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Wiltshire Health and Care

Delivery Plan - Full Version

2020-2023

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1. Introduction

Our Delivery Plan

This document sets out Wiltshire Health and Care’s plan for delivering its services over the

next three years. We call this our “Delivery Plan”.

As the pace of change quickens each year and the solution to many challenges across the

health and care sector lies in expanded and improved community services, this three year

plan is crammed full of proposed changes and delivery objectives, which cover these main

themes:

A range of activities this year to both adjust to and restart services in light of the

COVID-19 pandemic;

Development of new services and improvement of existing services to respond better

to urgent needs, support more people on discharge from hospital and work with

primary care colleagues to better meet the needs of local populations;

Improvements to the quality and standard of the tools made available to staff to do their

jobs, in particular information technology and use of buildings;

Developing our workforce through training, education and professional leadership and

maintaining, retaining and improving its diversity, resilience and skills.

How the plan was developed

Our Delivery Plan for 2020-2023 has been put together in the following ways:

1. Building on work from 2019/2020 - There were a small number of goals in our 19/20

plan that we have carried through to this plan – either because they are goals for all

NHS organisations that we need to continue to prioritise, or because we ended 19/20

with some outstanding components to our key local goals .

2. Ensuring that the long-term goals for the NHS, that are relevant to Community

Services, are included – On 7 January 2019, the Department for Health and Social

Care published a long term strategy for the NHS called the “NHS Long Term Plan”.

This plan covers all aspects of the NHS. We have made sure that our Delivery Plan

includes goals that help Wiltshire Health and Care deliver the ambitions of the NHS

Long Term Plan relating to Community Services. More recently, a number of service

specifications (documents stating how services should be delivered to patients by

providers) have been published. As part of our Delivery Plan, we have set out how

Wiltshire Health and Care will implement the service specifications relevant to

Community Services. In most cases, we will work closely with Primary Care to do this.

The other factor that we took into account was any changes to the NHS Standard

Contract. This is the contract that the local Clinical Commissioning Group asks

Wiltshire Health and Care to deliver each year. This contract evolves as the NHS

evolves, and as legislation evolves.

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3. Ensuring that goals for the delivery of healthcare decided by the entity

representing all providers of healthcare across Bath and North East Somerset,

Swindon, and Wiltshire, known as the Sustainability and Transformation

Partnership or “STP” are included - Our Delivery Plan takes into account the

objectives for healthcare across the local area or “system”, and where these are

relevant to Community Services, we have included them in our plan.

4. Input from our staff and volunteers – In January and February 2020, we held

engagement workshops in four locations (Chippenham, Trowbridge, Marlborough, and

Salisbury). During these workshops, we gathered feedback from a cross section of our

staff and volunteers on how services, and the infrastructure supporting our services,

should be developed.

5. Input from our patients and the local public – Our Executive Committee considered

key themes from feedback received from our patients and the local public. This

feedback came from “Friends and Family” feedback; complaints; compliments; and via

our social media channels. Areas for improvement identified through this analysis were

included in our plan.

6. Adjustments to account for COVID-19 – In the latter stages of the development of

this plan, we reflected on how the plan should be adjusted to ensure Wiltshire Health

and Care was well-prepared were there to be a second wave of infections due to the

virus, and to cover the changes that are needed to the way we deliver care whilst we

operate in an environment that is proceeding in a cautious manner to minimise spread.

How the plan works

Our Delivery Plan is set out in a grid – with each line of the grid representing an objective

(or goal) that Wiltshire Health and Care would like to achieve. The goals are detailed for

the first year of our plan, and set out our outline ambitions for the subsequent two years.

In putting together this plan, we have tried to use language that is meaningful to the

population we serve. We recognise, however, the technical nature of the plan itself so, to

support understanding, we have also included a Glossary at the back of this document

(page 14).

How the plan will be delivered

The plan sets out the activities that will be pursued by the whole Wiltshire Health and Care

team and, by setting out every aspect of change in the same place, allows those teams to

work quickly and effectively together. Whilst we acknowledge that this is a large plan to

achieve across the next three years, we believe its size is a reflection of both the ambition

of Wiltshire Health and Care to continue to improve and how much needs to be done to

deliver what the people of Wiltshire and the rest of the health and care system expects and

needs us to achieve.

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The Wiltshire Health and Care Board reviewed this plan on 25 th June 2020, and endorsed

its implementation. The Board will be monitoring progress against this plan on a quarterly

basis.

We would like to say a huge thank you to all our staff, volunteers, patients, carers, families,

and friends who continually contribute to the development of Wiltshire Health and Care.

If you have any questions regarding this document, please contact us at:

whc.communications@nhs.net or call 01249 456580. We are excited to implement these

developments in 2020-2023!

Regards

Douglas Blair Managing Director of Wiltshire Health and Care

Stephen Ladyman Chair of Wiltshire Health and Care

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Delivery Plan

2020-2023

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Wiltshire Health and Care (WHC) Delivery Plan: 2020-2023

Type of Objective How will the objective be delivered?

An objective from 2019/20 will

continue into 20/21 (and potentially

beyond).

Transformation Programmes

We deliver our ‘transformation programmes’ with the following infrastructure. Each programme will have: o An Executive-led Programme Board/ dedicated Executive oversight. o A senior programme manager as lead/coordinator for the programme. o A programme plan with key milestones – reported against monthly to the Executive

Committee. o Access to a matrix of resources to inform and support the delivery, under the

coordination of the programme manager.

A new objective proposed as part of

normal business activities/ currently

commissioned activity.

Projects We will deliver our ‘projects’ using team members who are in defined project roles, or team members who have work associated with the relevant Delivery Plan objective written into their annual work plan.

An objective proposed to support

delivery of the BSW programme of

work/ national requirements.

Service Developments

Each of our Service Developments involves us making (or planning) a step change to the way we deliver services. We will deliver these step changes using team members who have work associated with the relevant Delivery Plan objective written into their annual work plans.

An objective to test or scope a new

idea. It would require additional

funding to deliver.

Ongoing priorities

Each of our ‘ongoing priorities’ objectives will require us to evolve the way we do something “long term”. We will deliver this change by ensuring that our existing team members work differently.

Understanding this document

We have tried to use language that is meaningful to our patients and local population, but to support understanding we have also included a Glossary at the back of this document at page 12.

