Operational Plan - 2023/24

Welcome

We strive to provide excellent care for the communities we serve, continuing to make significant progress on our journey of improvement. This is an exciting year for the Trust with significant improvements and investment planned that will benefit patients and colleagues.

This Operational Plan sets out our collective priorities for 2023/24 to tackle our challenges and drive forward our key transformational programmes. It builds upon the positive progress we made in 2022/23, which also provides strong foundations for the year ahead. We continue to face significant pressures and have worked with leaders across all divisions to develop this year’s plan. We have set ourselves ambitious objectives which we will progress together for the year ahead.

2023/24 presents significant opportunities for the Trust, through our transformation and improvement programmes. This plan highlights the five objectives and five enablers that we will focus on for the benefit of our patients and colleagues now and for the future. This includes the launch of the first phase of the Electronic Patient Record (EPR), which is critical to improving our digital systems and will benefit the delivery of patient care.

Quality is the golden thread throughout this plan. Led by our clinical colleagues, our nine quality priorities focus on key areas to improve care and patient experience for everyone.

We know that our valued colleagues are central to the successful delivery of this Operational Plan and we remain incredibly grateful for the dedication and care demonstrated everyday. We can’t underestimate how important our colleagues are to delivering these objectives. Everyone has a role to play and we encourage every team to have a conversation about how they will support the delivery of this plan.

Sharing this plan will support every team and individual to have clear objectives setting out how their contribution can make a difference to these key priorities.

We remain absolutely committed to supporting our colleagues through our People Promise. We will continue to listen to suggestions and ideas from colleagues. Sometimes the smallest idea can make the biggest difference and we encourage everyone to take part. Our Improvement Hub can also support, email them at: sath. improvementhub@nhs.net

These objectives and enablers are critical to the Trust and we are confident that by working together we can deliver tangible improvement now and for the future.

Quality remains our overarching priority and is a golden thread throughout this plan.

Dr Catriona McMahon Chair

Louise Barnett Chief Executive Officer

Vision and values

Our vision is to provide excellent care for the communities we serve. The Trust strives to provide high quality, safe care for our patients in an environment in which our staff are proud to work.

We believe that by adhering to our Vision and working with our Values in mind we will behave in a way which will ensure a positive experience for the people that matter most – our patients and their families.

• Partnering – working effectively together with patients, families, colleagues, the local health and care system, universities and other stakeholders and through our improvement alliance.

• Ambitious – setting and achieving high standards for ourselves personally and for the care we deliver, both today and in the future. Embracing innovation to continuously improve the quality and sustainability of our services.

• Caring – showing compassion, respect and empathy for our patients, families and each other, caring about the difference we make for our community.

• Trusted – open, transparent and reliable, continuously learning, doing our best to consistently deliver excellent care for our communities.

Partnering Ambitious Caring Trusted

Our achievements 2022/23

Medicine and Emergency

c.1,900 patients benefitted from care by clinicians through the new Acute Medical Floor at RSH

3 new consultants recruited to create a new department of general internal medicine

80+ new international nurses

2 Ambulance Receiving Areas opened

102,526 Emergency Department attendances

Cardiology inpatient services moved to PRH in 2022

100+ patients supported through Virtual Ward with Shropshire Community Health NHSTrust enabling timely discharge from hospital

Surgery, Anaesthetics and Cancer

Reduced waiting times with no patients waiting over 104 weeks at the end of March 2023.

12,475 elective operations under surgery

£24million invested in a Planned Care Hub for PRH –building work started

1 new digital robotmodernising surgery

Refurbishment of Intensive Treatment Unit (ITU) at RSH

Oncology and haematology assessment area opens

Endoscopy suites at PRH and RSH expanded providing a better patient experience

Re-opened Ward 36 at PRH delivering elective orthopaedic services

Successful recruitment to theatre nursing roles at both hospitals - including supporting the development of our own staff

Bluespier technology introduced to theatres - live management of theatre utilisation and productivity supporting elective recovery

Successful pilot of trauma assessment unit at RSH on ward 31 supporting flow in the hospital

