council of governors meeting date: 8 july 2010 annual … · trust will take to ensure that...

COUNCIL OF GOVERNORS

Meeting Date: 8 July 2010

Agenda Item: 8 Paper No: D Title:

ANNUAL PLAN 2010/11

Purpose:

To provide the Council of Governors with the finalised annual plan for 2010/11

Summary:

The Annual Plan for 2010/11 contains the detailed plans for Poole Hospital NHS Foundation Trust for 2010/11 and continuing for the two subsequent financial years 2011/13. This document was submitted to Monitor (the regulator of Foundation Trusts) as part of the annual planning requirements at the end of May, having been signed off by the Board of Directors in the April meeting. The Annual Plan, as published, is supported by individual specialty and corporate directorate plans within the Trust to embed the planning process within the Trust as a whole and to ensure that the top level plan has been embedded within the operational processes of the Trust. The plan will be monitored through 2010/11 by the Board of Directors through the Trust Assurance Framework.

Recommendation:

For noting

Prepared by:

IAN TRIPLOW Business Development Manager

Presented by:

CHRIS BOWN Chief Executive

ANNUAL PLAN 2010/11

FOR PUBLICATION

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THE POOLE APPROACH

“Friendly, professional, patient-centred care with dignity and respect for all”

THIS MEANS THAT:

Our patients receive excellent care and treatment in a safe and clean environment and we:

•••• listen to our staff, patients and the public;

•••• give information that is relevant and accessible;

•••• safeguard patient privacy, confidentiality and choice;

•••• welcome and involve families, carers and friends to participate in care;

•••• treat each other with respect and consideration;

•••• value and benefit from diversity in beliefs, cultures and abilities;

•••• continually improve the quality of our services by learning from what we do;

•••• take responsibility and are accountable for our own actions;

•••• expect staff and patients to take their share of responsibility for their own health;

• work with and support all organisations who are committed to promoting the health of local people.

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1 TABLE OF CONTENTS

1 Table of Contents................................................................................................ 3

2 INTRODUCTION................................................................................................. 5

2 PAST YEAR PERFORMANCE ........................................................................... 6

2.1 Chairman and Chief Executive’s summary of the year (2009/10) ................ 6

2.2 Key Monitor Performance Targets for 2010/11 ............................................ 7

3 SUMMARY OF FINANCIAL PERFORMANCE 2009/10 ..................................... 8

3.1 High level comparison between plan and actual performance..................... 8

3.2 Other Major issues 2009/10 ......................................................................... 8

4 FUTURE BUSINESS PLANS............................................................................ 11

4.1 Strategic Content ....................................................................................... 11

4.2 Formation................................................................................................... 11

4.3 Strategic Overview..................................................................................... 12

4.4 2010/11 Key Corporate Objectives ............................................................ 14

4.5 National and Local Challenges .................................................................. 17

4.6 Summary of Financial Forecasts................................................................ 20

4.7 Clinical quality ............................................................................................ 22

4.8 Service development strategy.................................................................... 27

4.9 Workforce strategy..................................................................................... 29

4.10 Capital programmes (including estates strategy) ....................................... 34

4.11 Long Term Capital Developments.............................................................. 34

4.12 Sustainability/Climate Change ................................................................... 34

4.13 Operational/Financial effectiveness ........................................................... 37

4.14 Leadership and governance....................................................................... 41

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4.15 Regulatory.................................................................................................. 43

5 GOVERNANCE RISK ....................................................................................... 45

5.1 Introduction ................................................................................................ 45

5.2 Governance Commentary .......................................................................... 45

5.3 Significant Governance Risks .................................................................... 51

5.4 Health Care Associated Infections targets ................................................. 51

5.5 Mandatory Services Risk ........................................................................... 51

5.6 Financial Risk............................................................................................. 53

6 MEMBERSHIP REPORT .................................................................................. 55

6.1 Membership size and movements ............................................................. 55

6.2 Analysis of current membership as at 31 March 2010 ............................... 55

6.3 Membership Commentary.......................................................................... 56

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2 INTRODUCTION

The Trust has begun a period of transformation to ensure that it can continue to operate effectively in rapidly changing times. Against the wider context of national financial pressures, and local health economy initiatives, the Annual Plan sets out the path to achieving transformation whilst also maintaining high levels of clinical quality and patient safety. The Annual Plan describes the key priorities for the organisation and the actions that the Trust will take to ensure that services are developed and managed in line with its strategic intentions whilst ensuring that the Trust continues to deliver improved quality, performance and effectiveness in the national priorities set out in the NHS Operating Framework. Within this process of transformation, the Trust has also prioritised some specific areas to improve the quality of the services that it offers, with an intention to adapt and invest wisely so that it is prepared to deliver any substantial efficiency savings that the current economic situation may require in future years. This Annual Plan is supplemented by speciality and corporate plans, developed to ensure alignment and the delivery of key objectives in 2010/11. The Trust has a forecast turnover of £191m (FY 10/11), 777 beds (including 73 day beds) and employs approximately 3,800 staff (3,218 WTE). Each year, the Trust treats some 56,000 inpatients, 20,000 day cases, 74,000 new outpatients and 59,000 people via A&E. Poole Hospital NHS Foundation Trust provides a wide range of local, general and specialist acute services to the residents of the Dorset population and surrounding areas. Poole Hospital enjoys an excellent reputation with the local community for friendly, professional care delivered with dignity and respect, and scores highly in all patient satisfaction surveys Poole Hospital’s case mix is unusual in that a major proportion of its inpatient activity (excluding day cases) is unplanned. The Trust provides specialist services to the east of Dorset and the wider Dorset populations. These are: East of Dorset:

• the Trauma Centre;

• the Paediatric Centre;

• the consultant-led Obstetrics Centre and Neonatal Intensive Care;

• the Emergency Inpatient Gynaecology Centre;

• the ENT Services Centre. Whole of Dorset:

• the Cancer Centre;

• the Neurology Centre;

• the Oral Maxillofacial Centre. This Plan is supported by finance, activity, risk, and Foundation Trust membership templates which are submitted separately to Monitor (the Independent Regulator of NHS Foundation Trusts).

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2 PAST YEAR PERFORMANCE

2.1 CHAIRMAN AND CHIEF EXECUTIVE’S SUMMARY OF THE YEAR (2009/10)

2009/10 was a challenging year for the Foundation Trust. During the year, the Trust saw its financial position deteriorate, resulting in an operating deficit of £4.5m. A devaluation of the Trust’s estate required a year end accounting adjustment, which resulted in a final position of £8.134 deficit. This was clearly very disappointing and restoring financial stability is a top priority for the Trust. As such, the Board of Directors has conducted a detailed review to understand the circumstances and issues which led to the operating deficit. Throughout the forthcoming year, the Trust will focus on taking action to redress the current financial situation, whilst working to prevent further reoccurrences of this position. Patient safety and quality of care remained the top priorities for the Board of Directors during the year. Therefore, we were particularly pleased to have made significant progress in a range of quality improvements. These included a further reduction in hospital acquired infection; achieving zero MRSA infections for the year, compliance with the NHS hygiene code and reduced waiting times for our patients. 2009/10 also saw the completion of a state-of-the-art laparoscopic theatre, the introduction of a home therapy service, improved help for patients with mental health issues and a newly refurbished cancer ward. The Trust maintained Practice Development Unit (PDU) status within the Departments of Medicine for the Elderly and Surgery, and achieved PDU status within the Emergency, Medicine and Cardiology Departments. It is a testament to all our staff and their hard work that 93-95% of patients rated their care good, very good or excellent in the NHS national patient survey. This is due to the Trust’s commitment to continually reflect and improve services. The ‘Poole Approach’ to deliver excellent patient centred care and treatment with dignity and respect will underpin our approach to addressing the challenges that the Trust will face during the coming year and beyond. Last year, the Care Quality Commission rated the Trust as “excellent” for both the use of resources and quality of care. The Patient Environment Action Team also assessed our environment, food, privacy and dignity all as “excellent”. With the continuing pressure from the rising costs of delivering health services, 2010/11 will see the implementation of a Recovery Plan that will bring the organisation back into financial health. This plan will, of course, be challenging to deliver. However, as quality improvement forms the cornerstone of this plan, we will emerge from the coming year not only with an improved financial position, but also with clear improvements in the way we provide clinical services to the population we serve. 2010/11 will be a difficult year for us all, but with the. ongoing commitment of our staff, support of our Governors and members, improved efficiency and the overriding desire to improve quality it will also be a rewarding year.

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2.2 KEY MONITOR PERFORMANCE TARGETS FOR 2010/11

Risk Rating

Finance 3

Mandatory Services Green

Governance - All targets met Green

Peter Harvey Chris Bown Chairman Chief Executive

Telephone: 01202 442624 E-mail: [email protected]

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3 SUMMARY OF FINANCIAL PERFORMANCE 2009/10

During 2009/10 the Trust experienced a significant deterioration in its financial position, resulting in an operating deficit of £4.5million. A devaluation of the Trust’s estate required a year end accounting adjustment which saw a final position of £8.134 deficit. The operating deficit arose primarily as a result of the Trust undertaking activity which was not reimbursed, due to this being above the agreed contract value for the year. In addition, overspends on pay and non-pay items, as well as a failure to deliver planned efficiencies, contributed to the deficit. The cash balance at the end of the year amounted to £4.5million, which was below the planned level. This arose primarily as a result of the deficit and high capital expenditure. The Trust finished the financial year with a Monitor risk rating of 2.

3.1 HIGH LEVEL COMPARISON BETWEEN PLAN AND ACTUAL

PERFORMANCE

£ million 2009/10 plan 2009/10 actual

Income Clinical income 167.2 166.1

Non-clinical income 19.1 22.6 Total income 186.3 188.7 Expenses Pay costs 129.8 130.4 Non-pay costs 43.9 51.4

EBITDA 12.6 6.9 Financing costs 10.5 13.8

Net surplus/(deficit) 2.1 (8.1)

3.2 OTHER MAJOR ISSUES 2009/10

3.2.1 COUNCIL OF GOVERNORS

During the year the following changes were made to the Council of Governors governance arrangements. In March 2009, Air Vice Marshall (Rtd) Geoffrey Carleton was elected as a public Governor (he replaced Mr John Howes as his tenure ceased due to change of address) and Mrs Isabel McLellan was elected as a public Governor to a vacant position. In June 2009, the Borough of Poole terminated the appointment of their representative Mrs Carole Deas. On the 1 July Mr Michael Wilkins was appointed as the Governor representing the Borough of Poole In October 2009, public and staff governor elections were held and the tenure of the following Governors ceased;

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• P Alexander (Public)

• T Buckby (Public)

• F Cleeton (Public)

• A Horan (Public)

• M Hards (Public)

• C Tickell (Staff)

• D Calcroft (Staff) (Resigned from Trust employment) In November 2009, following public and staff governor elections, the tenure of the following Governors commenced;

• B Newman (Public)

• C Archibold (Public)

• A Creamer (Public) Reappointed

• E Chamberlain (Public)

• G Rigler (Public)

• S Yeoman (Public)

• S Power (Staff)

• K Knudson (Staff)

In December 2009 Mrs Janet Dover (the appointed representative for Dorset County Council) resigned and was replaced by Cllr David Jones in May 2010.