Most capitalised words are described in the Glossary. Clicking on these words will automatically navigate you to the Glossary section.

If you have any questions regarding this document, please contact us at whc.communications@nhs.net.

Implementing a new model of care WHC Delivery Plan

Objectives

# Objectives Lead Type 2020-2021 2021-2022 22-

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Objective KPI

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a new model

of care

(taking into

account

Wiltshire Joint

Commissioning

Priorities)

TRANSFORMATION PROGRAMMES

1. RESET AND RECOVERY PLAN

A. Our primary aim is to ensure we maintain the changes implemented during the COVID-19 response that have had a positive impact i.e.:

Discharge processes

Digital transformation

Service integration

‘Resetting’ and ‘recovering’, following COVID-19, will take time, and be implemented in a phased approach – in line with government guidance on social distancing/ shielding, and taking into account the availability of Personal Protection Equipment (PPE) and services previously supplied to WHC by System partners. We envisage phase 1 being applicable for the remainder of 20/21, and potentially into 21/22.

In phase 1, we will:

Deliver all Urgent Care

Deliver all high priority appointments - either virtually (ideally), and if not face to face.

Where it is not possible to deliver care on site, we will deliver care in our patients’ homes where we are able to gain access.

Respond in a way that maximises the safety and protection of our staff from health and safety and Infection Protection Control (IPC) perspectives.

Respond as required by the System if a second COVID-19 surge manifests.

Executive Lead;

COO (LH)

Programme Lead:

Service Transformation Manager (GP)

[STM:1]

All urgent and high priority

patients offered an appointment.

SERVICE DEVELOPMENTS

2. URGENT RESPONSE IN THE COMMUNITY

A. 2 hour crisis response services:

WHC will provide an agreed number of home response appointments within 2 hours of referral:

- Q2: We will design the service - Q3: Appointments will be available **

** If we have PPE and staff, and acknowledging that we might need to engage an NHS best endeavours solution to implement earlier.

Service

Transformation

Manager (AMN)

[STM:2]

Home repsonse appointments

available within 2 hours of

referral.

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3. OPTIMISING FLOW AND RESILIENCE

A. Home First pathway changes:

We will optimise the efficiency of the Home First pathway to support hospital discharge. Key elements of this will include:

- Managing at Locality level - Aligning WHC and Council pathways - Defining the new ‘pull model’ from our acute partners.

Service Transformation

Manager [STM:3]

and

Head of Operations – Community

Teams (HK)

Community and council services

supporting discharge are

aligned.

B. Broader bed base/ discharge processes:

We will model the requirements for bed-based discharge within the System, and help design a change in the use. - Community beds/ Intermediate care beds – a clearer

strategy for use of temporary use beds (clinical use beds; therapy beds; COVID-19 positive beds; and delirium beds).

- WHC to hold the ring on managing the Multi-Disciplinary Team (MDT) type discussions in relation to these beds.

Service

Transformation

Manager

[STM:3]

System bed base reviewed and

re-designed with appropriate

clinical input and MDT.

C. Covid resilience:

We will ensure plans are in place for our services to support additional demand that may be created by a second wave of COVID-19.

Service

Transformation

Manager (AMN)

[STM:2]

WHC is able to support the

System in the event of a second wave of COVID-19.

4. IMPROVING EFFECTIVENESS OF COMMUNITY TEAMS

A. We will review and reorganise the management of caseloads in Community Teams and working with GP practices. Including increased use of telephone contact (etc.). In 21/22, we will review how dementia support specialist

nurses can be incorporated into community teams

Service Transformation Manager (GP)

[STM:1]

Agreed caseload numbers and processes in place

B. In relation to Corsham, Chippenham, and Box Primary Care Networks (PCNs), we will redesign the Community Care and Primary Care nursing delivery model: - We will work with Chippenham, Corsham and Box to

map the current nursing resource - Q1 - We will identify areas of duplication and define the ‘to be’

delivery model – Q2/3 - We will implement the preferred model - Q4

Service Transformation

Manager [STM:5]

Preferred model agreed and implemented.

C. We will carry out a risk-based review of the number of assessments carried out by our Community Teams, and reduce the number where there is duplication. We will and use this information to update One functionality/ templates

“SystmOne” is the name of the electronic system that WHC

uses to keep a record of the clinical care provided to patients.

Service Transformation

and Clinical

Information Lead [STM:4]

Each SystmOne unit has been

reviewed.

Fewer assessments required – optimising staff time.

D. We will develop a model for adoption and spread of Personalised Care and Support Plans. Each patient should already have an individual management plan, but we may not consistently be capturing this in a way that meets national requirements. We will develop our approach to meet national requirements.

Service Transformation Manager (AMN)

[STM:2]

We capture individual

management plans in a manner that meets national requirements

E. Clinical leadership:

We will ensure that our Operational Structure appropriately supports our staff and the services that we need to deliver. This will include clinical development of Community Teams.

This will be carried out as follows: o Plan – Q1 o Implementation – Q2

Chief Operating

Officer (LH)

Head of Operations – Community Teams (HK)

Clinical leadership restructured

to better support teams and PCNs, and provide career progression opportunities.

5. ENHANCED HEALTH IN CARE HOMES/ ANTICIPATORY

CARE

A. Multi-Disciplinary Teams (MDTs)/ Enhanced Health in Care Homes (EHCH):

We will implement the new PCN and community services, and EHCH specifications. As part of this we will:

- Establish an agreed definition of the MDT - We will redefine the role of the Community Geriatrician - Look at ways to integrate Specialist Services with “core”

WHC services (our nursing and therapy teams). - Create Virtual Clinics with consultants in MDT for wider

cohorts, including care home patients - Identify and/or engage in locally organised shared

learning opportunities - Evaluate the impact of the virtual home rounds in care

homes and define the approach to broadening to the wider population

- Work with Primary Care Networks (PCNs) to support discharge from hospital and transfers of care between settings,

Service

Transformation

Manager

[STM:5]

Virtual clinics established to review patients in care homes – including MDT review.

B. We will work with primary care to risk stratify patients and provide Anticipatory Care to the local population.

Service

Transformation

Manager (AMN)

[STM:2]

20/21 – approach to risk

stratification defined.

C. In 21/22, we will work with commissioners to clarify the pathway for the management of frail patients outside of hospital.

