Five Year Sustainability Plan
2014-2019
[6th November 2014]
1.Executive Summary 3
2.Overview 9
i.Recent history of the Trust and strategic priorities ii.Developing clinical services
iii.Capacity and capability
3.Trust profile and market position 19
4.Factors impacting the Trust during the plan period 28 i.Demographic
ii.Demand for services and clinical policy developments iii.Commissioning
iv.Funding
5.Financial baseline and five year plan 56
i.2014/15 outturn ii.5 year base plan
6.Range of strategic options 79
i.Rapid cost reduction and value delivery
ii.Service development and commercial initiatives iii.Trust wide structural change
iv.Other options
7.Next steps - plan for the next 6 months 115
Appendices 124
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Lucy MooreInterim Chief Executive
Peter Wilson
Aim of this document
This Sustainability Plan (the “SP”, the “Plan”) follows Colchester Hospital University NHS Foundation Trust’s (the “Trust”)
Financial Recovery Plan ( the “FRP”) submission to Monitor in August 2014.
The overall aim of this Plan is to set out the detail of how the Trust will return to a financially sustainable position over the next 5 years and to do this, it has specifically considered : • where the Trust sits in its market and local economy, with
consideration of social and demographic change; • current and upcoming challenges facing the Trust,
focusing on quality and financial issues;
• how the Trust will stabilise its position over the next 18/24 months (incl. cost improvement plan (“CIP”) delivery); • longer term transformational plans which the Trust is
currently considering and will continue to work through over the next six months; and
• how the Trust will ensure that this Plan is prioritised and managed in the midst of other pressures.
As part of the diligence that the Trust has gone through to develop this Plan, it has been mindful of:
• its over-arching strategic objectives;
• the need for inclusion of and engagement with all staff within the Trust;
• the importance of close and open communications with external bodies (such as the Trust’s Clinical
Commissioning Group (“CCG”) and Monitor); and • the capability and capacity of the Trust to deliver.
Immediate priorities
Delivery of this Plan
The Trust has hired an interim Transformation Director, who will assume responsibility for oversight of delivery of this Plan. There is currently a further assessment of the resources
required to support delivery of the Plan. This assessment will be complete by the end of November 2014.
Quality improvements
The Trust is focused on continuing to improve the quality of its services at pace, as it has been doing over the past 12 months, in response to:
• the Keogh Review;
• the Care Quality Commission investigation (which found serious concerns regarding both the quality of some services for Cancer patients and the governance controls being applied by the Trust);
• Monitor putting the Trust into Special Measures, and applying conditions to the Trust’s provider licence; and • the Chief Inspector of Hospitals judging that the Trust
“Requires Improvement” overall (albeit identifying that in all areas “staff were caring and compassionate, and treated patients with dignity and respect”).
The Trust expects to be compliant on the following performance indicators in line with the following timelines:
• 18 week RTT – compliant by December 2014; • 4 hour A&E target – compliant Q4 2014/15; and
• Cancer target – 2 week and 62 day targets compliant by Q4 2014/15.
Workforce and capacity to deliver
Ensuring that the Trust has the capability and capacity to deliver this Plan is crucial – andthis is even more vital given that the Trust must also continue to address the aforementioned key quality and service delivery challenges.
Specifically, the Trust has evaluated and is focused on: • the leadership (Executive and Non-Executive) of the
Trust, both in terms of enhancing leadership through substantive recruitment (and strong interim recruitment where substantive recruitment is not possible), as well as divisional stability;
• governance within the Trust. The Trust now has an agreed Board Assurance Framework, corporate risk register, a complete risk register (owned by operational and corporate managers, and discussed monthly), and a detailed assurance and escalation policy;
• communications, between the Executives and Non-Executives, as well as the Trust and Governors, Monitor, and the CCG; and
• wider workforce development and engagement, both developing and delivering the Trust organisational development strategy, as well as a review of the scale, skill and profile of the entire Trust workforce.
Developing Clinical Services
The Trust developed a clinical services development plan in March 2014, building on the clinical strategy published in 2008, setting out a stepped approach to returning the Trust to clinical and financial sustainability.
The Trust will be focusing on this during the Plan period, alongside a review of sustainability of services currently provided, both from a clinical and a financial perspective.
Financial control and cost improvement plan (“CIP”) delivery
The Trust has a revised forecast deficit of £21.2m for 2014/15, after delivery of £8.4m of cost improvement plans. A best and worse case scenario have also been calculated.
The Trust plans to return to a £3.8m surplus by 2018/19. The plan is predicated on three key factors:
1. Tighter budgetary and financial control. For example “no order, no pay” enforcement, and tighter bank and agency controls (via vacancy panels);
2. Granular and detailed tracking of CIP delivery. The Trust has started to focus on CIPs this financial year, after years of under-delivery, and is forecast to deliver c.3%. The Trust has modelled consistent delivery of between 3.5% - 4.5% during the Plan period, which will require continued focus and effort. In recognition of this, the Trust has sought external help to start this process, as well as identify and develop opportunities;
3. Pursuit and delivery of longer term strategic options, shaped by the areas that the Trust sees itself focusing on in the future. Again, the Trust has sought external help to work with Trust staff, to develop strategic options together. The Trust will further detail these options, to ascertain which should be focused on as a priority, following submission of this Plan and over the next six months.
Trust profile and market position
The Trust faces many of the broader systemic challenges faced by other acute providers throughout the country, and a range of additional issues specific to its geographic and
socio-demographic surroundings. Specifically, the Trust must plan to address issues stemming from:
• Demand pressure on services due to an increasing local population, with particular growth in the patient categories that rely most heavily on health services (e.g. the young and old); and
• Service delivery and demand challenges due to increasing prevalence of long term conditions.
The Trust is also working with commissioners and partners to examine ways in which these issues can be managed against a backdrop of funding pressure and constrained commissioning budgets.
• The Trust recognises that it must contribute to Essex and region-wide initiatives to deliver improved whole health system value, and is committed to doing so via vehicles such as the Pan-Essex acute services review.
• The Trust also recognises that it must ensure that it complies with both national and regional clinical and governance policy developments if it is to develop and maintain strong relationships with commissioners. The Trust must also achieve these aims while also focusing on addressing the services in its portfolio that are unsustainable for clinical or financial reasons.
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Financial overview
2014/15 outturn
The Trust’s forecast deficit is £21.2m compared to the FRP deficit of £15.9m.
The significant causes of this variance to plan are: • Increased penalties from the CCG (-£1.9m) • Under-delivery of planned care (-£3.2m) • Pay and Non-Pay overspends (-£2.5m) • Under-delivery of CIP Plan (-£0.5m) • Other costs/benefits (+£2.8m) The Trust’s forecast financial position includes £8.3m of costs/income that are non recurrent, leading to a normalised or underlying deficit of £12.9m. Due to the pressures the Trust has faced in the recent period of time, these non-recurrent costs are higher than would usually be expected at other Trusts.