Women & Children’s

4,163 babies born

Achieved all 10 actions for the Clinical Negligence Scheme for Trusts (CNST) - improving maternity and neonatal safety

77% of Ockenden actions fully evidenced –ahead of schedule

1:1 care delivered in maternity since June 2022

100% of midwifery preceptees (Band 5-Band 6) chose to stay with the organisation

Saving Babies Lives Bundle fully delivered and embedded

All key leadership roles filled Delivered Cost Improvement Programme (CIP) of 235k against a plan of £230k

Improved staff survey response by 19%

Clinical Support Services

30,552 MRI scans

84,474 CT scans

Amongst first Trusts to develop an apprenticeship programme in radiology - 3 apprentices “growing our own”

Recovery of breast screening waiting times eliminated backlogseeing 17,000 women

Therapy Operating Department Practitioners (ODP) commended by OPD transformation team as the best performers for Patient Initiated Follow Up (PIFU) and Virtual Consultations

Improvement in Radiology

DM01 performance and recovery - 78% March 2023

The Commissioning for Quality and Innovation (CQUIN) targets linked to medicines all met their criteria in the last quarterly update (Pharmacy)

Dedicated celebration weeks to recognise our pharmacy teams

Reduced backlog for plain films from 9,000 to Zero

The Cellular Pathology Service is one of the top 10 performers regionally

Created a specialist therapy unit for Neonates.

Corporate

Significant £14.83 million investment secured to upgrade digital infrastructure by 2026

Strategic Outline Business Case approved for the Hospitals Transformation Programme –one step closer to securing £312 million much needed investment

Business Assurance Framework in place –strengthening governance

1,139 people joined our Community Members -supporting engagement with local communities. 3,730 members in total.

Complaints Peer Review Panel established providing independent oversight

Enhanced Care Supervision (ECS) team launched to support patient care

Discharge lounges extended to support safe and timely discharges

Shropshire Healthcare Procurement Service wins Health Care Supply Association (HCSA) award

Finalist for the Nursing Times Student Nurse Awards

Over 750,000 meals served for patients

Our Chaplains supported over 5,600 visits to patients

Our People

183 apprenticeships supported 92 international nurses recruited 532 individuals joined our Temporary Staffing Bank

Staff Psychology Service established 90% mandatory training compliance helping staff stay safe and deliver safe care

90,000 education courses completed 7 Schwartz rounds completed building a learning culture

Supported our first cohort of colleagues through the Galvanise Leadership Programme 239 colleagues attended leadership masterclasses

49% of colleagues completed the 2022 NHS Staff Survey informing our action plan

Financial wellbeing package in place supporting colleagues

26,475 hours given by our valued volunteers

Train the Trainer programme launched to enhance basic life support skills

Reduction in vacancy rates from 9.2% in December 2022 to 6.8% in March 2023

Leadership Development

Framework embedded

Launched our Strive Towards Excellence Programme (STEP) for new managers

Finalist for 2023 HPMA awards

23 Registered Nurse Degree Apprenticeships studying

1 2 4 3 5

Our objectives 2023/24

Building on our work over the last few years, we have five core objectives for the coming year which will provide focus and move us forward in our improvement journey.

We will...

Deliver phase three of our Getting to Good Programme to continuously improve care for our patients and community standards

• Assure ourselves that new processes and improvements are sustainable

• Validate metrics, to ensure they measure success

• Sign off sustainable improvement projects through evidence gathering and a governance framework

• Share successes across the organisation

We will...

• Achieve zero 65 week waits by end of March 2024

Restore and sustain elective orthopaedics and other services

• Ensure all waiting lists are administratively validated to maximise capacity

• Achieve 5% Patient Initiated Follow Ups (PIFU)

• Achieve 25% virtual outpatient appointment

• Achieve 85% theatre capacity

• Ring fence elective orthopaedic capacity

We will...

Achieve the 28 day faster cancer diagnosis standard for patients

• Ensure 75% of patients receive a diagnosis and are informed by day 28 of their pathway

• Maximise all diagnostic capacity

• Ensure all patient lists are accurate, through robust patient tracking

We will...

