HEREFORD HOSPITALS NHS TRUST PUBLIC TRUST BOARD …...with clinical leadership/engagement. Terms of reference include reviewing/monitoring of ... Development 3 Workshop for Members

Agenda No.8 (iv) Enclosure No.12

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HEREFORD HOSPITALS NHS TRUST PUBLIC TRUST BOARD MEETING 24 NOVEMBER 2008 DIRECTOR OF BUSINESS DEVELOPMENT Q2 PROGRESS AGAINST 2008/09 MILESTONES IN DELIVERY OF THE TRUST’S STRATEGIC OBJECTIVES FOR 2012/13

1.0 PURPOSE 1.1 To report progress in Q2 against 2008/09 milestones in delivery of the

Trust’s strategic objectives for the period to 2012/13

2.0 RECOMMENDATION 2.0 That the Board notes this report. 3.0 POLICY AND BUSINESS CONSIDERATIONS 3.1 Please refer to the attached report. 4.0 CONCLUSIONS The Trust is broadly on target in delivery of Q2 milestones. The Provider Services Review has delayed delivery of a number of milestones relating to service development, diversification and the Trust’s application for Foundation Trust status. The Trust continues to face major challenges in relation to its financial position.


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HEREFORD HOSPITALS NHS TRUST

Q2 PROGRESS AGAINST 2008/09 MILESTONES IN DELIVERY OF THE TRUST’S STRATEGIC OBJECTIVES FOR

21012/13

1. Reporting format Each Lead Director has provided an update on progress to date for those milestones for which (s)he is responsible. This update combines a scoring system with a (brief) commentary relating to the delivery of Q1 and Q2 milestones. The scoring system is as follows: Score Interpretation 3 Priority delivered 2 On track to deliver 1 Limited progress made/delivery behind

track 0 No progress made/milestone

superseded or abandoned The score and commentary has been validated by the Chief Executive and by the Executive Team on a peer review basis. The Board is asked to direct any questions or comments to the relevant Lead Director. In its review of Q1 performance, the Board noted that a significant proportion of milestones were scheduled for completion in Q4 which raised the prospect of ‘overload’ towards the end of the financial year. In response, individual Directors have reviewed the milestones for which they are responsible and, where possible, brought forward delivery. Thus, this report also contains commentary on (selected) Q3 and Q4 milestones.


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2. Progress against strategic objective 1: to enjoy a reputation for and be able to evidence exceptional quality and safety

Reference Milestone Deadline Lead Score Commentary 1.1 To improve performance

in the following areas in line with national targets:

- infection prevention and control

- cancelled operations

Q4 Chief Executive 2 Both targets on track. MRSA bacteraemia ‘ceiling’ for 08/09 increased to 12 by SHA

1.2 To review and improve the system for recording, reviewing and improving mortality rates

Q2 Medical Director 2 System for tracking monthly overall SMR established. Working group to undertake more targeted assessment, review and improvement being established

1.3 To develop and implement a strategy for improving the cleanliness of the County Hospital environment taking into account the NHS National Specifications for Cleanliness (2007), the Healthcare Commission report into cleanliness at the County Hospital and the forthcoming NHS England HCAI and

Q2 (depending on the strategy publication date)

Director of Nursing and Quality

2 Local strategy approved by the Board. Implementation continues to plan. Business Plan for 2009/10 to include introduction of 2007 cleaning standards incorporating 2004 cleaning frequencies NHS England strategy not


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Reference Milestone Deadline Lead Score Commentary Cleanliness Strategy

yet published

1.4 To review ward staffing

levels Q1 Director of

Nursing and Quality

3 Review completed Additional staff being recruited in line with 08/09 budget

1.5 To review the ITU/HDU bed base

Q1 Medical Director 1 Retrospective data being collated – data limitations identified. Prospective data collection in place from 1st August to identify level of care of all patients throughout hospital. Outcomes will feed into Q3 report to Trust Board.