PwC’s baseline analysis of the Trust’s financial position
reported earlier in the year indicated a deficit range of £11.8m to £23.8m.
The Trust is forecasting a CIP delivery of £8.4m, compared to a plan of £8.9m for the year.
When consideration to the non-recurrent element of the Trust’s forecast deficit is taken into account, the Trust’s forecast deficit is in line with other Hospital Trusts in Essex. Other Trusts will have elements of non-recurrent expenditure, but it is assumed that the levels of these are higher at Colchester than at peers. Thus the Trust compares it’s underlying deficit to it’s peers deficit in the following table:
CIP assumptions, and 2015/16 CIP Identification
In relation to the CIP target for 2015/16 (£9.2m, 3.5%), the Trust has undertaken a four phased approach to generate ideas for implementation, starting in month six of 2014/15.
Ideas have been generated from teams working on business cases (service transformation and finance leads) and from staff (through workshops with clinical and corporate departments). The Trust is working to a timeline whereby schemes for 2015/16 are identified by the end of December 2014, and developed into workbooks by the end of March 2015.
With regard to 2016/17, 2017/18 and 2018/19, the Trust has modelled national efficiency targets of 4.5%, 4.0% and 4.0% respectively. The Trust has modelled a range of annual CIP deliveries, this range is predicated on the following
assumptions:
• The Trust has historically delivered a low level of CIP, and has become more focused on its necessity during
2014/15.
• there will be a marginal improvement in CIP delivery from 3.1% in 2014/15 (£8.7m) to 3.7% (£9.5m) in 2015/16, as the Trust becomes more familiar and comfortable with CIP efficiency targets, and also deals with quality issues. • 2016/17 will be a more successful year in terms of CIP
delivery (6.2%), due to both familiarity and also less pressure from quality improvement plans.
• CIP efficiency targets will reduce to 3.8% and 2.9% in 2017/18 and 2018/19 respectively, as these are the two key years for implementation of strategic options (detailed further in Section 6 of this Plan), and as a result there will be competing pressures on Trust time.
Longer Term Strategic Options
The Trust recognises that delivering cost improvement plans will not be sufficient to address its quality improvement requirement, contribute to system-wide efficiency improvement programmes, and support its planned return to surplus by end 2018/19. It must also deliver service transformation, working in partnership with commissioners and delivery partners.
The Trust has provisionally identified seven key areas of focus for service transformation during the plan period, and completed an initial estimate of their potential quality and financial impact. These areas of focus are detailed in section 6 and include initiatives to transform, expand or re-shape the Trust’s involvement in:
• Community care;
• Elderly care and broader social care; • End of Life Care; and potentially • Primary Care.
The Trust is also exploring opportunities to repatriate elective care provided to local patients by other providers, and to exploit potential in its shared services.
Further work will be completed during the next six months to assess these initiatives in more detail. The assumed benefits profile for these schemes is:
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Hospital Forecast deficit
£m %
Colchester Hospital 21.2 8.0%
Colchester Hospital - Normalised 12.9 4.9%
Southend University Hospital NHS Foundation Trust 8.7 3.2% Basildon and Thurrock University Hospital 14.2 5.0% Mid Essex Hospital Services NHS Trust 18.6 6.5% Princess Alexandra Hospital NHS Trust 19.2 10.7%
Additionally, the Trust has begun to explore the potential to deliver quality and efficiency improvements by pursuing more significant structural change options including merger and partnership. At present the Trust does not plan to implement any of these options, but will continue to review this position during the plan period if it becomes beneficial to do so.
2014/15 – 2018/19 Plan
The Trust is working closely with it’s CCG colleagues to ensure that it’s plans fully reflect the Commissioners plans and strategic goals. The Trust plan aligns with current CCG strategies, specifically the impact of the Care Closer to Home agenda and the impact of the Better Care Fund. The impact of these on the Trust remain uncertain, there is potential that the impact on the Trust will be less than currently forecast.
The Trust will carry out a review of the sustainability of it’s services during the next 6 months. This review will look at all opportunities to improve the quality of patient care, react to demands placed on it’s services and improve it’s financial position. The review will use the Trust’s existing clinical, workforce, activity and financial data, including benchmarking and market analysis.
Where necessary, for the improvement of the quality of services to patients in future, the Trust will consider all options such as hub and spoke models, clinical alliances, growing services, developing into new markets and where necessary exit from sub-scale services.
The Trust recognises the significant challenge that it faces to move from it’s current financial deficit to the forecast surplus of £3.8m in 2018/19, especially in the current financial
environment.
The Trust is not unique amongst acute hospitals in facing this. However, this plan sets out a number of factors which enable the Trust to have confidence that it will deliver the plan. One of these factors is the extent that the Trust incurs disproportionate costs due to the level of multi-site working. The Trust will use Monitor’s recently published ‘Strategy Development toolkit’ to support it in planning and delivering it’s strategy during this plan period.
The Trust will deliver CIPs, develop and deliver a number of strategic options and review the sustainability of all it’s services over the plan period to ensure delivery.
Trust cash profile
The Trust’s cash position will be low by the end of the 2014/15 financial year, but the Trust has measures in place to deal with this, and potential mitigations in case it requires additional cash by year end.
The Trust projects that it will require £23m of cash support in 2015/16, £14m in 2016/17 and a further £7m in 2017/18. The projected move back to balance in 2018/19 means the Trust will not require any further cash support in this year.
Capital
The Trust will spend £56.4m over the 5 year plan period on capital items. This will largely be funded by internal resources, such as, depreciation and the sale of it’s Essex County Hospital. However, there may be a requirement to seek external support for a proportion of this expenditure.
Summary
The Trust is confident that this plan is deliverable within the timescales set out.
This Sustainability Plan (the “SP”, the “Plan”) follows Colchester Hospital University NHS Foundation Trust’s (the “Trust”)
Financial Recovery Plan ( the “FRP”) submission to Monitor in July 2014.
The Trust assumes knowledge of the FRP, and has not sought to include the background detailed in it within this Plan. Instead, in the section that follows the Trust provides a brief synopsis of its current position and changes in the past three months. The overall aim of this Plan is to detail the Trust’s priorities over the next five years, specifically;
• where the Trust sits in its market and local economy, with consideration of social and demographic change;
• current and upcoming challenges facing the Trust, focusing on quality and financial issues;
• how the Trust will stabilise its position over the next 18/24 months (incl. cost improvement plan (“CIP”) delivery); • longer term transformational plans which the Trust is
currently considering and will continue to work through over the next six months; and
• how the Trust will ensure that this Plan is prioritised and managed in the midst of other pressures.