3.2.2 BOARD OF DIRECTORS

In December 2009, Mr Philip James took up his position on the Board of Directors as the Director of Human Resources.

In January 2010, Mr John Knowles was re-appointed as Non Executive Director by the Council of Governors, and the Board of Directors agreed that Mr Knowles continue as the Senior Independent Director and Vice Chairman. In March 2010, Mr David Taylor, Director of Finance, resigned with immediate effect. Mr Andrew Goodwin took over the role as Acting Director of Finance. In March 2010, following a notice period of six months, Mrs Sue Sutherland retired from her position as Chief Executive. Following agreement of the Council of Governors, the substantive post of Chief Executive was filled by Mr Chris Bown with effect from 1 April 2010. The Trust undertook a Board Evaluation and Governance Review led by management consultants. The management consultants were also engaged by the Board of Directors to investigate the reasons for the 2009/10 financial deficit and to support the development of a recovery plan for the Trust.

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3.2.3 PERFORMANCE

Trust performance against the quarter three A&E target was 97.5%, against the standard of 98%. The underachievement was related to an unexpected period of high attendances. The Intensive Support Team from the Department of Health was invited to the Trust to be part of an immediate improvement team, and subsequently performance has improved to above the standard in quarter four. For the cancer 31 days for subsequent treatment (surgical) target, the Trust achieved 93.1% against the standard of 94% for quarter 4 of 2009/10. The underachievement against target was predominantly due to breaches in dermatology. Immediate improvement actions have been taken, led by the Director of Operations, and improvements were delivered during the quarter. All other core performance targets were met.

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4 FUTURE BUSINESS PLANS

4.1 STRATEGIC CONTENT

4.1.1 VISION STATEMENT

We will provide excellent patient centred emergency and planned care

to the people we serve To support this the Trust has five strategic goals for 2010 onwards;

• Deliver the highest possible standard of patient centred health care and contribute to improving the health and wellbeing of the population

• Provide a range of high quality NHS health services in the hospital and community

• Employ and engage a highly motivated, appropriately skilled workforce, seeking to improve employee satisfaction

• Involve patients, the public and partners in developing patient centred seamless services

• Maintain financial viability

4.2 FORMATION

The Trust’s Integrated Business Plan, developed during the application for Foundation Trust status, incorporates the Clinical Services Strategy (published November 2008). The Clinical Services Strategy is core to achieving our key clinical goals, which underpin the realisation of the vision for Poole Hospital. In light of the national economic situation and anticipated changes to health and social policy, during 2010/11 the Clinical Services Strategy will be updated. The Trust’s strategic development will continue to evolve and reflect the rapidly changing environment and context that it operates within. Changes to public sector funding, new political agendas and a focus to reduce acute activity and spend (as per the NHS Operating Framework 2010/11) will all inform the debate. In addition, local priorities such as the Trust’s new Academic Strategy (developed in 2009/10) will also have a bearing on the long term strategic direction. For example, this Academic Strategy will provide the foundation to focus on the training and development programmes that will enable the Trust to develop Centres of Excellence, and promote education and research opportunities that will assist in achieving University Hospital status during 2010/11, which holds a number of clear benefits for the Trust. Balancing national priorities against local initiatives will be key to ensuring that the updated strategy is appropriate to the local health economy, whilst providing foundations for our long term stability. To deliver the strategic ambitions for clinical services for 2010/11 and ensure the robustness of the Trust’s top level plan, each clinical specialty has been involved within the annual planning process. This has ensured the alignment and delivery of the key objectives within

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this plan, and means that it is supported by a suite of aligned specialty plans. Each speciality plan focuses on the current state of the specialty, the five year strategic vision, and the detail of what the specialty will deliver during 2010/11. Specialty plans have been reviewed and challenged by the Executive Team to ensure consistency across areas, reflection of the wider current policy and financial operating context, and strategic goals for the Trust as a whole. Corporate Directorates have also been involved in the 2010/11 annual planning process. Each key Directorate has produced a clear plan of action for 2010/11, which clearly states how it will support individual specialty priority actions. Both the corporate and specialty plans have contributed and informed the annual planning process and this top-level plan. The Council of Governors has a reference group which is involved in the discussion and development of future plans and priorities, prior to formal agreement by the Board of Directors.

4.3 STRATEGIC OVERVIEW

4.3.1 ABOUT THE LOCAL HEALTH ENVIRONMENT AND RELATIONSHIPS

WITH HEALTH CARE STAKEHOLDERS

CATCHMENT AREA DEMOGRAPHICS The Trust provides a wide range of local, general and specialist acute services to the residents of the Borough of Poole and the two district councils of Purbeck and East Dorset (giving an approximate main catchment population of 267,400). The general and specialist acute services including Maternity, Trauma, Child Health, ENT and Emergency (and Inpatient) Gynaecology Services are provided to the residents of Bournemouth Borough Council and Christchurch Borough Council increasing the catchment population to around 476,100. In addition, specialist acute services including Radiotherapy, Neurology and Oral Maxillofacial services are provided to the residents of the other three Dorset district councils (North Dorset, West Dorset and Weymouth and Portland) increasing the catchment population further to 701,900. These populations account for approximately 96% of the patient flow to the hospital, with the remaining 4% of patients coming from the neighbouring commissioning areas of Hampshire and Wiltshire as well as visitors to the area who access emergency care. As a medium sized county, Dorset County has a sparsely distributed and largely rural population, with a relatively large proportion of older people compared to national averages. 2008 statistics show that 29% of Dorset residents were of retirement age compared with 19% in England and Wales. However, whilst the local population is set to grow, forecasts indicate that this will happen at a slower rate than the national average over the next ten years. Population growth is strongest in the older age groups with residents over 65 set to increase by 23.7%, significantly higher than the national average of 16.0%, with the trend continuing for those aged 75-84 (set to increase 8.8% compared with a 5.7% national average).

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The gender split is approximately equal, with 48.5% of the population male, and 51.5% female. However, 66% of over 85 year olds in the area are females, with women only accounting for 48% of the population below the age of 30. Dorset has limited ethnic diversity, with below average numbers of black and ethnic minority residents: a level of 3.6%, about 8% lower than the national average. As numbers are low, Dorset does not tend to have readily identifiable geographic communities of black and ethnic minority residents, instead they are widely scattered. However, there are clear areas of deprivation in Dorset - located in Weymouth and Portland, although when compared nationally, Dorset appears to be relatively free from the degree of deprivation found elsewhere in the country. As our local population grows and lives longer, significant challenges will continue to be placed on local health services. This challenge is further complicated by rural factors affecting the placement of services. Demographic changes within the community will lead towards increased pressure of delivery for long term conditions and planned care, whilst heightening the requirement for delivering care out of an acute setting. In order for the Trust to respond appropriately to the requirements of the local population, close working with community services, social care and the Third Sector will continue to be critical in ensuring that patients continue to receive high quality care in the most appropriate setting. THE LOCAL HEALTH ECONOMY The Trust enjoys collaborative working relationships with NHS Bournemouth and Poole, NHS Dorset and NHS South West. In addition, the Trust works closely with three local authorities, other local Trusts, local education providers, and its MPs. The Hospital's two main commissioning Primary Care Trusts (PCTs) are NHS Bournemouth and Poole and NHS Dorset. The NHS Bournemouth and Poole contract element accounts for approximately 70% of the Trust's services and NHS Dorset element accounts for approximately 28%. Where Poole Hospital provides specialist services across Dorset or the east of Dorset there is collaborative working with the other two major hospitals in Dorset: The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust and Dorset County Hospital NHS Foundation Trust. The Trust also has close and long standing links with Wimborne, Swanage, Wareham, St. Leonard’s and Alderney community hospitals. Because of the complementary case mix in adjacent hospitals, the Trust has a formal plan for co-operation with The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust. Both Trusts jointly manage all medical and surgical emergency admissions for the east of the county. However, major trauma, paediatric and orthopaedic emergency admissions are solely managed by Poole Hospital. The Trust has a number of services such as anaesthetics that have a joint division across the two hospitals to maximise the professional development of senior medical staff and the training of junior doctors. There is regular contact between the two organisations both at corporate and operational levels. STRATEGIC RELATIONSHIPS Through mutually agreed Service Level Agreements (SLAs) with Dorset County Hospital NHS Foundation Trust, Poole Hospital provides the following clinical services for patients from the west of the county: Brain Injury, Neurology, Oncology, ENT, Oral Surgery, Clinical

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Neurophysiology, Medical Photography, Biochemistry and Breast and Bowel Cancer Screening (where Poole acts as the Dorset Centre). The three acute Trusts across Dorset will continue to review services across the county throughout 2010/11 going forward with the aim of providing the highest quality of clinical care with the most effective and efficient facilities and resources. The Trust also has a SLA with Dorset County Hospital NHS Foundation Trust for spinal services to be provided within Poole Hospital for patients in the east of the county. All hospitals in Dorset work especially closely to ensure that cancer patients requiring the service of more than one hospital are treated appropriately and within the required timescales. There is a strong network of active patient interest groups, particularly in the fields of cancer, cardiac and respiratory care, child health and diabetes. The Trust’s link with Southampton Hospital, currently the nearest major teaching hospital, is very important, particularly for specialist tertiary services such as Cardio-thoracic Surgery, Neonatal Surgery and Neurosurgery that relate to a number of hospitals’ secondary care services. The Trust also works closely with Bournemouth University as a major training centre for doctors, nurses and a number of allied medical professionals. This supports the future ambition to become a University Hospital. The Trust relates to three local authority Overview and Scrutiny Committees and has good working relations with each.

4.4 2010/11 KEY CORPORATE OBJECTIVES

In order to deliver the vision, five strategic goals for 2007/12 were agreed by the Trust. These were:

1. Ensure robust management of resources and the sustainable development of clinical services

2. Continuously improve the patient’s experience particularly in regard to care and safety

3. Continue to employ a highly motivated flexible workforce delivering excellent services 4. have governance arrangements to deliver strong public engagement and robust

corporate and clinical governance systems 5. maintain and develop successful partnership working

These goals remain central to the stability of the Trust, as well as ensuring that the quality of outcomes is maintained and improved. In order to ensure the delivery of these strategic goals, a number of key corporate objectives have been developed and agreed. These include:

• Clinical quality

• Service development strategy

• Workforce strategy

• Capital programmes (including estates strategy)

• Operational / financial effectiveness

• Leadership and governance

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• Regulatory By focusing on these areas, the Trust will be able to ensure that effort is maintained and prioritised on the key areas for development. This will mean that the Trust will maintain progress and momentum in achieving its strategic goals and long term vision.

4.4.1 KEY TRUST OBJECTIVES

The Key Corporate Objectives represent a summary of the areas of focus for the Trust during 2010/11. Whilst the Trust embarks on a period of transformation to ensure that it can continue to operate effectively in rapidly changing times, these objectives will help to balance the achievement of financial priorities against wider ambitions. During this period of transformation and financial recovery, the Trust will ensure that staff remain engaged and focussed on the Trust objectives, whilst contributing to specific improvement projects.