1.6 To review the systems, structures and processes for the actioning of the learning resulting from complaints and Serious Adverse Events and incorporating that learning into the governance assurance regime

Q2 Director of Nursing and Quality

3 HHT Patient Safety Group in place and functioning well with clinical leadership/engagement. Terms of reference include reviewing/monitoring of learning from complaints/ SAEs. Review of SAEs is a


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Reference Milestone Deadline Lead Score Commentary quarterly standing agenda item supported by a ‘confirm and challenge’ approach.


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Reference Milestone Deadline Lead Score Commentary 1.7 To review the Trust’s

plans for the management of major emergency incidents – specifically a flu pandemic, flooding and a terrorist attack – and effect any necessary changes


2 Business continuity workshops provided for departments to support the development of business continuity plans. Individual services are currently developing their business continuity plans. Overarching Trust Business Continuity Plan scheduled for completion Nov/Dec. Risk Manager has established links with W.Midlands colleagues to ensure local plans reflect regional overview

1.8 To improve the Trust’s rating in the Healthcare Commission’s Annual Healthcheck to ‘good’ for both quality of services and use of resources

Q4 Chief Executive 2 Delivery depends on meeting/maintaining key operational and financial targets


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Strategic objective II: To enjoy a reputation for and be able to evidence exceptional customer service Reference Milestone Deadline Lead Score Commentary 2.1 To develop and roll out a

customer care programme


Development: 3 Roll out: 2

Customer Care programme developed. Workshops underway following initial events for key staff. Target 500 staff pre xmas.

2.2 To engage Members in the development of priorities for service improvement in the following areas: internal communications, external communications, infection prevention and control, catering and nutrition, care of older people and services for younger people and to incorporate these priorities within the customer care programme

Q1 Director of Business Development

3 Workshop for Members held on 12/6. Outputs from workshop have been reviewed by Member Focus Groups and where appropriate incorporated in customer care programme. The External Communications Focus Group has developed an action plan based on Member feedback to improve HHT’s external communications (delivery scheduled for end of Q4)


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Reference Milestone Deadline Lead Score Commentary 2.3 To integrate current patient

and public involvement arrangements with evolving arrangements for Member involvement


2 Current arrangements reviewed by Director of Business Development and Director of Nursing and Quality. Proposals for revised arrangements reviewed and approved by Executive Team. Implementation in train but completion dependent on establishment of shadow Board of Governors

2.4 To improve the patient experience (as reflected in the Patient Survey results) in the following areas: infection prevention, privacy and dignity, perceived cleanliness of the hospital environment, quality of care, patient involvement in their care, patient information


2 Each target area has been allocated to individual ward leads tasked with identifying/piloting a suitable continuous quality improvement initiative which can be rolled out across the Trust. Local surveys are identifying improvements in comparison to last National Survey (2007).


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Reference Milestone Deadline Lead Score Commentary 2.5 To ensure that the

development of a competence based appraisal system (for both non-medical and medical staff) encompasses assessment of individuals’ adherence to customer care standards identified in the customer care programme. Trial of scheme to be developed in partnership for Jan-March 09. Then evaluated allowing for roll out during Q2 & Q3 in 09/10.

Q4 Director of Human Resources

2 Working Group established

2.6 To rerun the October 2006 GP survey and develop a performance improvement plan


2 n/a

2.7 To agree with the Trust’s PFI partners a hotel services customer care programme

Q4 Associate Director of Operations (Service Transformation)

2 Agreement to proceed reached with PFI partners. Partnership Board established. Programme outline to include: cleaning, sterile services and patient food.


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Strategic objective III: To provide a greater volume and range of healthcare services to a wider catchment population by increasing market share within our current ‘core’ catchment area and expanding our catchment area to include the ‘borders’ with Worcestershire, Gloucestershire, Shropshire and further into Wales Reference Milestone Deadline Lead Score Commentary 3.1 To identify gaps in local

service provision which could be filled by HHT


3 Gaps identified: • DVT 1 stop shop • EPAU scanning

(obstetrics) • Spinal services • Secondary care

services currently provided by Birmingham trusts.

The extent of referral to Birmingham for routine secondary care is currently being assessed. Plans to address other gaps will be developed as part of the 2009/10 planning round.

