Summary of our Five Year Strategic Plan 2015 - 2020 · our Quality Account ... • The delivery of a financially viable acute Trust; • Recruitment and retention ... Summary of our

SummaryofourFiveYearStrategicPlan|2015-2020

1 A great place to be cared for; a great place to work.

A great place to be cared for; a great place to work.

Summary of our Five Year Strategic Plan2015 - 2020



Contents

Section Item Page

Introduction 4

1 ExecutiveSummary 7

2 MarketAssessmentandCommissioningLandscape 12

3 TheClinicalModel 22

4 WorkforceandOrganisationalDevelopmentStrategy 30

5 TheEstatesStrategy 39

6 TheITandInformaticsStrategy 44

7 TheQualityStrategy 47

8 TheFinanceStrategy 50

9 Conclusion 57

Theinformationcontainedinthisdocument

weunderstandtobecorrectatthetimeof

goingtopress.Aswestrivetoimproveasan

organisation,figuresandinformationare

subjecttochange.





Introduction

OverthelasttwoyearstheTrusthascontinuedto

makesignificantprogressinitsrecovery,followinga

threestageprogrammeofstabilisation,transition

andtransformation.

TheTrustsetoutplansinitsOperationalPlan*

2014-2016,submittedinApril2014,fordelivering

highqualitysustainableserviceswithintheresources

availableoverthenexttwoyears.Researchhasshown

thatoperatingasitdoes,acrossthreemainsites

coveringawidegeographicalareawithrelativelylow

volumesofactivity,isunsustainableandcannotcontinue.

InourOperationalPlan2014-16,theTrustacknowledged

thatwewouldbemakingfurtherrevisionstoour

plansfollowingpublicationofthe‘bettercaretogether’

strategyinJune2014.

‘Bettercaretogether’isaclinicallyled,health

economy-wideprogrammeandisthemainroute

throughwhichtheTrust’slong-termfuturewillbe

delivered.Throughoutallofourplans,ourpriority

remainsthatofdeliveringhighquality,safeservices

thatmeetstheneedsandexpectationsofourpatients

andrequirementsofourregulators.

Attheheartofallourproposalsisanewmodelof

“outofhospital”careinwhichlocalGPpractices

becomethegatewayforpeopletoaccessallcare,

includinghospitalservices.GPswillworkcloselywith

awiderangeofotherhealthandcarepractitionersto

ensurepeople’sneedsaremet,andindoingsoreduce

delaysandexpenseintheexistingsystem.

*Find out more.

TheTrust’sOperationalPlanisavailableonourwebsite:

www.uhmb.nhs.uk

Underthisnewmodel,responsibilityforhealthand

carewillbecomeatruepartnershipbetweenpeople,

GPsandotherhealth-carestaffinthecommunity.

Therewillbeamuchmoreproactiveapproachto

care,wherebylocalintegratedcareteamswillidentify

patientsatrisksothattheycanreceivethesupport

theyrequirebeforeacrisisoccurs.Peoplewillbe

empoweredtomakelifestylechoicesthatwillkeep

themhealthyforlongerandtomanagelong-term

conditionsathomewiththeuseoftechnology.Fewer

elderlypeoplewillendupspendingtheirlastdaysin

hospitalbecausetherewillbetheoptionforthemto

becaredforathome.

Hospitalserviceswillwraparoundthisnewmodelof

carewithemergencycareandconsultant-ledmaternity

unitsremainingascoreessentialservicesateither

endofourpatch.Allowinghospitalstofocusonthe

aspectsofcarethatonlytheycanprovidewilldriveup

standards,reducethelengthofhospitalstays,improve

waitingtimesandinmanycasesreducetheneedfor

patientstotravel.Thisnewwayofworkingwillalso

reducecoststhroughmoreefficientuseofresources.

Inaddition,thereistheopportunityformanyhospital

stafftoprovidetheirexpertisewithinacommunity

setting,takingcaretothepatientratherthanbringing

thepatienttothehospital.



Throughthe‘bettercaretogether’strategytheTrust

willworkwithitspartnersacrossthelocalhealth

economyto:

•Developout-of-hospitalservicemodelsinallthree

localitiesthatarecapableofreducingthefuture

needanduseofhospitalservices,resultinginthe

releaseofhospitalservicecapacityandinfrastructure;

•Retainkeyessentialservicesinallthreelocalities

toprovideAccidentandEmergency,24hour

accesstourgentcareandmaternityservices:

Givenourgeography,muchoftheMorecambeBay

populationisunabletoaccessalternativeservices

withinatraveltimeof45minutestoonehour;

•Developconfigurationoptionsforsurgical

servicesthatimproveserviceefficiency,quality,

patientexperienceandsustainabilityofservices;

•Deliverprojectednetsavingsofapproximately

£23m,dependinguponthescaleofchange

deliveredandinvestmentrequired;

Thefollowingin-hospitalserviceswillstillbeprovided

acrossMorecambeBay:

•AccidentandEmergency(Type1)anddependent

servicesatFurnessGeneralHospitalandRoyal

LancasterInfirmary;

•WestmorlandGeneralHospital:PrimaryCare

AssessmentServiceprovidedbyCumbriaPartnership

NHSFoundationTrust;

•MaternityserviceswithobstetricfacilitiesatFurness

GeneralHospitalandRoyalLancasterInfirmary;

•MidwiferyledunitatWestmorlandGeneralHospital;

•Electiveservicesanddaysurgery.

Communityteamswillbedevelopedoutofhospital

withineachlocalityandwillbemadeupof:

• Integratedcoreteam;

•Urgentcareco-ordinationcentre

(withachildspecificservice);

• Integratedrapidresponseteamsforadultswith

separateteamsforchildren;

•Communityspecialistservicesforbothadultsand

children;

•Referralsupportsystemforbothadultsandchildren.

Throughoutallofourplans,including‘bettercare

together’andourfiveyearstrategy,ourpriority

remainsthatofdeliveringhighquality,safeservices

thatmeettheneedsandexpectationsofourpatients

andthepopulationthatweserve.

TheTrusthasdevelopedaQualityImprovementPlan

whichoutlinesourqualityimprovementambition

overthenextfiveyears–improvingpatientsafety

byreducingavoidableharmandmortality.These

goalsarealignedwithdeliveryoftheCareQuality

CommissionImprovementPlaninyearone,andwith

ourQualityAccountandCQUINpriorities.Improving

patientexperienceisfundamentaltodeliveryofthe

QualityImprovementPlanandthiswillbefurther

developedandmonitoredthroughtheintroductionof

the‘IWantGreatCare’servicethroughouttheTrust.

Theimplementationofseven-dayworkingfor

non-electiveservicesisconsideredakeyenablerto

thedeliveryofhighqualityandefficientcare.During

2014/15plansarebeingdevelopedinordertofully

understandtheimplicationsandcostsassociatedwith

providingtheseservicesoversevendaysbothinhospital

andinthecommunity.Expandingservicesinthiswayis

integraltothesuccessfuldeliveryofbettercaretogether.

Therecruitmentandretentionofstaffremainsakey

strategicriskfortheTrustandhasbeenthefocus

ofsignificantworksince2013/14.Thefindings

oftheFrancisandBerwickreviews,aswellasthe

introductionofguidelinesfornursestaffinglevels

internallyandnationally,hasmaintainedthefocus

onthisarea.Wehave,asanorganisation,invested

intherecruitmentofmedicalandnursingstaff,a

strategywhichhasproventobelargelysuccessful.A

comprehensiveapproachtoworkforceplanningand

organisationaldevelopmenthasbeenimplemented

acrosstheTrustandislinkedtotheemergentservice

modelsbeingdevelopedaspartofbettercaretogether.



Wehavedevelopedanestatesstrategythattakes

accountofthesubstantialcapitalinvestmentthat

isrequiredinordertoimproveclinicalefficiencies,

patientexperience,safetyandtheoverallenvironment

atourthreemainhospitalsites.Investmentinthe

estatewillhaveapositiveimpactonpatientandstaff

experienceaswellasimprovementsintheTrust’s

tradingposition.

In2013/14,weimprovedourfinancialpositionby

around£3minrealterms;ourinitialplansfor2014/15

forecastthatthistrendwouldcontinue,however

investmentinnurseandmedicalstaffing,andan

increaseinactivityhasmeantthishasnotbeen

realisedinthefirsthalfof2014/15.Asaresult,the

Trustcommencedafinancialrecoveryplanearlyin

theyear.

Thetransformationofourfinances,startingin2015/16

willbedrivenbycontinuedcostimprovementscombined

withapricingstrategyalignedtothenationalpricing

policyforTrustssuchasours.TheTrustsubmitted

aLocalPriceModificationapplicationtoMonitorin

September2014inlinewiththeguidanceavailable.

Thisapplicationiscurrentlybeingconsidered.

TheBoardofDirectorsfeelthatthismodeliskey

tosuccessfullymeetingthechallengesoftheNHS

nationallyandoftheuniquecharacteristicsofthe

geographyanddemographicsacrossMorecambeBay.

WeremainmindfulthattheNHSandLocalAuthority

partnersinNorthCumbriaandtherestofLancashire

arealsoundergoingchangesandwillcontinueto

workwithcolleaguesasourproposalsdevelopto

ensurethattheycomplementratherthancompete

withplanswithinthoselocalities.

Thesuccessfuldeliveryof‘bettercaretogether’,along

withtheTrust’sownCostImprovementProgramme

willresolvemost,butnotall,ofourfinancialdeficit.

Ourdetailedresearchandanalysishasshownthatthis

cannotbeachievedwithoutcuttingoutcoreservices

andwecannotrecommendthatasasafesolutionfor

localpeople.Ourplansdoprovideasolidplatformfor

ustobuilduponandwewillbeworkingwithNHS

Englandtoseekpoliticalsupporttoreviewtheway

thatfundingisallocatedtoreflectouruniquelocal

challenges.



1. Overview

OverthelasttwoyearstheTrusthascontinuedto

makesustainableimprovementsinthedeliveryof

highqualityservicestopatientsthrough:significant

investmentinnursingandstaffinglevels,improved

governance,astrengthenedBoardandinvestment

inclinicalleadership.

TheTrustcontinuestoworkcloselywithkey

strategicpartnersacrosstheHealthEconomyon

theimplementationanddeliveryofthebettercare

togetherprogramme.

Untilthelocalhealtheconomysolutionisinplace,the

Trustwillcontinuetofacethefollowingchallenges:

•Thedeliveryofsustainable,highqualityclinical

services;

•ThedeliveryofafinanciallyviableacuteTrust;

•Recruitmentandretentionofstaff(capabilityand

capacity);

• Impendingincreasesinlocalhealthcaredemands.

Over next two years 14/15 to 15/16Asreflectedinthetwoyearoperationalplan,the

Trusthasplannedarobustprogrammeofactivityto

mitigateriskandensurethemaintenanceofhigh

qualitysustainableservicesforourlocalpopulation

untilbettercaretogetherisrealised.TheTrustwill

continuetobuildonanddeliver:

•Transformationalandtraditionalcostimprovement

programmes;

• Implementationanddeliveryofkeyservice

developmentsbuildingonthebettercareprinciples;

•Researchanddevelopmentportfolios;

•Aninnovativeapproachtorecruitment,workforce

andorganisationaldevelopment.

Withinourfirstphaseofservicedevelopments,and

inlineinwithbettercaretogether,wewillaimto

deliverarangeofservicedevelopmentsinpartnership

withourlocalcommissioners.Duringthetransition

period,from2016to2019,theTrustwillfocusonthe

implementationanddeliveryofthenewmodelsof

serviceasoutlinedinthebettercaretogetherstrategic

caseincluding:

•Outofhospitalmodel;

• Inhospitalserviceprovision;

•Thedevelopmentofnewmodelsofcaresuchas

IntegratedCoreTeams;

•Acutebasedservices–emergency/elective/

maternity;

•Potentialcommunityspecialistservices;

• Integratedmodelsofservicesjointlywith

communityservicesandsocialserviceswhichwill

allowaccesstotheBetterCarefund.

Section 1Executive summary



1.1 Background

TheTrustprovidesacuteservicesfromfivesites,across

alargegeographicalareaservingasmall,dispersed

populationfocusedinthreemaincentresofpopulation

withsignificanthealthinequalitiesacrosstheregion.

Thelongtermstrategyforensuringfinancialand

clinicalsustainabilityistoundertakeareconfiguration

ofhealthandsocialcareacrossthebayarea.This

willbeachievedthroughthe‘bettercaretogether’

StrategywhichhasbeensubmittedtoMonitorand

NHSEnglandforconsiderationandcomment.

1.2 The trust’s current strategic risks

TheTrusthasidentifiedanumberofareasthatpresent

achallengetotheorganisationintheachievement

oftheTrust’sstrategicobjectivesandqualitygoals.

ThemainchallengesandriskthattheBoardare

respondingtoare:

•Deliveringsustainable,highqualityclinicalservices;

•Deliveringafinanciallyviablehealtheconomy;

•Deliveryofbettercaretogether;

•Recruitmentofstaff(capabilityandcapacity);

•Deliveryofseven-daynon-electiveservices;

•Effectivemanagementofnon-electivepatients

andsustainableachievementoftheemergency

carestandard;and

•Appropriateestates/environmentinwhichto

deliverservices.

Actionplansandprogrammesareinplaceto

mitigatetheserisks.Centraltotheseisthebetter

caretogetherStrategyandProgramme.TheTrust

anditspartnersacrossthelocalhealtheconomyhave

agreedaStrategythataimstodeliverafinancially

viablehealtheconomyandsustainable,highquality

primary,communityandacuteclinicalservices.The

preferredoptionwillseetheexpansionofprimary

andcommunityservicesleadingtoachangeinthe

provisionofacuteservicesbestsuitedtolocalneeds.

