Executive Medical Director

Vice Chair and Non Executive Director

Dorian Williams

Sally Yeoman

Executive Nurse/Director of Governance

Non Executive Director

Christine Samosa Director of Human Resources and Organisational Development

46

Bridgewater Summary Integrated Business Plan 2012-2017


Bridgewater Community Healthcare NHS Trust

Contacts Membership Anyone aged 14 years or over who lives in England is eligible to become a public member. Find out more about membership at www.bridgewater.nhs.uk or email membership@bridgewater.nhs.uk or call 01942 482672. Comments If you have any comments on this document or require it in another language or format please contact 01942 482655 or email communications@bridgewater.nhs.uk. Headquarters Bevan House, 17 Beecham Court, Smithy Brook Road, Wigan, WN3 6PR Telephone: 01942 482630 Email: enquiries@bridgewater.nhs.uk For more information on our Trust visit our website: www.bridgewater.nhs.uk

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