Service

Transformation

Manager (AMN)

[STM:2]

Pathway defined.

6. In 21/22, we will develop a common model for the provision of specialist advice and support for people with long term conditions. This will include:

o Identifying how community service specialists optimally

Head of

Service,

Diabetes

Long term model in place.

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wrap around the provision within PCNs to ensure: Appropriate escalation of the patient Diabetes Specialist Nurses also provide support to

primary care to help up-skill their diabetes nurses/GP’s so they are escalating at the correct time; this can be through virtual clinics, mentoring, training etc.

OTHER

7. We will support the expansion of the delivery of pulmonary rehabilitation and oxygen assessment services to patients in South Wiltshire.

Head of

Operations –

LTC MSK (CLJ)

Pulmonary rehab is delivered in

4 additional locations in South Wiltshire.

8. We will work with the Clinical Commissioning Group (CCG) to align current Minor Injury Units to agreed plan for Urgent Care in Wiltshire.

Director of Infrastructure

(VH) Then COO (LH)

once model defined

Clear plan for Urgent treatment Centres in place in Wiltshire.

9. In 21/22, we will work with the CCG to develop personalised wheelchair budget systems.

Head of

Operations –

LTC MSK (CLJ)

A clear process is in place for personalised health budgets.

10. In 21/22, we will work with the BANES, Swindon and Wiltshire (BSW) Sustainability and Transformation Partnership (STP) to define a System-wide solution for orthotics.

Head of Service

Plan to procure orthotics at System level agreed.

11. We will provide improved information about the availability and scope of specialist community services for each PCN area (“road map”)

Service

Transformation

Manager (GP)

Each PCN has access to an

understanding of WHC services in its network.

12. In 21/22, we will ensure that patients who have a ceiling of care have personalised Care Plans.

Chief Operating

Officer (LH)

There is a system in place to ensure that End or Life patients

receive personalised care plans.

13. We will deliver a pilot model for First Contact Physiotherapy in urgent care facilities (complete).

Head of

Operations –

LTC MSK (CLJ)

Pilot model for First Contact

Physiotherapy in MIU trialled.

ONGOING PRIORITIES

14. In 21/22 we will resume our goal of ensuring that no patient waits more than 52 weeks.

Chief Operating

Officer (LH)

No waits over 52 weeks.

15. In 21/22 we will resume our goal of reducing waiting times so the 18-week RTT target is always achieved.

Chief Operating

Officer (LH)

RTT target achieved.

16. In 21/22 we will resume our goal of reducing the number of bed days occupied by patients with an acute length of stay of 21 days or more waiting for discharge to Pathway 1 and Pathway 2.

Chief Operating

Officer (LH) Discharge to pathway 1 and 2

more timely.

17. In 21/22 we will resume our goal of reducing waiting times for patients waiting for wheelchair repair.

Head of Service

Waiting time targets met.

18. We will maximise cross working between inpatient wards and their local community teams (complete).

Chief Operating

Officer (LH) Through our escalation

framework, we now have the ability to provide cross cover between wards and community teams.

Developing our People WHC Delivery Plan

Objectives

# Objective Lead Type 2020-2021 2021-2022 22-

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Objective KPI

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our people,

and

strengthening

our workforce

TRANSFORMATION PROGRAMMES

19. SAFER STAFFING PROGRAMME Exec Lead: Managing Director (DB)

Programme Lead: Head of People (HM), supported by Paula Lye

A. We will implement E-roster across all services at team level.

Head of People

(HM) E roster implemented across all teams.

B. We will implement a centralised rostering approach across inpatients and Minor Injuries Units (MIUs).

Head of People

(HM) Inpatient and MIU rosters to be

managed centrally.

PROJECTS

20. We will ensure there is documented workforce planning across all services in WHC to provide resilience in light of an ageing and diminishing workforce: o Develop the pipeline more creatively. o Improve manager understanding of the importance of

the process. o Ensure that new services are effectively scoped.

Joint

accountability:

Head of People (HM) and COO

(LH)

Ongoing review of development of services in line with workforce planning principles.

21. We will participate in the shared education programmes and sharing of workforce resources across BANES, Swindon, and Wiltshire via a virtual platform and bookings system. This will improve skills in key areas that traditionally do not access skills training (primary care and nursing homes etc.) and allow us to identify efficiencies to allow us to deliver a broader range of material across our System.

Education and Traning Lead

WHC staff members have

access to a wider range of course material and at a higher frequency than in 2019/20.

SERVICE DEVELOPMENTS

22. We will continue to deliver the Wellbeing Charter to ensure that the wellbeing of staff is at the heart of

Head of People

(HM) To deliver and implement the milestones within the Wellbeing Charter, and report

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everything we do, and the decisions we make progress through the Workforce and Development POG (WDPOG), whilst seeing a reduction in wellbeing concerns raised through the annual staff survey.

23. Creating our workforce for the future: o We will put together a marketing strategy to target

people who would be interested in “return to practice” o We will design flexible options to support “return to

work”.

Head of People

(HM) Agreed and ratified recruitment marketing strategy, which supports the reduction of

vacancies to a target of 8% by 21/22.

24. We will have a comprehensive plan to develop and grow our Trainee Nurse Associates (TNAs) and apprenticeship levels (NHS People Plan).

Education and

Traning Lead

Fully utilise our apprenticeship levy.

Work as an STP to transfer levy to expand apprenticeships by 10%.

25. We will expand development opportunities for both clinical and corporate staff.

Education and

Traning Lead

We will improve retention to target levels of 13% as an organisation.

26. We will create networks for peer support, using the Local

Workforce Action Board (LWAB) and training hubs for help.

Education and

Traning Lead

Improved levels of engagement and peer support, along with recognition of participation in the System.

27. We will extend passporting of mandatory training to Local Authorities, hospices and social care (it is already in place between WHC, local acute hospitals, Avon and Wiltshire Mental Health Partnership NHS Trust, and the CCG – achieved 19/20).

Education and

Traning Lead

Success review of development through the STP and update report to WDPOG.

28. We will devise a work experience strategy to encourage uptake by young people with an interest in health care.

Head of People

(HM) Ratified plan for work experience activity.

29. There will be central coordination of bank staff employment (and central coordination of their supervision/ training)

Head of People

(HM) Clear approach for bank staff management, with progress reports through WDPOG.