Accidentandemergencyservicesandconsultant-led

maternityunitswillberetainedatFurnessGeneral

HospitalandRoyalLancasterInfirmary.

ArevisedStrategywassubmittedtoMonitorandNHS

Englandon31October2014.TheTrusthasappointed

aBetterCareTogetherTransformationTeamthatwill

beresponsiblefordeliveringtheTrust’scontributionto

theoverallStrategy.

Itisunlikelythattherewillbesignificantchangesto

thestructureandoperationoftheTrustintheearly

partofthedeliveryofthebettercaretogetherStrategy

untilinvestmentsinprimaryandcommunityservices

havebeendelivered.InthemeantimetheTrustneeds

toremainfinanciallyandclinicallysustainable.

TheBoardhascommissionedexternalsupportto

assesstheimpactofgeographicandstructural

challengesinoursystems,whicharecontributingto

arecurrentfinancialdeficitpositionofcirca£35m

(currentforecast).Thisexternalreview,byPwC,has

shownthattheMorecambeBayhealthsystemhas

beenchallengedforsomeyears.Thereporthas

demonstrated:

•Theneedtoprovidehealthcaretoawidely

spreadpopulationrequiringmorehospitalsites

thanhealthsystemsofcomparativepopulation

size,withaconsequenthighercostsofprovision;

and

•Theimpactofstaffpremiums,oftenupto70%

higherthanthecostofNHSstaff,andthe

requirementtoaddressqualityissuesarisingfrom

regulatoryreviewsbytheCareQuality

CommissionandMonitor.



TheimmediateresponseoftheBoardhasbeento

secureadditionalfundingfor2014/15fromthelocal

ClinicalCommissioningGroupsandNHSEngland.

For2015/16theBoardhasconsideredtheguidance

availablefromMonitorandhasmadeaformal

applicationforaLocalPriceModificationtorespond

totheimmediaterisksfacingtheTrust.

FollowingtheCareQualityCommissionHospital

InspectioninFebruary2014theBoardhasputinplace

anumberofmeasurestosustainandimprovequality

andperformanceoftheTrust,particularlyinrespect

ofCareQualityCommissionessentialstandardsand

harmfreecare.TheBoardhasapprovedaQuality

ImprovementPlandesignedtodeliverthelongerterm

qualityimprovementsneededoverthenextthree

years;theCareQualityCommissionImprovementPlan

willbeakeypartofthisinyearone.

TheCareQualityCommissionImprovementPlan

detailshowtheTrustwillsuccessfullyaddressthe

‘mustdo’and‘shoulddo’actionsidentifiedbythe

CareQualityCommissionfollowingitsinspectionof

theTrustinFebruary2014.

TheCareQualityCommissionImprovementPlanis

timelimited;ithastobe,astheTrustneedstodeliver

theimprovementsatagreaterpaceandbefore

ournextInspection.Toensuretheimprovements

canbesustainedandtotacklesomeofthelong

standingissuessuchasculture,weareestablishingan

‘ImprovementHub’toprovidesupportandassistance

toourstaff,helpingthemtofullyunderstandwhat

‘good’and‘outstanding’lookslikeandproviding

themwiththetoolstoachieveit.TheHubapproachwill

supportstafftousetriedandtestedtechniquesfor

deliveringconsistentchangesuchasListeningintoAction.

1.3 Estates strategy

TheTrustisdevelopinganEstatesStrategythatwill

deliveramoreeffectiveuseoftheTrust’sEstate.Itwill

seegreaterco-locationofrelatedservicesandrespond

tolongstandingissuesacrossourmainsiteswiththe

aimofimprovingefficiencyandthequalityofcare

andtreatment.TheStrategyisambitiousandwhilst

muchofitwillrequirecentralNHSsupporttheTrustis

planningtopressaheadwithanumberofimprovements

fromwithinitsexistingcapitalallocation.

1.4 Risk strategy

TheBoardhasrespondedtotherisksposedtothe

Trustbyfailuretorecruit,retainanddevelopstaffby:

•Developingworkforceplanstounderpinthe

reviewofvacanciesandmodelsofcarewithin

divisions,linkingtothemodelsofcareinthe

bettercaretogetherStrategy;

•TheExecutiveChiefNurseundertakingareviewof

nursingandmidwiferystaffing;

•TheTrustBoard,inautumn2014,agreedtoinvest

afurther£3millionintothenursingestablishment;

•RollingoutE-rosteringtoensurestaffaredeployed

wheretheyarerequired;

•Newrecruitmentstrategieshavebeenintroduced,

includingoverseasrecruitment,whichareproving

successful;

• Introducinganapprenticeshipschemetocreate

upto25newhealthcaresupportcadetsatboth

theFurnessGeneralandRoyalLancastersites;

•EstablishingaWorkforceAssuranceCommittee

oftheTrustBoardtooverseeworkforceissues

acrosstheTrust.



ChallengesremaininensuringtheTrustcanmaintain

deliveryofbothelectiveandemergencypathways

effectivelyinmedicalandsurgicalspecialties.Divisions

haveundertakenagapanalysisagainsttheten

Keoghclinicalstandardsandwilldevelopaction

planstodeliversevendayservices,inlinewiththe

nationaltimetable.In2014/15,theTrustwillfocus

onemergencypathways.Sevendayworkingwillbe

incorporatedintothequalityrequirementsoftheNHS

standardcontractin2015/16and2016/17.Despite

sustainedimprovementintheperformanceofboth

ourEmergencyDepartmentsagainstthefourhour

target,maintainingthisstandardcontinuestobe

challengingastheTrusthasnotseenasignificant

reductioninthenumberofemergencyadmissions.

Therehasbeenanincreaseinambulanceattendances

andmanypatientsthatarepresentinghavemultiple

co-morbiditiesandgreateracuity;andthusahigher

levelofneed.Thelocalhealtheconomycontinuesto

worktogethertodevelopoperationalresilienceand

capacityplansandatthesametimetheTrustisdeveloping

additionalcapacitytomeettheincreaseddemand.

TheserisksaremanagedthroughtheTrust’s

governanceframeworkandperformancemanagement

structureswithassurancesonprogressreported

totheTrustBoardregularlythroughtheBoard

AssuranceFrameworkandtheCorporateRiskRegister.

AssurancesonprogressarereportedtotheTrust

BoardthroughtheFinance,WorkforceandQuality

Committees.Thesuccessfuldeliveryofthe‘better

caretogether’StrategyiscentraltotheTrust’slong

termplansforsustainability.Riskstodeliveryofthe

strategyincludethefailuretosecuresupportforthe

servicechangestrategy;potentiallyleadingtodelaysin

implementation.

1.5 Response to the regulator

ThebettercaretogetherStrategyistheoverarching

planforthelocalhealtheconomythatwillimpacton

theTrust.BeneaththistheTrusthasdevelopedaseries

ofstrategicplansthathavetheaimof:

•Delivering core business;

•Preparing for the impact of better care

together including developing activity

modelling and capacity for the Trust;

•Trust service development ambitions;

•Responding to the requirements of

the regulators.

Inaddition,thesestrategiesarenowbeingaligned

toreflectthenewvisionandvalues,aswellasthe

objectivesandprioritiesoftheTrustBoard.Themain

strategiesandplansareoutlinedwithintable1.

Table 1:

UHMBT strategic and operational plans 2014/15

•QualityImprovementPlan

•CQCImprovementPlan

•QualityAccount

•TwoYearOperationalPlan

• ITandInformaticsStrategy

•EstatesStrategy

• FinancialStrategy

•WorkforcePlans

•RiskManagementStrategy

•CodeofCorporateGovernance(underreview)

•DivisionalBusinessPlans

•CommercialStrategy(indevelopment)

•HealthandSafetyStrategy

•ResiliencePlanning

•PatientExperience

•CommunicationandEngagement(underreview)



TheTrusthasbeenandremainssubjecttoanumber

ofregulatoryconcerns.TheTrustwasinspectedin

February2014aspartoftheCareQualityCommission

ChiefInspectorofHospitalInspections.Theinspection

highlightedanumberofimprovementareaswhichthe

Trustisrequiredtoaddress.MonitorplacedtheTrustin

specialmeasuresandattachedfurtherlicenceconditions.

TheChiefInspectormade15recommendationsin

total,eightofwhichtheTrust“must”undertakeand

sevenwhichtheTrust“should”undertake.All15

recommendationsareincludedinourCareQuality

CommissionImprovementPlan.Thekeythemesof

theserecommendationsaresummarisedbelow:

• Improvingourstaffinglevels;

•Engagingandcommunicatingmoreeffectively

withfrontlinestaff;

• Improvingperformanceinformationtodrive

improvementandgooddecisionmaking;

• Improvingournurserecordkeeping;

•Continuingtoimproveincidentreportingandthe

learningwegainfromincidents;

• Improvingtheavailabilityofcasenotesandtest

resultsinouroutpatientsdepartments.

TheTrusthassixconditionsattachedtoitsProvider

LicencebyMonitorandhasreceivedinspection

reportsfromtheCareQualityCommission,Ofsted

andtheHealthandSafetyExecutive.TheTrust

remainscommittedtoachievingcompliancewithits

providerlicencerequirementsandthatisreflectedin

itsstrategicplanningprocesses.InadditiontheTrust

developedaseriesofactionplanstoaddressthe

regulatoryconcernsraisedandprogressagainstthese

planswasandcontinuestobemonitoredbytheTrust

BoardanditsAssuranceCommittees.TheHealthand

SafetyExecutiveactionshavebeenundertakenand

signedoff(althoughtheHealthandSafetyExecutive

investigationisyettocomplete)andtheOfstedaction

hasalsobeenrespondedto.



2. The local population health challenge

IndevelopingthebettercaretogetherStrategy,an

indepthanalysishasbeenundertakentoassessthe

healthneedsofourlocalpopulation,understand

futuredemographicchangesandhowweneedto

shapeservicesforthefuturetomeetthecompeting

healthcaredemandsandchanges.

TheMorecambeBayfootprintcoversalarge

geographicalarea,1,800km2,whichismorethan

doubletheareaforthenationalaveragetrustof

815km2.Conversely,thepopulationweserve,

365,000,islessthanthe418,000servedbyan

averagetrust.Thegeographicalfootprintposes

varyingchallengesincluding:

•Adiversepopulationwithindustrialurban

centressuchasBarrowinFurness,theuniversity

cityofLancasterandsmallisolatedvillages,

suchasOverKellet,HawksheadandConiston,

whichimpactsonthestructureanddelivery

ofhealthcare;

•Thelargegeographyandlowpopulation

densityhaveresultedinaconfiguration

ofhealthcaredeliverythatdoesnot

makeoptimaluseofestate

andotherresources.

Eachofthelocalitieshasitsownindividualhealth

needsandchallengesandservicesmustbedesigned

toimprovethehealthofourlocalpopulationsas

outlinedintable3.

Section 2Market assessment



2.1 National and local guidance

Table 3: Local health population needs

Health needs CCG commissioning priorities

Population growth Life expectancy

Lancashire North

Prioritydiseaseareas:-•CVD•Cancer•COPD•Chroniccirrhosisof

theliver

Localpriorities:-•Toreducehealth

inequalities•Toreducepremature

deathsfromarangeofLTCs

Diseasesaffectingolderpeopleincluding:-•Dementia,circulatory

disease,diabetes,COPD,osteoarthritis,cancers.

Focuson:•Improvementin

strokeserviceprovision

•Improvingdementia

Higher than average predicted increaseintheproportionofolderpeopleinLancashireNorthovernext

10 years

1 year lower than national averagebutforthoseinthemostdeprivedareas:

Cumbria Prioritydiseaseareas:•Cancer•Cardiovascular

disease•Stroke•Respiratorydiseases

Localpriorities:•Reducinghealth

inequalities•Ensuringchildrenget

abetterstartinlife•Improvingmental

healthandwell-being•Supportinganageing

population

Toreduceavoidableunscheduledadmissionstohospitalforchildren

Toimproveclinicalqualityinthemanagementofstrokewithinthefirst30days

ImprovesupportforpatientstomanageLTCsfocusingonrespiratory

4.2%population growth over next 5 years

(comparedtothenationalaverage)inmostdeprivedareas

Furness AreasworsethantheEnglandaveragein2012:•22.7%ofadult

populationclassedasobese•Rateofalcohol

relatedharmhospitalstays

•Levelsofadultsmoking

Reducingalcoholmisuse

Reducingobesityinchildren

Reducingsmoking

Significant increase in >65yrs of

11.5%(comparedtothenationalaverage)inmostdeprivedareas

South Lakeland

1.ImprovinghealthandwellbeingofolderpeopleandthosewithDementia

2.Reducingroaddeathsandinjuries

3.ReducingalcoholSignificant increase in >65yrs of

16.7%

11.6 years lowerformen

6.4 years lowerforwomen



12 years lowerformen




(comparedtothenationalaverage)inmostdeprivedareas



AsaTrust,itisimperativethatwereflectnational

guidanceandlocalcommissioningplansinourstrategic

planningframework.