We will provide excellent patient centred emergency and planned care to the

people we serve

Deliver the highest possible standard of patient centred health care and contribute to improving the

health and wellbeing of the population

Provide a range of high quality NHS health services in the hospital and community

Employ and engage a highly motivated, appropriately skilled workforce, seeking to improve employee

satisfaction

Involve patients, the public and partners in developing patient centred seamless services

Maintain financial viability

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Strategic

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Key priority (and timescales)

How this priority underpins the strategic vision

Key milestones (2010/11)



Full financial recovery plan benefits realised


Benefits of £9.1million to achieve at least break even financial position

Recurring benefits of 2010/11 (£9.1million) and continuing cost improvement plans of £10.3 million

Develop robust CIP plan of at least £7 million and respond to tariff changes

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Key priority (and timescales)

How this priority underpins the strategic vision




Maintain key access and performance targets

Deliver the highest possible standard of patient centred health care and contribute to improving the health and wellbeing of the population

Achieve all compliance, access and performance targets (Monitor compliance framework and national priorities)



Maintain or increase clinical quality

Deliver the highest possible standard of patient centred health care and contribute to improving the health and wellbeing of the population

Improve performance on clinical quality indicators including, trauma waits, infection control, falls and pressure ulcers from 2009/10 as per quality report priorities

Improve performance on clinical quality indicators including, trauma waits, infection control, falls and pressure ulcers from 2010/11 Increasing number of priorities

Improve performance on the range clinical quality indicators including, trauma waits, infection control, falls and pressure ulcers from 2011/12 Increasing number of priorities

Achieve University Status

Employ and engage a highly motivated, appropriately skilled workforce, seeking to improve employee satisfaction

Achieve University Status by March 2011 Achieve Practice Development Status in Critical Care

Maintain University Status Maintain Practice Development Status in all areas

Maintain University Status Maintain Practice Development Status in all areas

Capital development programme

Deliver the highest possible standard of patient-centred health care and contribute to improving the health and wellbeing of the population

Deliver the Board agreed capital programme Develop all plans to time and cost (including recovery plan) plus enabling investments.

Deliver the Board agreed capital programme Review options for maternity and A&E (subject to financial viability based on 10/11 performance and medium term financial forecasts)

Deliver the Board agreed capital programme

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4.5 NATIONAL AND LOCAL CHALLENGES

In January 2010, recognising the rapidly changing political, economical, social, technological, environment and legislative landscapes, the Board of Directors reviewed the PESTEL analysis undertaken for the Annual Plan 2009/10 and updated it to reflect the current context for the organisation:

Political

• Government policies including actions to reduce the national deficit and cost pressures

• Government term and change leading to an uncertain operating environment and need for stability

• QIPP - quality, innovation, productivity and prevention

Economic • economic situation constraining the ability to expand

services and leading to a need to develop additional funding streams

• Lower national growth restricting public sector funding

Social

• Consumer attitudes and opinions and the impact of serving a more informed public and patients with raised expectations regarding healthcare and access to drugs

• NHS Constitution: patient rights and the need to clearly reflect these in our approach to care and service

Technology • Standardisation of procedures for non-clinical processes

• Research funding opportunities

Environment

• Energy tariffs

• Carbon emissions and a national public sector requirement to demonstrate efficiencies

• Travel/parking constraints, and a need to provide patients and staff with feasible environmentally responsible travel options

Legislative

• Regulatory bodies and processes changing and widening scope

• Continuing health care funding pressure on the health community

• CQC qualitative/inspection/action

Operating within the context of wider change and immediate financial pressures means that the Trust currently exists within an environment less stable than that of previous years. Locally, the Trust is already starting to see the impact of some of these factors. In the 2010/11 contract negotiations the Trust has been mindful of the lower funding growth available to the NHS and the revised tariff schedules and performance related payments. The budgets have been formulated to be able to deliver the required financial viability and take account of increased cost pressures on the Trust, such as increased pay and drugs costs. As a consequence, and in light of the predicted public sector funding for the next five years, the Trust has embarked on a period of transformation, started in 2010/11 with its focus on the recovery plan. Equally, the Trust has been required to respond to changes to employee legislation, and the 2010/11 workforce plans now reflect the compliance with European Working Time Directives and the need to continuously improve patient pathways in the provision of the Trust’s services.

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The Trust will continue to ensure that its strategic and annual plans are constantly reviewed to reflect local and national developments. This will require the Board of Directors to ensure that continual focus and attention is paid to the pace of change, economic pressures and commissioning intentions, including developments in the emerging health and social care landscape. Through continued monitoring of the key factors within the PESTEL, the Board of Directors will continue to review the rapidly changing policy environment throughout the year. The Trust will operate effectively and within its Foundation Trust authorisation.

4.5.1 KEY EXTERNAL IMPACTS

With these pressures and external influences on the Trust and its key activities for 2010/11, the main risks to the plan are set out below. Key external impact

Risk to the plan

Mitigating actions and residual risk

Overall expected outcome

Measures of progress and accountability

Economic situation (national/ local) PCT financial pressure

Medium Risk

The Trust has a long term financial model including continued efficiency savings planned. Focused recovery plan for 2010/11 Medium risk

The Trust’s financial plans currently cover the projected financial context and foreseen future for three years to secure financial viability

Monthly reports at to all budget holders and Hospital Executive Committee – summary to Board of Directors and Finance & Investment Committee Accountability to Board of Directors

External delays on discharge

Medium Risk

The Trust is working with external partners (Social Services and PCT) to limit the impact. Medium Risk

The Trust’s patient flow improvement work and length of stay may be impacted by external organisations – and the Trust will attempt to limit this effect

Summary of external delays to Board of Directors and Hospital Executive Committee. Accountability to Board of Directors

Medical staffing shortages

Medium Risk

The Trust relies on medical staff (both training and permanent) to provide clinical services – services are being reconfigured to reduce this reliance. Medical workforce group being established for 2010/11 Medium Risk

The Trust will continue to provide its range of services with the medical staffing available, and expand and extend other roles and work in wider clinical networks to ensure continuing quality and effectiveness

Summary of medical staffing vacancies to Board of Directors and Hospital Executive Committee. Accountability to Board of Directors

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Key external impact

Risk to the plan

Mitigating actions and residual risk

Overall expected outcome

Measures of progress and accountability

Increasing activity levels

Medium Risk

The Trust is working with commissioning PCTs to limit the impact, through demand management and reshaping patient pathways. Medium Risk

The PCT is being supported by the Trust to limit the demand within contractual levels, and ensure appropriate usage of acute services.

Summary of activity to Board of Directors. Accountability to Board of Directors

Staff engagement

Medium Risk

The Trust is fully involving its Staff Partnership Forum, Staff Governors and staff members in service improvement plans Ongoing communication programme with staff Medium Risk

The Trust and its workforce will undertake a range of successful service improvement projects

Workforce indicators to Board of Directors and Hospital Executive Committee. Accountability to Board of Directors

These risks, set against the wider financial situation and pressures on the Trust, local PCTs, and future funding means that it is of utmost importance that the Trust achieves its recovery plan in 2010/11. This will ensure that it remains well positioned for the continuing financial challenges from 2011/12 onwards, and in a fit state to respond to wider pressures.

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4.6 SUMMARY OF FINANCIAL FORECASTS

The table below summarises the financial forecast for the Trust over the next three years. There are no major capital developments or service developments assumed in the financial forecast.

£million 2010/11 2011/12 2012/13 Surplus 0.15 1.3 1.8 Cash 8.2 12.9 18.4 CIP 9.1 10.3 7.0 Capital Expenditure 4.9 5.0 5.0 Risk Rating 3 3 3

4.6.1 HOW THE PLAN WAS BUILT

The 2010/11 financial plan was built taking into account the commissioning requirements of the Trust’s local Primary Care Trusts which were formulated into an agreed activity plan and financial contract. In terms of cost, a bottom-up analysis of costs for each Directorate was calculated for all cost components. Budget setting meetings were held with the Clinical Care Groups at which agreement was reached on the level of funding to be provided in order to deliver the activity plan. The Trust, with the assistance of external management consultants, compiled a comprehensive Financial Recovery Plan which detailed cost improvement savings. These savings were agreed with each project sponsor in terms of total saving, cost of enabling where appropriate and phasing of saving and cost. Each project is supported by a project opportunity document and detailed delivery plans which have been approved by the relevant lead Executive Director. Adjustments were then made to the cost budgets for the effect of these savings.

4.6.2 KEY FINANCIAL ASSUMPTIONS

The Table below summarises the key financial assumptions used in developing the three year financial forecast. These are subject to further national guidance.

2010/11 2011/12 2012/13 Income inflation 0% 0% -1.5%

Pay inflation 2.2% 0 - 1.5% 1.0% Non-pay inflation Cost pressures

funded £600,000 Managed within

overall cost budget Activity reduction 0% -3.0% 0%

4.6.3 PHASING

The forecast assumes with the phasing of the activity contract and not on a consistent basis throughout the year. Costs are phased in two ways depending upon the type of cost; either in line with the activity contract or in equal twelfths.

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The capital expenditure is phased towards the end of each financial year.

4.6.4 LOANS AND WORKING CAPITAL

The Trust has no plans to secure loan finance. There is an agreed Working Capital Facility in place for £13 million with the Trust’s banker although it is not planned to utilise this facility. The cash position of the Trust improves over the planning period as a result of the capital expenditure being significantly less than the depreciation charge.

4.6.5 COST IMPROVEMENT PLANS (CIPS)

The Financial Recovery Plan provides full detail of the cost improvement plans for the years 2010/11 and 2011/12. Detailed plans are currently being developed for 2012/13. A summary of the savings is presented in the table below.

£ million 2010/11 2011/12 2012/13 Pay 5.2 6.2 4.2 Non-pay 2.1 2.2 1.5 Income 1.8 1.9 1.3 Total 9.1 10.3 7.0

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4.7 CLINICAL QUALITY

The Trust is registered with the Care Quality Commission (CQC) and received an excellent rating from the CQC for quality of its services in 2009. It will seek to maintain this through a comprehensive programme of clinical care audits and actions, as well as clinical improvement projects across a range of areas. The Trust has set a number of key quality improvement targets (as set out in the Trust’s Quality Report) for the financial year 2010/11 and for the following years. This section details the many areas in which the Trust will be aiming to improve clinical quality, whilst ensuring that financial recovery is undertaken. The Board of Directors has put in place a range of processes and measures to ensure that the recovery plan for 2010/11 will not compromise clinical quality. These will also be used to monitor the areas where the Trust will improve quality by becoming more efficient and effective. Specific areas of improvement include: Trauma services As Poole Hospital is the major trauma unit for East Dorset, the Board of Directors is committed to ensure that its trauma services are of the highest standards. In 2010/11 the Trust has set a quality improvement target of 90% of all medically fit trauma patients being operated on within 48 hours of admission where surgery is indicated. This will further increase over the two following years. To support this aim the Trust has embarked on a wide reaching review of the current utilisation and usage of its theatres, and further supported this with an improvement project for the trauma patient journey from admission to discharge. This project is supported by a multi-disciplinary team. Stroke services The Trust has developed expert services for people who have had a stroke. The Board of Directors are committed to maximise the use of these services to give the greatest benefit to patients; and provide the best outcomes. Quality improvement targets have been set to include that 70% of patients with a stroke are to spend 90% of their inpatient time on the stroke ward during 2010/11, further increasing over the following years. The continued development of these services is supported by a Dorset-wide stroke network, and internally supported by work to improve the flow of patients and ensure that stroke patients are able to stay in dedicated stroke beds, and cared for by appropriately trained staff. Venous thromboemblolism(VTE) assessment The Trust provides early assessments for patients at risk of VTE. During 2009/10 an internal clinical audit demonstrated that 84% of patients had been assessed. The Trust will now aim to improve this to 90% during 2010/11 and further through the following years. Key to this improvement is the continued sharing and education of the clinical teams, and the support of an internal project group. Pressure ulcers The Trust has worked hard to reduce the number of pressure ulcers acquired by patients during their stay in the hospital. A dedicated team work continuously to improve, support and educate staff and patients. The Trust will aim to improve this position for 2010/11 by continuous improvement and reduction in the number of avoidable grade 3 and 4 pressure ulcers.

