1. health and fitness

Bridgewater Community Healthcare
NHS Trust
Summary Integrated
Business Plan
2012-2017
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Contents
Chairman and Chief Executive’s Introduction
Page
4
About Us
5
Mission, Vision and Values
6
Key Facts
8
Health Profiles of our Communities
9
Our Services
13
NHS Foundation Trust status
15
Market Assessment
16
Building the Bridgewater Strategy
18
The Bridgewater Offer
20
Service Developments
21
Performance
27
Financial Performance
32
Risk
34
Cost Improvements and Quality of Care
37
Workforce and Leadership
41
Our Board
43
Bridgewater Summary Integrated Business Plan 2012-2017
3
Chairman and Chief Executive’s
Introduction
We are delighted to present our Summary Integrated Business Plan (IBP) which sets out
the key elements of our five year business plan for the Trust, including future plans for
services as we develop as a successful NHS Foundation Trust.
The Trust provides community health services to the residents of Ashton, Leigh and
Wigan; Halton; St Helens; Trafford and Warrington. We also provide specialist community
dental services in these areas plus Bolton, Tameside, Glossop, Stockport and western
Cheshire.
Bridgewater Community Healthcare NHS Trust (Bridgewater) was established in April
2011 as a result of the transfer of community services from four local boroughs into
Ashton, Leigh and Wigan Community Healthcare NHS Trust. To recognise this significant
change in the geographical area the Trust was renamed as Bridgewater.
Our five year business plan sets out a clear vision and strategy to develop as a
Foundation Trust that is well managed, has sound governance, is financially viable and
will be legally constituted. We have a focus on patient safety and put the patient at the
centre of everything we do.
As a Foundation Trust we will be giving our patients, staff, members and stakeholders a
strong voice in our future so that they can influence our development and growth as an
organisation and as a provider of choice.
We hope you find this document a useful and informative summary of our business plan
and an aid to understanding our strategy for bringing high quality, integrated care, closer
to home in the communities we serve.
If you have any comments on our plans please contact us using the details at the end of
this document.
4
Harry Holden
Dr Kate Fallon
Chairman
Chief Executive
Bridgewater Summary Integrated Business Plan 2012-2017
About Us
Bridgewater was developed as a platform for change in the health and social care
delivery system. The majority of our services are delivered in patients’ homes or at
locations close to where they live, such as clinics, health centres, GP practices,
community centres and schools. As a provider of both mainstream and specialist care,
our role is to focus on providing cost effective NHS care, keeping people out of hospital
and supporting vulnerable people throughout their lives.
As a dedicated provider of community services, our strategy is to bring more care closer
to home. This means providing a wider range of services in community settings to keep
people healthier for longer and developing more specialist services to support people to
live independently at home.
Bridgewater Summary Integrated Business Plan 2012-2017
5
Our Mission, Vision and Values
Our mission is:
To improve local health and promote wellbeing in the communities we serve
Our vision is:
To work closely with local people and partners to promote good health and to be
a leading provider of excellent community healthcare services in the North West
The Board consulted with staff, patients and commissioners to review and reaffirm our
mission, vision and values throughout 2011/12. The values are listed in Figure 1 below.
Figure 1- Bridgewater’s Values
6
Value
What this means
Patient Centred
Patient care is our priority
Encouraging
Innovation
We encourage and embrace new ideas to deliver
improvements in patient care
Open and Honest
We communicate clearly to develop relationships
based on mutual trust and respect
Professional
We provide a quality service for patients by
investing in our staff, recognising and valuing their
contribution
Locally Led
We will continually develop our knowledge of the
communities we serve so that we can be
responsive to local need
Efficient
We will use our resources wisely to ensure quality
patient care and value for money
Bridgewater Summary Integrated Business Plan 2012-2017
Figure 2 - Bridgewater’s Strategic Focus, Aims and Goals
Strategic Focus
Strategic Aim
Strategic Goal
Patients
We will provide
excellent, timely and
personal healthcare
close to patients homes,
ensuring that we tailor
our services to meet
their individual patient
need.
We will continue to demonstrate
improvement in the delivery of high
quality, safe, excellent and effective
personal community healthcare for our
patients.
We will work with our
local communities and
strategic partners to
ensure that we design
and implement
integrated services
which improve access,
reduce health
inequalities and
promote health and
wellbeing.
We will continue to work with local
communities to improve services that
support their health and wellbeing,
establishing targets that will demonstrate
that we are achieving this.
We will ensure that our
organisation has longterm financial viability
and sustainability, is well
governed and is
accountable to the
communities we serve
for the services we
deliver.
We will continue to deliver value for
money by ensuring efficiency in all our
activity and processes in local health
economies.
Community
Organisation
We will make it easier for patients/carers
to access our services where and when
they need them.
We will continue to engage with
stakeholders and the local community to
ensure that we develop a community
organisation that is recognised as
contributing positively to the lives of the
local population.
We will achieve Foundation Trust status
by 2013 and be assessed as the leading
provider of community healthcare in the
North West by 2015.
We will continue to be financially secure
and accountable across our entire
organisation.
People
We will invest in the
development of our staff
to ensure that they have
the skills required to
deliver high quality and
safe services to the
communities we serve.
We will develop world class skills,
competencies and experience, to deliver
high quality care through our workforce
planning, organisational development
and education and to be seen as the
employer of choice.
We will continue to engage with our staff,
fostering talent and developing leaders,
to deliver change, innovation and
improvement.
Bridgewater Summary Integrated Business Plan 2012-2017
7
Key Facts
The table below provides a summary of key facts about Bridgewater.
Figure 3 - Key facts about Bridgewater
Area Covered
266 square miles across five boroughs
Population Served
1,015,370 (ONS 2010)
1,779,300 including dental service (ONS 2009/10)
Headcount
(as at April 2012)
4,035 (3365 wte)
Labour Turnover
12.37% as at April 2012
Number of Inpatient Beds
29 (Newton Community Hospital)
Number of Properties
210
Reference Cost Index
(by division 2010/11)
ALW
HSH
Trafford
Warrington
Overall Income
£167.9m split into the following (£m)
ALW
£43.3
Dental
£6.73
HSH
£51.03
Trafford
£23.65
Warrington
£27.23
Others*
£16.0
*Other income includes Local Authority
(£6.21m), Trusts/Foundation Trusts(£3.43m),
Other non-protected income includes Road
Traffic Accidents (RTA) (£1.78m), Service
Increment for Teaching (SIFT) (£0.15m),
Non-Medical Education and Training (NMET)
(£0.76m), Healthcare Libraries (£1.50m), Other
(£0.69m), Non-patient services to other bodies
(£0.96m), other revenue (£0.52m)
8
103
101
77
71
PCT Localities
•NHS Ashton, Leigh & Wigan
•NHS Halton & St Helens
•NHS Trafford •NHS Warrington
Clinical Commissioning
Groups
•Halton •St Helens •Trafford •Warrington
•Wigan
Lead Commissioner for
Community Dental Services
NHS Halton & St Helens
PCT Clusters
•Greater Manchester •Merseyside •Cheshire
Local Authorities
•Halton •St Helens •Trafford •Warrington
•Bolton •Tameside •Stockport
•Cheshire West & Chester •Wigan •High Peak
Bridgewater Summary Integrated Business Plan 2012-2017
Health Profiles
of our Communities
The Trust operates across a large, complex, health and social care footprint, addressing
the needs of populations. The geography of Bridgewater includes some of the most
deprived communities in England with the associated health and lifestyle challenges.
This means there are significant variations in morbidity and mortality between the most
affluent and deprived communities served by the Trust.