National guidance 2015/16ThenationalNHSplanningguidancefor2015-16

waspublishedinDecember2014.However,the

contractingandtariffguidanceisstillyettobe

finalisedandpublished.Indicationsarethat:

•TheNHSwillreceiveasingle-yearfinancial

settlementfor2015/16.Followingthegeneral

electioninMay2015,theincomingGovernment

willsetoutitslongertermprogrammeand

fundingplans;

•Theoverarchingobjectivesofthe2015/16

planningroundwillbetorefreshthesecondyear

ofexistingtwoyearoperationalplansand

establishafoundationforlongerterm

transformationbasedontheNHSFiveYear

ForwardView;

•ThereisaneedtosecurealignmentwithBetter

CareFund;

•TherewillbeanexpectationthatClinical

CommissioningGroupswillcontinuetheirworkto

implementtheirexistingfiveyearplans;and

•Emergingareasofchangeare:co-commissioning

ofprimarycare,futurecommissioningmodels

forspecialisedservicesandintroductionof

integratedpersonalcommissioning.

TheNHSFiveYearForwardViewguidance,published

inlateOctober2014,setsoutadirectionoftravel

whichiscompletelyalignedtotheTrustandourlocal

healtheconomy’svisionandambitionaroundthe

deliveryofthe`bettercaretogether’strategy.

Theguidanceoutlinedthefollowing:

•AcleardirectionfortheNHSoverthenextfive

yearsdiscussinghowthehealthserviceneedsto

change,whychangeisneededandhowthe

futuremightlook.Itarguesfor:amoreengaged

relationshipwithpatientsandcarers;settingup

ofpartnershipswithlocalcommunities,hard-

hittingapproachestomajorhealthriskssuchas

smokingandobesity;fordecisivestepstobe

takeninbreakingdownbarriersinhowcare

isprovided;theneedforcaretobedelivered

morelocallyandunderstandingthata‘onesize

fitsall’approachwillnotwork;theneedforcritical

decisionstobemadeoninvestmentandalsolocal

flexibilityinthewaypaymentrulesandregulatory

mechanismsareappliedtosupportrequiredchange;

•Theneedtogetseriousaboutpreventionof

avoidableillness;empoweringandsupporting

patientswithlongtermconditionsinmanaging

theirownhealth;

•Anumberofradicalcaremodelsaresuggested

inamoveawayfromthetraditionaldivide

betweenprimarycare,communityservicesand

hospitalserviceswiththedirectionoftravelbeing

tomanagenetworksofcare,expandand

strengthenoutofhospitalcare,integrateservices

aroundthepatient.Emergingmodelsinclude:

>MultispecialtyCommunityProviders(MCPs)

-thiswillpermitgroupsofGPsgroupsof

GPstocombinewithnurses,othercommunity

healthservices,hospitalspecialistsand

perhapsmentalhealthandsocialcareto

createintegratedout-of-hospitalcare.Care

couldbeofferedinafundamentallydifferent

way,makingfulleruseofdigitaltechnologies,

newskillsandroles,andofferinggreater

convenienceforpatients.Thisapproachaligns

tothevisiontheTrusthaswithkeypartners

forserviceprovisionaroundthe

Millomcommunity.



>PrimaryandAcutecaresystems-combining

generalpracticeandhospitalservices,similar

toAccountableCareOrganisations.A

rangeofcontractingandorganisationalforms

arenowbeingusedtobetterintegratecare,

includinglead/primeprovidersandjointventures.

>UrgentandEmergencycarenetworks-

AcrosstheNHS,urgentandemergencycare

serviceswillberedesignedtointegrate

AccidentandEmergencydepartments,

GPout-of-hoursservices,urgentcarecentres,

NHS111,andambulanceservices.

>Viablesmallerhospitals-NHSEnglandand

Monitorwillworktogethertoconsider

whetheranyadjustmentsareneededtothe

NHSpaymentregimetoreflectthecosts

ofdeliveringsafeandefficientservicesfor

smallerprovidersrelativetolargerones.This

viewisinkeepingwithourapplicationfora

LocalPriceModificationtoreflectour

structuralcostsandthedeliveryoflocalservices.

AsanNHSfoundationtrustwewillplanfor:

•Changestothewayspecialisedservicesare

commissionedandtheimpactofthisonlocal

serviceprovisionandcommissioningarrangements;

•Changestothewayservicesarefundedandany

potentialimpactonservicedelivery;

•Changingcaremodels,includingintegrationwith

healthandsocialcareandhowthatwillimpacton

serviceswedeliver;

•Differentcommissioning/contractingmodels

proposalsandthepotentialforprimeprovider

models;

•ChangestoTariffguidanceandpaymentsystems;

includingemergencycare;and

•Potentialdecommissioningofcertainspecialised

services;followingthetransferofVascularservices

fromtheTrustfromApril2015.

2.2 Local financial challenges within Morecambe Bay

The ‘Bay-wide’ affordability gapThetotalhealthandsocialcarespendintheMorecambe

Bayhealthandcaresystemisover£500m.Wehave

ademographicandstructuralchallengeinoursystem

contributingtoafinancialdeficitof£25m-£30mwiththe

affordabilitygapprojectedtoriseto£71minfiveyears’

timeifwemaintainthestatusquo.Evenifallefficiency

targetsareachieved,therewillstillbearesidual,

recurringfinancialgapof£30minfiveyearstime,

whichwillcontinuetogrow.Asahealtheconomy,the

‘donothing’optionisnotfeasibleifwewishto

continuetoprovidehighqualityclinicalservicesfor

theourlocalpopulation.Overallhealthexpenditure

withinthelocalhealthsystemis£422m,excluding

relatedlocalauthorityexpenditure.Thelocalhealth

system’soverallfinancialpositionisfragileandthere

areincreasingpressuresoncommissionersaswellas

providerstoreducethefinancialgap.

Particular system wide themes that add to financial pressures are: •Theimpactofstaffpremiums,oftenupto70%

higherthanthecostofNHSstaff,andthe

requirementtoaddressqualityissuesarisingfrom

regulatoryreviewsbytheCareQuality

CommissionandMonitor;and

•TheCumbriahealthsystemisoneofelevenmost

challengednationally.

Thefinancialimpactofthesefactorsaddsfurther

pressuretothealreadyfinanciallyfragilehealthsystems

inMorecambeBayandacrossCumbriaasawhole.

Also,theneedforadditionalinvestmenttoaddress

backlogmaintenanceintheTrustisapressure.Capital

investmenthasbeensuppressedinrecentyearsasaway

ofaddressingfinancialandcashpressures.Thishasnot

onlyresultedinalackofday-to-daymaintenancewhich

nowneedstobedealtwith,butmoreimportantly,has

deferredchangestoclinicallayoutsandotherphysical

alterationsthatwouldhelpimproveserviceefficiency.



Market AppraisalWehavemadesignificantinroadstoimprovethe

qualityandsafetyofourclinicalservicesforour

patients,andarecommittedtoaprogrammeof

improvementandservicedeliverywhichwillensure

thatweareequaltoifnotbetterthantheother

providerswithinthesurroundingareas.Outlined

belowisanassessmentofwheretheTrustsitsin

relationtolocalNHSproviders.

Table 5: Competitor performance analysis 2014

Data source UHMBTLancashire Teaching Hospitals Foundation Trust

NorthCumbria UniversityHospitals NHS Trust

Blackpool Teaching Hospitals Foundation Trust

Wrightington, Wigan and Leigh Foundation Trust

Note Monitor Enforcementaction;Specialmeasures

CQC InadequateRequiresImprovement

RequiresImprovement

TDASpecialmeasures(Keogh);Deficitof£27mProposedmerger

Governance Monitor Red Green N/A Green Green

TDA Poor

Continuityofservicesrating

Monitor 2 3 N/A 3 4

RTT(NHS 91.01% 80.39% 82.22% 91.96% 91.37%

England) 97.53% 95.37% 94.50% 96.81% 97.71%

Incomplete 95.50% 92.33% 90.99% 94.82% 94.21%

Cancer(NHSEngland)

2ww 94.79% 94.86% 93.72% 95.12% 98.66%

62Day 84.04% 81.95% 81.33% 87.04% 91.87%

A&E(NHSEngland)

A&EAttendances

95.12% 95.07% 94.12% 94.34% 95.71%

MRSABacteraemiaper100,000BedDays

HED 0.44 1.26 0.52 0.35 1.23

CDiffRateper100,000BedDays

HED 22.21 17.26 12.47 9.09 19.75

ElectiveOperationsCancelledatLastMinute

NHSEngland

538 675 475 541 358

SHMI HED* 104.07 104.27 93.62 115.9 104.33

*monthlySHMIdata,preInformationCentrerelease

Registration



Our strengths and weaknessesAsanorganisationitisessentialthatweunderstand

ourstrengthsandweaknesses,enablingustoriseto

anychallengeinordertoprovidehighqualityservices

forourlocalpopulation.ASWOTanalysishasbeen

undertakenwhichidentifiesboththeopportunities

fortheTrustandthechallengesthatstillneedtobe

addressedandisoutlinedintable6.

Table 6: UHMBT SWOT analysis 2014

STRENGTHS WEAKNESSES OPPORTUNITIES THREATS

• NewBoardwithenhancedcapacityandcapability

• StrongclinicalengagementwithClinicalCommissioningGroups

• Clinicallyledoperationaldivisions

• Strongclinicalengagementinplanningandchangeprocess

• NewrobustGovernanceFramework

• OverallStableworkforce

• Corefinancialandassociatedsystemsarerobust

• NationalPatientSurveyresultscomparabletolocalcompetitors

• ImprovingEstatesandFacilities

• TheTrustrecognisestheveryseveredenttoitsreputationalimageasaresultofthepreviousfailingsinsafetyandquality

• Costsofoperatingonthreesites

• Needtoimprovebusinessintelligencecapabilitiestoimprovecorporate,operationalandclinicalperformance

• Furtherimprovementsincustomercareneededtoenhancepatientexperience

• Elective/nonelectivephysicalseparationduetolegacyestatesissues

• MorecambeBayclinicalstrategycouldprovidescopetoexpandtheprovisionofservicesalongthepathway

• Incomegainfromrepatriationofmorespecialistservicesandnewserviceareas

• JointworkingwithCCGsandotherpartnerstomaximiseestateutilisation

• Exploitationofnewtechnologye.g.Lorenzoelectronicpatientrecord

• PartnershipworkingwithotherTrustsonclinicalnetworksandsupportservicestoimprovesustainabilityandefficiency

• Plannedimprovementsinbusinessintelligencecapabilitytodriveequalityandefficiencybenefits

• ContinueworktoengageCouncilofGovernorsandFTMembersinthetransformationprocess

• Securinganagreementtoaclinicalstrategythatdeliverssustainableservicesinthemedium/longerterm

• Abilitytosecuretransitionalfinancialfundingtoallowforimplementationofclinicalstrategy.(MonitorlicenserequiresnoDHfundingbeyondMarch2014)

• Ensuringdeliveryofimprovementspermonitorlicenserequirements

• AnyQualifiedProvider–newprovidersenteringthemarketinlesscomplex/profitableareasofTrustbusiness

• FuturechangestoPBRtariffundernewregime

• Increasingtrendtospecialisationthroughspecialistcentresinmajorconurbationsresultinginlossofservices/incomee.g.vascular



Commissioning IntentionsWorkingcloselywithourcommissioners,thedrive

forallcommissioningdecisionsfrom2014and

forthenextfiveto10yearsisthedeliveryand

implementationofthebettercaretogetherStrategy.

Thefootprintofthehospitalwillshiftandchange

astheoutofhospitalmodelsofservicestarttobe

embeddedonthenextstage.Workingcollaboratively

withcommissionersandpartnersacrosshealthand

socialcareisakeycommitmentfromtheTrust.

Diagram2showsthebettercaretogether

OutofHospitalModel.

However,thediversityofourlocalpopulationmeans

thattherewillbespecifichealthneedswhichourlocal

commissionerswillneedtofocuson.Abriefsummary

ofthelocalcommissioningintentionsishighlighted

below,allofwhichareimplicitwithinthebettercare

togetherStrategymodel.

CumbriaCommissioning IntentionsCumbriaCCG’scommissioningintentionsfocuson

fourkeyareas:Inequalities;ChildrenandYoungPeople;

MentalHealthandWellbeingandtheAgeingPopulation.

Intheshort-to-mediumtermCumbriaCCGhas

identifiedthefollowingkeypriorities:

•Reduceavoidable,unscheduledadmissionsto

hospitalforchildren;

• Improveclinicalqualityinthemanagementofa

strokewithinthefirst30days;

• Improvesupportforpatientstoself-managea

longtermcondition,focusingonrespiratory

illness.

Lancashire NorthCommissioning IntentionsLancashireNorthCCGhasidentifiedsixmajorstrategic

prioritiesfocusingonthemajorissuesfacingthe

healthofthelocalpopulationandwillworkwithits

partnerstoensurethatlocalhealthservicesaresafe,

sustainableandofhighqualityinlinewiththebetter

caretogetherStrategy.LancashireNorthCCGwillalso

haveaparticularfocuson:

• Improvementinstrokeserviceprovision;

• Improvingservicesforthosewithdementia;

• Improvingsupportforthosewhoprovidea

caringrole;

• Improvingservicesformilitaryveterans;

•Ensuringthatthehealthvisitorimplementation

planisimplemented.



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5



Our vision for health and care services across Morecambe Bay

By2025MorecambeBaywillhaveawell-deserved

reputationasoneofthebesthealthandcare

systemsintheworld.

Promotingwellbeingandpreventingillhealth

willbeourprimepurposewithmentalhealth,

children’s,andolderpeople’sservicesreceiving

equalprioritywithallotherareasofcare.

Workingherewillbeanexperiencethatattractshigh

performing,compassionatestaffwhoareasdrawnto

ourcultureofachievingexcellenceastheyaretothe

beautyandvarietyofourlandscape.