30. We will put in place a coordinated approach and strategy to support T levels (new qualifications for 16-19 years old). There will be a T level for health and social care.

Education and

Traning Lead

Success review of development and update report to WDPOG.

31. We will set clear expectations for remote staff on how to work – working styles; home working; working efficiently productively.

Head of People

(HM) A ratified approach and process for staff working in remote and revised ways.

32. We will identify a way forward for more local pre-registration nurse training (in the south and west particularly) to allow us to recruit more newly qualified staff.

Education and

Traning Lead

Increase in appointments of newly qualified staff year on year.

33. We will set up and Equality, Diversity, and Inclusivity Forum within WHC’s existing governance structure – reporting to the Workforce Development POG (WDPOG). Through this we will provide a place for our staff to express their views on how WHC supports diversity, and take the feedback from this forum to develop actions to make improvements.

Head of People

(HM) All members of staff and volunteers feel that they can achieve and be the best that they can be with no fear of conscious or unconscious discrimination.

ONGOING PRIORITIES

34. We will continue to increase our voluntary workforce by 10-15% using our embedded approach.

Head of People

(HM) Volunteer workforce increased

by 10-15% from March 2020.

35. We will improve flexible working options so it is attractive to work on the WHC bank

Head of People

(HM) Clear and developed approach

for bank staff management,

with progress reports through

WDPOG.

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Supporting staff and patients with good Information Technology &

Governance (IT and IG)

WHC Delivery Plan

Objectives

# Objective Lead Type 2020-2021 2021-2022 22-

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Objective KPI

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our staff

and patients

with good IT

& IG

Strengthening

foundations

Supporting

our teams to

work

efficiently

Supporting

digitally

enabled health

care

PROJECTS 36. IT SERVICES

A. We will transfer the hosting of IT services, and first and second line support, from GWH to Centrality (cloud-based solution): o Ensuring access to the data warehouse, and therefore

able to submit comprehensive Community Services Data Set (CSDS).

Head of IT (KS)

IT services transferred to

Centrality, and WHC still has

access to data warehouse and

able to submit comprehensive

CSDS.

B. In early 21/22, we will carry out a significant network hardware refresh for every WHC site. This is required to achieve Cyber Essentials Plus certification.

Head of IT (KS)

All WHC sites have network

hardware that is vendor-

supported.

C. We will complete migration to Office 365 by October 2021.

Head of IT (KS)

Completion of migration of Office

365 by October 2021 as

mandated.

NEW USE TOOLS TO SUPPORT DIGITAL TRANSFORMATION (how existing technology can be utilised to enhance care provision)

37. CLARITY AROUND USE OF NEW TOOLS

Links to sustainability below

A. We will put in place an agreed protocol setting-out expectations for when digital tools should be used. We will particularly encourage greater use of online tools as an alternative to face to face in the following areas to enhance sustainability: o Internal meetings o Delivery of training o Patient delivery

Managing

Director (DB),

supported by

KHJ

Staff survey outcome indicates

that more meetings are held

utilising digital meeting technology

by the end of 20/21, than in 19/20.

38. ATTEND ANYWHERE

A. We will put in place video consultation software (Attend Anywhere), so that clinicians across all of our services have a way to conduct electronic consultations with patients

Service

Transformation

and Clinical

Information

Lead [STM:4]

15 services have access to Attend

Anywhere to deliver virtual

consultations to patients.

B. We will develop Attend Anywhere so for use in Care Home consultations – including use by PCNs

Service

Transformation

and Clinical

Information

Lead [STM:4]

An Attend Anywhere modules set

up for each of the Wiltshire PCN

areas, so that practice staff and

WHC staff can communicate with

care homes.

39. WEBINAR FUNCTIONALITY Links to sustainability below

A. We will roll out the use of a webinar-type product that will allow us to provide remote education/groups for patients, carers, and other health care professionals/ internal staff training. This will allow us to carry out live broadcasts or share pre-recorded content, and track who has attended as well as getting feedback and participation from attendees through interactive functionality.

Service

Transformation

and Clinical

Information

Lead [STM:4]

Tool enabling staff to deliver

webinars approved for us; training

developed; and application rolled

out to key staff.

40. OPTIMISING ENGAGEMENT THROUGH OUR WEBSITE Links to P&PI below

A. Once we have put in place a new WHC website in early 21/22, we will develop its content so that it is interactive and supports patient self-management: o We will enable a chat function within the WHC

website to communicate with patients (PALS, central booking, and direct service health advice).

o We will use videos/ pre-recorded material to support consultations and to support patient self-care.

To commence

21/22

WHC website has enabled chat

functionality – which can be

utilised by patients to engage with

our clinical and support services

(and vice versa).

41. REDUCE INAPPROPRIATE REFERRALS

A. We will align referral forms. Specifically, we will work with the company that provides referral forms to GP practices (Ardens), to ensure recognisable WHC forms across services.

S1 System Manager (HMcC)

The forms on Ardens reflect the

referral choices relevant to WHC.

42. HEALTH RECORDS DIGITISATION/ SHARED CARE RECORD

A. We will progress the transformation of WHC’s health records. To start with, this will include:

I. Establishing an internal medical records team II. Ratifying a clear Standard Operating Process (SOP) for

scanning paper records into electronic form in compliance with legislation.

III. Reviewing use of paper records, and scoping approaches to cease this practice.

IV. Putting together business case(s) for the proposed solution(s) to cease use of paper records, so that we can subsequently move to procurement (subject to funding).

V. Looking at ways to work across the STP (Local Health Care Record Exemplar, LHCRE).

Director of Governance and Legal

(KHJ) oversight, with

project delivered by IG manager, with support from Tonia Welsh

WHC has its own medical records

team (20/21); WHC has a clear SOP for scanning paper records (20/21);

WHC can articulate where paper records are still in use, and has put together relevant business case(s) to define its approach for ceasing this practice in each area (early 21/22); procurement and implementation of the proposed

approach(is)(21/22 and potentially into 22/23)

B. We will participate in system wide efforts to implement a shared care record (Graphnet).

Head of IT (KS)

Engagement at relevant

programme board.