• Improve discharges before midday and utilisation of the discharge lounges

Improve flow through our hospitals by delivering our Emergency Care Improvement Programme

• Implement criteria led discharge at weekends

• Utilise Virtual Ward capacity

• Reduce length of stay for inpatients

• Reduce the number of patients in hospital over 14 and 21 days

We will...

Improve efficiency, deliver within our budget, demonstrating financial prudence and making every penny count

• Reduce our expenditure on expensive temporary staffing, for example, agency staff, by recruiting to our vacancies and reviewing the required staffing every day

• Play our part to reduce the dependency on escalation space which is unplanned, inefficient and does not offer the best care for our patients

Our enablers

In addition to our five objectives we have identified five key enablers, which will help ensure success. 1 2 3 4 5

Value difference and live the People Promise in our teams

Progress our Hospitals Transformation Programme plans to improve care for all

Implement phase one of our Electronic Patient Record (EPR) programme - includes replacing the Patient Administration System

Estates – develop an estates plan to optimise our current estate

Information Governance – improve culture and practices

Our quality priorities

Patients are at the heart of what we do. Our quality leads, working with all divisions, have agreed the core quality priorities for 2023/24. These priorities will be embedded in everything we do to deliver high quality care for everyone.

Patient Safety

Learning from events and developing a safety culture

Integrate learning from both positive and negative incidents through a range of channels.

Support deteriorating patients

Clinical Effectiveness

1 4 7

Identify, escalate and support the timely intervention for deteriorating adults and children.

Reducing inpatient falls

Patient Experience

3 6 9

2 5 8 Operational Plan 2023 8

Continue working on the principles of cohorting and preventing deconditioning. Implement a new Trust falls training programme and continue to recruit into our Enhanced Care Supervision Team.

Right care, right place, right time - emergency care

Ensure an improved patient experience in our Emergency Departments. Reducing waiting times, making timely decisions and supporting effective interventions.

Right care, right place, right time - admission and discharge

Improve our admission and discharge processes through the Trust.

Delivering the best clinical outcomes

Address and improve care for people with diabetes through close working with system partners.

Learning from experience

Demonstrating that as a Trust we are learning and improving experience through complaints, surveys, feedback and compliments.

Focus on vulnerable patients

Improve the care of patients with a Learning Disability or Autism in the Trust.

Improving palliative and end of life care

Continue with delivering our strategy focusing on improving our care after death through ongoing education, support and monitoring.

Quality improvement

Quality improvement benefits everyone and ultimately leads to the delivery of outstanding care for patients. We have robust foundations to build upon through our Getting to Good and quality improvement programmes. Through our Review, Action and Learning from Incidents Group (RALIG), we are absolutely committed to continually improving the quality of all services for our patients.

Making the NHS safer

This year will signal a significant shift in how the NHS nationally and locally responds to patient safety incidents. The Patient Safety Incident Response Framework (PSIRF) fundamentally changes our approach to developing and maintaining effective systems and processes. At the heart of the framework is supporting a learning culture across our Trust, and partners, increasing understanding about how incidents happen and supporting the identification and embedding of lessons learned.

Our work in previous years has laid strong foundations and we have seen a focus within teams that is encouraging. We are absolutely committed to embedding PSIRF throughout the organisation and will be fully supporting colleagues through education and training. We will need everyone’s help in embedding this new way of working, which will improve quality for patients and provide a supportive environment for our colleagues.

Our Improvement Hub is here to support and empower colleagues at all levels to have the confidence, capability and passion to test changes and make improvements for the communities we serve.

If you have an idea for improvement please email sath.improvementhub@nhs.net who will be able to support you to take this forward.

Our People

We work with 7,590 incredible colleagues and everyone has a role to play in delivering this Operational Plan and supporting our ambition of Getting to Good.

Listening and responding to your feedback is at the heart of our work to ensure the Trust is a great place to work and receive care for everyone. In 2022/23 we improved across many elements of the NHS People Promise and themes in our NHS Staff Survey. This shows that what we are doing is making a difference and we are absolutely committed to building on this in 2023/24. We know we still have more to do and will keep our focus on developing and embedding the culture we desire.