Specialistteams,includinghospitalconsultants,will

increasinglyworkinthecommunity,sharingtheir

expertisewithGPsandcommunityteams.Thesehealth

andcareprofessionalswillworkinapartnershipof

trustwithpatientsasequalstokeeppeoplefitand

well,Whenpeopleareilltheywillreceivehighquality

careandsupporttohelpthemtomanage

theirowncondition-mainlywithintheirownhomes

orlocalcommunity.

Ifpeopledoneedtogointohospitaltoreceivecare

theywillhaveconfidencethattheywillbetreatedwith

dignityandrespect.Theywillexpecttorecuperateat

ornearhome,freeingupacutehospitalbedsforthose

whoreallyneedthem.A&Edepartmentswillbeseen

asthelastratherthanthefirstportofcall.

Thefundingwereceivewillfairlyreflecttheneedsof

ourlocalpopulationsenablingustomakethebestuse

ofeveryNHSandSocialCarepound,meaningthatas

wellasmaintainingexistingserviceswecantake

advantageofnewtechnologyandadvancesin

medicineatanearlystagetoprovideevenbetter

outcomesforourpatients.

Peoplewilllivelongerandintermsoftheirhealthand

well-beingwillhaveabetterqualityoflifewherever

theylive,whatevertheirincome.Whenpeoplereach

theendoftheirlives,whereverpossiblethiswillbeat

homeinthecomfortoffamiliarsurroundingsorina

specialistplaceofcaresuchasanursinghomeorhospice.

Section 3The clinical model



3.1 Overview TheTrust,inpartnershipwiththeClinical

CommissioningGroupsinCumbriaandNorth

Lancashire,hasbeenworkingtodevelopitsstrategic

visiontoachieveclinical,operationalandfinancial

stabilityforthelasttwoyearsthroughthebetter

caretogetherProgramme.Whilstinitiallyfocussing

onthechangethatcouldbedeliveredbytheTrustin

secondarycareservices,intheautumnof2013the

programmewasextendedtoincludeprovisionout

ofhospitalinthecommunity,primarycareandsocial

care.ThebettercaretogetherStrategydescribesthe

fiveyearstrategyforthefuturedeliveryofhealth

servicesacrossthelocalhealtheconomy,including

theacuteservicescurrentlyprovidedbytheTrustand

thoseoutofhospitalservicesprovidedbyourpartners.

Afundamentalprincipleunderpinningthebetter

caretogetherStrategyiscloserworkingbetween

thoseprovidingcareintheTrust(InHospitalservices),

andthoseprovidingcareinthecommunity(OutOf

Hospitalservices),toensurethatourpatientsreceive

therighttreatmentintherightenvironmentfortheir

needs.Awiderangeofcliniciansfromacrossthe

healtheconomy,includinghospitaldoctors,GPs,

nurses,midwivesandalliedhealthprofessionals,have

beeninvolvedin,andhavedriven,thedevelopmentof

theStrategyfromtheoutset.

Theactivitymodellingthathasbeenundertakenby

thebettercaretogetherprogrammeteam,supported

bytheTrust,predictsthatthisapproachwilldeliver

significantreductionsinthedemandplacedupon

hospitalbasedservicesinthefuture.Asaresult,

thebettercaretogetherStrategydescribesafuture

hospitalmodelwithfewerin-patientbeds,running

fewerout-patientclinics,but,importantly,retaining

emergencyandobstetriccareprovisionattheFurness

GeneralHospitalandRoyalLancasterInfirmary

sites.Inanumberofcasesitmaybeappropriateto

concentratesomespecialistproceduresononeortwo

ofoursitestoimprovethequalityofcareprovidedto

ourpatientsandimprovetheefficiencyofourservices.

Thetwoyeardeliveryplan,supportsthedeliveryofa

rangeofplannedcareservicesfromtheWestmorland

GeneralHospitalsite;thosepatientsrequiringcomplex

carewillcontinuetobeseenatFurnessGeneral

HospitalortheRoyalLancasterInfirmary.

Inordertosupportthedeliveryofthebettercare

togetherStrategyacrossthelocalhealthcommunity,

fourservicechangeworkstreamshavebeencreated:

•OutofHospital–SouthCumbria;

•OutofHospital–LancashireNorth;

•Womenandchildren’s;

•Plannedcare.



3.2 In hospital

Afurtherworkstream,In-hospital,considerstheoverall

impactoftheproposalsfromtheservicechange

workstreamsontheTrusttoensurethattheimpact

ofalltheindividualschemes,includingtheTrust’sown

“businessasusual”efficiencyandcostimprovement

activities,whencombined,donotcompromisethe

operationalviabilityoftheTrust.Bymonitoringkey

performancemetricstheTrustwill,forexample,be

abletodemonstratethattheanticipatedactivity

reductionshavetakenplacetoenableittosafely

reduceitsbedbase.

Cliniciansandoperationalmanagersfromacrossthe

localhealthandsocialcareeconomyleadthese

workstreamsandhavesupportedthedevelopment

ofasystemwidetwoyeardeliveryplan.TheTrust

hasclinicalandoperationalrepresentationoneach

workstreamandourpartnersarerepresentedonthe

in-Hospitalgroup.TheTrust’sTwoyearOperational

Planlinksinextricablytothissystemwidedeliveryplan

outliningthekeybuildingblocksrequiredintheinitial

twoyearsofthisfiveyearstrategy.

3.3 Out of hospital

TheOutofHospitalmodelaimstoimprovecareand

patientexperience,keepingpeoplefitandwellfor

longerinthecommunity.Thedeliveryoftheoutof

hospitalmodelofcareacrossSouthCumbriaand

NorthLancashirewillbeimplementedinphases

throughIntegratedCare/PrimaryCareCommunity

teams,rapidresponseteamsandcarecoordination

centresthatbringtogetherstafffromprimarycare,

communityservicesandsocialcare.Asaresult,

activitythatdoesnotneedtobedeliveredinanacute

settingwillbemovedtoacommunitysetting.These

integratedteamsaredesignedtopreventattendance

atAccidentandEmergencythroughearlyintervention

andrapidresponse.TheywillalsoworkwiththeTrust

tofacilitatetheeffectivedischargeofpatientswho

aremedicallyfit.Theimpactofthesechangeswill

begintobeseeninyearoneofthedeliveryplanwith

theimpactincreasingthroughthefiveyearsofthe

Strategy.

3.4 Planned care

Theplannedcareworkstreamwilldesignandimplement

new,integrated,modelsofplannedcareacrossthe

localhealtheconomythatwilldeliverhighquality

serviceswhicharesustainableandmakethebest

useoftheresourcesavailable.Byenhancingthe

relationshipsbetweenprimaryandsecondarycare,

pathwayswillbecomemoreeffectiveandefficient

andpatientexperiencewillbeimproved.Thereare

threecoreareasofactivitywiththeplannedcare

workstream:Adviceandguidance,referralsupport

andclinicalpathwayredesign.

•Advice and guidance–enhancingdecisionmaking

inprimarycarebyprovidingaccesstoadviceand

guidancefromhospitalspecialists,thereby

ensuringappropriatetreatmentplansforpatients

andreducingunnecessaryappointments.

Thescheme,pilotedinNorthLancashirein2014,

wasnominatedforaHSJinnovationand

technologyaward.

•Clinical Pathway redesign–reducing

unnecessaryattendancestohospital,including

outpatientfollowups,throughincreasedpatient

managementinthecommunitybyspecialist

communityteamsandtheintegrationofclinical

services,resultinginabetterpatientexperience.

Theprogrammewillinitiallyfocusonfour

highvolumepathways:ophthalmology,cardiology,

musculoskeletalandrespiratory;followedby

gastroenterology,dermatologyandrheumatology

andurology.

•Referral Support Service–willprovideaccess

tospecialistAdviceandGuidanceanddiagnostic

investigationsforcommunitybasedhealth

professionalsthroughprofessionalsupportinthe

developmentofcarepathwaysacrossspecialities,

includingtheuseofdecisionaids.Theservicewill

actasthecentralrepositoryforclinicalpathway

informationforallthoseinvolvedinpatientcare.

Undertakingstructuredpeerreviewsofreferrals

forspecialistopinionandprovidingeducational

supporttolocalclinicalteams.



3.5 Operational delivery for clinical divisions

TheTrusthasfiveclinicaldivisions:AcuteMedicine,

ElectiveMedicine,SurgeryandCriticalCare,Core

ClinicalServicesandWomenandChildren’s.Each

divisionalmanagementteamisledbyaClinical

DirectorsupportedbyaDivisionalGeneralManager

andanAssistantChiefNurse.

TheoperationalstrategyfortheTrust’sfiveclinical

divisionsisalignedtothedeliveryofthebettercare

togetherStrategy,theQualityImprovementPlanand

internalefficiency/costimprovementprogramme.

Anumberofcross-cuttingthemes,impactingonall

fivedivisions,havebeenidentifiedwhichreinforce

theneedforcollaborationacrossthelocalhealth

economy.Thekeystrategicaimscommontoallfive

clinicaldivisionsare:

•Developing,recruitingandretainingaworkforce

whichsharestheTrustvaluesanddeliverscarein

linewithourobjectives;

•Engagingourworkforcethroughinitiativessuchas

ListeningintoAction;

•Developingourestatesothatitisfitforpurpose

andabletosupportthedeliveryof21stcentury

careinanefficientandeffectiveway;

•DeliveringthetenKeoghstandards;

•DeliveringtherecommendationsoftheFrancis

andBerwickreviewreports;

•Supportingthedevelopmentoftechnology

toimprovepatientcarethrough,forexample,the

deliveryofthePaperlitestrategywhichaimsto

deliver80%ofoutpatientconsultationswith

anElectronicPatientRecordratherthanpaper-

basedmedicalnotes,andenableremotereporting

fordiagnosticfilms;

•Providinganefficientoutpatientservicethatdelivers

highqualityclinicaloutcomesandapositive

patientexperience;and

• Furtherdevelopingtheethosofanevidence-based

approachtoclinicalpracticeandanexpansionof

ourportfolioofeducationandresearch.



Asummaryoftheplansforeachdivisionareshownin

thetablesbelow:

Table 8: Core clinical services division(IncorporatingTherapyServices,Pharmacy,Diagnostics,OutpatientServicesandMedicalRecords)

Scheme Year of Plan better care together workstream

Outpatientimprovementplansfocussedonimprovingpatientexperience

2014-2017 PlannedCare

ProvisionofRadiologyservicesthroughamanagedservicecontract,sharingriskandimprovingtheviabilityofalocalserviceforpatients

2015-2016 N/A

ProvisionofPharmacyoutpatientdispensingthroughanoutsourcedmodeltofacilitatethedeliveryofsaferandmoreeffectivemedicinesmanagementbyTrustPharmacistsforpatientsrequiringastayinhospital;theseareoftenthesickestpatientswiththehighestcarerequirements.

2015-2017 InHospital

RedesignofPathologyservicestoensuregreatestefficiencyandsafetywhilstsupportingthedeliveryoflocalcare.

2015-2017 PlannedCareInHospital

Become“theprovider”ofcommunitytherapyservices,providingservicestothecommunitiesofSouthCumbriaandNorthLancashire.AlliedHealthProfessionscurrentlyprovidearangeofservicesacrosshospitalandcommunitycare.

2016-2017 OutofHospitalPlannedCare



Table 9: Surgery and critical care division(Incorporatingtheatres,adultcriticalcare,anaesthetics,orthopaedics,headandneckservices,generalsurgery,breastsurgery,ophthalmologyandurology.


CentralisingemergencyENTandUrologyServices 2015-2016 InHospital

Managingcapacityanddemandthroughtherolloutofthe“GOOROO”systemincludingforecastscapacityrequirementsbasedonreferrallevels

InHospital

Musculoskeletalclinicalpathwayredesign 2015-2016 PlannedCare

Ophthalmologyplannedcareclinicalpathwayredesign


Urologyclinicalpathwayredesign 2015-2016 PlannedCare

SupportingtheconsolidationofspecialistvascularservicesincludingtheredesignofGeneralSurgerytofacilitateanewmodelofservicedelivery

2015N/A:partofSpecialistCommissioningplansforvascularservices.

Redesigningpathwaystosupportdeliveryofincreasedoutpatientprocedures

2015–2016 PlannedCare

Redesigningpathwaystosupportthedeliveryofmoreproceduresasdaycases

2015–2016 PlannedCare

Continuingdevelopmentofmacularservicestosupportthegrowthindemandasaresultofanageingdemographyandtechnologicaladvancesinthetreatmentofthesedebilitatingeyeconditions

2015-2017 PlannedCareWorkstream



Table 10: Women and children’s division(Incorporatingobstetrics,gynaecology,maternityandpaediatricservices)


RespondingtotheMorecambeBayInvestigationrecommendations

2015-2016 WomenandChildren’s

Provisionofcommunitypaediatricservices 2015-2017 WomenandChildren’s

Supportingthedeliveryofthebettercaretogether“stakesintheground”commitmenttoobstetricunitsatFurnessGeneralHospitalandtheRoyalLancasterInfirmaryandamidwife-ledbirthcentresupportedbycommunitymidwivesatHelmeChase,Kendal.