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Patient falls The Trust has worked hard to reduce the number and severity of avoidable falls experienced by patients during their stay in the hospital. A dedicated Falls Co-ordinator supports the ward staff with education and one to one support to advise patients, staff and relatives, of the safest way to limit the risk to falls. The Trust will aim to improve the position for 2010/11 from the 2009/10 level and continuously reduce the number of avoidable falls. Improving length of stay The Trust has a wide range of inpatient clinical pathways, across a range of specialties. After benchmarking these specialities against an established set of peer Trusts, improvement projects have commenced to improve length of stay to 20% better than the average of the peers. This project is supported by all the clinical teams, and will aim to improve each individual patient’s experience as an inpatient, by reducing delays throughout their stay. This improvement is a key aspect of the Financial Recovery Plan in 2010/11. Improved patient pathways The Trust undertakes surgical procedures on elective and non-elective patients. To aid in the recovery of and outcomes for these patients the Trust has commenced improvement projects to increase early enhanced recovery for patients after surgery, as well as increasing same day admission and pre-operative screening. The aims of these projects are to reduce post-operative stay in the hospital, and reduce the need for patients to be admitted day(s) prior to their surgery. This improvement is also reflected in the Financial Recovery Plan in 2010/11. Improving clinical productivity The Trust’s theatres, outpatients, and other shared clinical services are used across a range of specialities. The Trust has commenced service improvement projects to improve the overall utilisation of these facilities, allowing more flexible use of the resources and facilities required to deliver these services and meet the changing demand and capacity of patients. This improvement is also reflected in the Financial Recovery Plan in 2010/11. Infection prevention 2009/10 was the Trust’s most successful year in preventing hospital acquired infections. During the year the Trust had no cases of hospital acquired MRSA bacteraemia. Clostridium Difficile infections also reduced significantly during 2009/10 as a result of the Trust’s focus on infection prevention. To maintain this progress the Trust will continue its zero tolerance of patients acquiring infections. Each and every MRSA /C. Difficile infection will be subjected to analysis and implementation of actions, if there are lessons to be learnt. As well as these key quality improvements, the Trust will maintain the quality of the patient experience at the Hospital; ensure that care and treatment are effective whilst keeping patients, the public and staff safe. Patient safety remains of the highest priority for, the Board of Directors and will be monitored on a ongoing basis by the Board and the Trust’s clinical leaders.

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4.7.1 CLINICAL QUALITY PRIORITIES – QUALITY REPORT

Clinical quality priorities (key areas for improvement as detailed in Quality Report)

Contribution to the overall vision

Key actions and delivery risk Performance in 2009/10

3 year targets / measures 2010/11 2011/12 2012/13

Increase the percentage of patients having surgery for a fractured neck of femur within 48 hours of admission

Delivering a higher standard of patient care

Theatre project (increasing the utilisation) Patient flow project (reducing pre-op waits and post-op delays) Extra trauma theatre sessions Risk of increased numbers and morbidity of patients

75% 2009/10 average

2010/2011=90% 2011/2012=95% 2012/2013=98%

Increase the percentage of patients with a diagnosis of stroke who spend 90% of their inpatient time on the stroke unit


Patient flow project improving access and limiting delays Stroke team work on improving recovery times Risk of increased numbers and morbidity of patients

2009/10 – 64% 2010/2011=70% 2011/2012=75% 2012/2013=80%

Ensure that 90% of patients have an assessment of Venous Thromboemblolism (VTE) risk on admission to hospital

Providing high quality patient care to all patients admitted to Poole Hospital

VTE group – undertaking focus process review Audit and dissemination Risks of high patient flows into hospital

84% in March 2010 audit

2010/2011=90% 2011/2012=95% 2012/2013=98%

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Clinical quality priorities (key areas for improvement as detailed in Quality Report)




Reduce the number of grade 3 and 4 pressure ulcers acquired by inpatients at Poole Hospital


Tissue Viability Team supplying education and support Hot line reporting and associated actions Raised awareness and education Risk of acuity of patients presenting for admission

Grade 3= 13 Grade 4= 5

2010/2011 < grade 3 outturn < grade 4 outturn

Reduce the number of inpatients falling during stay in Poole Hospital


Falls Co-ordinator providing dedicated support and training Hot line reporting Raised awareness and education Risk of acuity of patients presenting for admission

Total Falls= 1525 2009/10

2010/2011 <2010/2011 outturn

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4.7.2 CLINICAL QUALITY PRIORITIES – OTHER KEY PRIORITIES

Clinical quality priorities (other key priorities)




Improving Length of Stay to 20% better than peer group average

Delivering a higher standard of patient care Financial viability

Reduced LoS in oncology and elderly wards Match rate of admission to discharge Risk of external delays and demand capacity

Geriatric LoS 13.4 days

2010/11 £0.6 million saving 2011/12 £2.2 million saving

Improved patient pathways Delivering a higher standard of patient care Financial viability

Roll out of Enhanced Recovery programme and same day admissions unit Risk of external delays and demand capacity

Pre-operative bed days 4053

2010/11 £0.6 million saving 2011/12 £0.6 – 1.1 million saving

Improving clinical productivity

Delivering a higher standard of patient care Financial viability

Improved utilisation of theatres, endoscopy, and outpatients Integrated critical care unit Risk of demand capacity

Utilisation of outpatients < 90%

2010/11 £1 million saving 2011/12 £1.7 million saving

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4.8 SERVICE DEVELOPMENT STRATEGY

There are no major capital developments or service developments assumed in the financial forecast for the next three years. However, the Trust will investigate the potential to manage Community Services in accordance with a tendering exercise being undertaken in 2010/11 by NHS Bournemouth and Poole. The initial submission of an expression of interest to the Primary Care Trust will be made in May 2010, and subject to approval to move to the next stage, further detailed plans submitted. The Trust recognises that the integration of primary care and social care is essential to the achievement of key objectives, including patient experience, clinical productivity and reduced costs. Integration at management level is the starting point and the Trust has considered a model to support the necessary integration at operational level. If successful joint performance management arrangements with cross cutting key performance indicators which affect patient pathways will be developed. There are no financial implications to this service in 2010/11 – with opportunities and development of the service expected in 2011/12, based on NHS Bournemouth and Poole timescales and approval. Due to the demanding financial environment, other major service developments will be restricted. However, a range of service improvements will be progressed and are embedded in Care Group Annual Plans, e.g. extension of the breast screening service, installation of a new 3T MRI scanner (charitable funds), and recruitment of an acute physician. Care Group developments will be subject to agreeing a clear funding source and business case approval before implementation can commence.

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4.8.1 SERVICE DEVELOPMENT PRIORITIES

Service development priorities Contribution to the overall vision Key actions and delivery risk

Key resource requirements

Measures of progress 2010/11 2011/12 2012/13

Acquisition : Transforming Community Services Bournemouth and Poole Community Services tender by NHS Bournemouth and Poole

Deliver the highest possible standard of patient-centred health care and contribute to improving the health and well being of the population.

Submit expression of interest to PCT Develop full tender (if approval to move to next stage) Explore possible joint venture / partnership with local health and social care providers Risk of services not being financially viable/complementary to Trust services

Project team including finance and clinical support

May 2010 – submit tender Mid 2010 (dependant on PCT timescales) develop full tender 2011/12 transfer of services (if successful)

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4.9 WORKFORCE STRATEGY

The Workforce Strategy for Poole Hospital NHS Foundation Trust is centred on supporting the delivery of the highest possible standards of clinical care, through the effective deployment of our staff. This approach is imperative in a complex healthcare environment, which is changing at significant pace. We are committed to using innovative approaches and best practice to enhance the optimum delivery of health care to our patients. Staff are our key resource and the way in which they are developed and deployed is a key element of the Trust’s sustainability and Financial Recovery Plan, and the key workforce driver in 2010/11 going forward. Approximately 70% of the Trust’s annual budget is associated with workforce costs and as such we need to seek the views of our staff in a meaningful way through engagement and involvement, for example through the Staff Partnership Forum. This will enable us to get their input into redesigning patient services to deliver quality, clinical and financial stability, and take into consideration any impact on staff. The Trust’s Financial Recovery Plan requires a reduction in pay costs of £5.1m during 2010/11: this equates to some 250 WTE posts. This reduction is allocated across the recovery plan. However, the approach the Trust will take is to focus on effective workforce planning that makes use of existing vacancies, a reduction in agency spend, bank usage and effective redeployment of staff. The aim is to keep transitional costs to a minimum.

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4.9.1 WORKFORCE PRIORITIES

Key workforce priorities

Contribution to the plan

Key actions and delivery risk Key resource requirements


Ensure all staff are actively engaged in improving the patient experience, service transformation and financial recovery.

Deliver the highest possible standard of patient centred health care through service transformation and recovery projects.

Improve staff engagement through continued communication and briefings Develop supported learning Utilise effective change management processes Risk: disengagement, inadequate resources, meeting expectations

HR Team Development of organisational change teams Development of the Staff Partnership Forum Staff communication

Staff survey results Educational outputs Review of Staff Partnership Forum Audit and survey of communication processes

Develop a national reputation as the employer of choice with the ability to attract and retain high calibre staff in difficult to recruit areas

Employ and engage a highly motivated, appropriately skilled workforce, seeking to improve employee satisfaction

Develop a workforce resourcing strategy to address key workforce challenged areas such as middle grade medical staff Risk: fragility of specialist employment market areas Reduction in medical training posts

Continued implementation of the new electronic recruitment system Poole Integrated Process Dedicated HR time to implement with Care Groups

Reduction in vacancies covered at premium time and using temporary staff. Improved efficiency

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Fully integrate workforce planning into service line management, activity and capacity planning process


Refine workforce data to Trust’s needs Develop service systems to support staff and managers Support the development of service line management Risk: ESR data set and payroll interface

Human Resources System utilisation and development

HR data support framework and Clinical best practice benchmarks

Ensure that strong clinical leadership is in place and strategies established to promote and sustain high quality leadership development and deliver services transformation.