As part of the diligence that the Trust has gone through to develop this Plan, it has been mindful of:
• its over-arching strategic objectives ;
• the need for inclusion of and engagement with all staff levels within the Trust;
• the importance of close and open communications with external bodies (such as the Trust’s clinical
commissioning group (“CCG”) and Monitor); and • the capability and capacity of the Trust to deliver.
1. Quality challenges
As detailed in the FRP, 2012/13 and 2013/14 were particularly difficult for the Trust, with investigations by the Keogh Review team, followed by a Care Quality Commission (“CQC”) investigation and report. The CQC report found serious
concerns regarding both the quality of some services for Cancer patients and the governance controls being applied by the Trust. These concerns resulted in Monitor putting the Trust into
Special Measures, and applying conditions to the Trust’s provider licence.
The Chief Inspector of Hospitals inspected the Trust in May 2014 and published findings in July 2014, identifying that in all areas “staff were caring and compassionate, and treated patients with dignity and respect”. However it also noted a number of areas where improvements were required and made a number of recommendations to support this improvement. The Inspector’s judgment was that the Trust overall “Requires Improvement”. A more detailed breakdown of the rating is shown below:
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Are services safe? Requires improvementAre services effective? Good Are services caring? Good
Are services responsive? Requires improvement Are services well-led? Inadequate
In particular where services are deemed ‘inadequate’ or ‘requiring improvement’:
• ‘Are services safe?’ – Requires Improvement: the rating
reflects nurse staffing levels being lower than best practice; inconsistent quality of equipment and medicine checks ; ‘Five steps to safer surgery’ not being
undertaken consistently and staff mandatory training not being up-to-date.
• ‘Are services responsive?’ – Requires Improvement: the
rating refers to the response level being in the review period; a significant number of outpatient appointments being cancelled at short notice and allegations of manipulation of waiting list data.
• ‘Are services well-led?’ – Inadequate: the rating refers to the lack of stability at trust board-level and the number of services being rated as requiring improvement in terms of local leadership.
Across this period, the Trust has remained focused on stabilisation and improvement of the quality of services. The Trust expects to be compliant on the following performance indicators in line with the following timelines:
• 18 week RTT – compliant by December 2014; • 4 hour A&E target – compliant Q4 2014/15; and
• Cancer target – 2 week and 62 day targets compliant by Q4 2014/15.
2. Financial performance challenges
The Trust reported a £2.4m financial deficit in 2013/14. Further the Trust has planned a deficit of £15.9 after CIP plans.
Some of the key reasons for this deficit include the local impact of national tariff adjustments, turnaround costs, and cost pressures (CNST, additional nursing spend and other staff pressures).
The Trust understands that it needs to fight hard to win back the trust of its patients, its health partners and its local communities, and is doing so.
In support of this Plan, and since the FRP, the Trust has commissioned an independent review of its modelling assumptions for 2015/16 – 2018/19, with a view to building a model which is evidence-based and gives a robust steer of the Trust’s future sustainability. The Trust has completed this exercise.
The Trust has also compiled market intelligence and developed an assessment of market trends in its key service areas. Using this intelligence the Trust has defined its goals and identified the broad range of, as well as a selection of particular, strategic options to enhance the baseline position and transform the organisation over the Plan period and beyond.
Finally, the Trust has agreed its strategic priorities, developed a framework for its clinical strategy,and developed its workforce and organisational development strategy.
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Progress made towards achieving sustainability
In August 2014 the Board agreed that in order to deliver on the Trust’s vision, and to begin to regain the trust of our patients, partners and communities, the Trust needs to focus on eight strategic priorities. These priorities are set out below. The Trust’s priorities capture the need to achieve or maintain high levels of patient care, quality and patient experience; to change the ways in which the Trust works externally and engages with partners; to deliver changes to its infrastructure; and to identify options for and then deliver a sustainable financial future for the Trust.
Put the patients at the centre of all that we do
Provide high quality and safe care for our patients Realise the potential of our workforce, empowering them to deliver
Deliver services ‘right first time’ improving patient pathways and reducing our waiting times
Achieve sustainable financial performance
Improve our infrastructure
Be a strong partner with health, social care, education and academic colleagues and other key stakeholders Bring our Governance structures up to the standard of best practice
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Strategic priorities and aims of this Plan
The Trust created a clinical services development plan in March 2014, building on its clinical strategy (published in 2008), as well as updated market share and commercial opportunity
investigation, and quality review feedback through the Keogh and CQC inspections.
The clinical services development plan sets out a stepped approach, focused on returning the Trust to clinical and financial sustainability, and sits alongside a suite of other strategy documents, all contributing to this Plan.
The broad steps taken in developing the clinical services development plan are:
1. Stabilisation – in response to the Keogh and CQC reviews across 2013 and 2014, as well as the financial investment required from the Trust to address respective concerns. This investment spread across core clinical staff, strengthening of governance arrangements and leadership capability.
2. Understanding the market – in relation to current market trends impacting the Trust, services requiring investment, and a review of the Trust’s short to medium term strategy. 3. Understanding the risks to sustainability – initially in
response to immediate short term risks (ref. Keogh and CQC), followed by risks assessment over the next five years; 4. Development of plans to deliver – following the above,
development of cost improvement plans for years zero to two of the Plan, as well as strategic plan development across year two to five;
5. Recognising the key risks to delivery of plans.
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In the context of the above, the Trust aims to provide: • High quality core local services – emergency care,
paediatrics and maternity care;
• Patient centred planned/elective care where possible delivered in an OP or day case;
• Specialist services in key areas of expertise which are developed building on the current portfolio including specialist cancer and vascular services;
• Increasing the range of community services supporting out of hospital care, including therapies and outreach
consultant led specialist care.
Amongst a number of other areas, key to delivery of the clinical services development plan will be:
• Forging strong partnership with NE Essex and other CCG’s to ensure that the Trust’s ambition is linked to CCG future plans;
• Developing strong partnership with other local NHS and other providers to enable joint approaches to service delivery where appropriate;
• Developing strong partnerships with other local acute providers to drive quality improvement across more
specialist services – developing the ‘hub’ and spoke’ model where appropriate; and
• Ensuring our key stakeholders are communicated with regularly.
Ensuring that the Trust has the capability and capacity to deliver this Plan is crucial – and this is even more vital given that the Trust must also continue to address the key quality and service delivery challenges outlined elsewhere in this document.