3.2 To audit the viability of vulnerable services (including those identified in Investing for Health) and scope the opportunities for strategic


2 Outputs from Darzi/Next Steps Review , SHA rollout of Investing for Health and Service Line Reporting exercise have been reviewed and the range of potentially


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alliances with other providers

vulnerable services identified. Further scoping/action planning to be undertaken with the support of the Medical Director and Clinical Cabinet. Exploratory meeting with Gloucestershire Hospitals NHS FT being arranged. NB Requirement for review of HHT service portfolio identified by Provider Service Review.


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Reference Milestone Deadline Lead Score Commentary 3.3 To complete negotiations

on preferred provider status and model of care with Powys LHB


2 ‘Preferred provider status’ no longer an appropriate model for HHT’s future relationship with the LHB. Initial meeting between clinical staff at Llandrindod Wells Community Hospital and HHT clinicians held in July. Proposals to take forward a suggested clinical model submitted to LHB. Follow up meeting with the LHB Director of Operations scheduled for 21/11

3.4 To agree with target GP practices increased levels of referrals to HHT

Q4 Associate Director of Operations (Service Delivery)

2 Target practices identified and discussions with key localities initiated. Evidence from the Dr Foster Hospital Marketing Manager tool is that levels from ‘borderlands’ practices are increasing


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Strategic objective IV: To provide more rapid access to services (specifically by ensuring faster access than NHS England minimum standards) Reference Milestone Deadline Lead Score Commentary 4.1 To deliver a maximum 18

week care pathway for 100% of patients by December 2008


2 On track to deliver by November 08 Significant and consistent improvements made. Sustainability work well advanced

Reference Milestone Deadline Lead Score Commentary 4.2 To deliver all operational

access, booking and choice targets in respect of cancer care, A&E waits and stages of treatment


2 On track – please refer to performance report Decision taken to set a local target of 80% of patients to be seen within 2 hours in A&E in 2009/10

Strategic objective V: To deliver these services as close to the patient’s home as possible (specifically by continuing to decentralise ambulatory care to community settings) Reference Milestone Deadline Lead Score Commentary 5.1 To develop an agreed Q1 Director of Business 3 Agreed model


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model for the provision of ambulatory care on a decentralised basis

Development developed. Implementation to be taken forward by Associate Director of Operations (Service Delivery) and/or included in 2009/10 contract negotiations (as appropriate)


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Reference Milestone Deadline Lead Score Commentary 5.2 To agree with the PCT

and local GPs the changes in care pathways required in the light of the unbundling of tariffs


2 Lead responsibility lies with PCT - little progress to date. Work programme agreed in draft form. Immediate priority areas include pre-operative assessment and follow up of colonised MRSA patients.

Strategic objective VI: To enjoy a reputation for and be able to evidence delivery of a material contribution to reducing local health inequalities and improving the health status of local people Reference Milestone Deadline Lead Score Commentary 6.1 To respond as appropriate

to the requirements of the Cancer Reform Strategy

Q4 Medical Director 2 n/a

6.2 To respond as appropriate to the requirements of the Stroke Strategy


6.3 To audit compliance with Every Child Matters and the Children’s Plan and effect any necessary changes



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6.4 To review the recommendations of the End of Life Care Strategy and the potential for HHT to extend its service portfolio

Q4 Medical Director 2 New End of Life Strategy published 16th July 2008

Strategic objective VII: To be seen by staff and potential employees as an excellent employer and have in place systems to recruit, develop and retain the staff we need to realise our vision Reference Milestone Deadline Lead Score Commentary 7.1 To deliver the following

key milestones of the Trust’s HR strategy: - a selection process to support the implementation of Service Line Management - the Single Equality scheme - a patient focussed, competence based appraisal process - a HR skills based management development programme - measures to reduce sickness absence rate by 20% from 07/08 outturn


2 Selection and organisational change processes in support of new structure are being worked through. Appraisal working group established HR skills development programme implemented Sickness absence reducing and on target: underlying trend for 12 months to September 3.58%


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7.2 To develop/implement an improvement programme in response to the 2007 staff attitude survey covering key metrics