Employ and engage a highly motivated, appropriately skilled workforce, seeking to improve employee satisfaction Support implementation of service line management

Review leadership development needs Review with HEC the current clinical management structures Ensure appropriate leadership development opportunities are in place Establish SLM training and development programme

Human Resources Training and development resources

Management development programme and clinical leadership Enhanced involvement of clinicians in management of Trust Trust implementation of Service Line Management

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Recognise the important contribution of staff health and wellbeing to improving organisational performance and incorporate this into the Trust performance management framework

Deliver the highest possible standard of patient centred health care and contribute to improving the health and well being of the population

Implement FIT note practice Implement good practice inspired by Boorman review Risk: fragility and complexity of current occupational health services.

Human Resources Occupational Health Department restructure/merger

- Improved staff satisfaction – Staff Satisfaction Survey - Reduced sickness absence – Reports to the Board of Directors

Implement e-Rostering Maintain financial viability Employ and engage a highly motivated, appropriately skilled workforce, seeking to improve employee satisfaction

Introduce e-Rostering system across Trust Reduce bank and agency nursing through optimised rotas and standardised shifts Risk of implementation through resistance in change through staff representative bodies

Project manager and clinical support team

2010/11 £0.1 million saving 2011/12 £0.5 million saving

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Review clinical staffing Maintain financial viability

Review extra sessions and consultant job plans Identify funded posts / income streams Review senior nursing cost profile Determine productivity levels Risk: organisation capacity to implement – reliance on achievement of clinical productivity projects

Project manager and clinical support

2010/11 £1.2 million saving 2011/12 £1.2-3.0 million saving

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4.10 CAPITAL PROGRAMMES (INCLUDING ESTATES STRATEGY)

The Trust has a capital programme of £4.85 million for 2010/11. Of this, £1.3 million relates to the estate and addresses key environmental upgrades, statutory and mandatory requirements and carbon reduction. The capital programme has been appropriately risk assessed. A Ward refurbishment (Brownsea Ward) is expected to start in June 2010 and completion is expected in September 2010 funded by charitable donations. In addition, the Trust will be investing in the replacement of essential medical equipment and the ongoing development of information technology. The Trust will also be making investments utilising existing charitable funding.

4.11 LONG TERM CAPITAL DEVELOPMENTS

The Trust has an aspiration to develop key services through major capital development, these services include:

• Provision of a modern and purpose built maternity unit • Extension of the Emergency Services Department incorporating a remodelling of the

main front entrance • Phased programme of ward reconfiguration and ward upgrades

These developments would improve service delivery, improve patient care and provide environments which support infection prevention, improve privacy and dignity and ensure patient choice. However, until such a time that the Trust is in a financial position to commit to these developments, limited investment can only be made in these areas which are aimed at managing risk.

4.12 SUSTAINABILITY/CLIMATE CHANGE

The NHS is the biggest single public sector contributor to climate change releasing over 18 million tonnes of CO2 each year. Poole Hospital has formally signed up to the NHS Carbon Reduction Programme which requires the Trust by 2015 to reduce its 2007 carbon footprint by 10%. Poole Hospital has set its own more ambitious target reduction of 18% by 2015; in order to achieve this reduction the Trust has joined the NHS Carbon Management Programme (NHSCMP) and is developing a robust Carbon Management Implementation Plan. This plan will focus on low-cost measures such as good housekeeping, education/awareness programmes and longer term plans such as the installation of energy efficient equipment. Poole Hospital has also undertaken an assessment using the Good Corporate Citizen Model; this will guide the Trust in the development of its new Sustainability Policy. The new policy will cover areas such as transport, procurement, facilities management, employment and skills, community engagement and new buildings. The Sustainability Policy will be monitored by Senior Managers and the Board of Directors will ensure the related targets and information is disseminated throughout the organisation.

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4.12.1 CAPITAL PROGRAMMES (INCLUDING ESTATES STRATEGY) KEY PRIORITIES

Key capital expenditure priorities

Amounts and timing Contribution to the plan (including service delivery)

Key actions and delivery risk

Development:

Refurbishment of Brownsea Ward £1.3 million June – September 2010 (charitable funds)


Relocation of ward for period of refurbishment – June 2010 Refurbishment complete – September 2010 Risk reduced beds available during refurbishment – improving patient flow projects to mitigate

Maternity and A&E developments Review options for investments in maternity and A&E in 2010/11 to ensure that risks are mitigated. Major developments on hold.

Delivering a higher standard of patient care and managing risk. Maintaining financial viability

Review options for maternity and A&E investments to reduce risk in 2010 within the capital programme. Risk: financial viability based on 10/11 performance and medium term financial forecasts

Other capital expenditure:

Medical equipment and IT £2.3 million 2010/11 Delivering a higher standard of patient care

Tender, purchase and install relevant items as detailed within agreed capital plan by Board of Directors.

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Key capital expenditure priorities

Amounts and timing Contribution to the plan (including service delivery)

Key actions and delivery risk

Recovery Plan estates enablers £0.7 million 2010/11 Delivering a higher standard of patient care Maintaining financial viability

Tender, purchase and install relevant items as detailed within agreed capital plan by Board of Directors. High priority to enable recovery programmes to be implemented

Other estates strategy:

Develop Carbon Management Implementation Plan (CMIP)

Board presentation May 2009 Poole Hospital’s target for carbon reduction has been set at of 18% by 2015

Maintaining financial viability Review good housekeeping measures Education/awareness programme Develop plans and timescales for upgrading boilers, improved monitoring systems and additional insulation

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4.13 OPERATIONAL/FINANCIAL EFFECTIVENESS

The Trust has a full financial recovery plan for 2010/11. This will deliver recurrent savings that will be realised during 2010/11, and then recurrently in 2011/12 onwards. The total value of the recovery plan is £9.1 million in 2010/11, rising by £10.3 million for 2011/12 and a minimum rise of £7 million required in 2012/13. Future year recovery plans will be developed in more detail during 2010/11 reflecting progress against existing plans, and other opportunities as they are developed including opportunities that are developed by Pan- Dorset QIPP working groups. As part of the development of the recovery plan, all areas of the Trust have been reviewed for financial effectiveness. The recovery plan covers all areas of clinical improvement, workforce review, as well as a range of service improvement projects detailed within this section. This financial review identified that the Trust could improve efficiency and effectiveness of a range of corporate “back office” services. This includes the use of its existing estate (and any that is further identified or released as part of other service improvement programmes) to increase the amount of income that these provide. Within the Trust, the procurement team will investigate reducing the overall spend on non-pay stock items, through the increased management of the demand of regular stock (with additional focus on those of high cost, and on those where they are high rates of purchase – i.e. the top 100). Savings will also be made in management costs, including reviews across administration and clerical areas, non-ward based nurses, and allied health professionals. The Trust will also reduce spending on drugs through more efficient usage and reducing purchasing costs. The Trust will also investigate fully all opportunities to improve income from its Research and Development activities and from private patient income streams. This is likely to involve providing specialist services and diagnostics to private patients. All private patient income will be undertaken within the financial limits as agreed with Monitor. The Trust will focus on the implementation of the Service Line Management, as agreed by the Board of Directors, which will equip key clinical and managerial staff with an improved understanding of the cost and income for each speciality, to find additional opportunities for improved efficiency savings and implement these throughout this financial year and into 2011/12.

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4.13.1 OPERATIONAL / FINANCIAL PRIORITIES

Key operating efficiency programmes

Amounts and timing


Key actions and delivery risk Resource requirements

Milestones 2010/11 2011/12 2012/13

Non-pay (procurement, demand management)

£1.0 million savings 2010/11 £1.9 million savings 2011/12

Cost savings project (reduced demand, reduced cost)

Complete “top down” review of all spend lines and pro-active review of any categories which have not been tendered recently Implement clinical demand management and reduction in products Review supplier list and agree strategy for rationalisation Risk: reduction in general stock and flexibility

Procurement department with support from clinical departments


Increased income including research and development

£1.3 million 2010/11

Increased income for Trust at limited cost

Maximise private patient income in areas such as diagnostics Maximise non-pay income generation, and research and development income Risk: project and organisational management capacity to implement

Project manager and support from clinical departments

£1.3 million 2010/11 £1.8 million 2011/12

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Amounts and timing



Milestones 2010/11 2011/12 2012/13

Estates – Income

£0.1 million 2010/11 £1.4 million 2011/12

Increased income Estates – Income per square metre increased to median of peer (£2,488) Other minor opportunities including car park costs Project dependant on other cost improvement programmes freeing up space for 2011/12 Risk: limited private investors and dependant on other service improvement projects

Estates Department with support from clinical departments

£100k 2010/11 £1.4 million 2011/12

Service Line Reporting/ Management

£0.7 million Savings 2010/11

Cost savings project Maintain financial viability

Use patient level data to highlight services which are not making a financial contribution and therefore should be the focus of service improvement Implement action plan as agreed by Board of Directors including training and development Risk: general clinical and management capacity

Project management support, Executive and Clinical Leads for pilot areas Training programme resources

£0.7 million 2010/11 £0.7 million 2011/12

Clinical support enablers

£0.2 million savings 2010/11


Review staffing structures and costs for AHP’s Implement e-Prescribing and review prescribing practices Risk: national contractual guidance

Project management support

£0.2 million 2010/11 £0.6-1.0 million 2011/12

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Amounts and timing



Milestones 2010/11 2011/12 2012/13

Clinical support – implement e.Prescribing a review drug prescribing



Implement e-Prescribing system (2011) Implement updated outpatient prescribing practices Review inpatient drug usage Risk: drug contracts with existing supplies

Project management support.

£0.3 million 2010/11 £0.8 million 2011/12

Minor corporate schemes



Minor corporate schemes including department restructures, income schemes and premiums Projects completed early Q1 2010/11

Project management support.

£0.9 million 2010/11 £1.0 million 2011/12

Review management, administrative, and back office functions to improve efficiency and reduce costs



Identify opportunities to improve administration processes and efficiencies Implement change programme and reduce costs Review and optimise back office functions and systems Review management structures (see 4.14.1) Risk: organisational capacity to implement complexity of change programme

Project manager (s) and clinical support team

2010/11 £0.6 million saving 2011/12 £1.1 – 1.7 million saving

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4.14 LEADERSHIP AND GOVERNANCE

High quality and effective leadership at all levels will be essential for delivering the major change programme facing the Trust in 2010/11 and beyond. During the year a new Director of Finance will be appointed by the Board of Directors and the current management structure will be reviewed with the aim of increasing the clinical leadership capacity, ensuring clear accountability and reducing overall costs. The Trust will also ensure that its leaders have the appropriate opportunities to develop so that the individuals and teams are equipped for the significant challenges that are ahead.

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4.14.1 LEADERSHIP AND GOVERNANCE PRIORITIES

Key leadership and governance priorities

Key risks (and gaps) Actions to rectify/mitigate Milestones 2010/11 2011/12 2012/13

Appoint permanent Director of Finance

Statutory appointment so appointment (permanent or interim) will be made Risk: limited suitable candidates

Appoint permanent Director of Finance Strengthen Programme Management Office through interim appointment of Director of Recovery.

Interviews for DoF in June 2010 Permanent DoF in post Q2/Q3 2010/11

Review management structures including the implementation of Service Line Management to support 2010/11 recovery plan, and future transformation programmes

Increased clarity in accountability and authority of key management roles across the Trust would drive value and add to patient care and service development.