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43. DELIVERING SYSTMONE TO WARDS

A. In 21/22 we will scope and start to implement what is needed to achieve fully digitalised records on our wards (i.e. Implementing SystmOne). - 21/22 – Q1 – scoping - 21/22 – Q2-4 – project development - 22/23 – Go live The change management plan will be informed by input from operational colleagues.

To commence 21/22

Change management plan for the implementation of SystmOne on our wards fully scoped involving input from operational colleagues.

B. In 21/22, we will revisit options for WHC’s data warehouse provision in line with time scales for moving from Medway to SystmOne.

Advanced Info Analyst (JC)

WHC is able to maintain continuity of reporting

44. TELEPHONE SYSTEM

A. In 21/22, we will engage professional services support to scope WHC’s requirements for a new telephone system, so that we are in a position to run a competitive tender for a new telephone system provider.

To commence

21/22 Delivery of specification for new

telephone service.

B. In 21/22, we will procure the new telephone system. To commence

21/22 Tender awarded.

C. In 21/22, we will engage professional services support to help us to implement the new telephone system.

To commence

21/22 Implementation of new telephone

system completed.

SERVICE DEVELOPMENTS

45. We will make IT training available to staff, with particular focus on: - Training for Windows 10 - Video consultation software (Attend Anywhere) - MS teams - New clinical applications - Integrated clinical record (Graphnet) - Office 365

We will also ensure that relevant staff members receive

appropriate training for Power BI and new the informatics

system.

This team will also develop and support a network of clinical

digital champions.

IT trainer

WHC has the resource and

capacity to deliver a rolling

programme of IT training to staff.

46. We will establish Wi-Fi for patients at community sites from which in patient services are provided.

Head of IT (KS)

Patients at all inpatient sites have

access to Wi-Fi.

47. We will migrate to a new data visualisation tool (we will move from Business Objects to Power BI).

Advanced Info Analyst (JC) WHC is able to maintain continuity

of reporting

48. We will increase saturation of available laptops on wards, and ensure that all staff who are not regular computer users understand how to obtain log in for occasional use.

Head of IT (KS)

Increase in the number of

available machines on wards.

49. We will create a new role of Clinical Information Lead and ensure that a Chief Clinical Information Officer is identified in line with the NHS Long Term Plan ambition.

Executive Team

Clinical Information Lead in post.

Chief Clinical Information Officer

identified.

50. In line with our legislative and contractual requirement, we will put together a comprehensive Information Asset Register for WHC (a database of all electronic and physical assets used to store personal data), and ensure that each asset has a dedicated Information Asset Owner (IAO) and Information Asset Administrator (IAA), each of whom are clear of their responsibilities and act to safely secure personal data.

Director of

Governance

and Legal

(KHJ)

WHC has a comprehensive

Information Asset Register.

51. In line with our legislative and contractual requirement, we will put together a comprehensive database of WHC’s data flows for Personal Identifiable Data (PID) (i.e. a database of what PID is collected by WHC; by whom; for what purpose; stored where; and who shared with). We will align this with our privacy notices.

Director of

Governance

and Legal

(KHJ)

WHC has comprehensive data

flow mapping.

52. We will map out WHC’s relationships with its data processors, and agree appropriate schedules of processing, accompanied by data processing terms.

Director of

Governance and Legal

(KHJ)

`

WHC has data processing terms

agreed with all relevant entities.

ONGOING PRIORITIES

53. We will carry out a hardware age-replacement programme for desktop machines. This will get us to a position to carry out an ‘annual rolling refresh’.

IT Project

Manager (DT)

Elimination of hardware that is

more than ten years old.

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Supporting patients and staff with physical infrastructure that betters

meets need WHC Delivery Plan

Objectives

# Objective Lead Type 2020-2021 2021-2022 22-

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Objective KPI

Q

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Q

2

Q

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patients and

staff with

physical

infrastructu

re that

betters

meets need:

Improve quality and efficiency of

existing accommoda-tion

Transformed

estate to support new models of

care

PROJECTS

54. BSW ESTATES STRATEGY

A. We will contribute to the BSW Estates Strategy, including ‘PCN plans’ and ‘place plans’.

Director of

Infrastructure

(VH)

BSW estates strategy includes

strategies for community estate,

and plans for for all areas.

55. ESTATES CAPITAL PLANNING

A. We will support BSW CCG to develop the estates capital pipeline.

Director of

Infrastructure

(VH)

The BSW capital pipeline includes

the capital requirements of the

estate in Wiltshire.

56. INTERMEDIATE CARE CENTRES

A. We will contribute to the development of the financial business cases for the Devizes and Trowbridge Intermediate Care Centres.

Director of

Infrastructure

(VH), supported

by Service

Transformation

Manager

[STM:3]

The financial business cases for

Trowbridge and Devizes

Intermediate Care Centres

incorporate the requirements of

WHC.

57. LONGLEAT WARD

A. We will move Longleat ward to the ground floor of Warminster Community Hospital.

Director of

Infrastructure

(VH), supported

by Service

Transformation

Manager

[STM:3]

The design development for the

move meets the needs for WHC

including the enabling works which

impact on other services.

58. ESTATES SOLUTIONS FOR CHIPPENHAM AND MELKSHAM

A. We will support BSW CCG to scope future estates solutions for Chippenham and Melksham.

Director of

Infrastructure

(VH)

The estates solutions scoped for

Chippenham and Melksham

include the requirements for WHC

within a context of working across

boundaries in health and social

care.

SERVICE DEVELOPMENTS

59. As part of changes to estates facilities arrangements, we will transfer medical records and receptionist staff from GWH into WHC.

Director of

Infrastructure

(VH)

Medical records and receptionist

staff will be employed directly by

WHC. 60. We will work with our facilities management team to eliminate

use of single-use plastics in WHC. Key areas for 20/21 will be:

o Single use plastic straws o Plastic cutlery o Plastic cups/ food containers

Director of

Infrastructure

(VH)

Report from Estates Facilities

Management team demonstrating

a reduction in use of plastic in the

key areas higlighted across.

Aim: to eliminate by Summer

2020. ONGOING PRIORITIES

61. We will put in place a lease for occupation of Malmesbury Health Centre.

Director of

Infrastructure

(VH)

Lease agreed and signed for the

space that WHC occupy.

62. We will liaise with NHS Property Services to agree leases/ licences for the premises WHC occupies.

Director of

Infrastructure

(VH)

WHC has signed leases/ licences

in place for the premises it

occupies.