The population is ageing, so demand on our services will continue to grow during a
period of unprecedented financial pressures. Across our local health economies, this
necessitates a new model for the delivery of more care out of hospital, in partnership with
General Practitioner (GP) colleagues and other stakeholders, to ensure patients receive a
seamless service.
The health profiles of each of our boroughs are summarised as follows: -
Wigan Health Profile
• The health of the people in the borough of Wigan is generally worse than the
England average. Deprivation is higher than average and about 12,100 children live in
poverty. Life expectancy for both men and women is lower than the England average.
• Life expectancy is 11.1 years lower for men and 8.0 years lower for women in the
most deprived areas of Wigan than in the least deprived areas.
• Over the last 10 years, all-cause mortality rates have fallen. Early death rates from
heart disease and stroke have fallen, but remain worse than the England average.
• 19.3% of Year Six children are classified as obese. Levels of teenage pregnancy,
breast feeding initiation and smoking in pregnancy are worse than the England
average.
• Estimated levels of adult “healthy eating”, smoking and obesity are worse than the
England average. Rates of hip fractures, smoking-related deaths and hospital stays
for alcohol-related harm are higher than average. Rates of sexually transmitted
infections and road injuries and deaths are better than the national average.
• Priorities in the borough include reducing avoidable premature deaths from
cardiovascular disease (CVD) and cancer and reducing teenage pregnancy
rates.
Bridgewater Summary Integrated Business Plan 2012-2017
9
Halton Health Profile
• The health of people in Halton is generally worse than the England average.
Deprivation is higher than average and about 7,000 children live in poverty.
Life expectancy for both men and women is lower than the England average.
• Life expectancy is 11.1 years lower for men and 10.8 years lower for women in the
most deprived areas of Halton than in the least deprived areas.
• Over the last 10 years, all-cause mortality rates have fallen. The early death rates from
heart disease and stroke have fallen, but remain worse than the England average.
• 23.8% of Year 6 children are classified as obese, higher than the average for England.
Levels of teenage pregnancy, breast feeding initiation and smoking in pregnancy are
worse than the England average.
• Estimated levels of adult “healthy eating” and smoking are worse than the England
average. Rates of sexually transmitted infections, smoking related deaths and hospital
stays for alcohol related harm are worse than the England average. The rate of
statutory homelessness is lower than average.
• Priorities for Halton include smoking, alcohol, mental health, obesity and
breastfeeding.
St Helens Health Profile
• The health of the people in St Helens is generally worse than the England average.
Deprivation is higher than average and about 8,600 children live in poverty.
Life expectancy for both men and women is lower than the England average.
• Life expectancy is 11.5 years lower for men and 8.4 years lower for women in the most
deprived areas of St Helens than in the least deprived areas.
• Over the last 10 years, all-cause mortality rates have fallen. Early death rates from
cancer and from heart disease and stroke have fallen, but remain worse than the
England average.
• 21.9% of Year Six children are classified as obese, higher than the average for
England. Levels of teenage pregnancy, General Certificate of Secondary Education
(GCSE) attainment, alcohol-specific hospital stays among those under 18, breast
feeding initiation and smoking in pregnancy are worse than the England average.
• The estimated levels of adult “healthy eating” and smoking are worse than the England
average. Rates of sexually transmitted infections, smoking related deaths and hospital
stays for alcohol related harm are worse than the England average. The rate of violent
crime is lower than average.
• Priorities for St Helens include smoking, alcohol and mental health, obesity
and breastfeeding.
10
Bridgewater Summary Integrated Business Plan 2012-2017
2
Trafford Health Profile
• The health of the people in Trafford is generally better than the England average.
Deprivation is lower than average, however about 6,900 children live in poverty.
Life expectancy for women is higher than the England average.
• Life expectancy is 10.6 years lower for men and 5.7 years lower for women in the most
deprived areas of Trafford than in the least deprived areas.
• Over the last 10 years, all-cause mortality rates have fallen. Early death rates from
cancer and from heart disease and stroke have fallen and are similar to the England
average.
• 16.4% of Year Six children are classified as obese, lower than the England average.
Level of teenage pregnancy, GCSE attainment, breast feeding initiation and smoking
in pregnancy are better than the England average.
• The estimated level of adult obesity is better than the England average. The rate of
hospital stays for alcohol related harm is worse than the England average. Rates of hip
fracture, sexually transmitted infections and road injuries and deaths are better than
the England average.
• Priorities for Trafford include tobacco and smoking, alcohol, obesity and active
lifestyle.
Bridgewater Summary Integrated Business Plan 2012-2017
11
Warrington Health Profile
• The health of the people in Warrington is mixed compared to the England average.
Deprivation is lower than average, however about 5,700 children live in poverty. Life
expectancy for both men and women is lower than the England average.
• Life expectancy is 9.7 years lower for men and 7.0 years lower for women in the most
deprived areas of Warrington compared to the least deprived areas.
• Over the last 10 years, all-cause mortality rates have fallen. Early death rates from
cancer and from heart disease and stroke have fallen, but the latter remains worse
than the England average.
• 17.5% of Year Six children are classified as obese. Levels of alcohol-specific hospital
stays among those under 18 and breast feeding initiation are worse than the England
average. The level of GCSE attainment is better than the England average.
• An estimated 19.0% of adults smoke and 22.9% are obese. Rates of road injuries and
deaths, smoking-related deaths and hospital stays for alcohol-related harm are worse
than the England average. The rate of sexually transmitted infections is better than the
England average.
• Priorities in Warrington include tackling health inequalities, reducing levels of
CVD and reducing harm caused by alcohol.
It is clear from the information above that the major health issues associated with
deprivation, unhealthy behaviours and lifestyle choices are prevalent within each of our
boroughs. The impact of these problems is different in each locality, each neighbourhood
or each household. As a provider whose staff are in contact with people within their own
communities on a day-to-day basis, our services must understand the local issues and
respond to these health needs at each level.
12
Bridgewater Summary Integrated Business Plan 2012-2017
Our Services
2
Bridgewater provides approximately 136 different clinical services across its core footprint
(there is some overlap between divisions that will be resolved). The largest are general
services, such as district nursing, health visiting, physiotherapy, podiatry, speech and
language therapy. Our workforce increasingly provides healthy living and lifestyle advice
services. We manage three walk-in centres, provide health care in three prisons and our
specialist dental services care for some of the most vulnerable people in our
communities. We have one state of the art community hospital at Newton-le-Willows.
The nature of community services is that they are patient-focused, looking at the needs of
the individual and family or carers, not just at one single condition or pathology. We
deliver holistic care, often working in partnership with other agencies in health and social
care to provide a seamless service.
Figure 4 - Services provided by Bridgewater
CAMHS (Child Adolescent
Mental Health Services)
Children's orthoptics
Cancer and
palliative care
Children's speech and
language therapy
Care home support
Children's therapies
Child safeguarding /
looked after children
Community cardiology
Childrens audiology
Community equipment
Children's community
learning disabilities service
Community hospital
Children's community
nursing
Community matrons
Children's continence
Community mental
health
Children's continuing
healthcare
Community neuro
rehab
Children's
development
Community
phlebotomy
Bridgewater Summary Integrated Business Plan 2012-2017
Warrington
Trafford
Halton & St Helens
Services
ALW
Provided to:
Warrington
Trafford
Halton & St Helens
Services
ALW
Provided to:
13
Figure 4 - Services provided by Bridgewater (cont.)