Assess the accountability and authority of the key roles in the current management model with aim of reducing costs Work with the CE and HEC to adjust the management model including strengthening clinical leadership and implement SLM plan as agreed by Board of Directors Risk: management capacity to deliver major change programme/financial recovery and meet external governance requirements


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4.15 REGULATORY

Delivering the 2010/11 financial recovery plan is a key, priority for the Trust. Ensuring financial health is a pre-requisite to realising the Trusts strategic plans and future service developments including new maternity and A&E facilities. The financial recovery plan will be monitored on a weekly basis by the CE and Executive Directors, and monthly by the Board of Directors, Hospital Executive Committee, and Finance and Investment Committee. The Board of Directors will continue to monitor and focus on the other key governance targets in its compliance framework with Monitor, the NHS Operating Framework, and its acute services contract with NHS Bournemouth and Poole as lead commissioners.

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4.15.1 REGULATORY RISKS

Key regulatory risks Nature of risk Actions to rectify/mitigate and

responsibilities Measures 2010/11 2011/12 2012/13

Finance (governance risk) Trust performance against the recovery plan and financial forecasts Requirement to achieve break even position as a minimum

Implement financial recovery plan as agreed by the Board of Directors to save £9.1 million in 2010/11 Establish plans for further cost reduction in future years

Deliver financial targets including break even position for 2010/11. Developed and delivery full cost improvement plans for 2011-13.

Cancer performance (governance risk)

Trust performance against cancer national standards (in particular cancer 31 days for subsequent treatment)

Improvement actions (internal and external) implemented in 2009/10 Lead – Director of Operations

Achievement of all cancer standards 2010-13

A&E performance (governance risk)

Trust performance against national maximum waiting time of four hours in A&E from arrival to admission, transfer or discharge

Improvement actions implemented in 2009/10 Implement outcomes of Intensive Support Team issues relating to sustainability. Lead – Director of Operations

Achievement of maximum waiting time 2010-13

MRSA – meeting the MRSA target(governance risk)

Trust performance against MRSA targets as agreed within local acute contract

Zero tolerance policy in relation to hospital acquired infection including robust root cause analysis Lead – Director of Nursing

Achievement of all infection control standards 2010-13

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5 GOVERNANCE RISK

5.1 INTRODUCTION

The quality of care that the Trust offers its patients and their safety is of paramount importance and the number one priority for the Board of Directors. To support this the Trust has a comprehensive risk reporting and analysis system in place. Alongside all risks there are mitigating action plans and robust performance management, against a suite of key performance indicators (KPI’s) to support the delivery of safe and improving services.

5.2 GOVERNANCE COMMENTARY

The Trust’s 2010/11 predicted compliance against the seven governance elements defined within Monitor’s Compliance Framework is as follows:

5.2.1 LEGALITY OF CONSTITUTION

The Trust’s Constitution is legal and compliant. When necessary legal advice will be taken and due process will be undertaken for the agreement of changes prior to submitting to Monitor for approval.

5.2.2 GROWING A REPRESENTATIVE MEMBERSHIP

The Trust’s membership broadly reflects the populations it serves in terms of diversity, gender and age. However, as may be expected given the demographics of the local area, it has proportionally slightly more members in the female and older age groups.

Membership by constituency and class Public constituency Poole 3,288 Purbeck, East Dorset and Christchurch 1,700 Bournemouth 1,138 North Dorset, West Dorset and Weymouth and Portland 315

Staff constituency Clinical 3,758

Non-clinical 1,598

There are higher than expected changes to the number in the staff members of the Trust (new and leaving), this is due partly to a data clearing of the clinical bank register followed by a promotion of new staff to the clinical bank. The other factors are that the Trust saw a high percentage of retired personnel in the year and lastly that the staff figure quoted for 2009/10 excluded all of the volunteers of the Trust.

5.2.3 APPROPRIATE BOARD ROLES AND STRUCTURES

The role of the Board, committees and management structures was the subject of review by external management consultants in 2008/9 (and continuing in 2009/10 by Internal Audit) and whilst they remain appropriate and have overseen strong performance to date, the Trust has implemented some procedural changes to ensure strong performance is maintained. The governance arrangements for the Board of Directors were further strengthened following a review by management consultants as part of the review of the 2009/10 financial performance to ensure improved control and reassurance of Trust process to the Board of

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Directors, including extending the membership of the Finance and Investment Committee to the full Board, and improving the reporting to the Board. Changes to the Board of Directors were made during 2009/10 and are detailed within Section 3.1.2. The Board of Directors operates with the support of three Committees (Audit and Governance, Finance and Investment, and Remuneration). The Board of Directors maintains a Register of Interests and can confirm that there are no material conflicts of interest in the Board. The Board of Directors will appoint a new Director of Finance during the year. The Board of Directors possesses a strong range of skills, knowledge and experience and has an in-depth knowledge of operational performance which enables effective scrutiny and the necessary leadership to deliver the Annual Plan. The Board of Directors and the Council of Governors continue to work together with some Directors and Non Executive Directors attending the Council of Governors Meetings, Annual Members Meetings and the Reference Groups. Governors attend the Board of Director meetings and have the opportunity to raise questions and discuss issues. The Council of Governors is subject to an annual review to ensure the delivery of its roles and responsibilities and its local accountability.

5.2.4 SERVICE PERFORMANCE

5.2.4.1 Infection Control

Whilst a rising incidence of hospital acquired infection such as MRSA and Clostridium difficile remains a low risk, an increase in non hospital acquired infection such as Norovirus and influenza remains significant:

Management action

• a zero tolerance policy in relation to hospital acquired infection including robust root cause analysis;

• robust infection control policy;

• high profile hand washing campaigns, weekly audits and monthly reports to the Board of Directors;

• comprehensive plans to deal with the consequences of a pandemic influenza;

5.2.4.2 Cancer Waiting Times

The majority of cancer waiting times were achieved during 2009/10. However, there are areas of concern which will remain a focus for attention. For the 31 days for subsequent treatment (surgical) the Trust achieved 93.1% against the standard of 94%. An exception report was issued to Monitor in February notifying of likely breach and the position remains of concern. The underachievement against target was

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predominantly due to breaches in dermatology. Improvement actions have been implemented. The 62 day cancer target is also a concern going into 2010/11.

Management action

• A recovery programme with the Dermatology Department and a number of changes have been made to patient pathways.

• Detailed work is being undertaken to address the issues related to achievement of the 62 day target on an ongoing basis which are multifactorial.

• Detailed and proactive monitoring of areas where performance is fragile, with particular attention paid to data validation.

• close liaison with referring Trusts to highlight problems as soon as they are identified;

• Cancer Referral Protocol is robustly implemented;

• referrals after the treatment deadline actively challenged with a view to refusing shared breaches when Poole has no ability to retrieve the position;

Specifically, there are capacity constraints in tertiary centres requiring the Trust to share breaches: Management action

• each breach is analysed in detail and where the tertiary centre is the principal cause of the breach this is followed up with the Chief Executive if necessary;

Specific patient pathways are identified as complex patients with cancer: Management action

• Cancer Teams continue to focus on ensuring the fast track start of patients is maintained throughout their pathway;

• Systems are in place to examine prospective monitoring processes to ensure they are as robust as possible.

5.2.4.3 Access Times

The Trust has continued to achieve both the admitted and non-admitted referral to treatment target during 2009/10. The Trust will contract to achieve 18 weeks referral to treatment target in 2010/11 within the parameters set by the NHS Constitution. There is a potential risk of unpredictable and significant fluctuations in demand outside the levels of capacity contracted by the Primary Care Trust which could jeopardise achievement of the target. Management action

• Trust to monitor progress on achieving 18 weeks as well as activity levels against contract, paying close attention to specialty level performance and breach validation. Thus working toward compliance with the NHS Constitution.

• The PCT is working with General Practice and the Trust to maintain demand within the contracted limits.

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There is a further risk associated with increased bed occupancy levels related to delayed discharge, outbreaks of infection (particularly Norovirus) and increases in emergency referrals which may impact on the Trust’s ability to maintain elective activity: Management action

• In conjunction with Primary Care Trusts, a focus on actively managing continuing healthcare delays for assessment and transfer, and self-funding patients who may account for a large number of bed delays;

• A work programme is in place to improve discharge planning from the day of admission;

• A trauma review has been undertaken external support and a new Clinical Director for Trauma appointed to lead change. This has enabled the Trust to improve preoperative length of stay for fractured hips and post operative management;

• The Norovirus Plan has been updated to ensure as far as possible that the impact of outbreaks are minimal.

5.2.4.4 Accident and Emergency Target

The four hour target has been achieved on a quarterly basis in 2009/10 except for quarter two, despite continued bed pressures and some ongoing staffing issues. There are risks to sustainability because of variability in numbers of attenders and case mix. Management action

• A recovery programme was implemented in quarter three and the Trust achieved the 4 hour target from September 2009.

• The National Intensive Support Team have worked with the Trust and the local health community to identify the key issues related to sustainability. Including the development of a whole system urgent care strategy as well as some specific focus in the Emergency Department itself.

• The Trust is now working to develop specific professional standards for each stage of the patient pathway.

• A n additionalr consultant has been appointed to enable the Trust to improve senior cover during the ‘out of hours’ periods.

• Service improvement programmes have been implemented to target minor injuries.

5.2.5 CLINICAL QUALITY

Clinical quality remains the top priority for the Board of Directors. The Trust has in place, and will maintain, effective arrangements for the purpose of monitoring, benchmarking and continually improving the quality of healthcare provided to its patients. Clinical performance is managed alongside other performance as described in the section below. The Trust has a comprehensive programme of clinical audits and patient surveys. The Board of Directors receives a range of clinical indicators to monitor clinical quality, and will ensure the delivery of the 2010/11 priorities set out in the Trust’s Quality Report. A particular focus will be on ensuring that the implementation of the Financial Recovery Plan does not impact negatively on the quality of care.

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5.2.5.1 Care Quality Registration

The Trust has successfully registered with the Care Quality Commission as a provider under the Health and Social Care Act (2008). This registration was granted unconditionally.

5.2.5.2 Quality Report

The Trust will publish a Quality Report for 2009/10 at the end of June 2010. This report will identify the quality performance of the Trust as well as the priorities for quality improvement in 2010/11.

5.2.6 EFFECTIVE RISK AND PERFORMANCE MANAGEMENT

5.2.6.1 Risk Management

The Trust has a well developed risk management and safety structure with a designated Executive Director Lead. The Executive Lead chairs the Risk Management and Safety Committee that reports into the Hospital Executive Committee and is scrutinised by the Audit and Governance Committee. The Trust has a Risk Management Team with leads on clinical risk and health and safety. Across the Trust, there are also risk management leads in each of the Clinical Care Groups and Directorates. There is a robust assessment of risks impacting on the organisation. These assessments populate a live Risk Register which is reviewed regularly. The key corporate risks are distilled from the Risk Register and reported to the Board of Directors on a regular basis. All new risks (red and amber) in the organisation are reviewed by a high level risk review group and once validated are reported to both the Audit and Governance Committee and the Risk Management and Safety Committee. Potential risks impacting on the achievement of corporate objectives are highlighted in the Trust’s Assurance Framework which identifies any gaps in assurance. The Board of Directors will ensure that the identified risks associated with the Financial Recovery Plan are managed throughout the year. The Trust has successfully been assessed at level 3 (the highest level) for the NHS Litigation Authority’s Risk Management Standards for Acute Trusts.