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Quality Focus – consistently improving the quality of services WHC Delivery Plan

Objectives

# Objective Lead Type 2020-2021 2021-2022 22-

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Objective KPI

Q

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Q

2

Q

3

Q

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SERVICE DEVELOPMENTS

63. QUALITY IMPROVEMENT (QI)

A. We will put in place Quality Improvement (QI) training (bronze level), and roll this out to all relevant staff as part of their role essential training.

Service

Transformation

Manager (GP)

All relevant staff have access to

Q1 training module (bronze)

B. We will set up a dedicated QI area on WHC’s intranet, to: o Share WHC’s QI strategy. o Promote QI tools and methodology to all staff, and

explain how the tools can be used. o Provide a portal for sharing QI ideas.

Service

Transformation

Manager (GP)

Dedicated QI area set up on

WHC intranet. We will monitor

usage/ engagement through an

analytics report.

C. We will host carers’ strategy meetings across our sites at regular intervals throughout the year (quarterly). The aim of this is to give direction to the development of staff, patient, and carer partnerships; ensuring that the carers’ voice is heard their expertise acknowledged, and we support an integrated approach to identify and assess

carer health and wellbeing.

NB: To support carers on an individual basis, we will also continue to host carers’ cafes.

Service

Transformation

Manager

(AMN)

Carers to be directly involved in

the development of key priorities

for WHC carers’ strategy.

64. FREEDOM TO SPEAK UP (FTSU)

A. We will set up and maintain a dedicated Freedom to Speak Up page on WHC’s intranet – to enhance staff awareness of how to raise a concern, and who to contact.

Service

Transformation

Manager (GP)

We will submit on to the FTSU

national portal on a quarterly

basis.

B. In early 21/22, we will develop, train, and implement a Freedom to Speak Up champion model

Service

Transformation

Manager (GP)

To have trained champions in all

localities, who are diverse from

all services.

65. EQUALITY, DIVERSITY, AND INCLUSION (creating a culture where people feel comfortable being themselves)

A. We will ensure that our website meets Accessibility Standards.

Corporate

Project Officer

(JN)

WHC website meets

Accessibility Standards.

B. We will carry out a project to ‘get to know’ the diversity of our patients better. We will use a variety of different engagement methods to build a picture of our patient diversity. From this, we will be better informed to meet our patients’ E,D,&I needs, and enhance equality of opportunity, so that we can subsequnetly implement a plan to eliminate disadvantage, promote understanding and advance equality.

Equality

Diversity and

Inclusion

Officer (new

Quality team

role)

WHC has a data set which

provides an idea of the diversity

of its patients.

ONGOING PRIORITIES

PROJECTS

66. CQUINs

A. We will deliver our CQUINs requirements: o Continue to monitor priority aspects of suspended

2020/21 schemes (all year) o Prepare for implementation of CQUIN schemes in

2021/22 (Q4 – 20/21)

Director of

QPW

CQUINs delivered in line with requirements.

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Public and patient involvement

WHC Delivery Plan

Objectives

# Objective Lead Type 2020-2021 2021-2022 22-

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Objective KPI

Q

1

Q

2

Q

3

Q

4

Q1-

Q2

Q3-

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engagement and

involvement

PROJECTS

67. We will create a database of people who wish to actively participate in activities to develop the services of WHC (a “Public and Patient Involvement Database”), and regularly communicate with the people on this database. Using this database, in year 2 we will create our own

patient group(s). In doing so we can progress towards

our aim of ensuring that our services are informed and

developed by feedback from our patients and local

population.

Director of

Governance &

Legal

IG compliant database

established. In readiness for the

return of our Public and Patient

Involvement Officer from

maternity leave in Q4.

68. In 21/22, we will implement alternative ways to seek feedback from patients (i.e. non-paper-based feedback). The chat function within our new WHC website will be

one such method (see objective in IT section above).

Service

Transformation

and Clinical

Information

Lead – new

resource

[STM:4], PPIO

(LM)

WHC website has enabled chat

functionality, utilised by patients

to engage with our clinical and

support services (and vice

versa).

SERVICE DEVELOPMENTS

69. Staff awareness: we will develop a Training Tracker module for staff, so staff can learn why patient and public involvement/ engagement is so important.

Patient and Public

Involvement Officer (LM)

Training tracker module developed for staff, and part of role specific training requirements.

70. Staff awareness: we will subsequently develop the above module, so that it includes guidance on the importance of our patients’ E, D & I characteristics.

Head of Patient Safety (CW)

Above module evolved to include E, D, & I.

71. We will put in place new ways to involve patients and the public in our activities. Including: o Contributing to the development of our services o Reading WHC patient leaflets/ other literature o Contributing to staff interview processes (where

applicable). o Developing our website, and how we communicate

with the public.

Prior to the establishment of our forum (year 2), we provide the opportunity for interested patients/public to work with us in the above areas.

Patient and Public

Involvement Officer (LM)

It perceived as the culture of WHC to involve patients and the public in the way we develop our services and the way we share information about our services.

Financial sustainability and productivity/ environmental sustainability WHC Delivery Plan

Objectives

# Objective Lead Type 2020-2021 2021-2022 22-

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Objective KPI

Q

1

Q

2

Q

3

Q

4

Q1-

Q2

Q3-

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Q1-

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sustainability and

productivity

Environ-mental

sustainability

SERVICE DEVELOPMENTS

72. We will ensure that information to support sustainable travel plans will be made readily available to WHC staff on the intranet.

Corporate

Project

Manager (JN) Dedicated page on Intranet with

guidance and tips.

73. We will put in place arrangements so that our lease cars are low or ultra-low emissions in line with the NHS Long Term Plan commitments. Next year we will review targets for electric vehicles.

Contracts

Manager (SG) Arrangements for lease cars will

be low or ultra-low emissions.

74. We will reduce travel through utilisation of digital platforms to contact and engage with patients and colleagues, and to undertake training.

Finance team

(AC) Staff mileage is reduced in 20/21 compared to 19/20 levels (adjusted for COVID-19).

75. We will engage NHS Property Services and our other landlords to obtain certain data, so that we can appropriately report on:

o Gas (kWh) and electricity (kWh) use across our hospital sites

We will combine the measurements provided above, with the energy used use from transport to calculate our Green House Gas (GHG) emissions in Co2e.