To ensure that the Trust can do so, it has assessed its current capability and capacity to delivery, and sought to address gaps identified. Specifically, the Trust has evaluated:
1. the leadership (Executive and Non-Executive) of the Trust; 2. the delivery and tracking of this Plan;
3. governance; 4. communications;
5. wider workforce development and engagement. a) workforce requirements
b) workforce trajectory
1. Leadership
To deliver this Plan in the right way, a substantive Board, with the right blend of skills and experience, is needed. The Trust is working hard to put this in place.
There have been some changes to the Trust Board since the FRP: • Peter Wilson has assumed the post of Chairman as of
October 2014, whilst the Trust seeks to appoint substantively;
• Lynn Lane has accepted a substantive role as Director of Human Resources and Organisational Development, as of August 2014;
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• Sandy Spencer has been appointed as Interim COO, starting in December. The COO role has been enhanced to include Deputy CEO and Divisional Director
accountabilities. Substantive recruitment is planned for November 2014.
• Shane Morrison-McCabehas been appointed as Interim Deputy COO;
• Andy Morris has started as Interim Director of Finance. Substantive interviews will take place in November 2014; • Jackie Brown has assumed the post of Interim Director of Transformation. Substantive recruitment will begin shortly; • Ann Alderton has joined the Trust as Interim Company
Secretary. Substantive recruitment has started. Also, an interim has been appointed to support on governance and risk, and commenced at the Trust in October 2014; and • Dr Barbara Stuttle has been appointed as Interim Director
of Nursing. The substantive appointment process has started.
Appropriate handovers between interim and substantive staff will continue.
The Interim Company Secretary is also reviewing the allocation of governance responsibilities within the Board (both Executive and Non-Executive positions, as well as those directly supporting these staff) to ensure that the Trust has the correct governance domains covered.
The Trust is focused on divisional stability. Key initiatives have included or will include:
• the appointment of key divisional leads. Eleven of twelve key appointments have been made, with interviews due for the final position of Associate Director of Operations in Medicine;
• the “Three at Top” programme for Divisional leaders is underway, focusing on local vision, priorities and success factors to drive performance of the team;
• external support has been commissioned to support the divisions on a transformation change programme; and • a review of divisional director roles is underway to ensure
appropriate focus and support.
2. Delivery and tracking of this Plan
In section 7of this Plan, the Trust has detailed its critical path over the next 6 months, to ensure that both momentum is maintained and also that the Plan is embedded within the organisation. This critical path is supported by a more detailed, granular, action plan.
Oversight of the delivery of the Plan will pass to the Trust’s Transformation Director. There is currently an on-going
assessment of the team resources required to support delivery of the Plan.
The team will have the right skill mix, and the Trust will be seeking a range across business planning, market analysis, commissioner and partner engagement, as well as the ability to provide practical day-to-day transformation support to clinical staff. Of course, the Trust will aim to utilise and develop its existing staff base where possible and appropriate.
3. Governance
The Trust has put significant focus on clarifying and improving its governance procedures. Areas of focus have included:
• Developing theBoard Assurance Framework (“BAF”) into and effective Executive tool, which is being developed for review at all appropriate Trust Board committees and Trust Board;
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• Improving the content and utilisation of the corporate risk register, as a means of ensuring that risks are identified, assessed and escalated appropriately, for regular review; • A full risk register, in standard format, which now driven
and owned by operational and corporate managers and reviewed by risks manager on a monthly basis;
• Embedding and communicating an assurance and escalation policy; and
• New performance management arrangements have been put in place.
4. Communications
Alongside efforts to ensure that the Trust has a committed workforce, with a common vision and focus, the Trust is also working on maintaining and improving open and transparent communications between:
• The Executive and Non-Executive team; • The Trust and its Governors;
• The Trust and Monitor; and • The Trust and its CCG.
Specifically with regard to the CCG, the Trust recognises the importance of developing and implementing this Plan together, and working closer together going forward. An extract of the CCG strategic priorities is included in the Appendix (page 127).
In recognition of the above, the Trust held a workshop to take the CCG through its approach and thinking for the Plan on 6 October 2014.
Regular meetings will continue to take place, namely:
• The Trust CEO continues to meet regularly with the CCG CEO, as they have been over the past few months;
• The Trust interim COO and CFO meet with their respective counterparts;
• A nominated member of the CCG attends the steering groups held at the Trust to develop and deliver this Plan; and
• Regular Chair to Chair, Chair to CEO and Executive to Executive meetings.
The CCG also attended and contributed to the update meeting to Monitor on the Trust’s progress of this Plan on 13 October 2014.
5. Wider workforce development and engagement
The Trust has lacked expertise in this area to date, and is recruiting senior and experienced practitioners to develop further and deliver its organisational development strategy.
A review of the scale, skill and profile of the Trust workforce, in the light of the significant challenges that the Trust face will commence shortly. In particular this review will assess the Trust’s ability to address challenges related to:
• getting out of Special Measures;
• ensuring operational national standards i.e. A&E, RTT and Cancer are achieved sustainably to the communicated trajectories;and
• Addressing further pressures that the Trust will face (e.g. an ageing population and other demographic changes).
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There is a need to develop the Board, senior and middle management (including clinicians) immediately, as opposed to waiting for a fully substantive Board. The Trust will support this work by using leading edge management and development techniques for existing staff, and having identified the “Top Leaders” in the Trust, will engage with the Leadership Academy and LETB, to explore development opportunities.
The Trust will prioritise this, along with dealing with its quality and financial challenges, if this Plan is to be delivered successfully. The Director of Human Resources and Organisational
Development will lead this work.
Engagement with Trust staff, and empowering them to do what is right for the patients of the Trust, as well as holding staff to account for delivery, is of key focus for the Trust moving forward. Linked to this, the Trust has re-launched its “At Our Best”
programme, focusing on recognition of staff, senior management role-modelling, increased accountability through appraisals and recognition of staff.
Further, the Trust has taken action to listen to and act on staff feedback over the past year, in terms of their ideas with regard to the direction in which the Trust should go, in an effort to ensure that this is developed together and that it is not dictated from “the top”. The Trust is to conduct an all staff survey for 2014, which it expects will give rise to Trust-wide, divisional and individual team insight.
Engagement with clinicians has also been key, ensuring that the right balance between the finance element of running the Trust, and the maintenance and improvement of quality of services is achieved.
The Trust is currently carrying out it’s annual review of staffing requirements on the wards (Acuity review), as well as the corporate side of the workforce, with a view to assessing how to flex it most efficiently.
5a. Workforce requirements
In 2014/15, the Trust financial plan assumes 68.6% of all expenditure to be on workforce.
The requirement to ensure sustainable services at the Trust will lead to a number of impacts on the Trust’s workforce.