5.2.6.2 Performance Management Framework

The performance framework strengthens the management arrangements associated with the delivery of targets. The framework uses a Red, Amber, Green (RAG) rating which denotes levels of performance.

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Green On target: Achieving profile or position set out in the Annual Plan

Amber Area of concern: A robust recovery plan in place to recover performance

Red Not achieved: Action required, Turnaround style monitoring and intervention Director to appoint a lead for the recovery plan

The key performance indicators are stored in a directory and include the following details:

• The definition and the source of the indicator

• The frequency reporting that is required

• Details of the calculation required to report the indicator. Key targets are reported by the Performance Management Team on a daily basis. The relevant Executive Director is made aware of any concerns regarding performance. On a weekly basis the Performance and Information Team review each Care Group’s current performance on access times against a range of defined criteria. Variance from expected or required performance is raised with the relevant manager with any significant issues that cannot be satisfactorily resolved raised with the relevant Executive Director. The Board of Directors and Hospital Executive Committee reviews performance on a monthly basis. Quarterly Performance Review is the formal mechanism by which the Executive Directors monitor the Trust’s performance in relation to the Monitor Compliance Framework, Care Quality Commission Annual Health Check domains, Corporate Objectives and Commissioner Contract. The Trust financial recovery plan for 2010/11 will be formally reported to the Executive Team on a weekly basis, with the Hospital Executive committee, Finance and Investment Committee, and Board of Directors receiving monthly summaries. The Executive Team will monitor a range a financial, non-financial and clinical quality measures during the year to ensure that the recovery plan continues to increase clinical quality and effectiveness, whilst reducing overall costs.

5.2.7 CO-OPERATION WITH NHS BODIES AND LOCAL AUTHORITIES.

The Trust co-operates effectively with other NHS bodies, local authorities and other partner organisations. As part of the Trust’s approach to continually engage with key partners the plan will be distributed to local NHS bodies, the three local councils and other local bodies. In order to deliver its key targets the Trust has robust commercial arrangements with commissioners, other local NHS bodies and the three local councils through service developments, service redesign and clinical networks. The Trust maintains a register of third parties with roles in relation to Poole Hospital NHS Foundation Trust. There are no instances of non-cooperation identified that require notification to Monitor.

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5.3 SIGNIFICANT GOVERNANCE RISKS

The Trust maintains a Risk Register populated from a variety of sources. The Risk Register is subject to scrutiny by the Board of Directors. Clear accountabilities exist for the identification of risk, actions to mitigate risk and the evaluation of the net/residual risk. The Trust considers the most significant governance risks as:

• Finance rating and viability (residual risk significant);

• trauma surgery waits (residual risk moderate);

• delayed discharge (residual risk moderate);

• high activity due to demand (residual risk moderate);

• workforce recruitment and retention (particularly middle grade medical staff) (residual risk moderate);

• failure to deliver A&E and maternity developments (residual risk moderate)

• infection outbreak (residual risk low);

• access times for admission (residual risk low). There are a range of other risks that the Board of Directors have considered. These risks do not present significant governance risks other than the areas listed above.

5.4 HEALTH CARE ASSOCIATED INFECTIONS TARGETS

The details of the locally agreed targets for hospital acquired infections are presented below. This table also includes the previous year’s targets.

Target Q1 Q2 Q3 Q4

2009/10 Target 3 3 3 3 2009/10 Actual 0 0 0 0

MRSA

2010/11 Target 1 (to be confirmed)

1 (to be confirmed)

1 (to be confirmed)

1 (to be confirmed)

2009/10 Target 19 19 19 19 2009/10 Actual 11 10 10 14

C.Difficile

2010/11 Target (to be confirmed)

(to be confirmed)

(to be confirmed)

(to be confirmed)

Note; these targets are subject to finalisation and agreement with NHS Bournemouth and Poole as lead commissioner.

5.5 MANDATORY SERVICES RISK

5.5.1 MANDATORY SERVICES COMMENTARY

Mandatory Service Provision

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The Trust’s activity and income projections reflect recurrent referral patterns and are estimates of the volumes required to continue to meet commissioning intentions, national plan targets and local contracts. These are consistent with and show no significant changes from the mandatory services plan previously submitted.

Protected Asset Disposal and/or Declassification

The Trust is not planning the disposal or declassification of protected assets during 2010/11.

5.5.2 SIGNIFICANT MANDATORY SERVICES RISKS

The Trust has assessed that there are no significant risks to its mandatory services in 2010/11.

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5.6 FINANCIAL RISK

5.6.1 COMMENTARY ON FINANCIAL RISK RATING

The financial risk rating for the Trust is projected as 3 for each of the three years from 2010/11 going forward. However, in the first two quarters of 2010/11, the risk rating will be limited to 2 due to the overriding rating rules as a result of two or more indicators achieving a risk rating of 2. This arises primarily as a result of the phasing of the cost improvement programme towards the later half of the year. The Trust is continually reviewing its balance sheet position to try to achieve further improvements in the risk rating whilst ensuring that the financial plan for each month is achieved. The Trust has identified the following key financial risks:

• achievement of cost improvement plan • emergency activity over contract level • capital expenditure in excess of plan • pay and non-pay costs in excess of plan

5.6.2 SIGNIFICANT FINANCIAL RISKS

Of the risks identified above, the first two are significant. In terms of the delivery of the cost improvement plan, a programme management office has been established to ensure that the savings are delivered. A Director of Recovery is to be appointed to lead this work and until this time external support has been commissioned to support the management team. Weekly progress reports are presented to Executive Directors and savings against plan are reported monthly to the Board of Directors, Finance & Investment Committee and Hospital Executive Committee. Emergency activity over contract levels is reimbursed at 30% of tariff. Should this occur, the Trust will not be able to deliver this activity within this funding envelope as direct variable costs are higher than 30%. Modelling of these two significant risks has been undertaken and is summarised in the table below.

Scenario Financial Impact Mitigation Non-delivery of CIP -£2.8 million Accelerating of future year

schemes and identification of further CIPs. Robust performance management of CIP delivery.

Emergency activity over contract

-£0.7 million Demand management at front door. Appointment of acute physician funded by the PCT.

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5.6.3 SERVICE-LINE MANAGEMENT (SLM)

The Trust has implemented a Patient Level Costing System during 2009/10 and this is now at a stage to be released on a phased basis throughout the Trust. This also incorporates a Service Line Reporting facility. This is to be refined as part of the SLM programme. A timetable for SLM has been agreed, a number of early adopters identified, business rules are currently being developed and a review of the Trust’s clinical management structures has also commenced. A focus is being given to understanding the current cancer services SLR data in Q1, which currently raises concerns over income and expenditure.

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6 MEMBERSHIP REPORT

6.1 MEMBERSHIP SIZE AND MOVEMENTS

The following provides information on the size of membership and estimated movements:

Public constituency Last year Next year (estimated)

At year start (April 1) 6,141 6,441

New members 344 322

Members leaving 44 64

At year end (March 31) 6,441 6,764

Staff constituency Last year Next year (estimated)

At year start (April 1) 4,794 5,536

New members 1,596 700

Members leaving 854 750

At year end (March 31) 5,536 5,486

Patient constituency Last year Next year (estimated)

At year start (April 1) n/a n/a

New members n/a n/a

Members leaving n/a n/a

At year end (March 31) n/a n/a

6.2 ANALYSIS OF CURRENT MEMBERSHIP AS AT 31 MARCH 2010

The following provides information on membership:

Public constituency Number of members Eligible membership

Age (years):

0-16 107 41,473

17-21 260 37,661

22+ 6,074 524,022

Ethnicity:

White 6,150 591,978

Mixed 25 4,189

Asian or Asian British 26 2,457

Black or Black British 12 1,325

Other 228 3,207

Socio-economic groupings

ABC1 2,822 217,989

C2 460 35,593

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D 1,241 95,951

E 1,918 253,623

Gender:

Male 2,641 289,515

Female 3,800 313,641

Patient constituency Number of members Eligible membership

Age (years):

0-16 n/a n/a

17-21 n/a n/a

22 + n/a n/a

6.3 MEMBERSHIP COMMENTARY

6.3.1 CONSTITUENCIES

Poole Hospital NHS Foundation Trust has four public constituencies and one staff constituency. The four public constituencies are based on geographical areas that reflect the general, emergency and specialist service catchment areas; local government boundaries; and population numbers. They are:

• Poole;

• Purbeck, East Dorset and Christchurch;

• Bournemouth;

• North Dorset, West Dorset, Weymouth and Portland. The staff constituency is divided into two classes: clinical and non-clinical. Anyone aged 12 and over who lives in Dorset and is not employed by Poole Hospital can become a public member. The Trust’s staff and hospital volunteers automatically become members unless they choose to opt out. At 31 March 2010 the Trust had 6,441 public members, against a revised year-end target of 6,550. This equated to a 10 per cent target and was revised from the original figure of 20 per cent by Governors in light of the financial situation and the increased costs of recruiting and managing the membership The Trust’s staff and volunteer members totalled 5,536.

Membership by constituency and class Public constituency Poole 3,288 Purbeck, East Dorset and Christchurch 1,700 Bournemouth 1,138 North Dorset, West Dorset and Weymouth and Portland 315 Staff constituency Clinical 3,758 Non-clinical 1,598

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6.3.2 REPRESENTATIVE MEMBERSHIP

The Trust’s membership broadly reflects the populations it serves in terms of diversity, gender and age. However, as may be expected given the demographics of the local area, it has proportionally slightly more members in the female and older age groups.

6.3.3 BOARD MONITORING MECHANISMS

A revised Membership Development Strategy was approved by the Board of Directors in August 2008. The strategy will be reviewed by the Fundraising and Membership Engagement Reference Group of the Council of Governors (CoG) in 2010. The Board of Directors receive six-monthly reports each May and November on membership recruitment plans, growth against targets and on membership engagement.

6.3.4 PAST YEAR MEMBERSHIP DEVELOPMENT

The main aim of the Membership Development Strategy is to ensure that Poole Hospital NHS Foundation Trust continues to grow a membership that is representative of the community it serves and that members have the opportunity to be fully engaged with the Trust. In line with the revised strategy, the major membership activity has concentrated on the following areas:

• increasing governor participation in the recruitment and engagement of members;

• increasing the numbers of younger age members, who are under represented in the Trust’s current public membership;

• organising membership events to increase opportunities for membership engagement and participation;

• working to increase overall public membership number in line with agreed annual targets.

Governors were invited to attend public events, including:

• Poole Fest;

• a membership stand at Barclays House;

• fundraising abseil event.