We will use the GHG emissions measurement, and convert this into an intensity ratio (e.g. CO2e per full time equivalent).

We will site the methodology used to calculate the above information.

Director of

Infrastructure We will be able to comply with

our obligations under The Companies (Directors’ Report) and Limited Liability Partnerships (Energy and Carbon Report) Regulations

2018.

ONGOING PRIORITIES

76. 2.5% of our resources will be released from planned expenditure for reinvestment to support services.

Executive

Committee Cost improvement plans in place

and delivered.

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Wiltshire Health and Care Delivery Plan, 2020-2023: Glossary

“Accessibility Standards” The Government has set a specific standard for what a website must be capable of doing in order that it is “accessible” to those with certain disabilities.

“Acute Trust Liaison” A person that acts as an intermediary between the wards in the acute trusts, and those arranging a bed for the patient in an alternative setting, including a community bed.

“Anticipatory Care” Anticipatory care helps people to live well and independently for longer through proactive care for those at high risk of unwarranted health outcomes. Typically, this involves structured proactive care and support from a multidisciplinary team (MDT). It focuses on groups of patients with similar characteristics (for example people living with multi-morbidity and/or frailty) identified using validated tools (such as the electronic frailty index) supplemented by professional judgement, refined on the basis of their needs and risks (such as falls or social isolation) to create a dynamic list of patients who will be offered proactive care.

Community Services will be a vital part of the MDT team, involved in proactively monitoring and caring for those patients identified as benefiting from this kind of oversight.

NHS England and NHS Improvement have released a service specification in relation to Anticipatory care, and Wiltshire Health and Care must work with Primary Care Networks to support the delivery of this Service Specification.

“Bed-based discharge” When a patient is covered from care in a ward in one location, to care in a ward in a different setting.

“BSW” Bath and North East Somerset, Swindon and Wiltshire.

“BSW Estates Strategy” Bath and North East Somerset, Swindon and Wiltshire’s strategy for using buildings for NHS purposes.

“Caseloads” The number and variety of patients that an individual clinician cares for.

“Clinical Commissioning Group” or “CCG”

Clinically-led statutory body, responsible for the planning and commissioning of health care services in a local area.

The “BSW CCG” is the Clinical Commissioning Group responsible for planning and commissioning of health care services in Bath and North East Somerset, Swindon and Wiltshire.

“Community beds” Beds on a ward in a community hospital (for Wiltshire Health and Care, these beds may be in Chippenham Community Hospital; Warminster Community Hospital; or Savernake Hospital, Marlborough).

“Community Care” Clinical care that is provided in a patient’s home; in a clinic in a community hospital; or in a community bed.

“Community Geriatrician” A consultant who specialises in care for the elderly, who provides care to patients in their homes; in a clinic; in a clinic (rarely); or in a community or intermediate care bed. With the developments that are taking place to embed anticipatory care, the Community Geriatrician, may also contribute to Multi-Disciplinary Team discussions involving patients being cared for in a care home or nursing home.

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“Community Services Data Set” or “CSDS”

Providers of publicly-funded community services are legally mandated to collect and submit community health data, as set out by the Health and Social Care Act 2012. The type of data that needs to be submitted by Wiltshire Health and Care is set out on this webpage, maintained by NHS Digital: link.

“Community Team” The clinical team that care for patients in their place of residence. This typically includes: nurses, occupational therapists, physiotherapists, and health care assistants as the “core”. As part of our Delivery Plan, we are seeking to align our specialist services with the care provided by our core Community Teams.

Wiltshire Health and Care has 11 Community Teams. These are aligned with the 12 Primary Care Networks in Wiltshire (with the twelfth Primary Care Network sharing a Community Team resource).

“CQUINs” “CQUIN” stands for “Commissioning for Quality and Innovation”. CQUINs are targets set by CCGs for organisations providing NHS care. They are targets that promote improved quality of care for patients, and have historically been paired with a financial incentive where providers achieve the targets.

“Cyber Essentials Plus” Cyber Essentials is a Government-backed, industry-supported scheme to help organisations protect themselves against common online threats. Cyber Essentials Plus involves an additional element; an external vulnerability scan.

“Data visualisation tool” Consuming large sets of data isn’t always straightforward. Sometimes, data sets are so large that it’s practically impossible to discern anything useful from them. That’s where data visualisation comes in. Data visualisation tools provide analysts with an easier way to create visual representations of large data sets.

“Data warehouse” A data warehouse is a system used for reporting and analysing data. A data warehouse is a central repository of integrated data from one or more disparate sources. They store current and historical data in one single place that are used for creating analytical reports.

“Digital transformation” The term has been used to describe the fact that we intend to use a broader range of digital products to change the way that we deliver care.

“Discharge processes” The approaches used to ensure that a patient can be safely discharged from care in a bed in one setting, and their care moved to a new setting.

“Enhanced Health in Care Homes (EHCH)”

People living in care homes should expect the same level of support as if they were living in their own home. This can only be achieved through collaborative working between health, social care, Voluntary, Community, and Social Enterprise (VCSE) sector and care home partners.

The Enhanced Health in Care Homes (EHCH) model moves away from traditional reactive models of care delivery towards proactive care that is centred on the needs of individual residents, their families and care home staff. Such care can only be achieved through a whole-system, collaborative approach.

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As a Community provider, Wiltshire Health and Care is required to participate in this scheme via additional provisions that have been added to its provider contract by the CCG. These provisions specify the additional support that must be offered by Wiltshire Health and Care to care homes – as part of a collaborative approach by providers. The specifics actions that we will take are set out as objective 5 of this plan.

“E-Roster” An E-Roster is an electronic roster, which supports us to organise the shifts that our staff will work in a proactive way, and allows staff to directly interact with the system to book additional shifts.

“Escalation of the patient”

When a patient’s condition gets worse, they are likely to need additional input. Community care is largely non-medical, and so it is important for our teams to have processes in place for seeking medical or specialist input.

“First Contact Physiotherapy”

This is a scheme that involves physiotherapists working closely with GP practices (and usually working within a GP practice). Under this scheme a physiotherapist will be the first practitioner to review the patient with a musculo-skeletal condition (i.e. instead of the initial assessment being carried out by a GP). Applying certain criteria to this process, this approach can divert patients from the GP caseload – providing additional capacity for GPs to see and treat other patients.