Continence
Podiatry
Dermatology
Respiratory
Diabetes
School nursing
Dietetics
Sexual health
District nursing
Speech and language
therapy
Ear nose and throat
Stroke
Falls
Tissue viability
GP Out of Hours
Walk-in centres
Health improvement
Weight management
Health visiting including
family nurse partnerships
Wheelchairs/mobility
Warrington
Trafford
ALW
Services
Halton & St Helens
Provided to:
Warrington
Trafford
Halton & St Helens
Services
ALW
Provided to:
Homeless and
vulnerable
Western Cheshire
Tameside & Glossop
Bolton
Stockport
Learning disabilities
Warrington
Dental
Trafford
IV therapies
ALW
Intermediate care
Halton & St Helens
Infection, prevention
and control
Midwifery
Nursing out of hours
Occupational therapy
Offender healthcare
Older people's
services
Pain management
Physio/orthopaedics/
musculoskeletal
14
Special Care
Dentistry*
Children’s
Dentistry
Out of Hours
Dentistry
Minor Oral
Surgery
Oral Health
Promotion
Dentistry in
Prisons
* Also in Prestwich Hospital, North Manchester
Bridgewater Summary Integrated Business Plan 2012-2017
Clinical Networks
In order to support service development and delivery, we have established Clinical
Networks to allow healthcare professionals working in the same discipline but in different
localities to work together for mutual patient and professional benefit. The focus of these
groups is developing clinical leadership, service improvements and pathway redesign
which ensures the skills and experiences available across the Trust are maximised. The
six clinical networks that have been established are: Urgent Care, Children’s Services,
Specialist Services, Offender Health, Long Term Conditions and Health and Wellbeing
(including dental).
NHS Foundation Trust Status
Bridgewater aims to become a Foundation Trust during 2013 and our ambitions are
underpinned by a commitment to engage and involve patients, staff and partners in our
plans for the future.
As part of our application to become a Foundation Trust we carried out a full public
consultation in early 2012. The results of this confirmed support for our Foundation Trust
plans.
The Foundation Trust model, with a wide local membership and a Council of Governors,
provides an obvious strategic fit with the culture of a community trust.
Achieving Foundation Trust status will provide the following benefits: • Local decision making as opposed to decisions dictated by central government.
• We will have members (patients, local people and staff) who will be informed about
developments within the Trust and have the opportunity to influence decisions about
services and the direction of the Trust.
• Public and staff members will elect fellow members to serve on the Council of
Governors, who will represent their views at a senior level within the Trust.
• The Council of Governors will consist of 33 governors – 17 governors elected by public
members (patients and local people); nine governors elected by staff and seven
partner appointed governors.
• The Council of Governors will hold the Board of Directors to account on behalf of the
community that the Trust serves and is responsible for the appointment of the
Chairman and Non-Executive Directors. In addition, the Council of Governors
approves the appointment of the Chief Executive.
Bridgewater Summary Integrated Business Plan 2012-2017
15
• Through our Foundation Trust members and governors, we will ensure that we are
more accountable to our local communities and our staff. We will engage our
members and governors in service redesign, performance reviews and on-going
service development and challenge sessions.
• As a Foundation Trust we will ensure that we reinvest surpluses in the design and
implementation of new and innovative services which ensure that patients are cared
for in a safe way in a community setting.
• We will be independently regulated by Monitor.
Achievement of Foundation Trust status will enhance our status within our local
community and we will use this to recruit and retain high quality staff. We will use our
financial freedoms to ensure that we reinvest in service development, organisational and
staff development.
We will ensure that we use our brand as an NHS Foundation Trust to develop strategic
service delivery partnerships locally. We will build upon our brand to support our
commercial strategy of organic service growth as a premier provider of local community
services.
The rigour of the Monitor compliance framework is welcomed by the Board and staff who
are keen to demonstrate the improved health outcomes and service experience our
patients receive, as well as the efficiency and value for money we provide for
commissioners.
Market Assessment
Bridgewater operates in a complex health and social care market where many of our
partners are also our competitors. This is equally applicable across secondary care,
primary care, mental health services and some elements of social care provision.
The commissioner landscape is changing rapidly, with the relationship between the roles
of the Clinical Commissioning Groups (CCGs), National Commissioning Board and local
authority commissioning arrangements still to be fully established. Working as we do
across five local Boroughs (plus the additional five areas covered by the dental network),
our assessment of the market takes into account the intentions and plans of five main
CCGs, three primary care trust (PCT) clusters and five local authorities, each of which is
functioning in the context of its own Joint Strategic Needs Assessment (JSNA).
Our commissioners’ intentions are summarised in the diagram opposite:-
16
Bridgewater Summary Integrated Business Plan 2012-2017
2
Figure 5 - Summary of Commissioning Strategies
Commissioners’
Golden Thread
Service
Principles
Commissioning
Intentions
Quality
Innovation
Productivity
Prevention
Care Outside
Hospital
Patient-Centred
Care
Integrated Service
Delivery
National Policy
Drivers
WIGAN
WARRINGTON
HALTON
ST HELENS
TRAFFORD
DENTAL
Urgent Care
Reform
Urgent Care
Reform
Urgent Care
Reform
Urgent Care
Reform
Urgent Care
Reform
Specialist
Dentistry
LTC Management
Integrated
Community
Nursing
Integrated
Community
Nursing
Integrated
Community
Nursing
Cancer
Specialist
Paediatric
Dentistry
End of Life Care
COPD & CHD
Pathways
COPD & CHD
Pathways
COPD & CHD
Pathways
HV Expansion
Community OPD
Community OPD
Community OPD
IAPT
Risk Stratification
Risk Stratification
Risk Stratification
Stroke Care
Teenage
Pregnancy
Teenage
Pregnancy
Teenage
Pregnancy
Community
Cardiology
Alcohol
Minor Oral
Surgery
Cancer
Bridgewater is leading the way on integration, with social care and prevention services
being best placed within communities to form the “glue” between hospital and social
care. Engagement with stakeholders such as each of our main local authorities, GPs,
voluntary agencies and housing agencies has enabled us to further develop our model for
integrated working within our health and social care economies and to embed this within
communities.
Bridgewater Summary Integrated Business Plan 2012-2017
17
Building the Bridgewater Strategy
The following diagram illustrates how Bridgewater has arrived at our strategy for meeting
the health needs of our local populations in each of the areas we service and delivering
on our commissioners’ intentions within the current regulatory and economic
environment.
Figure 6 - Building the Bridgewater Strategy
Population
Characteristics
• High levels of deprivation
• Poor lifestyle choices
• Growing elderly population
• Growing younger population
JSNAs
Health
Consequences
Commissioner
Response:
• High levels of long-term
conditions
• Often multiple long-term
conditions
• People living longer with
them
• Deliver QIPP
• Reduce hospital spend
• Reduce hospital capacity
• Care closer to home
• Better management of longterm conditions
• Intergrated delivery
Financial context:
Flattening of NHS revenues
Demand projected to keep rising
Significant growth in hospital spend
QIPP
Evidence of value for money
Current Service
Response
Quality &
Outcomes:
• Performance Framework
• Quality Impact Assessments
• Extensive hospital interventions
• High rates of emergency
admission
• Hospital diagnosis
• High use of outpatient services
• High rates of planned
admissions
THE BRIDGEWATER OFFER: COMMUNITY SERVICES AS A PLATFORM FOR SUSTAINABLE
REFORM
QIPP: Intergrated Delivery. Personalisation. Care closer to home. Patient centred care
Effective relationships. Productive Community Services. Telehealth.
Service Line Management. Redesigned pathways
Urgent care. Early diagnosis. End of life care. LTC Management. Diagnostics.
