2013/14 Summary

Annual Plan

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Chief Executive message

The annual plan describes the top priorities that our patients, our own colleagues, and our partners tell us we should focus upon. As a Trust Board we need to listen well to that advice, whilst being mindful of the minimum standards set by our regulators, which we must consistently exceed. Our clinical divisions and each executive director have helped us to balance the immediate improvements that we need to make, with work we need to do now with an eye to 2014, 2015 and beyond.

That longer term vision is important. We want to become renowned as the integrated care organisation that is the best in the NHS. Our organisation has a strong future if we plan and get ready now for the shape of care to come: More emphasis on preventative work, delivery of care in patients’ homes and in GP surgeries, a better deal for older people, and a recognition of the pressures that a smaller, but more acute, hospital service brings. That preparation is about having a model of care we are working towards, making job roles attractive to both hire and retain the very best people, and building teams that are well led and values driven.

I hope you find very little in this plan that is new to you. It builds on what has been achieved over the last decade. But the challenge of 2013-14 is not new ideas. It is consistent, relentless implementation. Making the best of what we do, what we do.

Breast Unit Team with their HSJ award

Chief Executive message

That applies to infection control where we need to match our C.Difficile and MRSA success by tackling norovirus. That applies to admission avoidance and supporting patients at home, where we have some successful pathways and projects that are not consistent across seven days or across our sites. That applies to outpatient services, where our eight core standards can help to improve patient satisfaction as well as make a complex set of systems easier for us all. And of course it applies to emergency care; whether improving how we manage acutely ill patients, or those with psychiatric conditions, patients with tuberculosis or diabetes, or homeless people and refugee communities attending our sites as a place of safety.

The key to our plan is you. You and how you spend your time. What you do not do in order to focus on what is in this plan. And you in how your behaviours help to shape a culture in our Trust, in which we can all take pride and in which safety is nurtured - excellence and error openly discussed.

Chief Executive - Toby Lewis

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This is the Trust’s annual plan for 2013/14. It sets out our main priorities for the year ahead and captures areas where we need to develop and improve to ensure that we continue to deliver safe, high quality care to our patients.

The plan includes:

• A summary of 2012/13 performance.• Our strategic objectives and their long term measures of success.• Key areas of focus – overarching areas of focus that underpin all priorities and

developments in the coming year.• Annual priorities – specific objectives for the Trust in 2013/14.• National Quality Dashboard – areas for improvement.• Supporting strategies – the strategies that underpin the delivery of the Trust’s

long-term strategy.• Major developments - key clinical and non-clinical service developments.

We have developed a summary diagram to show how all of the areas listed above are linked to our strategic objectives. This can be found in the centre of the booklet and is for all staff to pull out and keep. If would like to find out more detail about the different sections of the summary diagram, each section is described in turn throughout this summary, or alternatively, please see the full annual plan which is on the staff intranet.

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21st CenturyFacilities • Deliver Midland Metropolitan Hospital (MMH) when circumstances

allow• Support compliance with Care Quality Commission (CQC)

registration• Invest in the estate through capital schemes to support clinical

strategy

An Engaged & Effective

Organisation • Become an NHS Foundation Trust• Develop a culture that empowers and enables staff to deliver

compassionate, safe high quality care and front line services • Develop our health informatics systems to reduce variability and

ensure safe, error free and efficient care• Identify and promote our ‘beacon’ or specialist services

Accessible and Responsive Care

Safe, High Quality Care

Care Closer to Home

• Deliver our Quality and Safety Strategy• Achieve a year on year measurable reduction in preventable harm

to patients• Achieve a positive patient feedback score for inpatient adults of 85

by March 2018 • Develop further our systems for reviewing mortality rates and

making improvements

• Meet all national access targets year on year• Ensure that our services are perceived as at least as culturally

sensitive as those of our neighbours and those measured by local and national patient surveys

• Be perceived by GPs as more responsive to their needs than our competitors

• Listen to our patients and our GPs and strengthen our reputation as a provider of safe, high quality care to those who access our services

• Achieve greater integration of community services with both acute and primary care allowing seamless patient care and care closer to home in line with RCRH

• Meet RCRH activity projections for reducing demand for acute care through investment in alternative models of care

• Reduce Health Visitor caseloads in line with national recommendations by 2016

• Increase the proportion of our beds that are non-acute

Good use of Resources

• Deliver our 5 year Transformation Programme of £125m TSPs• Ensure we meet FT financial governance measures• Use Service Line Management (SLM) to devolve decision making

and inform corporate decisions

Stategic Objectives

Below are the Trust’s strategic objectives. The measures of progress in the right hand boxes have helped us chose the priorities for 13/14 which can be found on the summary diagram.

Sandwell & West Birmingham Hospitals NHS Trust – 2012/13 performance

The Trust has had a busy and challenging year. The following highlights key areas of performance in 2012/13:

• Performance against key targets and standards – we are rated as performing, but failed to meet the minimum standard for emergency care.

• The financial plan was delivered with a year end surplus of £5.7m (£2m in excess of target set by Department of Health).

• Delivered year 1 of the Quality & Safety strategy.• Achieved Clinical Negligence Scheme for Trusts Level 2 for our Maternity

services• Trauma & Orthopaedics – all inpatients consolidated at Sandwell Hospital site

to give a single inpatient unit, and confirmed validation as a Trauma Unit for both City and Sandwell Hospital sites.

• All inpatient Stroke and Neurology services and Transient Ischemic Attack (TIA) outpatient clinics consolidated at Sandwell Hospital.