DevelopourImprovementPartnerModel(startingwithmaternity)tosupportthedeliveryofsafe,sustainable,highqualityservices


Table 11: Elective medicine divisionIncorporatingrheumatology,dermatology,gastroenterology,oncology,haematology,respiratoryandcardiology)


Expandingtheworkforcetobalancecapacityanddemand,whilstsupportingthepathwayredesign

2015-2017 PlannedCareOutofHospital

Supportingthedeliveryofadviceandguidance 2015-2016 PlannedCare

Redesigningclinicalpathwaysforrespiratory 2015-2016 PlannedCare

Redesigningclinicalpathwaysforcardiology


Redesigningclinicalpathwaysfordermatology 2016-2017 PlannedCare

Redesigningofclinicalpathwaysforgastroenterology


Redesigningofclinicalpathwaysforrheumatology 2016-2017 PlannedCare



Table 12: Acute medicine division(IncorporatingEmergencyDepartment,ElderlyCare,AcuteMedicalUnitsandalldownstreammedicalwards)


SustainablydeliveringEmergencyDepartmentqualitystandards

2015-2017 InHospital

Supportingthedeliveryofoutofhospitalcaretoreducedemandsonacuteservicesthroughavoidanceofadmissionsandearlierdischarge

2015-2017InHospitalOutofHospital

DeliveringEarlySupported.DischargeforthepopulationsofSouthCumbriaandNorthLancashire

2015-2016 OutofHospital

RedesigningFrailElderlypathwaystoimprovethequalityofcareandreducemortality,unnecessaryadmissionsandavoidreadmissions

2015-2017 InHospitalWork

RedesigningtheurgentfloorandEmergencyCareatFurnessGeneralHospital

2015-2016InHospital;WorkstreamOutofHospital



4.1 Overview

OurambitionisforUHMBTtobe:

“A great place to be cared for; a great place to work.”

Webelievethiscanonlybeachievedthroughthe

developmentofaflexible,highlyskilled,motivated

andengagedworkforce.

ThebettercaretogetherStrategyoutlinesthescale

ofchangefacingourhospitalsoverthenextfive

yearsandthis,alongsideourchallengingfinancial

environmentandourdrivetoimprovequality

standards,meansthatitisessentialthatwedevelopa

workforcestrategythatwilladdressthesechallenges..

TheoverarchingaimsoftheWorkforceStrategyareto:

•Developaflexible,highlyskilled,motivatedand

engagedworkforcethatisabletodeliverthe

Trust’svision,mission,valuesandobjectives;

•Buildonourstrengths;

• Fundamentallyaddressourareasfordevelopment;

•Deliveragainsttheworkforcechangesthatare

requiredoverthenext5years.

4.2 Workforce Strategy components

Overthenextfiveyears,thekeycomponentsofthe

workforcestrategywillbeto:

1.Developarobustworkforceplantosupport

deliveryoftheTrustStrategyandthelocalhealth

economy’sbettercaretogetherStrategy;

2.DevelopaworkforceabletodeliverourQuality

ImprovementPlan;

3.Createagreatplacetoworkthatensuresagreat

placetobecaredfor;

4.Createtherightconditionstoattractandretain

thebestpeoplethroughefficient,effectiveand

valuebasedrecruitmentunderpinnedby

continuousdevelopmentprocesses;

5.Createanenvironmentwhereallstafffeelhealthy,

happyandsafe;

6.Createaplatformforinnovation,changeand

improvementwherestaffareactivelysupported

throughchangeprocesseswithinacultureof

continuousimprovement;

7.Createacultureofengagementwhereallstaffare

activelyinvolvedinthedecisions

thataffectthemandtheservicetheyprovide;

8.Createthespaceandsupportiveenvironments

forallstafftoreachtheirfullpotential,toenable

themtomakeapositivecontributiontochanging

organisationallandscapes;

9.Createamodern,‘fitforpurpose’HRservicethat

addsvaluetothebottomline.

Section 4Workforce and organisation development strategy



Progressagainsttheseninecomponentsofthe

WorkforceStrategy,willbemonitoredthrough

DivisionalQuarterlyPerformanceReviews,the

WorkforceandAssuranceCommitteetoTrustBoard.

4.3 Creating a culture of improvement

AkeyfocusoftheWorkforceStrategyistobuildand

embedanorganisationalculturefocusedondelivering

agreatplacetobecaredfor;agreatplacetowork.

Recognisingthatconsistentlyexcellentpatientservices

willonlybedeliveredwherethereisaframeworkofour

vision,valuesandbehaviours,settingoutwhatwestand

forasaTrustwewillsetouttheattitude/behaviours

thatourpatientsshouldexpectfromallourstaff.

Webelievewearejudgedbyhowweactandthatour

reputationisdefinedbyhowwedeliveragainstour

visionandputintopracticeourcorevalues.OurVision&Values



Listening into Action

WehaveintroducedListeningintoActionandan

ImprovementHubtosupportthedevelopmentof

patient-centred,safety-focussedorganisationalculture,

builtaroundpatientsreceivinghighquality,effective

servicesfromcompassionate,caringandcommittedstaff.

Ifwearetodevelopaculturethatisinstantlyrecognisable

asanemployerwhodeliversagainstitsvisionand

values,thenweneedtodevelopaworkforcethat

deliverstherightcare,intherightplaceattheright

time,withtherightbehaviourstodeliverexcellence

everytime.

Wewillcontinuetoreviewourapproachto

recruitmentandretention,workingwithlocalpartner

organisationstoinvestinthelocalcommunity

providingopportunitiesforlearning,developmentand

employment.

WewillseektooptimiseourUniversityHospitalsstatus,

growingourresearchandeducationalportfoliosto

ensureweareabletorecruit,developandretainthe

clinicalstafftodeliverthehealthcareneedsofour

population.

Fromhowwetreatourpatientsorgoaboutour

businesswithcolleagues,staff,governorsandpartners,

ouractionswillalwaysbegovernedbyourvalues.

4.4 Workforce profile

The Trust currentlydirectly employs

4,983staff(4,218.7wte).

ThisexcludesbankstaffandthosedoctorsintrainingemployedbyPennineAcuteHospitalsNHSTrust.

Over the last three years, the Trust has invested nearly

£8mofadditionalresourceinmedical,nursingand

midwiferystaffingresultingin

25 more doctors

71 more registered nurses

11 more registered midwives

whencomparedtoApril2012.

Inaddition,asaresultoftheintroductionof“redrules”the Trust has made a commitment to invest a further

£3min front-line nursing staff based on clinical priorities.



Developing our workforce

Successfulrecruitmentofqualifiednursingand

midwiferystaffhasseenthevacancyratesteadily

reducingwithresidualvacancylevelsoftenbelow

nationalaverage.However,recruitmenttofrontline

clinicalstaffcontinuestobeahighriskfortheTrust

andwewillcontinuewithongoinglocal,national

andinternationalrecruitmentdrives,supplemented

bydevelopinginnovativeworkforcesolutionswith

partnerorganisations,includingotherhealthcare

providersandacademicinstitutions.

Despitenationalshortagesinanumberofspecialties

wehavemadesuccessfulappointmentsin

Gastroenterology,Anaesthetics,Cardiology,Radiology

andHistopathology.Anumberofhard-to-fillConsultant

postsinrecognisednationalshortagespecialtiesremain.

TheTrustwillcontinueitsapproachtocreatingand

expandingthedevelopmentofnewroles,suchas

ConsultantRadiographers/Sonographers,Advanced

PractitionersandPhysicianAssociates.Thebettercare

togetherStrategywillcreateopportunitiesforcross-

organisationalroledevelopmentwhichwewillexploit

inordertocreateinnovativenewpoststoattractand

retainclinicianswiththeskillsrequiredtomeetthe

healthcareneedsofthelocalpopulation.

Theageprofileofourworkforceissuchthatapproximately

25%ofourregisterednurses,33%ofourmedical

anddentalstaffandunregisterednursingworkforce

areaged51orabovewithalmost50%ofourEstates

staffalsofallingintothiscategory.Ourrecruitment

planswilladdressthisbutourlongtermplansalso

centreongrowingasustainableworkforcelocally.

TheintroductionoftheClinicalHealthcareApprenticeship

(DiplomaLevel3)inFebruary2015isthefirststep

intheprocesswiththefirstcohortof50apprentices

startinginFebruary2015.

Apprenticeshipsarealsobeingdevelopedinsupport

servicefunctions,commencingwithEstates

apprenticeshipsin2014.



4.6 Attendance managementWhilsttheTrust’ssicknessabsencerateisatthe

North-Westaverageforacutehospitals,itis

significantlyabovethenationalaspirationaltargetof

3.4%.Sicknessabsenceisestimatedtocostaround

£5mperannumindirectcostsalone.

TheTrust’sforwardfocusisaboutcreatingapositive

employmentculture,“agreatplacetowork”.Central

tothisisthedevelopmentofapositiveattendance

managementculture,wherestafffeelvaluedand

appreciatedfortheircontributionatwork.

Whilstitisclearthatsicknessabsenceneedsto

bemanagedmoreeffectivelyandappropriately,

recognisingandrewardinggoodattendanceisevery

bitasimportantasitwillcreateanenvironmentwhere

peoplewanttocometowork.

4.7 Contingent staffing

TheTrusthas,historically,operatedonthebasisthat

short-termstaffingrequirementswhichcannotbemet

fromwithinexistingstaffingresourcesoraninternal

bankarrangementareprovidedthroughtheuseof

agencyworkers.

In2013/14theTrustspentatotalof£16.4millionon

agencystaff,£13.6mofwhichrelatedtomedicaland

nursingstaff.Table13showsthecurrentposition.

Spendtodatehasincreasedby£1.5monthesame

periodlastyear:

Futureplansarebasedondevelopingamoresustainable

approachtocontingentstaffing,byconvertinglong-

standingcontingentspendintosubstantiveposts.

Whilsttherewillalwaysbeaneedforcontingentstaff

tocovercriticalvacanciesandunforeseenabsence

thereshouldbelessrelianceonagencystafftoprovide

corebusinessactivityonanongoingbasis.

Wewillreviewouruseofcontingentstaffsuppliers,

consolidatingwherepossibleinordertoensureoptimum

useismadeofcontingentstaffingarrangements.

4.8 Staff engagement

Thedeliveryofconsistentlyexcellentpatient

experienceisreliantuponanengaged,competent

andmotivatedworkforce,unifiedbyacompelling

organisationalculturebuiltaroundpatient-centred

andsafety-focussedcare.Thecommitmentto

staffengagementisenshrinedwithintheNHS

Constitutionalpledge:togiveeveryemployeethe

opportunitytobeinvolvedindecisionsthataffect

themandtheservicesthattheyprovide.

TheintroductionofListeningintoActionandthe

ImprovementHubwillcontinuethedrivetogiveall

ourstaffanincreasedvoiceonhowtheTrustcanbe

improvedandencouragethemtopersonallytake

actiontoachievethis.

Weknowthatittakestimetoachievethecultural

changewerequire;timetochangethewaypeople

think,actandbehaveinanorganisation.Wewillmonitor

ourprogressthroughtheannualNHSStaffSurvey.The

2013/14results,ourbaseline,areshownintable14. Table 13: Agency and locum staff spend

2013/14£m

2013/14%

2014/15(ytd)£m

2014/15(ytd)%

MedicalLocums

11.1 81.6 6.4 77.1

NursingAgency

2.5 18.4 1.9 22.9

Total 13.6 100 8.3 100

Table 14: UHMBT saff survey results 2013/14

Achievement Number %

Best20% 11.1 14%

Betterthanaverage 2.5 7%

Average 13.6 11%

Worsethanaverage 12 43%

Worst20% 7 25%



Whilstwewanttoimprovestaffexperienceoverall

ourkeyimprovementareasare:

Indicator 2013/14 Score

Staffabilitytocontributeto 65%

improvementsatwork

StaffrecommendationoftheTrust3.39outof5

asaplacetoworkor

receivetreatment

Staffmotivationatwork 3.76outof5

Ourambitionistoshifttheparadigmaroundstaff

experienceandengagement.Withinfiveyearswe

wantourstaffsurveyresultstodemonstratethat

60%oftheKeyResultAreasfallwithinthe

‘BetterthanAverage/Best’20%categories.

4.9 HR Cornerstones

Inordertodelivertheoverarchingworkforce

developmentandorganisationaldevelopmentplan,

sevencornerstoneprojectshavebeendeveloped

aroundthekeyelementsoftheemployeelife-cycle:

•Modernise

•Proposition

•Entry

•Wellbeing

•Transform

•Engage

•Raise

EachprojectisledbyaseniormemberoftheWorkforce

andOrganisationalDevelopmentteamwithprogress

monitoredbytheWorkforceCommittee.Each

cornerstoneprojectlinksdirectlytothecomponent

partsoftheworkforcestrategydescribedabove.

4.10 Improvement Hub

Inorderfortransformationalchangeandcontinual

improvementtotakeplaceacrossourorganisation

thereisaneedfortheTrusttobecomealearning

organisation:forimprovementandinnovationto

becomepartofeveryone’srole,andtobeconsidered

partofthedayjobi.e.partoftheculture,ortheway

wedothingsaroundhere,istocontinuallylookfor,

andimplement,improvements.AnImprovementHub

willprovideanorganisationalfocusforthis.

Our Improvement Hub will comprisethe following elements:

•Quality Improvement Panel(multi-disciplinary

andwithExecutiverepresentation)

• Improvement Team,headedbyanImprovement

Lead,providingoperationalleadershipandfocus

•Local Improvement Champions,toleadonlocal

improvementprojects.Theseindividualswill

receivetraininginimprovementscienceand

methodologiesandcoachingsupportasneeded.

•Local Improvement Teamstoensurea

multi-disciplinaryteambasedapproachto

improvement,maximisingstaffengagement.