Children & Families
Prevention. Health Improvement
18
Bridgewater Summary Integrated Business Plan 2012-2017
2
To ensure that our key stakeholders are informed, involved and engaged with our
development and direction, we have developed and implemented an engagement
framework. As part of this, all key stakeholders have been involved in discussions about
the development of the IBP, the development of our organisation and our future plans to
meet the needs of our local communities. These discussions have been supportive of our
plans but have also led to amendments to the IBP following stakeholder feedback.
In addition to the changing commissioner relationships at a local level, the national
imperatives of the Health and Social Care Act (2012) open up the NHS provider market
for community services. The ‘Any Qualified Provider’ (AQP) initiative is both an imminent
challenge and an opportunity. It requires a step change in our approach to service
delivery and to our ability to accurately assess our cost base and understand our current
models of provision. Understanding the impact of AQP initiatives on whole services is
critical in order to determine service viability where AQP initiatives remove key pathway
steps which in turn may compromise profitability of the pathway.
Bridgewater Summary Integrated Business Plan 2012-2017
19
The Bridgewater Offer
Community trusts are uniquely placed to support the reduction in avoidable attendance
and admission to hospital, working as we do at the population level within local areas, in
partnership with patients, families and general practices. In this way community trusts
support local quality, innovation, productivity and prevention (QIPP) challenges by freeing
up acute trusts to reduce their footprint and remain viable within an overall shrinking NHS
resource envelope.
Bridgewater is increasingly delivering and facilitating the provision of integrated care
pathways with hospitals and local authority partners, recognising the need for risk sharing
and true partnership working. We expect this approach to grow as demand rises due to
the ageing population and the rising incidence of long-term conditions.
We intend to stimulate discussion between Bridgewater and our commissioners, local
authorities, Health and Wellbeing Boards, GPs, NHS providers and other partners which
will result in us collectively realising the dividend that community services can bring to the
NHS in these challenging times. Much work is taking place within the boroughs that
Bridgewater operates.
Figure 7 - The Bridgewater Offer
Specialist Care for
Vulnerable Minorities
Cost benefit of large
population base
Personal Care for Long Term Conditions
Working in
partnerships,
avoiding admissions
Universal Services Early Years to End of Life
0-19 yrs, frail
elderly, dementia
Self-Care and Wellbeing
Services for Whole Populations
Public health related
long-term demand
We anticipate that competition and choice will be broadened out over the coming years
and our challenge, as a newly formed organisation, is to flex our service offer to respond
to the choice agenda within an overall reduction in resources.
20
Bridgewater Summary Integrated Business Plan 2012-2017
Service
Developments
2
Bridgewater’s service developments link directly with its strategic objectives and the
commissioning intentions of our local CCGs, local councils and Health & Wellbeing
Boards. They are developed with a view of the market and economic situation in which
we operate and are refined in consultation with partners.
The key strands of the service development plans in Bridgewater are around the following
areas:
• Building on the strong foundations of services that we already provide, we will shape
the local agenda, delivering holistic, innovative and integrated models of care by
working in partnership with patients, carers and their families.
• Working in partnership to deliver a platform of integrated care with partner
organisations to meet the growing health needs of our communities.
• Improving the delivery of care in community settings, bringing care out of hospital and
developing services closer to people’s homes.
• Improving access to services: educating, informing and empowering people, to
maximise their ability to use them. Removing barriers that prevent access by minority
groups.
• Improving people’s health, aiming to help them stay healthier for longer and using all
our staff to focus on ill health prevention.
• Educating and enabling citizens to manage their own long-term conditions, as well as
their wellbeing and quality of life, promoting self-care and maximising their potential
wherever possible.
• Providing universal services, that fully meet the health and social care needs of
individuals within whole populations, from birth to death.
• Utilising innovative and cost effective approaches, including technology, to deliver
community healthcare and provide more immediate communication and monitoring,
with easier access for patients.
The Trust is developing business cases to generate new or changed services that support
improved service efficiency and improved quality and effectiveness to support the delivery
of long-term financial viability of the organisation.
Bringing Bridgewater together has created opportunities for development and reorganisation of services. The following developments do not require investment from
commissioners and are largely within our gift to make happen.
Bridgewater Summary Integrated Business Plan 2012-2017
21
Figure 8 - Service Initiatives
Description of Initiative
Commissioning Drivers
Integrated Care Teams (All Divisions)
Neighbourhood, locality and borough-wide teams of
multi-disciplinary and multi-organisational
professionals will offer care ‘wrapped around’ GP
practice lists supporting the needs of risk stratified
patient groups, supporting the management of long
term conditions, offering tailored care and support
and drawing down more specialist community-based
services where necessary and reducing demand for
expensive hospital intervention.
• Care closer to home
• Management of long term
conditions
• Reform of urgent care
• Improving access
We will work with partners across sectors to identify
groups or populations that may not be engaged or
registered with GPs.
• QIPP
As well as delivering a reformed model of care within,
or closer to patients’ homes, this model of delivery
will incorporate a number of other service
developments.
Redesign of Offender Healthcare
(ALW and Warrington)
A review of the three custodial establishments across
Bridgewater has identified significant improvements in
service delivery which may be available by
streamlining the provision of GP, advanced nurse
practitioners and pharmacy services. The
Merseyside Cluster are involved in a project around
improving offender health and their care records,
taking into account the higher incidence of offenders
with learning difficulties. By working together with
colleagues across offender health, benefits of support
and sharing best practice will develop the service.
• Management of long term
conditions
• Avoidance of hospital
admission
• Reform of urgent care
• QIPP
The considerable expertise around offender
healthcare provision could develop into new business
in further establishments, custody suites etc.
Wheelchair Services Hub and Spoke
It has been recognised that the wheelchair services
across the organisation deliver high volume, low cost,
low complexity services alongside low volume, high
cost, and high complexity services. In all cases the
current services have challenges to address and each
strand of the service requires a different solution.
Recognising the scarcity of expertise, a hub and
spoke model is proposed for wheelchair assessments,
delivery of products and maintenance.
22
• Care closer to home
• Management of long term
conditions
• QIPP
Bridgewater Summary Integrated Business Plan 2012-2017
Figure 8 - Service Initiatives cont.
Description of Initiative
Commissioning Drivers
Specialist Services Redesign
One of Bridgewater’s key strengths is the availability
of highly specialised community based services. By
their very nature, these tend to be small services so
there are opportunities of scale and efficiencies of
management structures by reviewing across the
whole organisation that will increase the resilience of
these services and hence increase their ability to
reach some of our most vulnerable patients.
Redesign of Out of Hours Services (ALW and
Warrington)
A review of out of hours services across the
Bridgewater footprint to look at opportunities to
improve the use of scarce resources, particularly there
are opportunities to review call handling, triage and
clinical advice.
• Care closer to home
• Avoidance of hospital
admission
• Reform of urgent care
• QIPP
• Care closer to home
• Avoidance of hospital
admission
• Reform of urgent care
• QIPP
Customer Centre of Excellence
Bridgewater’s opportunity to bring together the
functionality and accessibility of a Call Centre will
deliver a single point of access to our services for the
public and professionals.
Its potential has yet to be fully explored but it is
envisaged that it will be a key hub for our engagement
with the public and access to patient services support
where required.
• Care closer to home
• Management of long term
conditions
• Reform of urgent care
• QIPP
Walk-In Centres (ALW and HSH)
• Care closer to home
In common with other services, there are
opportunities of scale and sharing expertise.
• Reform of urgent care
• QIPP
Our Business Plan also details our intentions for innovative and effective service developments
which will meet the needs of local people without having to rely on hospital based services.
These will require investment from commissioners or reinvestment of efficiency savings in order
to happen.
Bridgewater Summary Integrated Business Plan 2012-2017
23
Figure 9 - Service Developments
Description of Initiative
Commissioning Drivers
Telehealth
This development supports the work of the Integrated
Care Teams and is a key enabler supporting more
effective management of long-term conditions in the
community.