• All breast surgery services now based in the Birmingham Treatment Centre.• All inpatient Gynae-oncology services consolidated at City Hospital alongside

the Gynae-oncology Unit. • Vascular Surgery inpatient service transferred to the Queen Elizabeth Hospital

in Birmingham as part of a single Vascular Network. Day case surgery & outpatient clinics still delivered locally at City & Sandwell hospitals.

• Delivered year 2 of our Health Visitor Strategy and related expansion in health visitor numbers in Sandwell.

• The Trust established one of three national Centres for Behçet’s Disease in partnership with specialist clinicians in neighbouring Trusts.

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Key areas of focus for 2013/14

1. Safe, High Quality CareProviding safe, high quality care is critical to the delivery of all that we do. Key areas of focus include gaining better patient feedback and working with our staff to develop a culture that empowers and enables staff to deliver compassionate, safe hight quality care and front line services.

2. Improvements to the way we provide care for emergency and acutely unwell patientsWe need to reduce our emergency readmission rates and ensure that patients attending our Emergency Department are seen within 4 hours.

3. Further delivery of the Transformation Programme & 2013/14 Transformation Saving Plans (TSPs) The Transformation Support Office (TSO) will continue to work with the Trust’s Divisions in driving quality and efficiency improvements that will support their financial savings plans.

4. Developing our Health Informatics SystemsThe main priorities for 2013/14 are to review and stabilise core elements of the IT system and commence the delivery of key systems identified for replacement.

5. Make progress with the Midland Metropolitan Hospital (MMH) & our Foundation Trust (FT) application. The Project Team is in the process of updating the financial model which underpins our Outline Business Case (OBC). The Trust is looking to gain approval to allow procurement for MMH to commence by December 2013. In line with this, the Trust has revised the timeline for production of key documents as part of our FT application in view of the Treasury review of Private Finance Initiative (PFI) and aims to submit our FT application in Spring 2014.

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National Quality Dashboard: Areas for Improvement

Our quality improvement priorities were identified from the National Quality Dashboard which measures our performance against a number of key quality indicators in comparison with other acute trusts. The five that you can see below are those where we are amongst the lowest performing trusts. The Trust has developed an action plan for each of the areas of improvement.

Enablers

No. Improvement Priority Improvement Plan

1Emergency Re-admission Attain national mean for emergency

re-admissions

2A&E re-attendanceA&E patients seen within 4 hours

Improvement target: 5%Consistently attain national target: 95%

3Rates of written complaints per 1000 episodes

Reduce by 5% year on year

4 VTE risk assessment rate Attain national target: 95%

5 Sickness/absence – nurses & midwivesAttain 10% better than national mean for these staff groups

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Supporting Strategies 2013/14

We have developed a range of strategies to ensure that we can deliver the Trust’s strategic objectives year on year. Each supporting strategy has a number of annual targets and objectives, details of which can be found in the full annual plan for 2013/14.

The supporting strategies are listed below and can be found on the staff intranet:

• Quality & Safety• Workforce• Clinical• Estates• Membership • Health Informatics• Transformation Programme

The Imaging department’s new CT Scanner

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Major developments 2013/14

Clinical Service Reconfigurations:In order to improve the quality of services with identified deficiencies and to ensure future clinical sustainability, we have identified a number of clinical services with the potential need for reconfiguration ahead of the opening of MMH. We will complete our Stroke and Pathology service reconfigurations and we are working on proposals to improve services in Haematology, Cardiology and services for Frail Elderly people.

Integrated Care including RCRH New Models of Care and expansion of our Community Services:We will develop a programme to make sure our services are delivered more seamlessly around the needs of patients and better integrated with primary and social care providers. We will continue to be active partners in the RCRH Programme and will also work in partnership with primary care clinicians and SWB CCG to develop and implement new services models and innovative ways of working. Improvements to Emergency Care and Care of the Frail Elderly:We will develop our emergency care and frail elderly services in partnership with SWB CCG to ensure safe, high quality care, early senior assessment, alternative pathways to admission where clinically appropriate, integrated care and supported discharge.

Expansion of our Community Services:We will work with our CCG to reshape and refine our district nursing and community matron services. We will develop Sandwell Health Visiting Service in line with national standards for Health Visiting. We will extend the community Early Supported Discharge service for Stroke patients. We will expand both the Sandwell Community Respiratory team and the Palliative Care team to offer a wide range of services, closer to home.

CQUIN targets:The Trust’s CQUIN goals for 2013/14 are:

• Friends and Family Test• NHS Safety Thermometer• Dementia• VTE• Safe storage of medicines

• Dementia patient stimulation• Use of pain care bundles• Use of sepsis care bundles• Risk assessments for falls and pressure ulcers• Recording DNAR decisions

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Summary of income & expenditure 2013/14

This is where we think our money will come from in 2013/14:

Category

Revenue Income and Expenditure:

Income for NHS patient care 389.6

Income for education training and research18.9

Other income22.5

Operating Costs(403.3)

= Operating Surplus27.7

Financing Costs (23.1)

= Net Surplus/(Deficit) against DoH Target4.6

Revenue surplus as % of Income1.1%

Capital expenditure:

Capital expenditure plan20.5

2013/14Plan

£m

Capital Programme

The capital programme totals £20.5m. The Trust has sufficient internally generated cash to fund the proposed programme and does not require any loans from the DH. As well as the regular investment in estates/statutory standards, clinical equipment replacement and Health Informatics, the main features of the planned programme include:

• Land Acquisition – Midland Metropolitan Hospital (MMH)• Strategic investment • Service reconfiguration

A Teaching Trust of The University of Birmingham

Incorporating City, Sandwell and Rowley Regis Hospitals

Designed by The Department of Medical Illustration

www.swbh.nhs.uk