We have a cultural improvement programme and a Leadership Development Framework in place. As part of our Getting to Good journey, we are working towards ensuring our focus on tackling health inequalities and championing inclusion is integrated into everything that we do and similarly that our Values and Behaviours underpin all our work.

We are really proud of our colleagues for everything they continue to do for our patients, communities and each other.

Our People Promise

Prioritising the health and wellbeing of our people

Creating a great employee experience

Ensuring inclusion and belonging for all

Supporting and developing the people profession

Harnessing the talents of all our people

Leading improvement, change and innovation

Embedding digitally enabled solutions

Enabling new ways of working and planning for the future

Eliminating conditions in which bullying, harassment and physical harassment occurs

Improving recruitment processes and embedding talent management processes

Supporting a comprehensive induction and onboarding programme for international staff

We are committed to focusing on:

Partnering Ambitious Caring Trusted

Transforming care through technology

The EPR programme will involve transferring:

• Over 1 million patient records

• 5 million Referral to Treatment events

• 3.4 million outpatient appointments

• 5,000 colleagues to be trained in using the new systems

Due for completion

April 2023 - March 2024

EPR Phase 1

• Patient Administration and Emergency Department systems replaced

• Wardboards replaced

• Theatre system upgrades and integrated with CareFlow

• Patient observation system upgrades and integrated with CareFlow.

• 30 downstream systems integrated

• Reporting updated

Divisional Projects

• Therapy Monitor Dialysis

• Endoscopy Washers Phase 2

• Stream & Triage at RSH ED

• Heart Assessment Database

• Community Diagnostic Centre & Renal unit

Divisional projects with digital dependencies not listed here are not included in the 23/24 Digital Roadmap, and no commitment to delivery can be given regardless of operational plan inclusion

• Continuous electronic fetal monitoring (CTG) connected to Badgernet

• Women’s & Children’s patient information screens

• Glucose Meter Replacement

• Aria MedOncology upgrade

• Da Vinci Robot

• Surgical Assessment Unit Whiteboard

Digital transformation projects

• Digital Pathology

• Advanced clinical noting

• Single Sign-on

Operational Plan 2023 12

Due for completion

April 2024 – December 2025

EPR Phase 2 & Digital Solution Implementations

• EPR Phase 2 & Digital Solution Implementations

• Careflow connect

• Bluespier Pre-op Assessment

• Badgernet Neonatal

• Advanced clinical noting

• Vitals Paediatrics

• Flow and Capacity

• Electronic Prescribing and Medicines Management

• Laboratory Information Management System

• Digital Order Communications, Results & Reporting

• Data warehouse development

• Windows 11/Office 365

• Cyber Security measures

• Network refresh

• Patient Engagement Portal

• Population Health Management (system-wide benefit)

• Remote monitoring (system-wide benefit)

Divisional Projects

• Pending prioritisation

Transforming the way we care

We strive to deliver high quality care for our patients everyday – and our digital transformation will be essential in supporting all colleagues to deliver this ambition.

2023/24 will see the Trust take a significant step forward with an upgrade in our digital infrastructure. Phase one is to be delivered by Winter 2023. In 2022/23 we will replace our 20 year old SemaHelix patient administration system with the CareFlow Patient Administration System (phase one) and will revolutionise:

• Inpatient activity including admissions, discharges, transfers and live bed management

• Outpatient activity including waiting list management, referral to treatment (RTT) pathway management

• The Emergency Department including clinical noting and patient tracking.

The EPR is transforming how we store and access patient notes and is revolutionising the way in which we work. This is a significant step change and 2023 (phase one) will secure the necessary digital foundations, as we then prioritise even more exciting upgrades.

Find out more on our website: https://digital.sath.nhs.uk/

This will put us in a stronger position for 2024 with further enhancements and benefits for patients and clinical teams.

Developing our Estates Strategy

Maximising the use of our estate (buildings and land) is a priority and the development of a robust Estates Strategy will establish the blueprint for coming years. We will continue our estates refurbishment and investment programme throughout 2023/24.