It allows patients with long-term conditions to monitor
and manage their health and supports self-care. A
viable opportunity to increase efficiency and
effectiveness for services such as COPD could be
addressed within current work streams with the
Advancing Quality Alliance (AQUA).
• Avoidance of hospital
admission
• Self-management of longterm conditions
• QIPP
Community IV Therapy
This development will increase the provision of home
IV therapy services for patients with a defined
diagnosis of infection or other conditions requiring IV
therapy.
It provides a safe alternative to hospital admission. It
is also proposed to extend the service to further
reduce hospital admissions by offering blood
transfusions and chemotherapy in the community.
• Care closer to home
• Management of long term
conditions
• QIPP
Every Contact Counts
Developing self-care initiatives to provide information,
services and advice to people to assist them to
manage their own health for longer will be the key to
managing future demand for services. Ensuring that
every contact made by a community health
practitioner also has an element of health promotion
and ill health prevention will assist with this delivery.
• Care closer to home
• QIPP
Enhanced Diagnostic Support
To support the work of the integrated delivery teams
and to manage demand for hospital referral and
outpatient appointment, the Trust would build upon
existing community diagnostic services such as;
•
•
•
•
24
Community Cardiac Physiology
Ultrasound
Plain Film X-Ray
Scoping
• Care closer to home
• QIPP
• Reform of urgent care
Bridgewater Summary Integrated Business Plan 2012-2017
Figure 9 - Service Developments cont.
Description of Initiative
Commissioning Drivers
Home DVT Assessment (Wigan)
• Care closer to home
Within the integrated delivery teams, capacity would
be created to enable home deep vein thrombosis
(DVT) assessment within a patient’s home or
community setting thereby preventing the need for
hospital referral.
• Reform of urgent care
Family Nurse Partnership
A specialised service offering direct support to our
most vulnerable families.
• DVT assessment
• QIPP
• Family Nurse Practitioner
(FNP) research
• National Every Child
Matters and parenting
strategies
Call to Action
Expansion of our health visitor workforce.
In line with the national ‘Call to Action’ programme,
the Trust is expanding its health visitor workforce in
partnership with our commissioners across all
localities.
• National ‘Call to Action’
policy
Pain Management
An extension to our existing MSK services would
enable management of chronic pain including the
delivery of joint injections to take place in less
expensive community settings.
• Care closer to home
• QIPP
Dysfunctional-Uterine Bleeding Service
Bridgewater will provide a community based service
for the management of dysfunctional uterine bleeding.
This will include assessment, investigation and
treatment when appropriate by the insertion of Mirena
intra-uterine device. This will mean that women
presenting with the condition will be effectively
managed and followed up within a community setting.
Bridgewater Summary Integrated Business Plan 2012-2017
• Care closer to home
• QIPP
25
Figure 9 - Service Developments cont.
Description of Initiative
Commissioning Drivers
Family Planning Intra-Uterine Device (coil)
Insertion Service (IUCD)
Coil insertion is the preferred method of contraception
for many women but access to family planning clinics
at the appropriate time can be difficult to achieve.
Bridgewater will provide family planning clinics
specialising in coil insertion across the divisions
aligned to complement existing primary care based
family planning services.
• Care closer to home
• QIPP
Early Diagnosis of Dementia
• Care closer to home
Bridgewater staff, particularly district nurses, health
visitors and community matrons, are being educated
to assess patients for dementia and to refer on to the
most appropriate clinician.
• Dementia components of
CCG strategies
Integrated Sexual Health / GUM Service
This development will provide a fully integrated
service with a hub and spoke “one stop shop” model.
This will reduce duplication and provide a more
efficient and effective service to clients who will
receive appropriate advice and/or treatment at the
point of access.
• Care closer to home
• QIPP
• National Policy
Offender Healthcare – Styal Prison
Bridgewater is currently bidding for the tender to
provide a comprehensive, integrated healthcare
system across the prison community. The service will
reduce the number of healthcare visits outside of
prison and improve the health outcomes for offenders
and reduce health inequalities. This will add to our
current portfolio of three prison healthcare services.
26
• QIPP
• Improving access
• Avoidance of hospital
admission
• Care closer to home
Bridgewater Summary Integrated Business Plan 2012-2017
Performance
2
The development of a robust quality and performance management framework is a major
priority for the Trust if we are to enhance our ability to demonstrate high quality delivery,
efficiency and improved productivity. Work is advancing within the Trust and at a national
level, therefore we are adopting relevant national “general” indicators, working to agreed
community specific indicators with the Department of Health (DoH) and our peer trusts
and consulting locally with our commissioners to ensure that our metrics are fit for
purpose.
Since April 2011, Bridgewater has been responsible for the performance of its four
geographical divisions and the dental network, reporting to Trust Board and national
bodies (situation reports (SITrep), referral to treatment times (RTT), accident and
emergency (A&E), out of hours, prison health, units of dental activity (UDAs) using
nationally mandated standards. In addition, as contracts for Bridgewater services are
broadly still based on a PCT footprint, each division reports to its lead commissioner on
activity within the commissioner footprint. This arrangement will be superseded in 201314 with contract reporting directly to CCGs. Further information that describes the Trust’s
current and future commissioning arrangements is detailed in Figure 10 below:
Figure 10 - Commissioning and Performance Arrangements
Division
National
Current
Performance
Commissioner
Management
Board Performance
Management
ALW
PCT/CCG
Via NHS Greater
Manchester (ends
1/4/13)
Halton & St
Helens
Halton & St
Helens PCT/
CCGs
Via NHS
Merseyside
(ends 1/4/13)
Warrington
Division
Warrington
PCT/CCG
Via NHS Cheshire
(ends 1/4/13)
Trafford
Division
Trafford PCT
/CCG
Via NHS Greater
Manchester
(ends 1/4/13)
Activity, performance, contracts and
Finance
Dental
Division
Within each
PCT / CCG
area
Via national
dental reporting
arrangements
Clinical effectiveness and clinical
outcomes
Ashton Leigh
& Wigan
Bridgewater Summary Integrated Business Plan 2012-2017
Board receives a comprehensive
integrated performance report covering all
aspects of
Quality, safety & governance
Human resources (HR), organisational
development (OD)
& improvement
27
In 2011/12 the Trust met all of its quality targets and slightly over-performed on contracted
activity, delivering over 2.6million patient contacts.
The Trust manages performance within 4 domains :
1) Quality, safety, governance and risk
2) HR, organisational development and improvement,
3) Activity, performance, contracts and finance
4) Clinical effectiveness and clinical performance
Comparative performance within relevant areas for Bridgewater provided services is
outlined below in Figure 11.
Our data shows that patients treated in Bridgewater services receive their care in a more
timely way, to a high standard and in the majority of areas to a higher standard than both
national expectation and regional averages. In all areas where lower than expected
standards are seen, improvements are evident and underperformance is marginal.
Bridgewater clinical services perform well above average, deliver high quality and safe
care in a timely and patient friendly way. This places the Trust in a strong position to
retain business, attract new business and assure commissioners and patients that
patients and patient care is safe in our hands.