•Academic partner(s)toprovidetraining

andexpertiseinimprovementmethodologies

andcoaching/facilitationsupporttoproject

groups.Academicinputtodeveloprobust

performancemeasurestomeasureand

monitorsuccess.

•NHS Partner/buddy organisation(s)toprovide

expertise,experienceandtovalidateourapproach.



4.11 Listening into Action

ListeningintoActionisanevidence-basedwayof

workingwhichhasledtoimprovementsforpatients

andstaffinotherNHSTrusts.TheTrustsignedup

toListeningintoActioninSeptember2014,itis

akeymeansthroughwhichwewillimproveour

organisationalculture.

ThefirstyearofListeningintoActionwillsee:

•ahighprofileroundofstaff“BigConversations”

designedtogenerateanunprecedentedviewof

‘whatmatterstostaff’;

•aseriesof‘bigimpact’actionsinresponsetothe

“BigConversations”;and

• supportforthefirst10‘ontheground’toadopt

ListeningintoAction,followedbythenext

20teams.

ListeningintoActionisakeyvehicleforengagingall

therightpeopleinthepositivechangestheywantto

see,givingthempermissiontodeliverwiththefull

supportandbackingoftheTrust.

4.12 Hard Truths

AspartoftheHardTruthsreportrecommendations,

wepublishdatarelatingtonursestaffinglevelson

amonthlybasis.Wecontinuetoreviewourward

establishmentsandusethesaferstaffingtooltoassess

acuityacrossanumberofourwards.

WardInformationBoardsaredisplayedpublically

aroundoursitesandthesecontainlocalinformation

onstaffinglevels.Wehavemadesignificant

improvementsinournursestaffinglevels,butwe

stillhavemoreworktodotoensurethatwehave

therightnumbersandskillmixacrossallshifts.

4.13 Safe staffing and Red Rules

Inthepastyear,therehavebeenanumberofnational

reportsandrecommendationsrelatingtonursingand

midwiferystaffingandskillmix.TheTrusthasalsobeen

carryingoutitsownworktomakesureournurse

staffingismapped,notonlytothenumberofpatients,

butalsothecomplexityofeachindividual’sneeds.

‘RedRules’havebeenintroducedtoensuresafe

staffinglevelsonourwards.Theseincludeanescalation

processwherewhenstaffinglevelsfallshortofthese

toensurepromptactionistaken.Tosupportthis

morerigorousstandardofnursingcare,theBoardhas

recentlyapproved,inprinciple,over£3mtorecruit

additionalregisterednurses.

Wearenowintheprocessofworkingwithpartners

tolookatwaystosecureadditionalfundingandare

takingallstepstoensurewemeetandexceedthecare

standardsourpatientsdeserve.

4.14 E-rostering OurE-rosteringProjectisakeyenablerinthe

assuranceofsaferstaffingandtheefficiencyand

effectivenessofournursingteams.Roll-outacrossall

nursingareasisdueforcompletionbyJanuary2015.

Thesystemalsohasthepotentialtoallowactive

monitoringofstaffinglevelsagainstpatientacuityin

real-time.Itisourambitiontoextendedtheuseof

E-rosteringacrossotherstaffgroups.

Whenfullyimplementedthesystemwillprovide

aviewonreal-timeworkforceutilisationthathas

notbeenpreviouslybeenavailable,whichwilldrive

betteruseoftheworkforceandmoreinformed

investmentdecisions.



4.15 How our workforce needs to change

Thekeyworkforcecharacteristicsthatneedtochange

overthenextfiveyearsareoutlinedbelow:

Table 15:

Changing workforce profile

Workforce in 2014 Workforce in 2019

Hospitalbased Careclosertohome

inarangeofsettings

Reactiveworkforceplanning Integratedandclinically-

agreedshort,medium

andlongterm

workforceplans

Servicesattimesandplaces Servicesattimes

thatsuitstaff andplacesthatsuit

patients

Lessefficient Moreefficient

Lessengaged Moreengaged

Staffareawareofour Allstaffareawareof

trustvalues andareproudto

deliverourtrustvalues

4.16 The impact of better care together

Theproposedmodelsofcarereferredtowithinthe

bettercaretogetherStrategyhighlightanumberof

workforceconsiderations.Areviewofthemodelhas

beenundertakentoassessthehigh-levelimpactthat

thebettercaretogetherStrategywillhaveonthe

in-hospitalworkforce,basedupontheassumed

activityshiftswithintheStrategy.

Itisanticipatedthatactualrealisedstaffingreductions

asaresultoftheactivityreductionsinbettercare

togetherandassociatedchangestowaysofworking

mayresultinfewerhospitaljobsbeingneededinthe

future–althoughweexpectanyreductiontobemet

bypeopleretiringandreducingthenumberofagency

staff.

Overthe5-yearperiodoftheinitialstrategy,these

workforcecalculationssuggestthatitisunlikely

thattherewillbeasurplusofstaffavailablefrom

thein-hospitalworkforcetosupportthedeliveryof

theOutofHospitalmodelsofcaredescribedwithin

thebettercaretogetherStrategy,whichequatesto

approximately240wteadditionalstaff(although

thesenumbersaresubjecttofurtherrefinement).



ThebettercaretogetherStrategythereforepresents

theTrustandthelocalhealthandsocialcareeconomy

withtheopportunitytodesignandinvestinanew,

modernout-of-hospitalworkforcethathastheflexibility

andagilitytodelivercareclosertopatients’homes.

Thiswillrequirethedevelopmentofa‘system-wide’

attraction,recruitmentandretentionstrategythat:

•overtime,reducesinvestmentinthein-hospital

workforcesoastoallowgreaterinvestmentinthe

out-of-hospitalworkforce

• continuestoattractnewstaffvialocal,national

andinternationalrecruitment

•protectsexistingservicesfromde-stabilisation

duringperiodsoftransition

•minimisesany‘doublerunning’ofservices

Inordertosupporttheattraction,retentionand

recruitmentofstaff,therewillalsobearequirementto

developaneducationandtrainingstrategythatwill

enablenewandexistingstafffromacrossthelocalhealth

economytoeffectivelycarryouttheout-of-hospital

rolesdescribedwithinthebettercaretogetherStrategy.



5.1 The impact of better care together

TheTrust’sEstatesStrategycomprisesthreedistinct

elements:

1Backlogmaintenanceandequipmentreplacement

schemes–businessasusual;

2Schemestosupportdeliveryofthebettercare

togetherStrategy;and

3Capitalschemesdesignedtoaddressoldand

inefficientestate,particularlyattheRoyal

LancasterInfirmary.Theseplanswould

improveclinicalco-locationandalloweffective

patientflow;improvingtheexperienceofour

patients:improvinginfectionpreventionand

efficiency.Theseplanshavebeendeveloped

overan8-10yearperiod;however,thisstrategy

isfocusedonyears1-5.

Ourestateimprovementplansarefocused,

predominately,attheRoyalLancaster

InfirmaryandatFurnessGeneral

Hospital.Theycanbedeveloped

indiscretephasesandtheir

implementationcanbeflexed

toreflectchangestothe

deliveryoftheactivity

reductionswithin

thebettercare

togetherStrategy

ifrequired.

Royal Lancaster Infirmary

•MajorexpansionofthecoreCentenaryBuilding

attheRoyalLancasterInfirmarytoaccommodate

allclinicalareastherebyallowingdemolitionof

unsuitablespaceontheLancastersite.Eachphase

oftheexpansioncanbebuiltandcommissioned

separatelywhichenablestheTrusttoretain

flexibilitytoaccommodateanychangestoactivity;

•EnhancementoftheTrust’seducationalrolewitha

largerEducationCentre,andconcentrationof

non-clinicalandadministrativeuseswithina

refurbishmentoftheGradeIIlistedbuildingatthe

frontoftheRoyalLancasterInfirmarysite.

Diagram 4:

Provisional illustrations for the expanded Royal

Lancaster Infirmary

Section 5Estates strategy

ExpandedCentenary Building New multi-storey

car park for staff and visitors



Furness General Hospital

•Changeswillbemadetothecurrentclinicalspace

withinFurnessGeneralHospitaltoimprove

theflowofpatientsthroughclinicalunitsthrough

relocatingsomeservicesandrationalisinga

numberofothers.

Acrossallofoursiteswewilllooktoensurethatour

clinicalcapacityislocatedinthemostappropriate

placetofacilitatethedeliveryofthebettercare

togetherStrategy.Wewillupgradeourheating

systemsandenergyinfrastructuretoimprove

efficiency,reducerevenuecostsandcontributeto

nationalcarbonreductiontargets.

5.2 Business as usual

TheTrusthasacapitalbudgetofapproximately

£8.5millionperannum.

Capitalfundinghasbeenlimitedforanumberofyears

anditiscalculatedthat£59misrequiredtobringour

estateuptoERICstandard-conditionB.Theadditional

fundingrequiredtoprovidetemporaryclinicalareas,

suchastemporarywardsandtheatres,whilstthiswork

wastakingplaceisestimatedat£67million.Ifthebacklog

maintenanceiscarriedout,thisworkaspartofamore

comprehensiveestatesimprovementplan,wouldresult

inthebacklogcostsbeingreducedtoapproximately

£42million.

5.3 Latest equipment

TheTrusthasidentifiedanumberofitemsofmedical

equipmentthatareoperatingbeyondtheirnormal

life.Areplacementplanhasbeendevelopedtoallow

spendtobeprioritisedwithfundingof£25mrequired

overthefiveyearperiod.

Energyefficiencieswillbeachievedthrougha

programmetodesignandfinancearound£5mof

investment.

5.4 Impact of better care together

Anumberofelementsofthebettercaretogether

capitalprogrammecanbeachievedandimplemented

withouttheneedfortheadditionalinvestmentoutlined

withintheTrust’sEstatesStrategy.Anumberofareas

aredependentonthecompletionoftheseseparate

planssuchastheprovisionofadditionaltheatrecapacity

attheRoyalLancasterInfirmarysite.

TheEstatesStrategywill,inthefirsttwoyears,focus

onanumberofkeyimprovementstoclinicalefficiencies

andpatientexperience.Thesewillincludethecarpark

improvementsattheRoyalLancasterInfirmary,which

willsignificantlyimprovefacilitiesforpatients,their

relativesandourstaff,andworkwithourpartners

inthelocalhealtheconomytodeliveroutofhospital

benefitsinthecommunity.

AttheFurnessGeneralHospitalsitethebettercare

togetherStrategyenvisagesanadditionaltheatreand

remodellingoftheEmergencyDepartmenttoimprove

patientflowandclinicaladjacencies.

DuetothecomplexnatureoftheRoyalLancaster

Infirmarysiteasequenceofmovesisrequiredtorelocate

existingclinicalandeducationaldepartmentstoallowthe

developmentoffournewtheatreslocatednexttothe

existingmainfourtheatres,providingasurgicalflooron

level1.TheTrustmustfirstconstructtheadditional

groundfloorexpansionofthecentenarybuilding.

Theamountofcapitalinvestmentattributableto

the‘bettercaretogether’Programmeamountsto

£55million.Itrepresents22%ofthetotalinvestment

of£246mrequiredaspartofourexpandingplansto

maximiseourhospitals.





5.5 Our service development ambitions

TheTrust’swiderproposalstoreconfigureourestate

will,throughimprovedclinicaladjacencies,improve

patientsafetyandachievestaffingefficiencies.

TheTrustproposesanumberofdevelopmentswithin

itsestate,someofwhichhavetobeimplementedas

partofbettercaretogether.

AtFurnessGeneralHospitalwewillimprovethe

WomenandChildren’s,AcuteMedicineandCore

ClinicalDivisionareas.

AtRoyalLancasterInfirmarythemajorexpansionofthe

coreCentenaryBuildingisneededtoaccommodate

elementsofthebettercaretogetherschemebutalso

amajorrestructurewherekeyhospitalfunctionsare

locatedonthesite.Theschemewillallowallclinical

activitytobelocatedforthefirsttimeintoasingle

modernbuildingonthesite,withperipheralbuildings

vacatedanddemolishedorsold.

ParticularbenefitsatRoyalLancasterInfirmarywillbe:

•Allmedicinewardsclusteredinasingleblock

oftheflexibleCentenaryBuildingafterexpansion,

allowingeconomiesofstaffing;

•Allsurgerywardsandtheatresclusteredona

singlefloor,allowingeconomiesofstaffingand

betterpatientexperiencewhentransferred

betweenwardsandtheatres;

•Replacementofthecurrentunfit-for-purposeunits

foroncologyandophthalmology;

•ReprovisionoftheBloodScienceslabstoensure

continuedaccreditation;

•EndingthedrainonrevenuefundsforPatient

TransportAmbulancesandtaxisusedtotransport

patientsbetweendifferentpartsoftheRoyal

LancasterInfirmarysiteseparatedbyasteephill;

•Endingthesimilarproblemforlaundry,catering,

mortuary,wasteandotherserviceswhichhavetouse

tugsandvanstonegotiatethesteepinternalslope;

•Modernwarddesignwith50%singlerooms,

betterstorageanddistributednursebases;

•Moreflexibilitytorespondtodifferentproportions

ofmenandwomenintheAcuteMedicaland

AcuteSurgicalunits.

Buildingonthegrowingreputationofmedicaltraining

attheTrustandLancasterUniversity,anewEducation

andConferenceCentrewillbecreatedwithinthe

Grade2listedbuildinginthenorthernquarterofthe

site.ThiswillmaketheTrust’seducationalspacefitfor

asuccessfulfuture.TheschemewillalsocombineTrust

HQandsupportadministrationintoasinglelocation,

improvingoperationalefficiencyandreducingrunning

coststhroughthelong-awaiteduseofopenplan

administrativeoffices.