Developing two thriving hospitals

Communities across Shropshire, Telford & Wrekin and mid Wales are to benefit from exciting plans to transform care, experience and facilities at the Princess Royal Hospital, Telford (PRH) and Royal Shrewsbury Hospital (RSH) during 2023/24.

This includes a new Gamma Camera, additional ward space and increasing our radiology capacity at RSH.

£24million Planned Care Hub at the Princess Royal Hospital

This year we are excited to be opening our new purposebuilt £24million planned care hub, which will provide more theatres and recovery beds dedicated to day case surgery. This will substantially increase the number of same day operations that can take place, enabling services to be provided all year round.

Improved patient experience

As well as increasing planned care facilities, we will be transforming the ‘front door’ of PRH with an improved reception, better access and wayfinding for patients. The investment will provide increased retail space offering greater comfort and refreshments to people visiting the site.

2023 will see the launch of the first Community Diagnostic Centre in Hollinswood House, Telford. The purpose-built CDC will support elective diagnostic tests away from acute hospital sites and seperately from urgent diagnostic scans. Renal dialysis services will also move from the PRH to be located with the CDC. Moving renal services will create a better and more spacious environment within the community for patients to receive their dialysis treatment. It will also mean we are able to meet increasing future demand away from a hospital environment. The move also means we can release ward space providing more beds at PRH for patients who are acutely ill.

Hospitals Transformation Programme

The Hospitals Transformation Programme will improve care for everyone. Our ambition is to deliver two thriving hospitals and throughout 2023/24 we will continue to involve our clinicians, patients and partners as we develop our detailed clinical pathways that will improve services.

During 2023/24 we are aiming to complete the national approval process, which will release the significant £312m national investment so implementation works can commence.

As part of the necessary preparations, we will be seeking planning permission during 2023 for the development at the Royal Shrewsbury Hospital.

You can find out more about all these schemes on our website.

Improving health and wellbeing through partnership working

NHS INTEGRATED CARE BOARD

NHS ENGLAND

NHS PROVIDERS

PRIMARY CARE

LOCAL AUTHORITIES

POWYS HEALTH BOARD

VOLUNTARY AND COMMUNITY SECTOR

HEALTHWATCH

LLAIS

POLICE

FIRE

EDUCATION

UNIVERSITIES

COLLEGES

Nationally and locally, we know that to continue to deliver quality health and care services for future generations, we need to change how we work. This includes:

• Embracing new technologies

• Supporting our colleagues to embrace new skills and ways of working

• Exploring ways to collaborate

• Working to deliver sustainable services

• Reducing health inequalities for our communities and colleagues.

We recognise we cannot deliver this Operational Plan in isolation and have a key role as a partner in seeking to improve the overall health and wellbeing for all our communities in Shropshire, Telford and Wrekin and mid-Wales.

In 2023/24 we will be continuing to build effective relationships collaborating with partners, as we progress the successful work of the Virtual Ward programme and launch the new Community Diagnostics Centre in Telford. You can read more about these systemwide priorities on our website.

We also need to look beyond our NHS and local authority relationships, building closer working with multiagency providers, including the Police, Fire Service and voluntary, community and social enterprise (VCSE) sector. We know that the health of our communities is closely linked to education, income and other factors. Working with partners we will play an active role in leading, driving and supporting preventative care, reducing inequalities and providing

Everyone has a role in helping us to deliver these priorities and we hope that you continue to share your ideas and suggestions with us, so we can continue on our Getting to Good journey to provide excellent care for the communities we serve.

Conclusion

Our plan for 2023/24 is ambitious, but we are confident that by working together we can make a really positive difference for our communities. This is why we are so determined to deliver on these commitments. Focusing on these priorities will result in improvements in the quality of care for patients this year and will establish the necessary foundations to ultimately improve care for local communities and provide a better experience for our colleagues for future years.

Despite the significant pressures we continue to face, we are looking forward to the genuine opportunities 2023/24 presents for the Trust and wider system. We know the dedication, care and determination shown by our teams, and partners, will support the necessary culture change and focus on making a difference for patients.

We remain very grateful for all the support we receive from our patients, visitors, carers and volunteers.