Figure 11 - Comparative Performance within Relevant Areas for Bridgewater
Domain
Quality,
Measure
Target
Patient
90%
Experience
Satisfaction
Prison Health
100%
standards
Compliance
2012-13
performance
year to date
(to July 12)
Regional
average
where
available
Improvement
or
deterioration
from last year
BWT Perf
97.5
n/a
n/a
Governance
and Wigan
Halton &
CQUIN
St Helens
Compliance
Trafford
BWT Perf
100%
n/a
Improved
BWT Perf
On target
n/a
n/a
July 12
Achieve
BWT Perf
Compliance /
On target
n/a
n/a
Report
Target
July 12
Achieve
BWT Perf
compliance /
On target
n/a
n/a
compliance /
Target
Report
July 12
BWT Perf
Achieve
28
Report
Target
Target
Warrington
Report
July 12
Achieve
Compliance /
Report
July 12
Safety and
Ashton, Leigh
Source/
Date
On target
n/a
n/a
Report
July 12
Bridgewater Summary Integrated Business Plan 2012-2017
Figure 11 - Comparative Performance within Relevant Areas for Bridgewater Cont.
Domain
Measure
Target
NHS Safety
Compliance
Thermometer
With Plan
2012-13
performance
year to date
(to July 12)
Regional
average
where
available
Improvement
or
deterioration
from last year
Source/
Date
BWT Perf
Compliant
n/a
n/a
Report
July 12
CQUIN
Compliance
SHA
A&E
Indicators
Compliance
Met
Met
Same
July 12
Report
BWT Perf
Sickness
Absence
4.70%
3.30%
n/a
Improved
Mandatory
Training
HR, OD and
Improvement
Report
July 12
BWT Perf
100%
91.36%
n/a
Improved
Report
Compliance
July 12
Safeguarding
BWT Perf
Training
100%
91% +
n/a
Improved
Report
July 12
Compliance
BWT Perf
PDR rates
100%
79.70%
n/a
Improved
Report
July 12
Meeting
Contracts
SHA
Activity
Met
n/a
Improved
Targets
July 12
Report
Activity,
Performance,
A&E 4 Hour
Contracts &
Target
95%
99.83%
96.10%
Improved
to AUG 12
Finance
RTT 18 Weeks
Performance
SHA
95%
Above 99%
97.70%
Improved
Non Admitted
Report
Non Admitted
95th
July 12
SHA
18.3 Weeks
14 Weeks
Percentile
Bridgewater Summary Integrated Business Plan 2012-2017
15.5 Weeks
Same
July 12
Report
29
Figure 11 - Comparative Performance within Relevant Areas for Bridgewater Cont.
Domain
Measure
OOH (Carson
Standards)
Target
2012-13
performance
year to date
(to July 12)
Regional
average
where
available
Improvement
or
deterioration
from last year
Source/
Date
Compliant
NonCompliant
on 2
Standards
n/a
Improved
July 12
SHA
Report
SHA
Cancer 2
Weeks Waits
95%
100%
92.42%
Improved
Report
Cancer 31
Activity,
Days to
Performance,
Treatment
SHA
94%
100%
96%
Improved
SHA
Cancer 62
days to
85-90%
100%
85%
Improved
July 12
Report
Treatment
SHA
Meeting GP
Referral
July 12
Report
Contracts &
Finance
July 12
Meet Plan
Met
Met
Same
July 12
Report
Targets
Submit
IAPT
Standard
Met
Met
n/a
Data Set
BWT TFA
Finance
Surplus
Data
Submission
Surplus Met
Met
n/a
Improved
Return
July 12
FRR
3
BWT TFA
3
n/a
Same
Return
July 12
EBITDA
Finance
Margin
EBITDA
Achieved
BWT TFA
1
1.8
n/a
Improved
Return
July 12
100%
105.7
n/a
BWT TFA
Improved
Return
July 12
BWT TFA
I&E Surplus
1%
1.60%
n/a
Improved
Return
July 12
30
Bridgewater Summary Integrated Business Plan 2012-2017
Figure 11 - Comparative Performance within Relevant Areas for Bridgewater Cont.
Domain
Measure
Target
2012-13
performance
year to date
(to July 12)
Regional
average
where
available
Improvement
or
deterioration
from last year
BWT TFA
Debtor Days
>90 days,
Source/
Date
Met
Not Met
n/a
Improved
Return
July 12
5% Tolerance
Finance
Prior Year
Contracts
BWT TFA
Met
Met
n/a
Same
Closed
C Difficile
Infections
Clinical
SHA
None
Met
n/a
n/a
Accd’n
and Clinical
Breaches
July 12
Report
Mixed Sex
Efectiveness
Return
July 12
SHA
0
0
2
Same
July 12
Report
Performance
Vaccination
and
Met
Exceeded
Immunisation
Targets
Bridgewater Summary Integrated Business Plan 2012-2017
Met
BWT TFA
Same
Return
July 12
31
Financial Performance
Our financial plans
What are we trying to achieve?
• Delivering surpluses to allow for a significant capital investment to improve the quality
of our I.T. systems and buildings to support service modernisation.
• Delivering increased efficiencies whilst maintaining and improving the quality of our
services.
• Managing changes in service delivery and care pathways in partnership with our
stakeholders.
• Ensuring workforce changes are managed effectively.
• Delivering short, medium and long-term financial viability whilst contributing to the
overall financial sustainability of the health economies in which we operate.
What are we going to deliver?
Our financial plans are to:
• Put aside on average £1.6m (approximately 1% of turnover) each year in order to make
the planned improvements to our staff training and development, I.T. systems and
buildings and to create a small financial cushion to help us to manage future risks.
• Over the next five years, spend £11.8m on IM & T, estates and medical equipment to
improve the quality of our services provided to patients.
• Over the next five years, deliver £46.3m of savings by being more efficient, innovative
and productive.
• Get the balance right so that we achieve financial stability whilst at the same time
improving the quality of our services.
32
Bridgewater Summary Integrated Business Plan 2012-2017
Key Financial
Figures 2012 - 2018
Figure 12 - Income and Expenditure Projection Summary
2012/13
£m
2013/14
£m
2014/15
£m
2015/16
£m
2016/17
£m
2017/18
£m
163.3
160.7
157.8
156.1
154.4
152.7
4.6
4.5
4.4
4.3
4.3
4.2
Total income
167.9
165.2
162.2
160.4
158.6
156.9
Pay Expenses
(116.3)
(114.6)
(112.2)
(109.9)
(107.6)
(105.4)
Non-pay Expenses
(49.4)
(46.9)
(46.2)
(46.5)
(46.9)
(47.3)
(165.7)
(161.5)
(158.4)
(156.4)
(154.5)
(152.7)
2.2
3.6
3.8
4.0
4.1
4.2
EBITDA Margin
1.3%
2.2%
2.3%
2.5%
2.6%
2.7%
Non-operational Expenses
(0.5)
(1.8)
(2.1)
(2.5)
(2.6)
(2.4)
Surplus
1.7
1.8
1.6
1.5
1.5
1.7
1.0%
1.1%
1.0%
1.0%
1.0%
1.1%
Domain
Clinical Income
Other Operating Income
Total expenses
EBITDA
Net Margin
Figure 13 - Productivity Impact (excluding any service developments)
2012/13
Domain
Activity Increase
2013/14
2014/15
2015/16
2016/17
2017/18
1.96%
1.81%
2.20%
2.10%
1.83%
Contacts (000)
3,176
3,238
3,297
3,370
3,440
3,503
Clinical Staff (wte)
2,375
2,317
2,254
2,166
2,082
2,001
Contact/Week
31.8
33.3
34.8
37.0
39.3
41.7
Contacts/day
6.4
6.7
7.0
7.4
7.9
8.3
Bridgewater Summary Integrated Business Plan 2012-2017
33
Risk
Bridgewater has established a robust governance assurance process in order to assess
the viability of the Trust’s CIP both from a financial stand point and a quality impact
perspective.
The governance arrangements that the Trust has adopted have benefited from the
recommendations within the joint Monitor and Audit Commission good practice guide
entitled ‘Delivering Sustainable Cost Improvement Programmes’.