Specifically, it is expected that during the five year period, two significant transformations will occur which will automatically change the size of the Trust’s workforce:
• TUPE of Scientific, Therapeutic and Technical staff to the Joint Pathology Venture in 2014/15
• TUPE of a range of staff in a number of services expected to transfer from the Trust under the CCG’s Care Closer to Home tender
In addition to these changes, the Trust’s workforce will need to be more flexible, using tools such as fixed term contracts where possible to minimise the impact on staff and maximise the speed of transition.
The Trust will review its workforce requirements over the next six months, comparing this to its expected future workforce. The expected future workforce will take the following into account: • Staff turnover;
• Staff age profiles/expected retirements; • New ways of working; and
• Improved IT.
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This will be driven at a divisional level, and will be led by Human Resources and Organisation Development.
Where possible, temporary staffing will be replaced with substantive or fixed-term staff, to improve both the quality of services provided and the financial cost of these.
5b. Workforce trajectory
It is expected that the workforce will be able to maximise its clinical time following said reviews of workforce requirements. This will be delivered by a combination of back-office
transformation and improved IT use to enable clinical staff to increase their clinical time.
The Trust plans to escalate and develop its IT capacity in order to transform the organisation from a heavy reliance on paperwork for example purchase orders and certain HR processes, amongst many other areas.
For modelling purposes over the first three years of the Plan period, the Trust has started with its current workforce requirements. Then it has:
• over-laid changes that it is currently certain of, such as the TUPE of STT staff to the Transforming Pathology
Partnership;
• made assumptions on staff transferring from the Trust as part of the CCG’s Care Closer to Home agenda; and • made assumptions on staffing number requirements for
As an early indicator, this modelling suggests that the Trust workforce will be required to reduce from 4,008 whole time equivalents (“wte”) at the end of 2014/15 to 3,640 at the end of 2016/17. This is as a direct impact of CIP requirements faced by the Trust. Of the 368 wte (9.2%) projected reduction, 145 are due to TUPE arrangements linked to the impact of Transforming Pathology Partnerships and Care Closer to Home. Further workforce changes will be actively managed to minimise the impact on staff (naturally occurring events such as turnover, planned retirements etc).
The table below sets out these projections.
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Projected wte 2014/15 2015/16 2016/17 2017/18 2018/19
Base 4,008 4,078 3,945 3,640 3,637
Net investments 133 -
-TPP impact (63) -
-Care Closer to Home - - (82)
CIP and Strategic Developments Impact - (133) (223) (3) 198
Total 4,078 3,945 3,640 3,637 3,835
Modelled workforce number changes 70 (133) (305) (3) 198
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Key impacts1
2
3
This section assesses the main service offerings by the Trust and who the main commissioners and types of patient are for these
services. Within this, the commissioners’ current and future situations are assessed, as well as the Trust’s market share for the
key services and commissioners. Finally, key competitors market share and characteristics are compared with the Trust.
Trust profile and market position
Services
offered by
the Trust
Key
customers
Market share
in key
service areas
Competitive
landscape
Key
customer
strategies
Market
overview
Customer
specific
share of the
market
Assessment
of key
competitors
Section
overview
The Trust’s main commissioner is North East Essex CCG, and the main patient cohorts are Outpatients, Non-Elective, Elective and Other Acute.
The Trust has lost elective activity, particularly to private providers through Choose and Book. The Trust’s most immediate competition is from the Oaks Hospital (run by Ramsay Healthcare), a private sector provider delivering a range of elective surgeries especially in Trauma & Orthopaedics. Commissioners will be under increased funding pressure over the coming years. The Trust is conscious of the need to reduce costs and increase efficiencies, whilst aligning itself more closely with the commissioners’ key funding initiatives and policies.
Colchester Hospital University NHS Foundation Trust
provides healthcare services to around 370,000 people from Colchester and the surrounding area of north east Essex. In addition, the Trust provides radiotherapy and oncology services to the wider population of North and Mid Essex, which reaches around 670,000 people (including the population in Colchester). The services are provided across two main sites:
• Colchester General Hospital opened in 1984. There are 652 inpatient beds,54 maternity beds (including at Clacton and Harwich hospitals) and 14 critical care beds; and • Essex County Hospital opened in 1820 and two oncology
(cancer) wards have moved to Colchester General Hospital. A number of daycase and outpatient services remain on site.
The Board is currently transferring services and departments off the Essex County Hospital site to Colchester General Hospital with an aim to complete this in 2014/15/16. Services remaining are now limited to day case surgery, breast and outpatient services.
The Trust also provides services via Clacton, Harwich and Halstead which are important for the delivery of care close to patients.
The Trust provides services to the local populations of North East Essex and part of Mid Essex, including specialist services to the wider Essex and Suffolk populations.
Further, the Trust provides a range of community based services supporting care closer to home, including community paediatrics, and sexual health services.
Finally, the Trust is also an associate teaching hospital of the University of London, providing a range of training and education services.
The Trust has historically had a strong reputation and delivered strong clinical and financial performance across a range of specialties. In some of these areas, the Trust has implemented a number of innovative models of delivery, including
laparoscopic surgery which stands out for its quality and reputation, as well as its cancer and radiotherapy services. The hyper-acute stroke service is supported by a stroke team who provide services to support community care including a service supporting stroke care in a designated care home. The Trust’s Stroke Service provides a very high level of stroke care as demonstrated by its frequently high Stroke Improvement National Audit Programme (SINAP) results.
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Services offered by the Trust
The Trust’s main commissioner is North East Essex CCG (NEE CCG). Mid Essex CCG (ME CCG) and East Anglia Local Area Team (EA LAT), as NHS England Specialist Commissioning host, are the next largest commissioners. The contracted position for 2014/15 is shown in the table below :
As shown above Outpatients and Non-Elective alone represent more than 54% of the Trust’s contracted income with c.25% and 29% respectively. Other Acute (e.g. Maternity Pathway, Critical Care and Radiotherapy) also represents a large income source at 19% of total SLA income.
The majority of the volume is commissioned by NEE CCG, which accounts for 73.6% of services provided by the Trust. East Anglia LAT and Mid Essex CCG follow comprising 11.4% and 8.2% of commissioned services respectively.