Some planned membership development events were postponed in due to varying factors such as pandemic flu planning preparation, Norovirus outbreaks and lack of staffing resources, however robust plans to increase development and engagement with members has been undertaken ready for 2010/11. The Governor Reference Groups for Charitable Giving and for Membership Development agreed to combine their meetings and the first meeting of the newly formed Fundraising and Membership Engagement Reference Group took place in October. This group will review the Membership Development Strategy annually and continue to look at ways in which

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Governors can promote and engage with members in their constituencies both for fundraising and membership. The Trust held its second Annual Members’ Meeting on 24 September 2009. Public members were invited via the membership newsletter, FT Talkback, and letters to individuals who expressed an interest in attending previously. The event was also well publicised in the local press, on the website and throughout the hospital. Staff members were invited via the normal staff communication channels. The event was well attended and Consultant Surgeon Mr Tas Qureshi led a presentation on the latest developments in laparoscopic surgery at Poole Hospital. Following a successful “surgery” held in the Dolphin Restaurant the staff governors are planning to hold regular “surgeries” throughout the year where staff members can approach them to discuss any areas of concern. Staff Governors now attend induction sessions where they can meet new members of staff. Our presence again at Poole Fest gave us access to younger people and families, and provided a good opportunity to promote the Foundation Trust and for the Governors who attended to engage with the local community. This led to an opportunity to have a stand within Barclays House to promote membership to employees and visitors.

6.3.5 FUTURE MEMBERSHIP PLANS

The recommended target for increasing public membership for the coming year has been set at 5 per cent, which equates to 322 in number. The target has been set at this level after benchmarking against other Foundation Trusts. It will enable us to keep the costs associated with membership administration at an affordable amount and to allow us to focus resources on engaging more effectively with existing members. Although our membership is broadly representative of the local community, it is slightly weighted towards the female and older age groupings as might be expected given demographics of the area. We will continue to focus attention on attracting members from the younger population. We will be supported by in this work by a newly appointed clinical staff governor who specialises in work with younger people and will review the possible use of social media in increasing engagement with this age group. The Trust will seek alternative ways of sending leaflets to patients following the loss of the facility to send them with the second outpatient letters. This will include making the membership leaflets and posters more visible in all patient areas.

6.3.6 FUTURE ENGAGEMENT WITH MEMBERS

A detailed recruitment and engagement action plan has been put together to target events in 2010/11. This includes contacting local support groups to offer talks on the Foundation Trust. Governors will attend to promote membership, provide an insight into the Council of Governors and explain how members can have their say in the future of the hospital. Governors have been invited to events that the Fundraising Team have organised to use as a base to talk and engage with members and recruit new members. We plan to hold talks given by clinical teams on specific services run by the Trust. These events have been

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requested by our Governors who regard them as a popular and successful means of engaging and recruiting members and informing them of the new developments in the Trust. The planned redevelopment of our public website will feature a new members’ section which will be easily accessible from the home page. The Communications Strategy of the Trust sets out how the Council of Governors may engage with members. Members may contact the Council of Governors through the membership office by telephone 01202 448723, in writing, by e-mail: [email protected] or via the website www.poole.nhs.uk These details are publicised in ‘FT Talkback’, membership newsletters, on membership application forms, and on the website.

6.3.7 ELECTION OF COUNCIL OF GOVERNORS

Date of election

Constituencies involves

Number of members in constituency

Number of seats contested

Number of contestants

Election turnout %

18/09/2009 Bournemouth 1,070 1 4 20.7

18/09/2009 Poole 3,010 4 12 28.1 18/09/2009 Purbeck, East

Dorset and Christchurch

1,831 1 6 26.4

18/09/2009 Staff - Clinical Uncontested 03/11/2009 Staff – Clinical Uncontested

Elections were held in September to fill one vacancy in Purbeck, East Dorset and Christchurch and Bournemouth constituencies and four seats for the Poole constituency. The turnout averaged at 25% for all three constituencies, actual figures can be seen in the table above. While these figures were disappointing, it is hoped that with focusing more on membership engagement in the next year the turnout percentages will rise. Both the clinical staff governor posts were uncontested in September and November 2009. The Trust are due to hold elections in August/September this year for six public seats on the Council of Governors across the constituencies of Poole (4), Bournemouth (1), Purbeck, East Dorset and Christchurch (1) and that of clinical staff class (1) and non clinical staff class (1). The Trust will begin publicising the elections to existing and new members at the earliest available opportunity as a means of further engaging with members and with the objective of improving the turnout in this and future elections. The Board of Directors confirms that all elections to the Council of Governors are held in accordance with the election rules, as stated in the constitution.

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Appendix One

Glossary of Terms and Abbreviations

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GLOSSARY OF TERMS AND ABBREVIATIONS

ABBREVIATION EXPLANATION 13 week target Delivery of a maximum 13 week wait from GP referral to start of treatment -

one of the NHS’ key objectives A & E Accident and Emergency

AHP Allied Health Professions – (Arts therapies / Chiropody or Podiatry / Dietetics / Operating department practice / Orthoptics / Occupational Therapy / Physiotherapy / Prosthetics and Orthotics / Psychology / Psychotherapy / Radiography / Speech and Language Therapy)

Capex Capital expenditure

C.difficile Clostridium difficile - the major cause of antibiotic-associated diarrhoea and colitis, an intestinal infection that mostly affects elderly patients with other underlying diseases. Generally, it is only able to do this when the normal, healthy intestinal bacteria have been killed off by antibiotics used to treat other infections

CHKS CHKS is a national independent provider of comparative performance and benchmarking healthcare data

CIP Cost Improvement Programme – used synonymous with CRES (see below) CoG Council of Governors – the formal name of the Trust’s Board of Governors.

The CoG comprises: 14 public governors who are elected by members of their own constituency – Poole (8); Purbeck, East Dorset & Christchurch (3); Bournemouth (2); North Dorset, West Dorset , Weymouth & Portland (1); 4 staff governors who are elected by staff – clinical (3); non-clinical (1); 6 appointed governors nominated by the Trust’s partner organisations – Bournemouth & Poole PCT (1); Dorset PCT (1); Dorset County Council (1); Poole Borough Council (1) Bournemouth Borough Council (1); Bournemouth University (1).

CNST Clinical Negligence Scheme for Trusts CQC Care Quality Commission formerly known as the Healthcare Commission

CRES Cost Releasing Efficiency Saving Dr Foster Dr Foster Intelligence, a joint venture between the Department of Health’s

Information Centre and a private sector company Dr Foster LLP. Dr Foster provides a range of health information to the public (online and via supplements in the national media) and makes NHS performance data available under licence to health sector organisations

EBITDA Earnings Before Interest, Taxation, Depreciation and Amortisation EWTD European Working Time Directive - lays down minimum requirements in

relation to working hours/rest periods/annual leave for all workers and working arrangements for night workers. The current limit is an average of 48 hours work per week. There was an original exemption for medical staff but this has been amended to a 56-hour week by August 2007 and a 48-hour week by August 2009

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ABBREVIATION EXPLANATION Foundation Trust/FT

NHS Foundation Trusts are a key part of the reform programme in the NHS. They are autonomous organisations, free from central Government control. They decide how to improve their services and can retain any surpluses they generate, or borrow money, to support these investments. They establish strong connections with their local communities; local people can become members and governors. These freedoms mean NHS foundation trusts can better shape their healthcare services around local needs and priorities. NHS foundation trusts remain providers of healthcare according to core NHS principles: free care, based on need and not ability to pay. Poole Hospital NHS Foundation Trust was authorised on 1 November 2007

GP General Practitioners

H@N Hospital at Night - the provision of multi disciplinary teams working in hospital Out of Hours who between them have the full range of skills and competencies to meet patient’s immediate needs

HR Human Resources

IBP Integrated Business Plan ICU or ITU Intensive Care Unit or Intensive Therapy Unit

I&E Income and Expenditure IFRS International Financial Reporting Standards IT or IM&T Information Technology or Information Management & Technology

LDP Local Delivery Plan – the Trust’s annual agreement with its commissioners (NHS Bournemouth and Poole) on activity levels and funding

LoS Length of Stay LLP Limited Liability Partnership

LTFM Long Term Financial Model MMC Modernising Medical Careers - a major reform of postgraduate medical

education aimed at delivering a modernised and focused career structure for doctors

Monitor The independent regulator of NHS Foundation Trusts - Monitor rigorously assesses applicants for NHS foundation trust status and, once established, monitors their activities to ensure that they comply with the requirements of their terms of authorisation. Monitor has powers to intervene in the running of a Foundation Trust in the event of failings in its healthcare standards or other aspects of its activities, which amount to a significant breach in the terms of its authorisation. Inspection of the performance of foundation trusts against healthcare standards is carried out by the Care Quality Commission

MRSA Methicillin Resistant Staphylococcus Aureus – an antibiotic resistant infection commonly found on the skin and/or in the noses of healthy people. Although

usually harmless at these sites, it may occasionally get into the body (eg through

breaks in the skin such as abrasions, cuts, wounds, surgical incisions or indwelling

catheters) and cause infections. These infections may be mild (eg pimples or boils)

or serious (eg infection of the bloodstream, bones or joints). An infection of the

bloodstream is called a bacteraemia

NHS National Health Service

NHSLA National Health Service Litigation Authority NICE National Institute for Health & Clinical Excellence

NICU Neonatal Intensive Care Unit

NREC Nominations, Remuneration & Evaluations Committee - a sub-committee of the CoG responsible for the making recommendations to the CoG regarding the appointment, remuneration and performance review of the Chairman and non-executive directors

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ABBREVIATION EXPLANATION NSF National Service Framework - sets national standards and identifies key

interventions for a defined service or care group. Also sets measurable goals within specified time frames

PBC Practice Based Commissioning – an initiative which enables clinicians and other front line staff to redesign services that better meet the needs of their patients

PbR Payment by Results - the new funding system for the NHS in England. This pays a standard tariff for the treatment of different conditions. Not all hospital activity is funded by PbR and hospitals still have to negotiate “block funding” to cover these areas – eg. diagnostic and screening tests

PCT Primary Care Trust PEAT Patient Environment Action Team - PEAT team Inspections are a national

initiative coordinated by the Department of Health PESTEL A technique for analysing our environment for Political, Economic, Social,

Technological, Environmental and Legislative factors PFI Private Finance Initiative

PHFT Poole Hospital NHS Foundation Trust Poole Approach Our philosophy of care: “Friendly, professional, patient-centred care with

dignity and respect for all” PPI Private Patient Income

RBCH Royal Bournemouth & Christchurch Hospitals NHS Foundation Trust SHA Strategic Health Authority – NHS South West is one of the ten Strategic

Health Authorities in England formed on 1 July 2006. The organisation replaces three old Strategic Health Authorities (Avon, Gloucestershire, Wiltshire; Dorset and Somerset; and the South West Peninsula)

SLA Service Level Agreement - the main mechanism for service provision between NHS Trusts and Primary Care Trusts for NHS services. An SLA is an agreement that sets out formally the relationship between service providers and customers for the supply of a service by one or another

SLM Service Line Management – Service Line Reporting and Management provides a mechanism through which business decision making is devolved to the front line where the capability, knowledge, experience and patient relationships reside; by definition the resources and income related to individual activities.

UK GAAP United Kingdom Generally Accepted Accounting Principles WTE Whole Time Equivalent

council of governors meeting date: 8 july 2010 annual … · trust will take to ensure that...

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