Bridgewater has a strong track record in delivering a significant level of CIPs and the
forward targets are felt to be realistic and achievable.
Detailed plans exist for 2013/14 and 2014/15 with outline themes and high level plans for
the remaining three years of the planning period. The staffing impact in respect of
estimated headcount reductions and impact on productivity has been estimated for all
five years.
Key Risks
The major risks facing the organisation with the financial impact have been identified as
follows:
• CIP Shortfall – Where our CIP performance falls short by 15% in year one then 10% in
each year thereafter and resolved in the subsequent year.
• Financial Pressure – Monitor routinely imposes an additional 0.5% cost pressure
(per year) to applicant’s base cases. This could represent regulatory changes, price
competition, inflationary increases, etc.
• Activity Growth – It is assumed that there is activity growth of 1.2% per year with no
income growth. Associated costs (clinical staff costs, drugs, clinical supplies) rise
proportionately.
• AQP – The assumption is that in year two, the Trust loses approximately 4% income,
but is only able to lose 50% of the associated costs.
• Price Competition (whether through local QIPP targets or other) – this causes a fall in
income of 1% each year in years three to five.
Although the Board has identified mitigation for each of these risks, these sensitivities
have been combined to form a downside, and the table overleaf summarises the financial
impact of the downside as follows:
34
Bridgewater Summary Integrated Business Plan 2012-2017
Figure 14 – Income and Expenditure (I&E) Impact of Downside Scenario
Sensitivity
Domain
Explanation
CIP Shortfall
Underachievement by 15% in
Year 1, 10% in Years 2-5,
50% recovered in one year,
100% recovered in two years
Monitor
Additional Financial Pressure
Equivalent to 0.5% Reduction
in Income/Year
FY14
FY15
£m
FY16
(1.1)
(1.5)
(1.3)
(1.3)
(1.3)
(0.7)
(1.5)
(2.2)
(3.0)
(3.8)
(1.0)
(2.1)
(3.3)
(4.5)
(5.7)
FY17
FY18
Activity Increase of 1.2%/Year,
Activity Growth increase in associated costs
of 1.2%, no additional income
AQP
Loss of 4% Income FY15,
50% of AQP Services
Covered by TUPE
0.0
(3.0)
(0.8)
(0.7)
(0.7)
Price
Competition
Income to Fall by 1% FY16FY18, No Effect on Activity
0.0
0.0
(1.4)
(2.8)
(4.3)
Total Effect
(2.8)
(8.1)
(9.0)
(12.3)
(15.8)
Surplus
Domain
Base
Case
FY14
FY15
FY16
FY17
FY18
1.8
1.6
1.5
1.5
1.7
Downside
(1.0)
(6.5)
(7.5)
(10.8)
(14.1)
Cash
Domain
Base
Case
FY14
FY15
FY16
FY17
FY18
4.5
6.2
7.8
9.4
10.9
Downside
1.6
(4.8)
(11.9)
(22.5)
(36.7)
2
1
1
1
1
Financial Risk Rating
Domain
In order to mitigate against the downside, a series of actions and financial estimates have
been worked up and these are summarised overleaf together with the financial impact
from mitigation.
Bridgewater Summary Integrated Business Plan 2012-2017
35
Figure 15 - Mitigating Actions
FY14
FY15
£m
FY16
Pay Freeze/Review of Terms & Conditions
0.2
1.0
1.8
2.6
3.5
Exploit Income Opportunities
0.0
0.5
0.8
1.7
1.9
Manage Activity to Avoid Excessive Cost Growth
1.0
2.1
3.3
4.5
5.7
Control Non-Critical Spend
0.7
1.1
1.2
1.2
1.4
Increase Efficiencies
0.0
0.5
1.1
1.4
1.8
Other
1.8
1.4
1.1
1.1
1.0
Total Effect
3.7
6.6
9.3
12.5
15.3
Surplus
Domain
Base
Case
FY14
FY15
FY16
FY17
FY18
1.8
1.6
1.5
1.5
1.7
Downside
(1.0)
(6.5)
(7.5)
(10.8)
(14.1)
2.7
0.3
1.8
1.7
1.2
FY14
FY15
FY16
FY17
FY18
Domain
Base
Case
4.5
6.2
7.8
9.4
10.9
Downside
1.6
(4.8)
(11.9)
(22.5)
(36.7)
Mitigated Downside
5.6
6.0
7.5
9.3
10.3
3
3
3
3
3
Sensitivity
Explanation
Domain
Mitigated Downside
Cash
Financial Risk Rating
Domain
36
FY17
FY18
Bridgewater Summary Integrated Business Plan 2012-2017
Cost Improvements
and Quality of Care
Given the need to make significant savings through recurrent productivity and redesign
programmes, the Board ensures that quality impact assessments are undertaken by the
Medical Director and the Executive Nurse on all CIP proposals, since safety and
effectiveness must not be compromised in any circumstances.
Where appropriate, we are rolling out the uptake of new technologies to deliver patient
care in innovative ways to improve the patient experience.
Clinical Quality Strategy
The Trust has in place an Integrated Clinical Quality Strategy whose components are
illustrated below:
Figure 16 – Quality Services Target
Learning
Culture
Audit / R&D
New
Technologies
Inequalities /
Public Health
Promotion /
Marketing
Quality &
Safety
(Clinical
Governance)
Sustainability
Stakeholders
Public &
Patient
Engagement
Financial
Balance /
VFM
Workforce
Clinical
Engagement
Bridgewater Summary Integrated Business Plan 2012-2017
37
The Trust has developed and is embedding a “Quality Dashboard” that allows services,
divisions and the Trust Board to monitor, review and target key quality indicators. The
Trust has agreed with commissioners, and is leading nationally, on a programme to
implement an outcomes framework in the next contracting round. This will ensure that
services are commissioned and provided based on clinical value, patient and population
outcomes and quality of service.
The Quality Strategy underpins our commitment to excellence by setting up four key
domains;
1.
2.
3.
4.
Patient experience and involvement
Clinical effectiveness
Patient safety
Governance
Each of these domains has clear objectives, well defined targets and trajectories and
clear monitoring and success criteria so that the Board can track our progress and drive
the quality agenda forward within Bridgewater.
Patient Experience and Involvement
• Develop a Bridgewater patient charter.
• Ascertain patient’s views regarding the quality of our services on a regular basis
ensuring that patients.
➢
➢
➢
➢
Are treated with respect and dignity
Are provided with appropriate information or advice
Have confidence and trust in health professional(s)
Receive the care that mattered to me
• Conduct staff Surveys within Bridgewater on a regular basis, in addition to the
National Staff Survey, to ensure staff are: ➢
➢
Listened to and involved in shaping our decisions and strategic approaches
Motivated to provide the best patient experience
• Ensure lessons learnt from complaints/PALS are identified, acted upon and shared
across the organisation.
• The Trust will continue the implementation of the “Important Choice‟ agenda (End of
Life Care Pathway) supporting patients to be cared for in the place of their choice.
• The Trust will implement the new model for health visiting –“A Call to Action Health
Visitor Implementation Plan‟.
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Bridgewater Summary Integrated Business Plan 2012-2017
2
All Divisions will develop alternative methods of seeking service feedback including for
example:
➢
➢
➢
SMS texting
Family Echo
Care Cards
• The Trust will engage Members and Governors in ensuring the Board receives timely
patient experience feedback via:
➢
➢
➢
Council of Governors
Regular Involvement Activities
Annual Member Survey
Ascertain Members and Governors views regarding the quality of our services and areas
for quality improvement.