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Key commissioners
Commissioner OPs Non-Elective Other Acute Elective Daycases Elective Inpatients Excluded Drugs and Devices A&E TOTAL % of total income NHS NE Es s ex CCG 50.6 59.4 24.5 19.8 16.3 - 7.1 177.7 73.6% NHS Mi d Es s ex CCG 5.2 7.3 2.5 1.9 2.2 - 0.9 19.9 8.2% Es s ex LAT 0.7 - 3.2 0.8 - - - 4.7 1.9% Ea s t Angl i a LAT 0.6 0.3 14.0 0.2 0.2 12.1 - 27.5 11.4% Subtotal - contracted 57.1 67.0 44.2 22.7 18.7 12.1 8.0 229.8 95.1%
Non contra cted, other cl i ni ca l i ncome 11.8 4.9%
NHS Clinical Income 57.1 67.0 44.2 22.7 18.7 12.1 8.0 241.6 100.0% NHS Clinical Income 24% 28% 18% 9% 8% 5% 3% 100%
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• The Trust understands that its main commissioners are all under considerable funding pressures and that they are reviewing how
services will be commissioned in the next five years;
• Consequently, the Trust has considered strategic initiatives that enable it to reduce costs and provide services more efficiently, especially as competition by both NHS and private providers becomes stronger;
• All commissioners are likely to focus on the delivery of integrated, pathway-based care, potentially through the use of BCF funding and other large-scale integration schemes such as the CC2H agenda;
• Recent developments on pathway-based care represent both a threat to the Trust’s current income as well as an opportunity for
growth and reconfiguration of its services in line with local commissioning and policy initiatives.
Current situation Developments likely in next 3 years
NH S North Ea s t Es s e x CC G
• North East Essex CCG achieved financial balance in 2013/14, improving the efficiency of services by £7.8 million; • They currently concentrate funding on acute with 54% of
expenditure and GP and prescribing drugs with 14%; • Focus has been on the integration of health and social care
through work with Essex County Council.
• The CCG faces a productivity challenge of between 4% and 8% per annum;
• The CCG is planning savings of £73.3m (£18.5m in 2014/15, £13.9m in 2015/16 and £40.9m 2016-19);
• In 2014-16 the CCG therefore wishes to subject a number of services traditionally covered by the Trust to competitive procurement to deliver Care Closer to Home (CC2H).
NH S M id Es s e x CCG
• Mid Essex CCG has experienced under-achievement of Quality, Innovation, Productivity and Prevention (QIPP) and excess accruals for CHC that have led to a 2013/14 draft outturn deficit of £9.1 million;
• Their funding was £18m below the assessed need for the year; • They currently concentrate funding on acute with 50% of
expenditure and GP and prescribing drugs with 14%.
• CCG will operate a financial recovery plan following the incurred deficit and foresee a £7.8m deficit in 2015/16; • The CCG has appointed a Turnaround Director to ensure that
savings targets are met in 2014/15;
• Strategy will be driven by “phases of life” and an integrated approach in line with the Better Care Fund (BCF).
Ea s t A ng li a LA
T • East Anglia LAT is the specialist commissioner for the East of
England, including Suffolk ,area and the main commissioner of specialist secondary and tertiary services at the Trust.
• Ipswich and East Suffolk CCG has entered its second year of service redesign and plans to obtain savings of 20% by 2017; • One of their key priorities will be the individual’s health and
independence action, supported by the BCF.
Sources: NEE CCG five year strategic plan 2014-2019; Mid Essex CCG five year strategy 2014-2019; East Anglia Area Team Commissioning for Value Pack (February 2014); Essex 5 year Health and Care Strategy; NEE CCG Annual report 2013/14; ME CCG Annual Report 2013/14; The Future of Healthcare in Ipswich and East Suffolk 2013/2014
The Trust provides healthcare services to about 370,000 people in the North East Essex area. A breakdown of the Trust’s market share in its principal specialties is shown below:
As can be seen, there has been a loss of market share in several areas, particularly Trauma & Orthopaedic work, which has being lost to the Oaks Hospital, the local private provider. The Trust has begun work to address this and a specific plan is included in the strategic options section of this document.
North East Essex CCG
The NEE CCG inpatient market was worth c£136m in 2013/14. Colchester Hospital University NHS FT’s overall market share was 77.5% of this (66% of the elective market and 86% of the non-elective market).
3.5% (£4.7m) is accounted for by neighbouring acute trusts, with patients going south to Mid Essex Hospital NHS Trust or north to Ipswich Hospital NHS Trust.
5% (£6.8m) of elective expenditure goes to private providers, principally Ramsay Healthcare which runs The Oaks Hospital for mainly elective trauma and orthopaedic (T&O) and general surgery work.
Of the balance, 3% (£4m) per annum relates to specialist cardiothoracic work provided at Basildon Hospital, with the rest going to a mix of specialist acute providers and hospitals in London.
Mid Essex CCG
The ME CCG inpatient market was worth c£127m in 2013/14, of which Colchester Hospital University NHS FT had a 9.5% share, the principal specialties being radiotherapy, obstetrics, T&O, audiology and ophthalmology.
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Source: Healthcare Evaluation Data (HED) 2013/14Market share in key service areas
Market
overview
Customer specific share of the market
5 to 10 Mile radius Market Share 2013/14 (%) Market Share 2012/13 (%) Market Change (%) Share Change (%) Trust-wide 59.4% 58.7% 1.3% 0.7%
Trauma & Orthopaedics 49.8% 54.2% 1.6% (4.4%)
ENT 59.4% 58.0% 7.2% 1.3%
Urology 73.9% 71.3% 7.0% 2.6%
General Surgery 75.5% 73.7% 5.2% 1.8% Paediatrics 77.1% 74.3% 14.4% 2.9% Obstetrics 70.6% 75.0% (8.0%) (4.4%)
The Trust is one of three main NHS acute providers to the south and north of the A12 corridor with Mid Essex Hospital NHS Trust 26.1 miles to the south and Ipswich Hospital NHS Trust 21.4 miles to the north. All three providers are of a comparable size but with a different mix of sub-regional and regional services. Amongst it’s sub-regional services the Trust provides radiotherapy services to Colchester and Mid Essex and vascular services to Colchester and Ipswich. The Trust provides a range of District General Hospital work in addition to it’s sub-regional services.
The Trust has competition from the Oaks Hospital (Ramsay Healthcare), a 57 bed hospital located in close proximity to Colchester General Hospital providing elective surgery.
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Ipswich HospitalColchester Hospital The Oaks Hospital
Mid Essex Hospital
Competitive landscape
Ipswich Hospital’s market share
A visual representation of the market share for the Trust, Mid Essex Hospital and Ipswich Hospital is presented below. The map shows what percentage of the population (with outpatients used as a proxy) in Essex went to the respective competing hospitals in 2012/13. The red outline defines the Trust’s catchment area.
The Trust’s market share is concentrated primarily in the east. Significant flows of patients from the Colchester Trust’s notional catchment area are likely to travel to competitors (both private and NHS). By comparison, Mid Essex and Ipswich appear to have less patient outflow to competitors.