2 Bullying & Harassment and Appraisal Working Groups established


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Reference Milestone Deadline Lead Score Commentary 7.3 To introduce systems,

structures and processes for the recognition and acknowledgement of exceptional performance on the part of individual members of staff and teams


2 Scheme now devised and awaiting roll out

7.4 To review and improve staff communications


2 Format and contents of Team Brief reviewed and reworked Monthly communications cascade instituted from November ‘Delivering the Vision’ communications strategy currently being implemented

Strategic objective VIII: To have upgraded facilities and equipment to ensure a first class environment for the delivery of hospital based care Reference Milestone Deadline Lead Score Commentary 8.1 To progress the

reprovision of beds currently accommodated


2 Progress on the reprovision exercise is the subject of a separate


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in the hutted wards thus enabling their closure

regular report to the Board.

8.2 To progress the building of the Macmillan Renton Unit


2 Progress on MRU is the subject of a separate regular report to the Board


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Reference Milestone Deadline Lead Score Commentary 8.3 To produce a Strategic

Outline Case for the Clinical Decision Unit


2 The development of the CDU has been incorporated into the HHT bid for the Equitable Access to Primary Medical Care Services Programme submitted to the PCT in October If this bid fails, an Outline Business Case for discussion with the PCT has been scheduled for production in Q4

Strategic objective IX: To post financial surpluses on a routine basis to reinvest in service development by continuously improving efficiency and effectiveness Reference Milestone Deadline Lead Score Commentary 9.1 To deliver the operational

financial framework including - creating the conditions that enable the Trust to be in recurrent financial balance as a minimum and that deliver surpluses on a routine basis

Quarterly Director of Finance and Information

1 The Trust now faces a significant challenge in relation to delivery of its financial target in 08/09. A plan has been put in place to rectify this but there is a major risk about deliverability. The level of risk therefore


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- ensuring that the Trust has an appropriate positive cash flow - agreeing the Trust’s annual savings programme and ensuring delivery of the required level of savings - managing the Trust’s capital expenditure to ensure that capital spending is affordable and in line with the Estates Strategy

remains extremely high. In addition, there is a major funding and affordability issue relating to the capital programme and the estate strategy.

9.2 To lead the development and implementation of Service Line Reporting together with the Trust’s use of SLR outputs

Q3 Director of Finance and Information

2 Project manager appointed; project manager being sought; system being implemented; project plan agreed for implementation by March 2009

9.3 To improve the Trust’s score in the annual ALE assessment to ‘3’

Ongoing Director of Finance and Information

2 Action plan produced evidencing where efforts need to be focused to deliver a ‘3’. Progress report submitted to November Board


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9.4 To progress the service transformation projects covering - elective care - emergency care - outpatient care - diagnostic care


2 Focus of transformation concentrated on elective and emergency care. Projects initiated and key deliverables identified. Quarterly update provided to Board. The two major challenge facing service transformation are

• Profiling and extracting financial benefits

• Integrating the HHT programme with the proposed approach of the Manufacturing Institute


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Strategic objective X: To be acknowledged by stakeholders and partner organisations as responsive to their needs and wants Reference Milestone Deadline Lead Score Commentary 10.1 To agree systems,

structures and processes for joint working with local PBC and PST arrangements

Q3 Chief Executive 2 Issue flagged with PCT CEO. Importance emphasised in outputs from Provider Services Review

10.2 To improve the effectiveness of current joint working arrangements with the Trust’s PFI partners


2 PFI re-launch event held on July 24th Programme of ‘top team; meetings agreed. Inaugural meeting held 24/10 and work programme agreed


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Strategic objective XI: To have in place a large and engaged Foundation Trust Membership reflecting our catchment population Reference Milestone Deadline Lead Score Commentary 11.1 To increase HHT’s

shadow FT membership to 4,000


2 Dedicated resource being recruited Approach to PCT and Council to secure staff members made Meeting scheduled with Chamber of Commerce to discuss corporate membership arrangements

11.2 To hold elections for the shadow Board of Governors, agree/implement a Governor’s development programme and develop proposals for the functioning of the shadow Board