“GWH” Great Western Hospitals NHS Foundation Trust. This is an acute hospital, based in Swindon.

“Intermediate care beds” An “intermediate care bed” is a term used when a patient’s health condition does not require the level of oversight or intervention that is provided by an acute trust, or a community hospital. However, the patient does benefit from some oversight and intervention from a clinical team (nursing, therapy – with oversight from a GP or Community geriatrician). Typically, intermediate care beds are located in nursing or care homes.

“IPC” IPC stands for Infection Prevention Control. I.e. measures that are put in place to prevent the spread of germs that cause infections/ viruses/harm/

“Local Workforce Action Board”

“Local Workforce Action Boards” are entities established by Health Education England. There is typically one in each STP area. The LAWB that Wiltshire Health and Care contributes t, is the BSW LWAB. Its membership includes health and social care providers and commissioners. Its focus is the workforce and education of our current and future healthcare workforce. Generally, it considers initiatives that can be carried out “at scales” across BSW – and the embers collaborate to give effect to the agreed strategy.

“MDT” MDT stands for Multi-Disciplinary Team. It means a collective of clinicians +/- social care representatives, of various specialities, who each provide a contribution into the recommended future treatment and care of a person.

“NHS Property Services” An NHS entity that owns the majority of the real estate occupied by Wiltshire Health and Care. In most costs, NHS Property Services are our landlord.

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“Passporting of mandatory training”

Where certain training is undertaken in one organisation (in line with a set of common standards), it should remain “valid” in relation to a person’s employment with another organisation. To avoid a person unnecessarily having to re-do training simply because they have moved organisation, the passporting approach is used to confirm the validity of training.

“Personalised Care and Support Plans”

Personalised Care and Support Planning is a series of facilitated conversations in which the person, or those who know them well, actively participates to explore the management of their health and well-being within the context of their whole life and family situation.

“PPE“ “PPE” means Personal Protective Equipment. I.e. something that a person wears, or dons about their person to protect them from harm that may be caused by a hazard that they are potentially exposed to in their work environment.

“Primary Care Networks” or “PCNs”

PCNs are groups of GP practices working closely together - along with other healthcare staff and organisations - providing integrated services to the local population.

Since April 2019, individual GP practices can establish or join PCNs covering populations of between 30,000 to 50,000 (with some flexibility).

“Primary Care” Primary care providers act as the first contact and principal point of continuing care for patients within a healthcare system. Primary care providers coordinate other specialist care that patients may need. Patients typically receive primary care from the clinicians in their GP practice (e.g. their GP, nurse practitioner, or physiotherapist).

“Pull model” An initiative that seeks to identify patients being cared for in an acute hospital, and works to coordinate whatever is necessary so that the patient can be cared for in a setting outside of the acute hospital.

“Quality Improvement” The term 'quality improvement' refers to the systematic use of methods and tools to try to continuously improve quality of care and outcomes for patients. There are a range of different methods and tools.

“Risk Stratify“ The process of separating patient populations into high-risk, low-risk, and increasing-risk group. Having a platform to stratify patients according to risk is key to the success of any population health management initiative

“RUH” Royal United Hospitals Bath NHS Foundation Trust. This is an acute hospital, based in Bath.

“Service integration” In our plan, we use this term to mean when two services operating independently are re-designed in some way so that they function in collaboration or in a joined up manner.

“SFT” Salisbury NHS Foundation Trust. This is an acute hospital, based in Salisbury.

“Specialist Services “ Services that provide expert care in a particular specialism, such as learning disabilities, podiatry, speech and language therapy, respiratory. A full list of our specialist services is displayed on our website: https://wiltshirehealthandcare.nhs.uk/our-services/

“System” The system in which Wiltshire Health and Care operates is the “BSW” system. This means the network of health and

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social care providers and commissioners caring for patients across Bath and North East Somerset, Swindon, and Wiltshire.

“SystmOne” “SystmOne” is the name of the electronic system that WHC uses to keep a record of the clinical care provided to patients.

“Trainee Nurse Associates”

The Nursing Associate (NA) role is a new role being introduced in England to bridge the gap between registered nurses and health care support workers. The role is regulated by the Nursing and Midwifery Council (NMC). Whilst people are training for this role, they are Trainee Nurse Associates.

“Training Tracker” Training Tracker is an online portal that facilitates the provision of training to Wiltshire Health and Care staff and volunteers.

“TUPE transfer” TUPE stands for the Transfer of Undertakings (Protection of Employment) Regulations. This is relevant when contractual responsibility for a service or a function transfers from one organisation to another, and protects the employment rights of the individuals delivering the service or function when this moves.

“Urgent care “ Urgent care means care provided for illnesses or injuries which require prompt attention but are typically not of such seriousness as to require the services of an Accident and Emergency Department.

“Virtual Clinics” A virtual clinic is a planned contact by a health care professional with a patient for the purposes of clinical consultation, advice and treatment planning.

“Wellbeing Charter” The Workplace Wellbeing Charter is an opportunity for employers to demonstrate their commitment to the health and wellbeing of their workforce. The charter provides employers with a clear guide on how to make workplaces a supportive and productive environment, resulting in a healthy productive workforce. There are many benefits of taking part in the Workplace Wellbeing Charter, including the growing evidence to show financial benefits, including reduced sickness absence, improved productivity and reduced staff turnover. The primary driver being a happy and health workforce – long term.

“WHC” Wiltshire Health and Care.

“Workforce and Development POG”

The Workforce and Development POG (POG means “Policy and Oversight Group”), is the group within Wiltshire Health and Care’s governance structure that oversees decision making relating to workforce matters.

“Workforce planning” Workforce Planning is the process of analysing, forecasting, and planning workforce supply and demand - assessing gaps, and putting in place initiatives to address those gaps, to ensure that an organisation has the right people, with the right skills, in the right places, at the right time, to fulfil its contractual requirements and delivery/ business objectives.

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We would like to say a huge thank you to all our staff,

volunteers, patients, carers, families, and friends who

continually contribute to the development of Wiltshire

Health and Care.

We are excited to implement these developments in

2020-2023!

Wiltshire Health and Care Delivery Plan Version: 0.9

Approved by Board: [TBC]

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