This analysis only covers neighbouring NHS competitors. However, the Oaks Hospital (not shown on the map) is also a relevant threat to the Trust, holding high shares of the regional market in specialties such as T&O, General Surgery and Ophthalmology. The Trust plans to focus on repatriating those patients who are currently referring to other healthcare facilities and increase market share in its immediate catchment area and Essex overall, especially in growth areas.
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The Trust’s market share Mid Essex Hospital’s market share
*Market share is defined by outpatient flows in 2012/13, HES (Hospital Episode Statistics)
Competitive landscape (cont.)
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Trust assessment of key competitors
Key: Fully shaded circle is "Very high / strong", half shaded circle is "moderately high / strong", empty circle is "Low / weak".
The Trust has conducted a initial, desktop review of the relative strength of the existing competitors in the healthcare market. A summary of this is shown in the table below. The assessment for Colchester Hospital University NHS FT recognises the deterioration in the Trust’s competitive position as a result of the financial position and the impact of regulatory interventions.
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4. Factors impacting the Trust during
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This section assesses a wide range of varied factors that have the potential to affect the Trust during the plan period. In
addition to the reputational and regulatory actions the Trust is faced with, the Trust has reviewed a number of factors which
are not unique to it. Within the categories - demographic profiling, clinical policy developments and service reconfigurations,
commissioning and funding - exist many sub-factors which have been analysed in further detail.
Factors impacting the Trust during the plan period
Demographic
profiling
Demand for
services
Clinical policy
developments
and service
reconfigurations
Commissioning
Funding
Section overview
To understand the challenges and opportunities the Trust will face in the next 5 years, and inform the Trust’s strategic options
aimed at addressing the current issues for the Trust, it carried out an in-depth market analysis as well as an evaluation of
forecast NHS changes and commissioner policies and intentions. The current and planned funding situation was also
assessed in order to address the achievability of the strategic options.
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Key impacts1
2
3
Within demographic profiling, the current population characteristics for the area surrounding the Trust are analysed including that
of total population, age structure above 65 years old and predicted growth of the population over the next 5 years. The most
significant morbidity and health needs for both Colchester and Tendring DC are evaluated.
Demographic
profiling
Age structure
Population
growth and
demographic
structure
change
Morbidity and
health needs
Demographic profiling: section overview
There is an increasing number of patients with co-morbidities due to the ageing population as well as the black, minority and ethnic minority population in Colchester. Again, this places high demand on services which will need to address volume as well an health inequalities.
The growing ageing population and the increase in births represent both a challenge and an opportunity for the Trust. Increased demand will place pressure on services - however, the Trust will further integrate pathways with community and social care for the elderly and women and children.
In contrast, Tendring is one of the least ethnically diverse boroughs in Essex. However, there are problems with obesity and long term illness which the Trust intends to prioritise.
Colchester is the largest town in North East Essex. It is a largely affluent area with relatively low unemployment and above average life expectancy.
The Tendring peninsula is more rural and has a much higher concentration of elderly and economically less well-off people. Tendring is one of the two most challenged and socially vulnerable districts in Essex beset with many of the more complex social and health care issues; it includes the most deprived small area (LSOA; approximately 1,500 people) in England (LSOA E01021988).
2012 Census
The ONS 2012 Census total population data for the local authority and CCG areas principally served by the Trust and competitors was as follows:
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Demographic profiling
The age structure of the Tendring population is strongly skewed to the older age cohorts; this reflects high levels of later-life migration from London and the Home Counties to the coastal strip of the Tendring peninsula.
The population of all of Essex including North East Essex is expected to grow significantly in the planning period. ONS population projections suggest the growth between 2014 and 2019 in Colchester BC and Tendring DC will be disproportionately higher than the growth in the national population, and that the growth of the over 75 population (those who make proportionately larger use of hospital services) will be more significant than the national growth rate:
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• The demographic shift to a larger old and very old population will increase pressure on a range of services including: A&E, end-of-life, dementia, the frail and elderly care pathway; and it will increase the risk of bed blocking.
Age structure
Population growth and demographic structure change
Demographics in the area of Colchester and Tendring will develop as follows: • The population will increase by 4.4% over the next five years;
• Colchester and Tendring births will increase by 4.3% from 3,570 currently to over 3,720 by 2019; • Over 75s will increase by 13.33% from 33,000 to 37,400 by 2019;
• The underlying demand growth over the next five years is likely be faster than the population growth at around 10-15%, due to an increasing number of elderly and frail patients with multiple co-morbidities.
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Population growth and demographic structure change (cont.)
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Demand for services
The table to the right sets out a demographic 5 year growth analysis for A&E, Inpatients (Spells) and Outpatients.
The analysis sets out that:
• A&E growth in Colchester is expected to be higher than the Essex and England average;
• Inpatient growth in Colchester is expected to be higher than the England average, but lower than the East region and Essex average; and
• Outpatient growth is expected to be higher than the Essex and England average, but lower than the East region average. This analysis supports the comments on the previous page,
demonstrating how demographic developments is expected to translate into service demand.
Source: Office for National Statistics ONS 2012;Trust analysis
5 Yea r - North Ea s t Es s ex
growth POD
Al l a ges
NE Essex A&E 5.2%
East Region A&E 5.5%
England A&E 4.9%
Essex A&E 5.2%
Suffolk A&E 3.7%
NE Essex Spells 6.6%
East Region Spells 7.2%
England Spells 6.5%
Essex Spells 6.9%
Suffolk Spells 6.4%
NE Essex Outpatients 6.9%
East Region Outpatients 7.1%
England Outpatients 6.4%
Essex Outpatients 6.9%
Colchester
• Deprivation is lower than average, however about 5,500 children live in poverty; • Life expectancy for men is higher than the England average;
• Life expectancy is 8.4 years lower for men and 4.4 years lower for women in the most deprived areas of Colchester than in the least deprived areas;
• Over the last ten years, all-cause mortality rates have fallen. The early death rate from heart disease and stroke has fallen and is better than the England average;
• In Year six, 17.7% of children are classified as obese;
• The level of smoking in pregnancy is worse than the England average;
• The level of alcohol-specific hospital stays among those under 18 is better than the England average; • An estimated 22.5% of adults smoke and 23.6% are obese;
• The rate of road injuries and deaths is worse than average;
• Rates of smoking related deaths and hospital stays for alcohol-related harm are better than average; • The rates of statutory homelessness, violent crime and excess winter deaths are worse than average; • The rates of long term unemployment, hospital stays for self-harm and drug misuse are better than average;
The following summary is extracted from the Public Health England 2013 Health Profiles for the local authority in North East Essex:
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Overall Colchester finds itself in the 63rd percentile of the “most deprived” ranking, is more ethnically diverse than other towns in
Essex and the local black and minority ethnic (BME) populations are over-represented on certain disease registry.