Thisplanassumesthatsufficientfinancewillbe

availabletosupportourestatesredevelopment

strategytosupportboththebettercaretogether

proposalsandtheTrust’sownproposals.

QueenVictoriaHospital,whichcurrentlyprovides

outpatientservices,willhaveitsrolereinforcedasa

sitedeliveringcommunityservices,withsomeactivity

transferringtherefromtheRoyalLancasterInfirmary

underbettercaretogether.



6.1 Overview

TheTrust’sI3Strategy,approvedinMay2013,identified

eightkeythemesofdevelopmenttoenabletheTrust

tomoderniseandtransformhealthcaredelivery

supportedbycomplexinformatics.Theseeightthemes

remainvalidtodayandprovideasuitableframework

todevelopandgovernthiscomplexarea.Therehas

beensignificantprogressoverthepasttwelvemonths,

howevernewoperationalneedsandobjectives,

includingbettercaretogether,havepromptedthe

needforthestrategytobereviewed.

Asignificanteventwithinthisstrategywillbethe

formalend,inJuly2016,ofthenationalcontracts

forthedeliveryoftheTrust’sePR(Lorenzo)and

Theatre(Ormis)systems.ABusinessCasewillbe

preparedoutliningtheoptionsofre-procurementor

replacementofthecontracts.

Diagram 7: Key Milestones (next 12 – 24 months)

6.2 The electronic Patient Record (ePR)

TheI3Strategyfullysupportsthecontinueddevelopment

oftheTrustelectronicPatientRecord(ePR)Programme.

TheePRProgrammeisveryambitiousandisstillahead

ofmostotherHospitalTrusts.Overthenext24

monthstheprogrammewilldeliverelectronicPrescribing

andMedicationAdministrationacrossallourwards

anddepartments,electronicrequestingofdiagnostic

tests,somemedicaldeviceintegrationandamobile

workingcapability.Alltheabovework-streamswill

provideafirmplatformtoengageonaformalinpatient

paper-liteprojectthatwouldpotentiallystartin2016.

ImprovingdataqualityisakeycomponentoftheI3

strategy.Promotingdataqualityiseveryone’s

responsibilityanddevelopingacultureof“gettingit

rightfirsttime”arekeypriorities.

Section 6IT and informatics strategy

Apr 2016 - Local ePR Contract in effect

Aug 2014 - First year review of 13 Strategy

Feb 2015 - ePrescribing and Electronic requesting of Pathology and Radiology Plans

Dec 2014 - ePR Contract Replacement Business Care for Approval

Sept 2014 - Assurance of IPPMA module of Lorenzo

June 2015 - Bettercaretogether Implementation Commences

Apr 2015 - Completion of 13 Structural Changes



6.3 Clinical coding

Improvingthequalityandtimelinessofclinicalcoding

isaprioritytosupportthecompletenessoftheePRas

wellastheTrust’scontractualandfinancialprocesses.

TheI3strategyidentifiesfundingfortheintegration

ofclinicalcodingencodingsoftwarewithinLorenzo

whichhasthepotentialtoimprovecodingaccuracy,

completeness,incomegenerationsupportandcoding

auditgovernance.

Akeycomponentofthestrategyistheopportunity

tointegratecross-organisationallyandsupportend-

to-endclinicalcarepathways,supportingefficient

healthcare.Thestrategysupportsworkingwithour

twoClinicalCommissioningGroupsandpartner

providerorganisationsandothertertiarycentres.

Todatewehavemadeprogresswithprimarycare

throughdevelopmentsviatheMedicalInteroperability

Gateway(MIG)andtheStrataPathwayssystem.

TheI3strategyrecognisestheimportanceof‘end

toendcare’,andourapproachesandcapabilities

willsupportcreativemodelsofhealthcaredelivery

beingdevelopedbythebettercaretogetherInitiative

andthewiderNHS.Thestrategyhasdefinedtwo

significantrequirementsfortheI3Strategy;aunified

Information/Informaticsfunctionandabusiness

intelligencecapability.

6.4 Integrated informatics

ThebettercaretogetherStrategyhasdesignedanew

healthcaremodelwithintheMorecambeBayfootprint.

Thisstrategydescribeshowanextendedhealth

communitycoulddevelopanintegratedInformatics

environmentabletoproactivelysupporthealthcare

delivery.ThegoalofthisstrategyistopresentanePR

viewtocliniciansatthepointofcareorpointofclinical

decisionsi.e.ateverypatientcontactpoint.

Thevisionbuildson:-

•usingcurrentexistingsystemsinvestment,

• identifyinggapsincurrentsystemscapability;

• recommendingamodularprocurement

• significantprogressmadeineachcontributing

organisation.

Thisintegratedpatientrecordviewiscomplemented

witheffectivemultiorganisationalcareplanningand

resourcemanagementalongwithaneasytoaccess

knowledgelayer.Thevisionbuildsonthestrategiesof

thedifferentorganisationalsystems.Thebettercare

togetherinitiativerequiresarobustandprofessional

informaticscapabilitytodeliverthisvisionandalso

asingleservicemodeltosupportitmovingforward.

UHMBTMorecambeBaySharedInformaticsServiceis

ideallyplacedtoundertakebothfunctions.

6.5 Progress

Initsfirstyear,theI3Strategyhasbeensuccessfuland

confirmsthatthemainthemesoftheStrategyremain

valid.Itconfirmsthattheprimarydriveofthestrategy

tomovetheTrustintoapaper-liteworldiscorrect

one,toenablethetransformationofworkingpractices

andenablingthebettercaretogetherinitiative.The

StrategyhighlightstheneedforstrongClinicaland

Executiveleadershiptoembedthiscomplexandcrucial

agendaintotheTrust’s“businessasusual”operations.

ItidentifiestheneedforDivisionalChiefClinical

InformationOfficersandaformalChiefNursing

InformationOfficeraswellasarollingsecondment

programmeofeightWTEtodesignanddeployand

embedfuturechangedpractices.Inadditiontothe

workstreamsalreadyidentifiedinthisdocumenta

furtherquickwinhasbeenidentifiedasaresultoffull

rolloutoftheelectronicAdviceandGuidancesystem.

OurI3strategyidentifieseightthemesfordevelopment

whichwillenablesignificanthealthcareimprovements

andareoutlinedonthenextpage.



1: The need to reorganise the way we manage

our Informatics and Information resources

Thisthemedescribestheneedforclarityandfora

singlefunction,providingtheTrustasinglepointof

contactforeverythingtodowiththiscomplexagenda.

2: Complete the Lorenzo patient record

deployment and rollout.

UHMBThasdeployedasignificantelectronicPatient

Recordplatform,withtwokeycomponentsstilltobe

deployed:-ePrescribingandelectronicrequestingof

tests,witharolloutrequiredaroundtheTrustestate.

AnintegratedsolutionisalsorequiredforTheatresand

afullbusinessisrequiredinearly2015.

3: The need for business intelligence

Informationthatdescribestheoperationsofthe

Trustcomparesuswithourpeergroupandprovides

trendingcapabilitiestoassistwithpredictivemodelling

offutureserviceconfigurationsandpatientflow;

providesahigh-leveldashboardtypeviewofTrust

performanceagainstasetoflocallydefinedinitiatives.

4: A new I3 governance structure

Designedtoprovidevisibilityandaccountabilityforthe

wholespectrumoftheI3agendatobeimplemented.

5: eHospitals or paper-lite hospitals

ThisisthegoalofthedigitalelectronicPatientRecord

agenda,andthisshouldhavematuredtobeableto

supportpaperliteinpatientcarein2016.

6: Develop and maintain a project portfolio

Thestrategydefinesthatamorebusinessgrounded

managementoftheI3agendaisneeded,achievedby

publishingafullprojectportfolioofwork,withproject

alignmenttoitsbusinessdrivers,expectedbenefits

andnotecurrentstageofdelivery.Alongsidethe

portfoliowillbeanI3blueprintshowingthecurrent

landscapeofsystemsandcapabilitiesconfigurationat

thecommencementofthisstrategylifecycleandalso

whereweexpecttobeattheend(2019).

7: Inter-operability with other health community

patient record systems.

Todeliverclinicalcarealongpathways,involving

multipleorganisations,andtofacilitatetheITagenda

tosupportbettercaretogether,individualorganisations

needtoownandmaintaintheirownpatientrecord

systems.Thisstrategydescribeshowtheappropriate

levelofdataexchangeandviewingbetweenclinicians

acrossorganisationalboundarieswillbedevelopedto

supportthemosteffectivedeliveryofcare,wherever

thepatientisontheirpathwayofcare.

8: Infrastructure.

Ourtechnologyinfrastructureiswelldesignedand

robustandisapreciousasset.Wewillbuildonthis

toensurethatmaintenanceandsupportforthis

infrastructureandprovisionoftherequiredtechnical

toolstosupportmodernhealthcare,isgiven

sufficientpriority.



7.1 Overview

AstheTrustprogressesonitsqualityimprovement

journeyadetailedQualityImprovementPlanhas

beendevelopedtoensurethatweallworktogether

toachieveourcommitmentofdeliveringsafe,high

qualitycareforallofourpatients,aswellasmaking

ourhospitals,modernandefficientplacestowork.

YearOneoftheQualityImprovementPlanisimportant,

itistheyearwewilladdresstherecentfindingsofthe

CareQualityCommission.

Toensuretheimprovementscanbesustainedand

totacklesomeofthelongstandingissuessuch

asculture.Wehavealsobeguntoestablishan

ImprovementHub.

TheImprovementHubwillprovidesupportandassistance

toourstaff,helpingthemtofullyunderstandwhat

‘good’and‘outstanding’looklikeandproviding

themwiththetoolstoachieveit.TheHubapproach

willassiststafftousetriedandtestedtechniquesfor

deliveringconsistent,sustainablechange.

Everyoneknowsthatcommunicationiskeytothe

successofanyplan,ourplansforcommunicatingand

engagingwitheveryoneconnectedwithourhospitals

isequallyambitious.

OurQualityImprovementPlanreiteratestheTrust

Board’scommitmenttodeliveringhighstandardsof

safe,qualitycaretoourpatients,aswellasproviding

aworkingenvironmentandculturewhichpromotes

andwelcomeshonesty,safetyfirst,opennessand

compassionineverythingwedo.

7.2 What are we trying to accomplish?

Ourvisionistoconstantlyprovidethehighestpossible

standardsofcompassionatecareandtheverybest

patientandstaffexperience.Wewilllistentoand

involveourpatients,staffandpartners.

ThefocusofthisQualityImprovementPlanisthe

establishmentofourTrustasagreatplacetobecared

for,agreatplacetowork–itisarallyingcallforevery

singleemployee,volunteerandgovernortoensurethat

wedeliverexcellentcare,everytime,toeverypatient.

Our aim is to create a culture of continuous

improvement which is both patient-centred

and safety-focused. To do this, we must create

the conditions where we:

• Listentoandincludetheviewsofourstaffand

keystakeholders

• fullyembedtheTrustValuesineverythingthat

wedoinordertoensuretheworkingenvironment

isconducivetocontinualimprovementand

innovation

•activelyengagewithandenablestafftoleadand

delivermeasurablechangeandimprovement

• focusonhumanfactors-howwedelivercare

asteams.

Section 7Quality strategy



Wemustalsoensurethatimprovementisseenand

understoodtobeeveryone’sbusinessby:

•expectingallteamsandstafftobeinvolvedin

improvementandinnovationaspartoftheir

everydaybusiness

• localteamsregularlydiscussingperformance,

innovationandimprovement

Thisplanthereforeaimstoprovidestaff,patients

andthepublicwithacleardescriptionofourquality

improvementandexperienceprioritiesandhowthese

willbemeasuredandmonitoredover2014-17.

Theoutcomesofthisplanlinkcloselytothosedescribed

intheTrust’sQualityAccountsandtheCareQuality

Commission’sdomainsofSafe,Effective,Caring,

ResponsiveandWellLed.Theydemonstratehowthe

Trustisworkinginpartnershipwithcommissioners

todevelop,designandimplementanintegrated

long-termqualityandservicestrategyforthewhole

healthcareeconomy.

OurQualityImprovementPlanwillfocusonthreekey

improvementoutcomes.Theseare:

Better To reduce mortality and harm

Care To provide reliable care

Together To improve patient and staff experience

Deliveringourthreekeyimprovementoutcomesof

better,careandtogetherwillinfluencethedelivery

ofimprovedserviceswhichareeffectiveandwill

demonstratemeasurableoutcomesrelatingtohow

theyimprovestandardsofcare,patientandstaff

experienceandcontributetoourfinancialandservice

performance.

Please see the Trust’s Quality Improvement Plan for more details





Inadditiontotheharmsundertheumbrellaof‘Safety

Thermometer’,ourambitionistoachievea50%

reductioninhospitalacquiredinfectionswithin12

monthsasmeasuredby:

8.1 History

ThetablebelowshowstheTrust’sfinancialposition

overthelastthreeyearsandtheforecastfor2014/15.

Thedeficithasincreasedfrom£1min2011/12

becauseoftheinvestmentsmadetoimprovethe

qualityoftheservicesdeliveredbytheTrust.These

investmentshavebeenpartlypaidforbynon-recurrent

financialsupportfromtheTrust’stwomain

commissioners.