0 Subject to confirmation by the Foundation Trust Programme Board, this milestone will form part of the 2009/10 business plan. This in recognition of delay in progressing FT application resulting from the Provider Services Review

Strategic objective XII: To identify and maximise any opportunities for diversification

Reference Milestone Deadline Lead Score Commentary


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12.1 To support the PCT in the review of provider services in Herefordshire

Q2 Chief Executive 2 Trust actively supporting review at Steering and Working Group level. Timescale for completion shifted to Feb 2009. Impact on HHT monitored by FT Programme Board


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Reference Milestone Deadline Lead Score Commentary 12.2 To agree with HPCT and

the PST the optimum model for the management of delayed discharges


3 Model developed in Q1 now fully operational. Additional care package assessment resource (1WTE) in place since August. Nursing home placement timescales have improved. Number of delayed discharges at the County Hospital has reduced to an average of 10.


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Reference Milestone Deadline Lead Score Commentary 12.3 To review the potential for

the provision of increased volumes of care for long term conditions


2 Delivery of this milestone will follow on from the outcome of the Provider Services Review.

12.4 To review the potential for HHT providing out of hours services


2 Joint HHT/ Shropdoc/ City GPs response for the Equitable Access to Primary Medical Services (EAPMS) Programme invitation to tender submitted at the end of October. Assuming the consortium is shortlisted, a presentation to the PCT will be made on 17/11 and the contract agreed by the end of December. The Board has been briefed separately on the contents of the bid

12.5 To progress in association with local GP practices an option appraisal for the co-location of Hereford City GP practices on the


0 Preliminary discussions with City GPs held. HHT offer of an option appraisal has not been


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County Hospital site taken up. This milestone has been abandoned.


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Strategic objective XIII: To implement management systems, structures and processes to ensure that the Trust is ‘fit for purpose’ and able to deliver the twelve strategic objectives listed above Reference Milestone Deadline Lead Score Commentary 13.1 To submit an application

for FT status

Q4 Chief Executive 0 FT application process suspended during the first stage of the Provider Services Review. Work is currently underway to agree a revised timetable in consultation with the SHA. It is expected that an application will be submitted in 2009/10 and authorisation granted in 2010/11

13.2 To restructure the Trust in line with the requirements of Service Line Management and improved performance management

Q2 Chief Executive 2 Structure finalised and implemented in September. Business Unit Directors and Managers (excepting the Surgical Unit Manager) in post. Operational Board now meeting. Clinical Cabinet now meeting

13.3 To develop an Q2 Director of Finance 2 Draft strategy to be


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information strategy and proposals to improve the quality of data within the organisation

and Information submitted to Information Steering Group in November and Operational Board in December

13.4 To develop an IT strategy


2 Delays in the information strategy have had a knock on effect – draft strategy will be available in December


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Reference Milestone Deadline Lead Score Commentary 13.5 To implement

appropriate Information Governance structures and processes to ensure safe and appropriate uses of all types of information within the organisation


2 Action plans in development

13.6 To implement appropriate clinical governance structures and processes


2 Patient Safety Group (PSG) established with representation from all Business Units. Clinical governance arrangements in each Business Unit agreed and links with PSG defined. Clinical Governance new structure being implemented Patient Care Strategy in development

13.7 To implement appropriate corporate governance structures and processes

Q4 Chief Executive 2 Company Secretary in post. New operational committee structures developed. The role of Committees of the Board has been reviewed.


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This will result in Governance and Risk Committee and Finance and Performance Committee eventually being resolved. This will happen once the Board is satisfied that sufficient assurances are in place with regards to Patient Safety Group and Finance and Performance Group.


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Reference Milestone Deadline Lead Score Commentary 13.8 To continue the

development of the HHT Board


2 Development programme continues. Institute for Innovation & Improvement diagnostic completed September 08. Outline development programme to be reviewed/approved at November Board workshop Policy Governance implementation plans to be reviewed at December Board workshop

3. RECOMMENDATION The Board is asked to note this report.

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HEREFORD HOSPITALS NHS TRUST PUBLIC TRUST BOARD …...with clinical leadership/engagement. Terms of reference include reviewing/monitoring of ... Development 3 Workshop for Members