Smoking and obesity, particularly child obesity, are of concern. Priorities include supporting vulnerable people, increasing levels of physical activity and addressing homelessness.
Tendring DC
• Deprivation is lower than average, however about 6,200 children live in poverty; • Life expectancy for men is lower than the England average;
• Life expectancy is 8.8 years lower for men and 6.3 years lower for women in the most deprived areas of Tendring than in the least deprived areas;
• Over the last ten years, all-cause mortality rates have fallen. The early death rate from heart disease and stroke has fallen and is similar to the England average;
• In Year six, 18.8% of children are classified as obese;
• Levels of teenage pregnancy, GCSE attainment and smoking in pregnancy are worse than the England average; • The level of alcohol-specific hospital stays among those under 18 is better than the England average;
• The estimated level of adult physical activity is worse than the England average. The estimated level of adult obesity is better than the England average;
• Rates of road injuries and deaths and smoking related deaths are worse than the England average;
• Rates of sexually transmitted infections and hospital stays for alcohol-related harm are better than the England average; • Recent data identifies that Tendring also has a higher than expected, and increasing, number of people with severe learning
difficulties population; has higher than expected mental health needs and experiences lower than expected educational attainment.
The following summary is extracted from the Public Health England 2013 Health Profiles for the local authority in North East Essex:
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Overall Tendring finds itself in the 26th percentile of the “most deprived” ranking and is one of the least ethnically diverse boroughs in
Essex. Smoking, teenage pregnancy and obesity, particularly child obesity, are of concern.
Priorities in Tendring include reducing levels of obesity, improving the outcomes of people suffering from long-term conditions and improving mental health outcomes.
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Overall impact on the Trust
The growing ageing population and the increase in births will create both challenges and opportunities for the Trust.
Specifically, the Trust is likely to experience increased demand which will place pressure on services it currently
delivers.
Opportunities exist if the Trust can integrate pathways and services through primary, community and acute sectors.
This is especially true for elderly care and women and children’s services which will allow the Trust to more
efficiently manage the health impact of the demographic changes that Colchester and Essex are expected to
undergo in the next five to ten years.
Services and pathways linked to these demographics-driven changes will include: end of life care (EoLC),
management of co-morbidities and complex conditions (particularly for an ageing population diabetes, COPD,
dementia, etc.). Maternity services, gynaecology, and paediatrics should also see increased demand through
predicted population growth.
To realise the full potential of these opportunities and to be sustainable, the Trust will change services it currently
delivers and develop new expertise by investing in new services and integrated platforms. Development of current
services and investment will be required to establish a more effective interface between social and health care. At
the same time, the Trust will maintain and develop the services which it is strong in delivering.
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Key impacts1
2
3
This section looks at four key services that will place increased pressure on the Trust over coming years: frail and elderly care,
women and children care, and cancer treatment. The main drivers behind these increased service demands are considered as
well as what this means for the Trust going forward.
Demand for
services
Demand for services: section overview
Due to the high rates of obesity and long term illness in the population the Trust aims to provide care suitable to the local population in a setting and manner that minimises the demand for health services.
The Trust’s main commissioner, NEE CCG, has the aim of reducing cancer mortality rates over the next five years. The Trust will have to focus on this area of care in order to align with commissioners policy
In line with the demographic changes that are forecast for the ageing population, there will be a large increase in dementia in coming years. The Trust will need to prioritise elderly and frail care especially in the
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Service
Driver
Outlook
Frail and elderly care
• In the next 5 years the composition of the population of Essex will see an increase of 14.1% in the over 75 year old population people
• By 2019 Colchester’s population will see an increase of 16.7% in people over 75;
• By 2019 Tendring’s population will see an increase of 10.9% in people over 75.
• From the presented figures follows an increase in patients with dementia, and in those with long-term conditions;
• Frail and elderly care will become a crucial service for the Trust in terms of volume.
Cancer treatment
• North East Essex CCG presents a significant number of premature deaths from cancer compared to similar CCGs, although the figure remains below the national average.
• NEE CCG wishes to bring the rates of mortality down to the level of the best in Office of National Statistics cluster over the next five years;
• The commissioning intentions align with the Trust’s desire to focus efforts on improving its cancer care provision.
Sources: NEE End of Life Care Strategy 2014-2017, NEE CCG five year strategic plan 2014-2019, Mid Essex CCG five year strategy 2014-2019
Demand for services
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Key impacts1
2
3
This section evaluates the six main clinical policy developments that have occurred/ are occurring within the NHS that may affect
the Trust’s plan period and therefore need to be considered. Each policy or service reconfiguration is briefly detailed with
anticipated implications for the Trust.
Clinical policy developments and service reconfigurations: section overview
National policy on seven day working
Stroke reconfiguration
24/7 emergency cover
Clinical policy developments and service reconfigurations
Minimum volume for specialist services/ concern for single-handed and under-staffed specialties
Minimum nursing levels
Increasing community in-reach, hospital outreach and integrated service bundling
The push towards a more integrated care system will align with many other issues the Trust faces and the plan to extend the Trust’s community and social care reach.
Seven day working, 24/7 emergency cover, and minimum nursing levels all require an increase in care coverage which raises significant capacity issues for the Trust and will likely require a significant level of organisational change and investment.
Policies requiring minimum volumes in order to maintain competence present the Trust with both threats and opportunities. Consultant capacity will be an issue and may result in some specialties being scaled down or needing to develop a network approach for sustainability of services.
There have been a number of clinical policy developments within the NHS that have the potential to impact the Trust’s ability to offer certain services in a manner that is both safe and commercially viable. Examples of such developments include, but are not limited to:
1. National policy on seven day working; 2. Stroke reconfiguration;
3. 24/7 emergency cover;
4. Minimum volumes for specialist services/concern for single-handed and under-staffed specialties;
5. Minimum nursing levels;
6. Increasing community in-reach, hospital outreach and integrated service bundling.
These policy developments and the impact that they may have on the Trust are explored in further depth over the following slides.
In December 2013 the medical director of NHS England, Sir Bruce Keogh, announced that hospital trusts will in the future be contractually bound to run a full service seven days a week. The reason for the policy is centred around the need for hospitals to make more efficient use of their expertise and equipment, as well as seeking to address the issue of increased mortality amongst patients who are admitted on Saturdays and Sundays relative to those admitted on weekdays.
The exact shape of the change is unclear at present, but it is likely that it will first become evident in the areas of urgent and emergency care. The shift is likely to affect all parts of the hospital - ranging from the potential difficulties of getting adequate staff and specialists in place at a sufficient cost, through to the probability that equipment with increased
utilisation and less ‘downtime’ will need increased maintenance whilst at the same time not impinging on patients.