Clinical Effectiveness
• Clinical Network forum to drive forward continuous improvement of services for
patients, and their carers/families through clinical engagement.
• To focus on the development of care pathways (map of medicine) specifically for end
of life, dementia, cancer, and early diagnosis, and other long term conditions
managed through Urgent Care and Specialist Services networks.
• To maximise the potential for an integrated approach to providing effective and efficient
care patient care across the health and social care economy.
• Bridgewater will put in place a communication technology (telehealth/telecare) and
resource programme to support self-care and increase health literacy within its patient
and carer population. Whilst delivering efficiency gains by supporting patients to
manage their care and live more independently.
• Review Bridgewater offender health provision to reduce inappropriate variation and
maximise quality of services provided.
• To improve life chances for children aged 0-5 by improving the level of access and
support to families with children from 0-5 in line with the DoH Health Child Programme
(2009).
• Development of a range of clinical effectiveness and performance indicators.
Bridgewater Summary Integrated Business Plan 2012-2017
39
Patient Safety
• Increase patient safety incident reporting and reducing actual harm levels.
• Reduce or contribute to the reduction of:➢
➢
➢
➢
Community developed or deteriorating pressure ulcers
Residential home and acute trust developed or deteriorating pressure ulcers
Catheter acquired infections in the community
Falls in inpatient and intermediate care facilities
• Maintain adherence to the requirements of Hygiene Code of Practice.
• Establish a culture of “no avoidable infections.
• Implement a comprehensive, consistent, and patient centred approach to risk
management across the Trust.
• Establish and maintain safe and clean community premises which are fit for purpose.
Governance
• Reconfigure a governance structure that reflects the needs of the new organisation.
• Ensure effective monitoring of Clinical Quality Strategy to ensure key aims and
objectives are realised.
• Ensure compliance with the Monitor Quality Governance Framework (July 2010.)
• Ensure Bridgewater learns the lessons from all relevant national reports and enquiries.
• Implement an integrated business intelligence reporting framework (SLR/SLM) across
all service lines to ensure heads of service, divisional directors can monitor and report
on their performance from service line to board.
• Implement a programme of ‘walk-rounds’ to monitor the environmental standards
within clinics, led by Executive and Non-Executive Directors.
• Ensure Bridgewater quality impact assessment tool (QIAT) is completed for all cost
improvement plans (CIPS) and service redesigns.
• Maintain CQC registration without conditions for all regulated activities.
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Bridgewater Summary Integrated Business Plan 2012-2017
Workforce &
Leadership
2
2
Our Five Year Workforce Plan
It is recognised that our workforce is our most valuable resource and that the staff are
ambassadors for our mission and vision and also for creating our reputation of a highly
performing and responsive organisation.
Our workforce’s support of our development and growth is matched by a commitment
from the organisation to their future learning and development needs, which supports
their personal ambitions for the future, an improved patient experience and the
organisation’s need to be flexible to meet the future demands of the evolving NHS.
We know that having access to high quality training and development is vital to our
professional staff and is a key factor in recruiting and retaining a high quality team. Our
patients tell us that knowing our staff have the right skills to meet their needs is very
important to them.
We identify specific clinical learning needs to respond to short and long term service
needs ensuring staff are provided with ongoing skills development to support service
improvement and redesign.
In order to ensure the high quality leadership and people management that are crucial if
we are to meet the new agenda and the expectations of people who use our services, we
have developed a leadership model to support the continued development of leaders at
all levels of the organisation.
To continue to deliver the scale of change required and to respond to the challenges,
Bridgewater will continue to work to ensure we have a robust, integrated workforce plan.
The following assumptions have been made in planning for our future workforce:
• Funded vacancies will need to be included in our staffing baseline.
• Where posts have been offset against a CIP these posts will be removed from the
funded establishment figure/baseline.
• Our health visitor staffing levels will increase year on year in line with our trajectory, with
a commitment to training and supporting students on the widening access
programme.
• Administrative and clerical staffing levels will not increase, but staff will be deployed to
effectively support clinicians.
• Our Health Improvement team staffing levels will remain static as discussion on public
health provision is concluded with our local authority colleagues.
Bridgewater Summary Integrated Business Plan 2012-2017
41
• There will be a rationalisation of ‘back office’ functions.
• Consultant medical input will not decrease; however, effective partnerships with
specialist providers will be explored.
• Sickness levels will decrease.
• There will be a reduction in the use of bank and agency staff.
• There will be a more agile workforce, working in different ways, utilising technological
advancements that will impact on our estate requirements.
• The support worker roles will be developed.
• There will be a need to reduce or remove some roles within the Trust via voluntary or
compulsive redundancy or mutually agreed resignation terms.
Senior Leadership of the Trust
To realise the ambitions of the IBP, we demonstrate strong and effective leadership at
every level of the organisation and engender a shared commitment to the realisation of
our objectives.
The Board consists of five Executive Directors from within the organisation plus a
Chairman and seven Non Executive Directors.
The Executive Directors are: the Chief Executive Officer (CEO); the Director of Finance;
the Director of Operations; the Executive Nurse / Director of Governance; who is
responsible for quality, safety and standards; and the Medical Director.
The Director of Human Resources and Organisational Development attends Board but is
a non-voting member.
The Senior Management Team also includes a Director of Clinical Performance whose
remit is to develop our corporate performance framework and service line management
systems. This Director is not a Board Member, but is directly accountable to the CEO.
Similarly, there is a Director of Corporate Development who reports to the CEO and is
responsible for communication, strategic relationship management and new
developments.
Board members have a broad range of skills and experience. We have initiated a Board
Development Programme and are committed to its full implementation.
The Board has in place an extensive Assurance Framework which is reviewed on a
quarterly basis, with the implementation of the framework being carried out and monitored
by the Senior Management Team. The Board pays particular attention to quality and
safety, inviting patients to tell their stories and undertaking “quality walkabouts”.
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Bridgewater Summary Integrated Business Plan 2012-2017
Our Board
Harry Holden
Dr Kate Fallon
Chairman
Chief Executive
Karen Bliss
Steve Cash
Baron Frankal
Non-Executive Director
and Chair of Audit
Committee
Non-Executive Director
Non-Executive Director
Sue Musson
Bob Saunders
Colin Scales
Non-Executive
Director/ Designate
Senior Independent
Director
Non-Executive Director
and Chair of Quality
and Safety Committee
Executive Director of
Operations
Bridgewater Summary Integrated Business Plan 2012-2017
Bridgewater Integrated Business Plan 2012-2017
43
Mike Treharne
Dr Steve Ward
Dorothy Whitaker
Executive Director of
Finance, Information
and Performance /
Deputy Chief Executive
Executive Medical
Director
Vice Chair and NonExecutive Director
Dorian Williams
Sally Yeoman
Executive
Nurse/Director of
Governance
Non-Executive Director
Christine Samosa
Director of Human
Resources and
Organisational
Development
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Bridgewater Summary Integrated Business Plan 2012-2017
Notes
2
2
Bridgewater Summary Integrated Business Plan 2012-2017
45
Notes
46
Bridgewater Summary Integrated Business Plan 2012-2017
Bridgewater Community Healthcare
NHS Trust
Contacts
Membership
Anyone aged 14 years or over who lives in England is eligible to become a public member.
Find out more about membership at www.bridgewater.nhs.uk or email [email protected]
or call 01942 482672.
Comments
If you have any comments on this document or require it in another language or format
please contact 01942 482655 or email [email protected].
Headquarters
Bevan House, 17 Beecham Court, Smithy Brook Road, Wigan, WN3 6PR
Telephone: 01942 482630 Email: [email protected]
For more information on our Trust visit our website: www.bridgewater.nhs.uk