Table 20:

Financial position 2011/12 – 2014/15

Summary 2011/12 2012/13 2013/14 2014/15

SOCI Actual ActualActualForecast

£m £m £m £m

Surplus/ (1.0) (23.0) (19.0) (27.0)

(deficit)

Includes0.05.07.56.0

support

Theneedtorecruitadditionalfrontlinestaffandthe

difficultyofrecruitingtocertainpostshasledtheTrust

toincurincreasedspendingoninterimstaffasshown

belowintable21.Recruitmentofpermanentstaff

isacentralpartoftheTrust’squalityandworkforce

strategiesandisalsoamajorthemeinfutureCost

ImprovementPlans.

Table 21:

Agency expenditure 2011/12 – 2014/15

Agency 2011/12 2012/13 2013/14 2014/15

Expenditure Actual ActualActualForecast

£m £m £m £m

Agency6.012.916.417.5

Expenditure

8.2 Underlying trading position

Theforecastdeficitfor2014/15is£27m.The

normalisedposition(i.e.excludingnon-recurrent

commissionersupportandotheritems)is£35m.

AdetailedanalysisoftheTrust’sstructuralcostshas

beenundertakenbyPwC;thishascalculatedthat

regardlessofhowefficientweweretobecome

throughnormalcostimprovementmeasuresthere

wouldstillbeadeficitof£20m.Thisisduetoour

geography,population,theessentialrequirementto

meetsafeandappropriatestaffinglevelsandtheneed

tomeetregulatorystandards.FurthertothistheTrust

needstocontinuetoinvestinitsworkforcetoensure

safestaffinglevels.

However,thecurrenttradingpositionisworsethan

plannedandthefinancialstrategythereforeincludes

anelementofsavingsabovethatanticipatedfromthe

2015/16tariffchangesinordertoreducethedeficit.

Section 8Financial Strategy



8.3 Better Care Together

TheTrust’sfinancialstrategybuildsontheBetterCare

TogetherstrategydescribedinourclinicalStrategyand

diagram10outlinesthescenarioswhichwillimpact

uponourfinancialposition.

Diagram 10: UHMBT financial model

8.4 Assumptions

Thekeyassumptionsforourfinancialstrategyareas

follows:-

•Theforecastdeficitfor2014/15is£27m;

• Ithasbeenassumedthatfor2015/16onwards

thenationalefficiencyrequirementis3%perannum

andthateachyeartheTrustwillachieveaCIPof

£10m,whichisgreaterthanthe3%requirement;

•TheTrust’splanassumesvascularserviceswould

transferin2015/16;

•Demographicgrowthhasbeenestimatedat1%

perannumfrom2015/16andthishasbeenbuilt

intotheactivityforecast;

•ThepotentialimpactofBetterCareTogetherhas

beenincludedbasedonthe2yeardeliveryplan.

Ithasbeenassumedthatincomewillreducein

linewiththeTrust’splannedcostchanges;

•CapitalspendisbasedontheEstatesStrategy.

Thisshowsaspendof£251m2015/16to2018/19

andincludes£54mforbettercaretogether.

TheTrustrequiresPublicDividendCapitalto

supportthislevelofcapitalspend;

•Revenuesupportfromcommissionersisassumed

at£6min2014/15.For2015/16onwardsalocal

pricemodification,startingat£20mandrising

toreflectadditionalinvestment,isassumed.This

ofcourseissubjecttotheClinicalCommissioning

Groupsreceivingaspecificallocationtocoverthis;

•Asregardssevendayworkingthecostsassociated

withthishavebeenexcludedfromtheforecast

asitisexpectedthatfundingwillbemade

availablespecificallyviathetariff;

•BasedontheseforecaststheTruststillrequires

PublicDividendCapitaltosupporttheforecast

deficitaswellasthePublicDividendCapitalto

supportthecapitalinvestmentplan.

Do Nothing

TRUST CIP• Quality• Workforce• EPR• Estates• Commercial

CurrentDeficit£25-£30m

BETTER CARE TOGETHER

150Beds65ClinicsSiteCostsPremiumCosts

CIP-£9mperannum

£60-£70mperannum

ResidualFundingGap£8-10m

Local Price Modification

Better Care Together

1 2 3 4 5



8.5 Cost improvement plans

TheexpectedCostImprovementPlanrequirement

of3%wouldgivetheTrustatargetof£8mbutthe

financialstrategyenvisagesaCostImprovementPlan

of£10mtoreducethedeficitovertheperiodoftheplan.

Diagram8belowoutlinesthemainCostImprovement

Plan(CIP)themesandsomeofthetoolswhichwill

beusedtoplananddeliverthesavingsrequired.

DetailedCIPplanningwithdivisionswillcommence

inNovemberandwillfollowtheapproachusedin

previousyearsforagreedschemesofcompleted

workbookswithmilestonesandallschemessubject

toQualityImpactandEqualityassessments.

AmainthemeoffutureCostImprovementPlanswill

bethereductionoftheuseofexpensiveagencystaff

aswerecruitpermanentlytoarangeofmedicaland

nursingandmidwiferyposts.

MonitoringandreportingofCostImprovementPlan

deliverywillcontinuetobeviaformalmonthlyreports

totheTrust’sFinanceCommittee.



8.9 Procurement strategy

Duringthelastfewyearstherehasbeenanincreasing

focusontherequirementsfortheNHStoimprove

itsprocurementfunctiontocontributetowards

thenationalefficiencyprogrammebyeliminating

wastefulprocurementpracticesandreducingcosts.

Thishasbeenevidencedbytheissuingofanumber

ofreviewsandguidancedocumentsculminatingin

thepublicationof‘Better Procurement, Better

Value, Better Care: A Procurement Development

Programme for the NHS’.

TheTrustcontinuestousethisasaframeworkto

realiseitsambitionofcreatingamoderneffectiveand

efficientprocurementfunction,thattrulydeliversvalue

formoney,supportsinnovation,stimulatesgrowth

thathelpscontributetodeliveringthehighestquality

patientcare.

ThekeythemesuponwhichtheTrustprocurement

strategywilldevelop;

•Workmorecollaboratively-includingsharing

pricespaidtoensurethatallpaythesameprice

forthesameproductandundertakingjoint

procurementactivitiestoreducethe

‘managementcosts’;

•Developmentofpipelinetransformational

procurementprojects;

• Improvecontrolsonpurchasingtoensure

compliancewithcontracts;

• Increaseawarenessanddeliverthebenefitsof

strategicrelationshipmanagementtechniques,

toensurecontinuousimprovementanddelivery

ofcostsavings;

•ContinuethedrivefortheTrustprocurement

functiontobebetteratengagingandembracing

cliniciansinfosteringanddrivinginnovationand

change.Toofferprocurementasastrategictoolto

influenceandimprovepatientpathways;

•Providingvisibilityofspendtokeystakeholders

andExecutives.

Theprocurementstrategyisanenablerinallowing

theTrusttouseitsresourcestodeliverthemaximum

returnonitsexpenditure,providingthehighestquality

goodsandservicesforitspatients.Thestrategyseeks

toensureeachpoundisspentwiselyandspentwell.

Anumberofstrategicactionsthatwillimprovethe

performance,efficiencyandeffectivenessofits

procurementfunction,aswellascontributingtothe

overalldevelopmentofbetterprocurementacrossthe

Trusthasbeenset.



8.10 Research and development

TheTrusthasahistoryofparticipatinginmulticentre

researchparticularlyinoncologyandsince2007this

researchactivityhasgrown.Followingtheestablishment

oftheCumbria&Lancashirecomprehensiveresearch

network(CLRN)theTrusttooktheopportunityto

expandtheresearchinfrastructuretoenableother

specialtieswithintheTrusttoundertakeresearch.

In2007/8191patientswererecruitedintoNIHR

portfolioresearchstudies,by2013/14therecruitment

figureshadincreasedto1013patientsrecruited

toNIHRportfolioresearch.Howeverthereremains

considerablescopetofurtherincreaseresearchactivity

andpatientrecruitmentwhichshouldresultinan

increaseinpatientchoiceandqualityofcare.Our

ambitionforresearchanddevelopmentisakeypart

ofourstrategicplanandwewillaimto:

1. Toraiseourprofileanddevelopourreputation

forresearchexcellence

2. Torecruitmorepatientsandattractadditional

income

3. Todevelopandembedaresearchculture

Theresearchanddevelopmentteam,withthesupport

oftheExecutiveteamandtheTrustBoard,will

implementtheresearchstrategyfocusingonthe

followingportfoliosoverthenext3years.

1.Tocommitto2-6jointclinicalacademic

appointment’swithLancasterUniversity

2.Clinicalacademia–alignmentwithuniversity,

allowingustogrowourownstaff

3.Researchactivityineveryareabutwithspecific

areasdevelopedasspecialityresearchareas

4.Recruit5%moreparticipantsintoNIHRstudies

eachyear

5.Tohavegreaterthan15%ofallclinicalstaff

activelyinvolvedinresearchanddevelopment

6.Increasecommercialtrialincomeby25%over

thenext3years

7.Secureadditional£200Kresearchfunding



Research strengthCurrentresearchactivityisinfluencedbytheNIHR

portfoliowhichfocusesonNHSorganisationsproviding

abroadportfolioofresearchinallspecialties.

Approximately85%ofthefundingfortheR&D

departmentiscurrentlyprovidedbytheNIHRandas

suchweneedtomaintainthisbroadresearchportfolio.

TheTrustdoeshaveanumberofresearchstrengths,

wherewehavehadactiveprojectsconsistentlyover

thelastthreeyearsandsomedevelopingresearch

areas,wherewerunstudieseitherintermittently

orhavenewlyengagedinresearchwithinthelast

18months.Bothareasareledbyenthusiasticlocal

consultantswithboththeareasofstrengthandthe

developingareashavepotentialforgrowth.

TheTrustisamemberoftheNIHRNorthWestCoast

ClinicalResearchNetwork(NIHRNWCCRN).Academic

partnershipscurrentlyexistwiththeUniversitiesof

Lancaster,Liverpool,Cumbria,Manchesterand

CentralLancashire.

Undergraduate and post graduate research opportunitiesTheTrustthroughtheundergraduatemedicaleducation

teamcurrentlyisabletosupport6medicalstudentsa

yearthroughanintercalatedMScdegreebyresearch.

Thesestudentsareusuallyjointlysupervisedbyan

academicfromtheUniversityofLancasterandan

employeeoftheTrust.

Similarlythereisfundingeachyearforonenon-

medicalstudentPhDstudentship,againjointly

supervisedbyanacademicfromtheUniversity

ofLancasterandanemployeeofTrust.



Commercial researchCurrentcommercialresearchactivitysponsoredby

pharmaceuticalordevicescompaniesissmallbut

increasingandthereishugepotentialforgrowthin

thisareawhichwewillaimtopursue.

TheTrustscommitmenttoresearchanddevelopment,

stronglysupportedbyourclinicalleaders,willhelpto

buildourreputationandexpandourportfolioasakey

contributortoresearchbothlocallyandnationally.

8.11 Performance Monitoring

TheTrust’sfiveyearstrategywillbeusedtoinform

concurrentannualplanningprocessestoinform

detaileddeliveryplans.Thiswillinclude;

•AreviewoftheimpactoftheannualNHS

PlanningGuidance,includingNationalTariff

impact;

•Anannualassessmentandapplication

(whererelevant)foranappropriateLocal

PriceModification;

•Ariskreviewtoinformtheidentificationand

appropriatemitigationofkeystrategicrisks;

•ThedeliveryoftheStrategicObjectiveswill

bemonitoredmonthlyviatheBoardAssurance

CommitteesandQuarterlytotheBoardof

DirectorsviatheTrustManagementBoard.

Thiswillincludeadetailedreviewofriskand

atwoyearoreightquarterforecastbasedon

performanceoverthepriorperiod.



Conclusion

TheTrust’sfiveyearstrategyfortheperiodto2019/20

representstheculminationoftwoyears’work,

deliveredinpartnershipwithourkeypartnersinthe

LocalHealthEconomyandrepresentativesfromour

widerhealthcommunity.

Thesuccessfuldeliveryofthisstrategyreliesonthe

entirehealtheconomycomingtogethertomanage

ourhealthservicesholisticallyandunderthetheme

ofintegration–acorecomponentofthebettercare

togetherplanswhichhavebeensigneduptoby

respectivegoverningbodies.

Subjecttotherelevantsystemsupport,bothfinancial

andstrategic,thedeliveryofthestrategywillensure

accesstogoodqualityservices,withimproved

outcomesforourpatientsatalevelofinvestment

thatrepresentssignificantvalueformoneygiventhe

uniquegeographicchallengesUHMBTface.

Section 9Conclusion





Appendices

Appendix1:

Risk and Mitigation table

Appendix2:

Local Health population analysis

Appendix3:

Market appraisal

Appendix4:

The 2 year operational delivery model

Appendix5:

The Workforce Values

Appendix6:

The Communication Strategy

Appendix7:

Estates Strategy Proposals

Appendix8:

Funding Principles to support Innovation,

Informatics and Information

Appendix9:

Procurement Strategy Deliverables

Contact us

UniversityHospitalsofMorecambeBayNHSFoundationTrust

TrustHQ

WestmorlandGeneralHospital

BurtonRoad

Kendal

LA97RG

Email [email protected]

Twitter twitter.com/UHMBT

Facebook facebook.com/UHMBT

Tel 01539 716695 (Trust HQ)

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Dateofpublication:10 February 2015Version:1.0

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Summary of our Five Year Strategic Plan 2015 - 2020 · our Quality Account ... • The delivery of a financially viable acute Trust; • Recruitment and retention ... Summary of our